Chapter 15: Anxiety Responses and Anxiety Disorders My Nursing Test Banks

Chapter 15: Anxiety Responses and Anxiety Disorders

Test Bank

MULTIPLE CHOICE

1. When assessing a patient who gives the impression of being anxious, a nurse seeks to validate this impression because anxiety is:

a.

necessary for survival.

b.

communicated interpersonally.

c.

an emotion without a specific object.

d.

a subjective experience of the individual.

ANS: D

Anxiety is a subjective human experience. The nurse can infer that a patient is anxious based on selected behaviors but must validate this with the patient.

DIF: Cognitive Level: Comprehension REF: Text Page: 217

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. A nurse determines that a patient is able to follow directions but appears to experience a narrowed perceptual field and focus on immediate concerns. The nurse determines that the patient is experiencing anxiety at which level?

a.

Mild

b.

Moderate

c.

Severe

d.

Panic

ANS: B

Moderate anxiety is characterized by a focus on only immediate concerns and by the demonstration of a narrowed perceptual field as the person sees, hears, and grasps less. The person blocks out selected areas but can attend to more if directed to do so.

DIF: Cognitive Level: Comprehension REF: Text Page: 218

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. A patient has significant non-goaldirected motor activity, seems terror stricken, and experiences both distorted perceptions and disordered thoughts. When the nurse attempts to calm the patient, the patient does not respond. The level of patient anxiety can be assessed as:

a.

mild.

b.

moderate.

c.

severe.

d.

panic.

ANS: D

Panic-level anxiety is associated with awe, dread, and terror. The person is disorganized, is unable to relate to others, and experiences distorted perceptions and loss of rational thought. The person is unable to do things even with direction.

DIF: Cognitive Level: Application REF: Text Page: 218

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. A psychiatric patient is experiencing panic-level anxiety. The initial intervention of highest priority is:

a.

provide for the patients safety.

b.

reduce all environmental stimuli.

c.

respect the patients personal space.

d.

encourage the patient to discuss the anxious feelings.

ANS: A

Safety is of highest priority because the patient in panic is at high risk for self-injury related to increased non-goaldirected motor activity, distorted perceptions, and disordered thoughts. The remaining options are to be considered only after the patient is safe.

DIF: Cognitive Level: Application REF: Text Page: 232

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

5. A patient is experiencing panic-level anxiety. Of these medications listed on the patients prn medication administration record, which should be given?

a.

Buspirone (BuSpar)

b.

Lorazepam (Ativan)

c.

Phenytoin (Dilantin)

d.

Fluoxetine (Prozac)

ANS: B

Lorazepam (Ativan) is a benzodiazepine used to treat anxiety. It may be given as a prn medication. The remaining options are either not ordered for anxiety or as prn medication.

DIF: Cognitive Level: Application REF: Text Page: 233

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A nurse explains a patients behavior by stating, The patients anxiety stemmed from being unable to attain a desired goal. Which theory is the nurse basing the response upon?

a.

Learning

b.

Behaviorist

c.

Interpersonal

d.

Psychoanalytic

ANS: B

Behaviorist theory proposes that anxiety is a product of frustration caused by anything that interferes with attaining a desired goal. This is not the theory proposed by the other options.

DIF: Cognitive Level: Comprehension REF: Text Page: 223

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

7. A patient whose current behavior includes pacing and cursing tells a nurse, Im feeling edgy and cant concentrate. The nurse can assess the patients level of anxiety as:

a.

mild.

b.

moderate.

c.

severe.

d.

panic.

ANS: A

Restlessness is a behavioral symptom of mild anxiety, whereas edginess is an affective symptom, and inability to concentrate is a cognitive symptom.

DIF: Cognitive Level: Comprehension REF: Text Page: 221

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

8. During a staff conflict, one of your nursing peers defends her actions and asserts her own rights among the professional staff. Defending ones actions and asserting ones rights typify the coping mechanism of:

a.

emotion or ego focused.

b.

problem or task focused.

c.

physiological conversion.

d.

psychological conversion.

ANS: B

Task-oriented reactions are thoughtful, deliberate attempts to solve problems, resolve conflicts, and gratify needs. They are consciously directed and action oriented and can include attack, withdrawal, and compromise.

DIF: Cognitive Level: Comprehension REF: Text Pages: 225-226

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

9. Defense mechanisms:

a.

involve some degree of self-deception.

b.

are rarely used by mentally healthy people.

c.

seldom make the person feel more comfortable.

d.

are rarely effective in resolving basic conflicts.

ANS: A

Ego defense mechanisms operate unconsciously and usually involve some degree of self-deception and reality distortion. The remaining options are not true statements regarding defense mechanisms.

DIF: Cognitive Level: Comprehension REF: Text Pages: 225-226

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10. A patient tends to use the defense mechanism of displacement. When the patients spouse accuses the patient of being disorganized and flighty, the patient is most likely to react by:

a.

burning the spouses dinner.

b.

scolding the paperboy for being late.

c.

telling the spouse, Im so angry with you.

d.

promising the spouse to try be more organized and calm.

ANS: B

Displacement is defined as the shifting of an emotion from its original source to a person or object that is less threatening. The remaining options do not reflect a shifting of emotion onto a less-threatening person or object.

DIF: Cognitive Level: Analysis REF: Text Page: 226

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

11. A person who was raped several years ago denies having any memory of the event. The defense mechanism in use is:

a.

projection.

b.

repression.

c.

displacement.

d.

reaction formation.

ANS: B

Repression is the involuntary exclusion of a painful or conflicting thought, impulse, or memory from awareness.

DIF: Cognitive Level: Application REF: Text Page: 226

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

12. If a penny-pinching patient rationalizes personal behavior, a nurse will expect that the patient is most likely to:

a.

call other people wasteful.

b.

start spending money liberally.

c.

claim to exemplify the virtue of thrift.

d.

give vast amounts of money to charity on death.

ANS: C

Rationalization is the offering of a socially acceptable or apparently logical reason as a justification for an unacceptable impulse, feeling, behavior, or motive.

DIF: Cognitive Level: Application REF: Text Page: 226

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

13. After hitting a playmate, a child untruthfully states, The other kid hit me first! This is an example of:

a.

projection.

b.

sublimation.

c.

displacement.

d.

rationalization.

ANS: A

Projection is the attributing of ones thoughts or impulses to another person.

DIF: Cognitive Level: Comprehension REF: Text Page: 226

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

14. A police officer who uses reaction formation to deal with fears of acting cowardly is most likely to:

a.

call others cowards.

b.

develop paralysis of the leg.

c.

volunteer for perilous duty.

d.

have nightmares about running from an assailant.

ANS: C

Reaction formation is the development of behavior patterns or conscious attitudes that are the opposite of what one really feels or would like to do.

DIF: Cognitive Level: Application REF: Text Page: 226

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

15. A patient calls the community mental health center and shares, For the past 6 months, whenever I even think about leaving my house, my heart pounds, my body shakes, and I cry and feel dizzy. Theres no reason for me to feel this way, but I do. These symptoms can be assessed as being most consistent with:

a.

panic disorder with agoraphobia.

b.

obsessive-compulsive disorder.

c.

posttraumatic stress disorder.

d.

generalized anxiety disorder.

ANS: A

The patient has a persistent fear of open places. The extreme physical and emotional reaction is consistent with panic-level anxiety experienced when the feared situation is imminent.

DIF: Cognitive Level: Application REF: Text Page: 228

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

16. A patient is very anxious and can only follow simple directions with great difficulty. The patient tells a nurse about a fear of keeping clean in such a public place and is observed repeatedly dusting the furniture. The nurse should assess the patients level of anxiety as:

a.

mild.

b.

moderate.

c.

severe.

d.

panic.

ANS: C

Severe anxiety is characterized by a reduced perceptual field as evidenced by inability to follow directions. All behavior is aimed at relieving anxiety as evidenced by the rituals the patient performs.

DIF: Cognitive Level: Application REF: Text Page: 218

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

17. Which nursing intervention would be most therapeutic for a newly admitted patient diagnosed with obsessive-compulsive disorder (OCD) who is busily cleaning and straightening a bedroom?

a.

Ive inspected the room, and its very clean.

b.

Tell me why your clothes and room need to be cleaned.

c.

You will not be allowed in your room if you cannot control your cleaning behaviors.

d.

I can see how uncomfortable you are, but I would like you to take a short walk so I can show you the unit.

ANS: D

This remark acknowledges the patients feelings but addresses the newly admitted patients need to know important areas of the unit.

DIF: Cognitive Level: Application REF: Text Page: 231

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

18. A patient admitted to the psychiatric unit with a diagnosis of obsessive-compulsive disorder (OCD) tells a nurse of a need to perform oral hygiene at least 15 times each day while sleeping only 1 hour each night for the last 5 days. Within the next 48 hours, which outcome would best indicate that nursing interventions to relieve anxiety had been successful?

a.

The patient sleeps 6 hours nightly.

b.

The patient states that performing rituals is silly.

c.

The patient verbalizes that brushing ones teeth 15 times each day is too much.

d.

The patient admits to being acutely anxious and wants help.

ANS: A

Patients with obsessive-compulsive disorder may be so consumed by rituals that they are not able to stop long enough to eat, go to the bathroom, or sleep. Sleeping 6 hours per night in comparison with sleeping only 1 hour indicates improvement.

DIF: Cognitive Level: Analysis REF: Text Page: 231

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

19. Physiological responses associated with anxiety are modulated by the brain through which system?

a.

Autonomic nervous

b.

Cardiovascular

c.

Neuromuscular

d.

Endocrine

ANS: A

The autonomic nervous system, which comprises parasympathetic and sympathetic systems, is responsible for the individuals physiological responses to anxiety. The parasympathetic system conserves body responses, and the sympathetic system activates body responses. Sympathetic reactions predominate in anxiety.

DIF: Cognitive Level: Comprehension REF: Text Page: 219

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20. Several months after being trapped in a collapsed building for several hours before being rescued, a patient admits to currently feeling numb and being unable to relate well with people. The patient sometimes re-experiences the terror associated with being trapped. The data collected about the patient are consistent with the symptoms of which problem?

a.

Agoraphobia

b.

Panic attacks

c.

Posttraumatic stress disorder

d.

Obsessive-compulsive disorder

ANS: C

Posttraumatic stress disorder (PTSD) follows exposure to a traumatic event. Symptoms include a tendency to relive the experience, a feeling of emotional numbness, inability to relate, and persistent symptoms of arousal.

DIF: Cognitive Level: Application REF: Text Page: 224

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

21. A nurse who has spent an hour with a highly anxious patient shares with a peer, Im really feeling uptight! I need a quiet place to be alone. This can be attributed to:

a.

hypersensitivity on the nurses part.

b.

anxiety resulting from the patient contact.

c.

fatigue from the effort of establishing a relationship.

d.

a threat to the nurses self-esteem created by a difficult patient.

ANS: B

Anxiety is communicated interpersonally. Just as patients can become more anxious when the nurse is anxious, so too can nurses experience anxiety that has been transmitted by the patient.

DIF: Cognitive Level: Application REF: Text Page: 218

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

22. A patient experiences double approach-avoidance conflicts associated with the need to replace maladaptive behaviors with more adaptive behaviors. This tendency is exhibited when the patient:

a.

wishes to both pursue and avoid the same goal.

b.

is required to choose between two undesirable goals.

c.

seeks to pursue two equally desirable but incompatible goals.

d.

sees both desirable and undesirable aspects of two alternatives.

ANS: D

Double approach-avoidance conflicts result in experiencing both desirable and undesirable aspects of two alternatives. This dual emotional state is called ambivalence.

DIF: Cognitive Level: Comprehension REF: Text Page: 223

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

23. In the cognitive realm, which assessment finding most indicates depression?

a.

Uncertainty in negative evaluations

b.

Selective and specific negative appraisals

c.

Global view that nothing will turn out right

d.

Tentatively regards defects or mistakes as revocable

ANS: C

A depressed individual usually makes negative appraisals that are pervasive and global, is absolute about negative evaluations, believes mistakes or defects are beyond redemption, and has a global view that nothing will turn out right.

DIF: Cognitive Level: Comprehension REF: Text Page: 230

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24. A patient diagnosed with obsessive-compulsive disorder (OCD) tells a nurse, Im such a stupid person for behaving this way. The most therapeutic nursing response would be to:

a.

change the subject.

b.

agree that the behavior is problematic.

c.

ask about the feelings experienced before using the behavior.

d.

support the insight by asking for immediate behavioral change.

ANS: C

Helping the patient connect anxiety and the use of the symptom is an initial therapeutic step. The nurse acknowledges the patients feeling, attempts to label it, helps the patient describe feelings, and associates them with the use of a specific behavioral pattern.

DIF: Cognitive Level: Application REF: Text Page: 231

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25. A patient repeatedly states, Im so tense, and Im sure that Im going to be fired. Which statement would be most useful in helping the patient deal with his primary concern?

a.

Lets look at the evidence that youll lose your job.

b.

Im going to teach you how to make your body relax.

c.

Before we talk about this problem, you are going to the gym to work out.

d.

Lets use role playing to help you explain your actions to your superiors.

ANS: A

Sometimes patients jump to erroneous conclusions. Questioning the evidence used by the patient to support a particular belief can be helpful. The source of the patients data was his own thinking, rather than information supplied by superiors. The nurse could help the patient see that superior officers are unlikely to make a precipitous decision to fire him.

DIF: Cognitive Level: Analysis REF: Text Page: 236

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

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