Anxiety Disorder Practice Questions – Flashcards
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A client informs the nurse at the anxiety disorders clinic that he experiences palpitations, difficulty breathing, and a sense of overwhelming dread whenever he leaves his home. This problem began after he was assaulted and robbed on his way to work. He has been unable to go to his office for over a month. The client asks the nurse, "Don't you agree that not being able to go out is pretty awful?" The most therapeutic reply is: 1. "What do you mean by 'awful'?" 2. "You feel awful because you're afraid to leave home?" 3. "No, I don't think it's awful." 4. "I guess some people might say that being housebound is pretty strange."
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Answer = 2 Rationale: The nurse will be able to validate the possibility that the client is dissatisfied with being unable to control symptoms. The nurse should neither agree nor disagree with the client. It is important for the client to clarify his/her own thinking.
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The client in question #1 has elected to be voluntarily admitted to a private mental health unit in order to work intensively on his problem. He has refused to leave the unit for activities since the day of admission. An appropriate nursing intervention to include in the care plan is to: 1. encourage him to ask for a community pass. 2. ask another client to accompany him off the unit. 3. assist him to journal the challenges of leaving the unit. 4. point out the irrationality of his fear.
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Answer = 3 Rationale: Assisting the client to identify specific problems related to the phobia can foster problem solving, especially when cognitive therapy is used.
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A client has sought treatment for a specific phobia: fear of cats. The nurse in the anxiety disorders clinic has established the nursing diagnosis, Anxiety related to exposure to phobic object (cats). A realistic short-term goal for this client would be: within 10 days, client will 1. avoid feared object whenever possible. 2. face feared object unassisted. 3. state that feared object no longer produces feelings of dread associated with anxiety. 4. practice relaxation techniques and report less distress related to thoughts of the feared object.
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Answer = 4 Rationale: When the client is able to relax in the presence of thoughts, or the phobic object, the client will begin to experience a sense of control over the phobia.
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Which piece of subjective data obtained during the nurse's psychiatric assessment of a client experiencing severe anxiety would indicate the possibility of posttraumatic stress disorder? 1. "I keep washing my hands over and over." 2. "My legs feel weak most of the time." 3. "I'm afraid to go out in public." 4. "I keep reliving the rape."
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Answer = 4 Rationale: After a psychologically traumatic event, the person may re-experience the event via dreams or flashbacks.
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For the nursing diagnosis, Powerlessness related to inability to prevent rape, an appropriate nursing intervention would be to: 1. help the client discuss how she could have prevented the rape. 2. assist the client to identify coping strategies related to feeling helpless about the rape. 3. reassure the client that she has no control over situations such as these. 4. tell the client that everyone reacts in the same way she did.
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Answer = 2 Rationale: While the client may be reassured that she was not responsible for the event, to reduce feelings of powerlessness she should be encouraged to learn how to cope with her feelings.
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When the psychiatrist prescribes alprazolam (Xanax) for the acute anxiety experienced by a client with agoraphobia, health teaching should include instructions 1. about a tyramine-free diet 2. to adjust dose and frequency of based on level of anxiety 3. to avoid alcoholic beverages 4. to report drowsiness
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Answer = 3 Rationale: Drinking alcohol or taking other anxiolytics along with prescribed benzodiazepines should be avoided due to potentiation of the depressant effects of both drugs. Drowsiness is an expected effect and should be reported only if excessive somnolence is experienced.
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Which statement made by a client who washes his or her hands compulsively identifies the thinking typical of a client with obsessive-compulsive disorder? 1. "I know I'll get my hands clean eventually; it just takes time." 2. "I need a milder soap that won't damage my hands so much." 3. "I feel so much better when my hands are clean. I can do other things." 4. "I feel driven to wash my hands, although I don't like doing it."
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Answer = 4 Rationale: The person who uses obsessive-compulsive rituals generally acknowledges that the ritualistic behavior is not constructive, and that he/she dislikes doing it.
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For the client whose nursing diagnosis is Powerlessness related to inability to control compulsive cleaning, the nurse recognizes that the client uses cleaning to: 1. temporarily reduce anxiety. 2. gain a feeling of superiority. 3. receive praise from friends and family. 4. ensure the health of household members
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Answer = 1 Rationale: The primary gain achieved from the client's use of these rituals is anxiety relief. Unfortunately, the anxiety relief is short-lived and the client must repeat the ritual frequently.
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For the client with ritualistic handwashing whose goal is the use of more effective coping skills, the nurse should employ the intervention of: 1. allowing the client to set own handwashing schedule. 2. encouraging client participation in unit activities. 3. encouraging the client to discuss handwashing in all groups. 4. focusing on the client's symptoms rather than on the client.
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Answer = 2 Rationale: Since clients with OCD become overly involved in rituals, it is necessary to promote involvement with other people and activities in order to improve coping. Daily activities prevent constant focus on anxiety and symptoms.
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For the client with compulsive handwashing, which outcome criterion indicates that the goal of improved social interaction has been successfully met? The client 1. asks for anxiolytic medication at the first signs of anxiety. 2. spends more time talking to others in the community. 3. decreases the amount of time spent handwashing. 4. sleeps 7 to 8 hours nightly.
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Answer = 2 Rationale: The behavior that indicates improved social interaction is spending more time interacting with others.
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To help a client who compulsively makes lists, meet the goal of improved self-esteem, the nurse should: 1. assist the client to identify and develop strengths. 2. encourage the use of as-needed antianxiety medication. 3. engage in power struggles to limit list making. 4. encourage behavior changes only when client states feeling ready.
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Answer = 1 Rationale: Providing for successes in other areas of the client's life helps improve feelings of self-worth
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The nurse caring for a client diagnosed with generalized anxiety disorder tells a preceptor, "I find myself feeling uncomfortable and anxious around this client. When he starts trembling, perspiring and pacing, I find myself with cold clammy hands and my pulse races. I start worrying whether I'll be able to help him stay in control." In such an interaction, the client will most likely experience 1. claustrophobia 2. increased anxiety 3. fatigue 4. improved self-esteem
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Answer = 2 Rationale: Anxiety is transmissible. The client who tunes in to the nurse's anxiety usually experiences heightening of his/her own anxiety.
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When the nurse diagnoses that a client is experiencing panic-level anxiety, an intervention that should be immediately implemented is to 1. teach relaxation techniques 2. place the client in four-point restraints 3. reduce stimuli 4. gather a show of force
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Answer = 3 Rationale: Clients experiencing panic-level anxiety are unable to focus on reality, ruling out option 1. Although the client is completely disorganized, violence may not be imminent, ruling out options 2 and 4. Reducing stimuli is helpful since the client is unable to screen stimuli. A simplified environment reduces demands on the client and supports reintegration.
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Which of the following is a criterion for assessing the anxiety level in a client with an anxiety disorder? 1. ability to be assertive 2. ability to determine appropriateness of own behavior 3. attention span and concentration 4. sleep pattern
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Answer = 3 Rationale: The ability to concentrate and attend to reality is increased slightly in mild anxiety and decreased in moderate, severe, and panic-level anxiety. Anxiety level cannot be measured by assertiveness. Sleep patterns may be disrupted for other reasons.
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A client reveals that she becomes panic-stricken when she gets within visual range of a dog. The nurse can assess this behavior as being consistent with: 1. social phobia 2. simple phobia 3. agoraphobia 4. generalized anxiety disorder
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Answer = 2 Rationale: Intense persistent fear of an object is a clinical manifestation of a specific (simple) phobia. Specific and simple are used interchangeably.
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When working with a client with post-traumatic stress disorder who has frequent flashbacks, as well as persistent symptoms of arousal, the least effective nursing intervention would be to 1. encourage repression of memories associated with the traumatic event 2. explain that physical symptoms are related to the psychological state 3. teach effective stress management techniques 4. discuss possible meanings of the event
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Answer = 1 Rationale: The goal of treatment for PTSD is to come to terms with the event rather than suppress it.
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The nurse has a client who checks and rechecks her home in response to an obsessive thought that her house will burn down. The nurse and client explore the likelihood whether the house will actually burn. The client states there is little likelihood of this occurring. This is making use of: 1. desensitization 2. cognitive restructuring 3. relaxation technique 4. flooding
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Answer = 2 Rationale: Cognitive restructuring involves the client testing automatic thoughts and drawing new conclusions through practice and training.
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When a client asks what causes his panic attacks, the nurse responds that research shows evidence to support the theory that panic disorders have their etiology in: 1. faulty learning 2. traumatic events 3. genetic-biological factors 4. developmental fixations
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Answer = 3 Rationale: Panic attacks can be caused by the chemical dysregulation in the brain, thus supporting a biological theory of etiology. There is a close genetic relationship with members of the same family experiencing panic attacks
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For planning purposes, the nurse caring for a client with obsessive-compulsive disorder knows that an effective treatment for obsessive-compulsive disorder is: 1. analysis 2. group therapy 3. flooding 4. clomipramine
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Answer = 4 Rationale: Clomipramine (Tricyclic Antidepressant) has been effective in reducing OCD behavior in a large number of people with this disorder. The other strategies have been less successful on their own.
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When interviewing and planning care for a client with fear of public speaking, the nurse is aware that social phobias are often treatable using: 1. meditation 2. response prevention 3. modeling 4. beta blockers
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Answer = 4 Rationale: Beta blockers are often effective in preventing symptoms of anxiety associated with social phobias.
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A client tells the nurse that she wants her physician to prescribe diazepam (Valium) for anxiety reduction. The physician has prescribed buspirone (BuSpar). The nurse's reply should be based on the knowledge that buspirone 1. can be administered prn 2. does not predispose the client to blood disorders 3. is not habit-forming 4. is faster-acting
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Answer = 3 Rationale: Buspirone is considered effective in long-term management of anxiety since it is not habit-forming. Since it is long-acting, it is not valuable as a PRN medication.
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The nurse plans health teaching for a client with generalized anxiety disorder who is taking lorazepam (Ativan). Which topic should be included? 1. tyramine-free diet 2. caffeine restriction 3. skin care to prevent breakdown 4. dietary restriction of tryptophan
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Answer = 2 Rationale: Caffeine is a central nervous system stimulant that acts as an antagonist to the benzodiazepine lorazepam (Ativan). Daily caffeine intake should be reduced to the amount contained in one cup of coffee.
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The care plan for a client with agoraphobia includes increasing self-esteem via cognitive restructuring. When the client tells the nurse, "I'm not smart enough to get that job," the nurse should say: 1. "It must be difficult to be in that position." 2. "You shouldn't demean your abilities." 3. "Let's think about what you just said." 4. "It seems to me that you're intelligent."
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Answer = 3 Rationale: Cognitive restructuring requires the client to examine automatic negative thoughts and replace them with a more realistic evaluation of oneself and abilities
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The nurse teaches a client to snap a rubber band on her wrist whenever an obsessive thought enters her mind. This technique, designed to interrupt obsessive thinking, can be identified as 1. implosion 2. flooding 3. desensitization 4. thought stopping
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Answer = 4 Rationale: Thought stopping employs techniques such as rubber band snapping, saying "Stop" aloud, stomping one's foot, etc., to interrupt obsessive thinking.
