Anxiety Flashcards Preview

Patient Centered Care 3 > Anxiety > Flashcards

Flashcards in Anxiety Deck (55)
Loading flashcards...
1
Q

What are some potential factors and causes of personality disorders?

A
  1. Genetics
  2. neurobiology
  3. Trauma history
  4. Intrapersonal factors
  5. Sociocultural factors
2
Q

What are some risk factors for personality disorders?

A
  1. Genetics
  2. Unstable home life
  3. parental loss via death or divorce
  4. Verbal, physical, and sexual abuse or neglect
  5. diagnosis of other disorders (childhood conduct disorder)
  6. Low socioeconomic status
3
Q

What are some symptoms of BPD?

A
  1. Impulsivity, unstable emotions, depression, and self-harm
  2. Splitting
  3. low self-esteem
  4. dissociation
  5. tendency t take offense easily
  6. fear of abandonment
  7. manipulating
4
Q

What are some clinical therapies?

A
  1. Schema-focused therapy
  2. Dialectical behavior therapy
  3. CBT
  4. antidepressants, antianxiety, antipsychotics, and mood stabilizers
  5. Group therapy
  6. alternative therapy
5
Q

What is Dialectal Behavioral Therapy?

A

Striking a balance between 2 extremes; the therapies displays understanding and validates the pt’s behaviors and feelings while at the same time imposing limits and making the pt responsible for changing unhealthy patterns

6
Q

What is schema-focused therapy?

A
  1. combines aspects of CBT with other forms of psychotherapy to change a pt’s self-perception
  2. Aims to help pt’s view themselves differently so they can create new and more effective ways of interacting with their environment and others
7
Q

How would a nurse promote basic safety precautions with a patient that has a personality disorder?

A
  1. Ensure that the pt’s environment is free from items that may be used to harm self or others
  2. Provide close supervision and monitoring
  3. Encourage pt to seek assistance from members of the healthcare team when they need to process their feelings, including when they perceive that their stress levels are rising
  4. Encourage pts to participate actively in therapy and groups
8
Q

How would a nurse provide safety in the community setting for someone with a personality disorder?

A
  1. teach about meds and possible suicidal ideation with SSRIs
  2. Pts with NSSI= Contact providers if they experience increases in severity or occurrence
  3. Pts need to be in a nonviolent, financially stable, and emotionally stable safe environment
9
Q

How would a nurse promote a therapeutic relationship with someone who has a personality disorder?

A
  1. Avoid stigmatizing the pt because of an illness. They do not have a defective personality, they have a neurological imbalance
  2. Balance flexibility with firmness
  3. Focus on the strengths of the individual and his family system
10
Q

How would a nurse establish boundaries with someone with a personality disorder?

A
  1. teach the client about physical, social, emotional, and sexual boundaries
  2. Talk about how the client adopts others’ thoughts and feelings as own
  3. Teach them they have a choice of how to react to a comment
  4. Help client establish, maintain own boundaries
11
Q

How does impulsiveness increase the risk for injury?

A
  1. person does not think of the consequences, only the action.
  2. they do not think things through before doing them meaning they do not consider safety.
  3. there are no warning signs
  4. seeking a thrill
  5. cannot rationalize consequences
12
Q

A suicidal client is diagnosed with a borderline personality disorder. Which short-term outcome is most beneficial for the client?

  1. The client will be free from self-injurious behavior
  2. The client will express feelings without inflicting self-injury by discharge
  3. The client will socialize with peers in the milieu by day 3
  4. the client will acknowledge his or her role in altered interpersonal relationships
A

The correct answer is: The client will express feelings without inflicting self-injury by discharge

The client’s being able to express feelings without inflicting self inf-injury by discharge is an outcome that reinforces the priority for client safety, is measurable, and has a time frame.

Although it is important for the client to be safe and free from self-injurious behaviors, this outcome does not have a time frame and is incorrectly written.
Although it is important for the client to be able to socialize with peers in the milieu, is not the priority outcome and is incorrect.
The ultimate outcome for a client diagnosed with a borderline personality disorder is to understand better how specific personal behaviors affect interpersonal skills. Because this outcome does not have a time frame and does not reinforce the priority of safety, it is incorrect.

13
Q

After being treated in the ED for self-inflicted lacerations to wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority?

  1. Administer tranquilizing drugs
  2. Observe client frequently
  3. Encourage the client to verbalize hostile feelings
  4. Explore alternative ways of handling frustration
A

The correct answer is: Observe client frequently

The priority nursing intervention is to observe the client’s behavior frequently. The nurse should do this through routine activities and interactions to avoid appearing watchful and suspicious. Close observation is required so that immediate interventions can be implemented as needed.

Giving the client tranquilizing medications may have a calming effect and reduce aggressive behavior, but it does not address the client’s priority safety issues. Tranquilizing medications are considered a chemical restraint and would be used only when all other, less restrictive measures have been attempted.
Encouraging the client to verbalize hostile feelings may help the client to come to terms with unresolved issues, but it does not address the client’s priority safety need.
It is important to explore alternative ways of handling frustration, such as physical activities Although this may relieve pent-up frustration, it does not address the client’s priority safety need.

14
Q

What are some medications that can be used for BPD?

A
  1. Olanzapine
  2. Quetiapine
  3. Topiramate
  4. Risperidone
  5. Fluoxetine
  6. Buspirone
15
Q

A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication(s) would the nurse expect to administer? Select all that apply

  1. Lithium Carbonate
  2. Carbamazepine
  3. Fluoxetine
  4. Paroxetine
  5. Divalproex sodium
A

The correct answers are: Lithium carbonate, Carbamazepine, and Divalproex sodium

The goal of treatment in the acute phase is symptom reduction and stabilization. Therefore, mood stabilizers, such as lithium carbonate, carbamazepine, and divalproex sodium, are the mainstays of pharmacotherapy.

Antidepressants, such as fluoxetine or paroxetine, are not recommended in bipolar depression because of the risk of switching to mania.

16
Q

What are the risk factors for anxiety disorders?

A
  1. Childhood adversity
  2. family incidence
  3. Social factors
  4. Serious or chronic illness
  5. Multiple stressors
  6. More frequent in young girls
  7. could be in older adults because of cognitive impairment, one or more chronic physical impairments, and significant emotional loss
17
Q

What are the clinical manifestations of mild anxiety?

A
  1. increase in sensory perception and arousal
  2. Increase in alertness
  3. sleeplessness
  4. Increase in motivation
  5. Restlessness and irritability
18
Q

What are the clinical therapies for mild anxiety?

A
  1. coping mechanisms
  2. improved sleep hygiene
  3. relaxation techniques
  4. Behavior therapy
  5. Massage
  6. Aromatherapy
19
Q

What are the clinical manifestations of moderate anxiety?

A
  1. Narrowing of perceptual field and attention span
  2. reduction in alertness and awareness of surroundings
  3. Feeling of discomfort and irritability with others
  4. Self-absorption
  5. Increased restlessness
  6. Increase in respiration, heart rate, and muscle tension
  7. Increase in perspiration
  8. Rapid speech, louder tone, and higher pitch
20
Q

What are the clinical therapies for moderate anxiety?

A
  1. Cognitive and behavior therapy to identify triggers
  2. relaxation techniques
  3. Integrative therapies such as yoga, acupuncture, massage
  4. Low-dose antianxiety meds if symptoms do not improve with other therapies or if the meds exacerbate chronic conditions
21
Q

What are the clinical manifestations of severe anxiety?

A
  1. Perceptual field greatly reduced
  2. Difficulty following directions
  3. Feelings of dread, horror
  4. Need to relieve anxiety
  5. Headache
  6. Dizziness
  7. Nausea, trembling, insomnia
  8. Palpitations, tachycardia, hyperventilating, diarrhea
22
Q

What are the clinical therapies for severe anxiety?

A
  1. Cognitive and behavior therapy to learn to identify triggers and to learn better coping techniques
  2. Antianxiety meds (may include benzodiazepines)
  3. Relaxation techniques
  4. Integrative therapies such as yoga, acupuncture, massage
  5. Hospitalization may be required initially to manage severe anxiety until improved coping mechanisms are developed
23
Q

What are the clinical manifestations of Panic anxiety?

A
  1. Inability to focus
  2. Perception distorted
  3. terror
  4. Feelings of doom
  5. Bizarre behavior
  6. Dilated pupils
  7. Trembling, sleeplessness, palpitations, pallor, diaphoresis, muscular incoordination
  8. Immobility or hyperactivity, incoherence
24
Q

What are the clinical therapies for panic anxiety?

A
  1. Immediate, structured intervention required
  2. Place the patient in a quiet, less stimulating environment
  3. Use of repetitive or physical task to diffuse energy
  4. Administration of antianxiety meds
  5. Psychotherapy
  6. Pharmacologic therapy
  7. relaxation techniques
  8. Improved sleep hygiene
  9. Integrative heath therapies (massage, acupuncture, yoga, hydrotherapy)
  10. Nutrition consultation
  11. Mental health counseling
25
Q

What meds are typically used for Panic Disorder?

A
  1. Antianxiety medication used cautiously and sparingly
  2. Benzodiazepines for periods of 4-8 weeks
  3. SSRIs are the choice or anxiety disorders
  4. Some antipsychotic medications may trigger anxiety disorders
26
Q

What are some nonpharmacologic therapy options for Panic Disorder?

A
  1. CBT
  2. Medication
  3. Goal-oriented contracts
  4. Help clients test reality
  5. Children and group therapy
27
Q

What nursing interventions should a nurse implement for someone with mild anxiety?

A
  1. focus on appraisal
  2. Critically evaluate thoughts that may be increasing the client’s anxiety
  3. Recognizing the triggers
  4. diversion
  5. Introduce positive self-talk
  6. give meds
  7. muscle relaxation
  8. encourage therapy
28
Q

What interventions should a nurse implement for someone with moderate anxiety?

A
  1. Cognitive reframing
  2. diversion
  3. identify current stressors
  4. identify coping strategies
  5. encourage the patient to adhere to the treatment regimen
29
Q

What interventions should a nurse implement for someone with severe anxiety?

A
  1. immediate intervention
  2. isolate the client to avoid distressing others
  3. provide a safe, quiet environment
  4. Do not leave unattended
  5. give direct, clear communication and simple questions
  6. identify riggers
  7. give meds
30
Q

What interventions should a nurse implement for someone with panic anxiety?

A
  1. Calm demeanor. Speak slowly using a low-pitched voice
  2. Reduce environmental stimuli
  3. Reinforce reality when thought processes are altered because of fear
  4. Set limits as necessary to ensure safety.
  5. Allow pacing or harmless repetitive physical tasks
  6. Administer meds
31
Q

What are the most frequently reported obsessions for Obsessive-Compulsive Disorder?

A
  1. repeated thoughts about contamination
  2. Repeated doubts with fear of having hurt someone or leaving the door unlocked
  3. Need to have things in a certain order
  4. Handwashing
  5. Order, checking and locking
  6. Mental activity such as praying, counting, and repeating words silently
  7. Requesting or demanding assurances
  8. 90% of women with OCD are compulsive cleaners
32
Q

What are some aggressive, sexual, and religious obsessions with checking compulsions?

A
  1. Checks doors, locks, appliances, written work
  2. Confesses frequently (to anything)
  3. Needs to ask other repeatedly for assurance
33
Q

What are some symmetry obsessions with ordering, arranging, and repeating compulsions?

A
  1. Needs to have objects in fixed and symmetrical positions
  2. Repeats movements, such as going in and out of doorways, getting in and out of chairs
  3. Counts or spells silently or alound
34
Q

What are some contamination obsessions with washing and cleaning compulsions?

A
  1. Repeatedly washes hands, showers, bathes, brushes teeth

2. Cleans personal space frequently

35
Q

What are the clinical therapies typically used for OCD?

A
  1. SSRIs (Fluoxetine, sertraline, fluvoxamine)
  2. Antipsychotic meds such as risperidone
  3. Cognitive behavior therapy (Desensitization- Slowly exposing the person to their fear)
  4. Deep brain stimulation
36
Q

What kind of TCAs could be administered to someone with OCD?

A

Clomipramine

37
Q

What are some nursing diagnoses of OCD?

A
  1. anxiety
  2. Fear
  3. Ineffective coping
  4. Stress overload
  5. Disturbed sleep pattern
  6. Insomnia
  7. Fatigue
  8. Deficient knowledge
38
Q

What questions could a nurse ask their patient to assess for OCD?

A
  1. Does anyone in your family experience an anxiety disorder?
  2. Have you experienced intrusive or unwanted thoughts
  3. Do you find yourself performing repetitive actions and behaviors to alleviate your anxiety?
  4. How old were you when you first experienced these thoughts and behaviors?
  5. Do you use counting when feeling anxious?
  6. How has this disorder affected your relationships, spirituality, and emotional well-being?
39
Q

How would a nurse alleviate fear in a patient with OCD?

A
  1. Provide a calm presence for the pt that will encourage the pt to verbalize fears
  2. Provide facts related to the pts fears that are based on reality
  3. For pts who are hospitalized for treatment of the OCD or for any other reason, take steps to reduce environmental stimuli. Hide or remove items associated with their triggers
40
Q

How would a nurse promote effective role performance with a patient with OCD?

A
  1. Encourage pts to have healthy conversations with their family members about the disorder
  2. Listen to the pt describe how the ritualistic behaviors are disrupting his or her ability to perform normal roles
  3. Promote self-awareness for the pt to understand his reaction to environmental triggers
  4. Encourage the pt to participate in individual or family behavioral therapy or counseling.
41
Q

How would a nurse help promote social interactions for a patient with OCD?

A
  1. teach the pt time management skills to help the patient to be on time for social events.
  2. Encourage the pt to invite close friends and family to a counseling session so they can be a part of the healing process
42
Q

How would a nurse help a patient with OCD with Adaptive Coping?

A
  1. Help the pt realize that fears arise from the disease, not from any real threat.
  2. Help the pt meditate instead of performing a ritual and then recognizing that nothing bad happened as a result of the absence of the ritual
43
Q

Is the assessment for suicidal ideation important when admitting a new client with OCD? Why or why not?

A

Yes, a suicide assessment should be done. Sometimes clients with OCD are quite depressed about their condition, so the nurse would want to know if they have any thoughts of self-harm.

44
Q

If a client’s rituals involve an act that places her in danger, what actions can the nurse take to advocate for the client while not causing increased anxiety that can result from not being able to perform the ritual?

A

This client needs to be put into a safe/camera room by herself and have a 1:1 staff so that she does not hurt herself. She will need psychotherapy and likely some inpatient treatment.

offer alternatives to assist with patient safety
providing structure
promote new behavioral patterns
if the patient allows, get a spiritual leader involved
Medication
Calm and quiet environment
distraction techniques
patient sitter
45
Q

A client diagnosed with obsessive-compulsive disorder is newly admitted to an in-patient psychiatric unit. Which cognitive symptom would the nurse expect to assess?

  1. Compulsive behaviors that occupy more than 4 hours per day
  2. Excessive worrying about germs and illness
  3. Co-morbid abuse of alcohol to decrease anxiety
  4. Excessive sweating and an increase in blood pressure and pulse
A

The correct answer is: Excessive worrying about germs and illness

Excessive worrying about germs and illness is a cognitive symptom experienced by clients diagnosed with OCD.

  1. Compulsive behaviors that occupy many hours per day would be a behavioral, not cognitive symptom experienced by clients diagnosed with obsessive-compulsive disorder( OCD)
  2. Co-morbid abuse of alcohol to decrease anxiety would be a behavioral, not cognitive symptom experienced by clients diagnosed with OCD.
  3. Excessive sweating and increased blood pressure and pulse are physiological, not cognitive symptoms experienced by clients diagnosed with OCD
46
Q

A client diagnosed with the obsessive-compulsive disorder has been hospitalized for the past 4 days. Which intervention would be a priority at this time?

  1. Notify the client of the expected limitations on compulsive behaviors
  2. Reinforce the use of learned relaxation techniques
  3. Allow the client the time needed to complete the compulsive behaviors
  4. Say “stop” to the client as a thought-stopping technique
A

The correct answer is: Reinforce the use of learned relaxation techniques

It is important for the client to learn techniques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these techniques should begin by day 4.

  1. The nurse would include, not notify, the client when making decisions to limit compulsive behaviors. To be successful, the client and the treatment team must be involved in the development of the plan of care.
  2. By day 4, the nurse, with the client’s input, should begin setting limits on compulsive behaviors.
  3. The client, not the nurse, should say the word “stop” as a technique to limit obsessive thoughts and behaviors.
47
Q

Which of the following medications would the nurse expect to administer to a client who is experiencing ritualistic behavior that interferes with job performance and activities of daily living?

  1. Fluphenazine
  2. Fluoxetine
  3. Lorazepam
  4. Carbamazepine
A

The correct answer is: Fluoxetine (Prozac)

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that corrects the imbalance of serotonin in anxiety disorders such as obsessive-compulsive disorder.

  1. Fluphenazine is an antipsychotic and not appropriate for anxiety disorders.
  2. Lorazepam is a sedative with central nervous system depressive side effects that is used mostly for sedation and to manage status epilepticus.
  3. Tegretol is used mainly for seizure disorders.
48
Q

The nurse caring for a client with obsessive-compulsive disorder (OCD) will expect to assess this client for which of the following?

  1. Self-mutilation
  2. Fear of inability to escape
  3. Excessive dependence
  4. Potential to harm other
A

The correct answer is: Potential to harm others

Due to guilt, anxiety, and fear, the OCD client is at risk of harming others.

  1. The client with agoraphobia is dependent and afraid of the inability to escape.
  2. The client with a borderline personality disorder is apt to perform self-mutilation behaviors.
49
Q

The nurse has concluded that an assigned client’s anxiety has reached the panic level as evidenced by which of the following manifestations?

  1. Dizziness, palpations, and nausea
  2. Feelings of butterflies in the stomach
  3. Feelings of fatigue and inability to stay awake
  4. Obsessive thoughts and compulsive behaviors
A

The correct answer is: Dizziness, palpitations, nausea

Subjective complaints of panic level of anxiety include choking, chest pain, dizziness, and fear of death.

  1. Butterflies in the stomach are a fight-or-flight response.
  2. Feelings of fatigue and inability to stay awake may be seen in the exhaustion stage of general adaptation syndrome.
  3. Obsessive thoughts and compulsive behaviors are manifestations of obsessive-compulsive personality disorder.
50
Q

A client with a personality disorder has a nursing diagnosis of Impaired Social Interaction. Applying the principles for caring with this client, which of the following nursing interventions is essential to the care plan?

  1. demonstrate honesty and sincerity in interactions with the client
  2. Assist the client in identifying personal thoughts
  3. Demonstrate unconditional positive regard when confronting inappropriate behavior
  4. Model assertive communication
A

The correct answer is: Demonstrate honesty and sincerity in interactions with client.

Establishing a bond of trust is an important consideration with clients experiencing a personality disorder. Attempts to help the client will be rejected if trust is not established.

  1. Identifying personal strengths will not help the client to socialize
  2. Unconditional positive regard in the face of inappropriate behavior is counterproductive since clients need limits.
  3. Assertive communication is not a positive means of teaching or modeling socialization.
51
Q

A client experiencing a panic attack would display which physical symptoms?

  1. Fear of dying
  2. Sweating and palpitations
  3. depersonalization
  4. Restlessness and pacing
A

The correct answer is: Sweating and palpitations

Sweating and palpitations are physical symptoms of a panic attack.

  1. Fear of dying is an affective, not physical symptoms of a panic attack.
  2. Depersonalization is an alteration in the perceptions or experience of the self so that the feeling of one’s own reality is temporarily lost.
    Depersonalization is a cognitive, not physical symptom of a panic attack.
  3. Restlessness and pacing are behavioral, not physical, symptoms of a panic attack.
52
Q

A client diagnosed with borderline personality disorder coyly requests diazepam (Valium) When the physician refuses, the client becomes angry and demands to see another physician. What defense mechanism is the client using?

  1. undoing
  2. splitting
  3. Altruism
  4. Reaction Formation
A

The correct answer is: Splitting

The client in the question is using the defense mechanism of splitting. An individual diagnosed with borderline personality disorder sees things as either “all good” or “all bad” In the question when the client’s manipulative charm does not work in obtaining the drug from the “good” physician, the client determines that the physician is now “bad” and seeks another physician to meet his or her needs.

  1. The defense mechanism of undoing is the symbolic negation or cancellation of thoughts or experiences that one finds intolerable. The only thing that the manipulate client in the question finds intolerable is the physician who refuses to give the requested drug.
  2. The defense mechanism of altruism is considered a mature defense and is used when emotional conflicts and stressors are dealt with by meeting the needs of others. The client in the question is meeting no one else’s needs but his or her own.
  3. The defense mechanism of reaction formation prevents unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating the opposite thoughts or types of behaviors. The client in the questions does not perceive his or her thoughts or behaviors as either unacceptable or problematic and is not exaggerating the opposite behavior.
53
Q

The correct answer is: Splitting

The client in the question is using the defense mechanism of splitting. An individual diagnosed with borderline personality disorder sees things as either “all good” or “all bad” In the question when the client’s manipulative charm does not work in obtaining the drug from the “good” physician, the client determines that the physician is now “bad” and seeks another physician to meet his or her needs.

The defense mechanism of undoing is the symbolic negation or cancellation of thoughts or experiences that one finds intolerable. The only thing that the manipulate client in the question finds intolerable is the physician who refuses to give the requested drug.
The defense mechanism of altruism is considered a mature defense and is used when emotional conflicts and stressors are dealt with by meeting the needs of others. The client in the question is meeting no one else’s needs but his or her own.
The defense mechanism of reaction formation prevents unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating the opposite thoughts or types of behaviors. The client in the questions does not perceive his or her thoughts or behaviors as either unacceptable or problematic and is not exaggerating the opposite behavior.

  1. I may suffer from a mild rash when taking this medication
  2. I will likely experience hyperactivity when taking this medication
  3. Occasional seizures may occur when starting this new medication
  4. I may be a little drowsy at first when I start taking this medication
A

The correct answer is: “I may be a little drowsy at first when I start taking this medication.”

The client may experience drowsiness as Xanax is a benzodiazepine that exerts a tranquilizing effect. Mild drowsiness or sedation is a frequent, early adverse reaction.

  1. A rash is not expected when taking a benzodiazepine such as Xanax and may be a sign of an allergic reaction.
  2. The client is more likely to experience a tranquilizing effect as benzodiazepines exert their effect by potentiating the effects of gamma-aminobutyric acid (GABA).
  3. Antianxiety drugs are commonly prescribed to treat convulsions or seizures, not cause them. A seizure or convulsion can be a serious withdrawal symptom
54
Q

When discussing various types of anxiolytic medications with a client, the nurse recognizes which medication has the lowest potential for abuse?

  1. Alprazolam
  2. Diazepam
  3. Buspirone
  4. Lorazepam
A

The correct answer is: Buspirone

Buspirone is a nonbenzodiazepine medication that does not have abuse potential.

Benzodiazepines such as alprazolam, lorazepam, and diazepam have abuse potential and may become addictive.

55
Q

The nurse is caring for a client receiving fluvoxamine and behavior therapy for obsessive-compulsive disorder. What outcome does the nurse expect of this client?

  1. The client establishes adequate nutrition after 1-2 days
  2. The client is able to sleep for at least 4 hours per night after 5 days
  3. the client is able to identify the cause of anxiety after 1 week
  4. the client is able to identify individual strength and abilities after 2 weeks
A

The correct answer is: The client is able to sleep for at least 4 hours per night after 5 days.

The client responding effectively to treatment must be able to sleep for at least 4 hours per night.

  1. Adequate nutrition must be established within 4 to 5 days.
  2. The client is expected to identify the cause of stress and anxiety within 2 to 3 days.
  3. Individual strengths and abilities must be identified and reviewed with staff within 3 to 4 days.