Week 4- Anxiety Flashcards
Which mental health disorder can be a direct physiological result of hyperthyroidism?
Anxiety
Panic attacks
Generalized anxiety disorder
Obsessive-compulsive disorder (OCD)
Anxiety
Anxiety can be a direct physiological result of hyperthyroidism. Panic attacks are a key feature of panic disorders. Generalized anxiety disorder is excessive worry, which is out of proportion to the true effect of events or situations. It is often comorbid with major depressive disorder and other anxiety disorders. OCD is characterized by both obsession and compulsions that may occur as a result of a genetic disposition or trauma.
Which action is included in the nursing plan of care for a patient diagnosed with panic-level anxiety who is exhibiting severe hyperactivity?
Place the patient in seclusion.
Attend to the patient’s physical needs.
Help the patient identify the source of anxiety.
Communicate using simple, loud, clear statements.
Attend to the patient’s physical needs.
The nursing care plan for a patient diagnosed with anxiety who is exhibiting severe hyperactivity is to attend to the patient’s physical needs. Severe hyperactivity is characteristic of a panic level of anxiety and attending to physical needs such as elimination, fluids, and nutrition are important. Seclusion should only be initiated after all other interventions have been tried and are unsuccessful. Helping a patient identify the source of anxiety is more effective for a patient experiencing mild to moderate anxiety. When the nurse is communicating with a patient experiencing severe anxiety, a low-pitched voice should be used.
A patient is displaying symptomology reflective of a moderate anxiety. To help the patient regain control, the nurse would respond in which way?
“You need to calm yourself.”
“What is it that you would like me to do to help you?”
“Can you tell me what you were feeling just before your attack?”
“I will get you some medication to help calm you.”
“Can you tell me what you were feeling just before your attack?”
A response that helps the patient identify the precipitant stressor is most therapeutic. It is nontherapeutic to tell a patient “You need to calm yourself.” If the patient is capable of self-calming, the patient already would have done so. Asking, “What is it that you would like me to do to help you?” is focusing the attention on the nurse. Getting medication may not be necessary if the nurse is able to help the patient lower their anxiety level.
A patient approaches the nurse’s station, begins tapping a finger on the desk, and tells the nurse, “I am feeling pretty anxious.” Which nursing action will assist this patient?
Move the patient to a quieter setting.
Escort the patient to an exercise class.
Offer the patient antianxiety medication.
Encourage the patient to attend art therapy.
Escort the patient to an exercise class.
The nurse’s best action is to escort the patient to an exercise class. The patient is displaying a sign of moderate anxiety by tapping their fingers on the desk, and it is ideal to provide this patient outlets for working off excess energy. A patient experiencing severe to panic levels of anxiety should be moved to a quieter setting. Medication is offered to a patient experiencing severe to panic levels of anxiety only after all other interventions have been tried and are unsuccessful. Art therapy will not offer an outlet for expending excess energy the way an exercise class will.
Which outcome is the primary purpose of performing a physical examination before beginning treatment for any anxiety disorder?
Protect the nurse legally.
Establish the nursing diagnoses of priority.
Obtain information about the patient’s psychosocial background.
Determine whether the anxiety is primary or secondary in origin.
Determine whether the anxiety is primary or secondary in origin.
A patient diagnosed with panic disorder is prescribed chlordiazepoxide. Which instruction is the most appropriate suggestion by the nurse?
Follow contraceptive methods.
Stop the medication after 3 months.
Change the medication if there is insomnia.
Coffee and tea are fine to drink and will not interact with the medication.
Follow contraceptive methods.
Chlordiazepoxide belongs to the benzodiazepine class of antianxiety drugs. It causes congenital anomalies in the fetus; therefore the patient should avoid becoming pregnant. As caffeine decreases the efficacy of the benzodiazepines, the nurse should suggest the patient avoid drinking coffee and tea. The nurse should suggest discussing continuing medication with the healthcare provider after 3 to 4 months. Abruptly stopping the medication can cause withdrawal symptoms like dry mouth, tremors, and convulsions.
Psychiatric patients often pull out hair to relieve stress. This condition is called _______________
. Trichorrhexis is a defect in the hair shaft where the hair becomes thin and breaks off easily. Patients who secretly swallow the pulled hair have a condition called trichophagia. The masses of hair present in the stomach are referred to as Rapunzel syndrome.
trichotillomania
Buspirone is prescribed for a patient with anxiety. Which instruction would the nurse provide to this patient?
“Take this medication on an empty stomach.”
“Take this medication only when you feel anxious.”
“It will take 2 to 4 weeks for you to feel the full benefit.”
“Avoid aged cheese products while you are taking this medication.”
“It will take 2 to 4 weeks for you to feel the full benefit.”
Buspirone is an alternative antianxiety medication that does not cause dependence, but 2 to 4 weeks are required for it to reach full effect. It should be taken with food. The drug may be used for long-term treatment and should be taken regularly. Aged cheese products should be avoided when taking monoamine oxidase inhibitors (MAOIs).
A patient is fearful of riding in elevators and always takes the stairs. Which brain structure is involved in this fear and behavior?
Thalamus
Amygdala
Hypothalamus
Pituitary gland
Amygdala
Which therapeutic intervention can the nurse implement within the scope of nursing practice guidelines to help a patient diagnosed with a mild anxiety disorder regain control?
Flooding
Modeling
Thought stopping
Systematic desensitization
Modeling
Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be used independently, within the scope of practice guidelines. Flooding, thought stopping, and systematic desensitization require agreement of the treatment team. Healthcare providers such as psychiatrists or psychiatric nurse practitioners would be providing those interventions.
Which statement demonstrates an expression of anxiety rather than fear?
“I can’t stand spiders.”
“You’d never get me on a roller coaster.”
“I dislike knowing when I’m older, I won’t have enough money.”
“I can’t imagine why anyone would want to parachute out of an airplane.”
“I dislike knowing when I’m older, I won’t have enough money.”
Anxiety is an emotion without a specific object that is provoked by the unknown or by new experiences. Being worried about future finances is a common expression of anxiety. An intense dislike for spiders, roller coasters, and parachuting are fears because they are focused.
Which defense mechanism has an adaptive use?
Splitting
Undoing
Projection
Conversion
Undoing is a defense mechanism with an adaptive use. Splitting and conversion do not have adaptive uses and are almost always pathological. Projection is a defense mechanism that is considered immature and does not have an adaptive use.
A patient diagnosed with panic disorder begins a new prescription for lorazepam. Which daily activity would the nurse instruct the patient to discontinue?
Knitting
Mowing the lawn
Playing video games
Preparing dinner for the family
Mowing the lawn
Lorazepam is a benzodiazepine commonly prescribed for short-term management of anxiety. These medications may make it unsafe to handle mechanical equipment, such as a lawn mower. It would be safe for the patient to knit, play video games, and prepare meals.
Which serotonin norepinephrine reuptake inhibitor (SNRI) is used to treat generalized anxiety disorder?
Fluoxetine
Oxazepam
Venlafaxine
Escitalopram
Venlafaxine
Which scale would the nurse use during a clinical interview to measure phobias present in children?
Yale-Brown obsessive-compulsive scale
Hoarding scale self-report
Fear questionnaire
Panic disorder severity scale
Fear questionnaire
A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and “burns” money that could be better spent to feed the poor is demonstrating which defense mechanism?
Undoing
Projection
Rationalization
Reaction formation
Reaction formation
Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. Undoing involves a person making up for an act that they regret. Projection refers to the unconscious rejection of emotionally unacceptable features and attributing them to others. Rationalization consists of justifying illogical or unreasonable ideas by developing acceptable explanations that satisfy the teller and the listener.
If the health record mentions that the patient habitually relies on rationalization, the nurse might expect the patient to exhibit which behavior?
Miss appointments.
Make jokes to relieve tension.
Justify illogical ideas and feelings.
Behave in ways that are the opposite of their feelings.
Justify illogical ideas and feelings.
Which category of medication used to treat anxiety has a potential for dependence?
Tricyclics
Benzodiazepines
Selective serotonin reuptake inhibitors
Selective serotonin norepinephrine reuptake inhibitors
Benzodiazepines
Which symptom is commonly associated with panic attacks?
Obsessions
Apathy
Fever
Fear of impending doom
Fear of impending doom
Which assessment finding can the nurse expect in a patient experiencing a panic level of anxiety?
Withdrawal
Depersonalization
Scattered attention
Distorted perceptual field
The nurse can expect to find depersonalization in a patient experiencing a panic level of anxiety. Depersonalization is the sense of feeling unreal. Withdrawal, scattered attention, and a distorted perceptual field are more likely to occur in the patient experiencing severe anxiety.
Before transferring a patient for a scheduled procedure, the patient tells the nurse, “I feel like I am going to die.” Based on the statement the patient made, which level of anxiety is the patient experiencing?
Mild
Panic
Severe
Moderate
Severe
When a patient has been prescribed lorazepam for generalized anxiety disorder, which action would the nurse take?
Tell the patient to expect mild insomnia.
Teach the patient to limit caffeine intake.
Explain the long-term nature of benzodiazepine therapy.
Question the healthcare provider’s prescription because the drug is likely to be ineffective.
Teach the patient to limit caffeine intake.
Caffeine is an antagonist of antianxiety medication; therefore patients should avoid beverages containing caffeine because it will decrease the desired effects of the drug. Quitting lorazepam—a benzodiazepine—after the first month of use may cause insomnia. Benzodiazepine therapy should be used only for short periods of time because it has a potential for dependence. Benzodiazepines have a quick onset of action and are shown to be effective in the treatment of anxiety disorders.
Two staff nurses applied for promotion to nurse manager. The nurse not promoted initially had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse’s response?
Reaction formation
Suppression
Altruism
Intellectualization
Altruism
A person who feels unattractive repeatedly says, “Although I’m not beautiful, I am smart.” This is an example of what defense mechanism?
compensation.
devaluation.
repression.
identification.
compensation.
