Chapter 30: Anxiety Disorders

1. A nurse hears a clinician state, This client has a phobia of elevators because he had a frightening experience in an elevator when he was a young child, or because he observed his mother's fear of elevators. The nurse understands that this statement would most likely be made by a clinician who is operating from which paradigm? A) Physiological B) Psychoanalytic C) Humanistic D) Behavioral 2. A client tells a nurse that she refuses to eat in a restaurant because she is afraid others will laugh at the way she eats. The nurse understands that this behavior is associated with which condition? A) Posttraumatic stress disorder B) Generalized anxiety disorder C) Social phobia D) Obsessivecompulsive disorder 3. Since starting college, a client has been unrealistically worried about his academic performance as well as his relationship with his girlfriend. He cannot sleep or concentrate because he cannot stop worrying about the numerous papers and assignments that are due over the course of the semester. He is irritable and on edge. A nurse understands that this behavior is associated with which condition? A) Posttraumatic stress disorder B) Generalized anxiety disorder C) Social phobia D) Obsessivecompulsive disorder 4. Since starting college, a client has been unrealistically worried about his academic performance as well as his relationship with his girlfriend. He cannot sleep or concentrate because he cannot stop worrying about the numerous papers and assignments that are due over the course of the semester. He is irritable and on edge. Which actions should be included in the plan of care for this client? Select all that apply. A) Increasing caffeine intake B) Engaging in physical activity three times per week C) Practicing relaxation techniques D) Identifying signs and symptoms of escalating anxiety 5. A client with obsessivecompulsive disorder develops a number of compulsive washing rituals over the years. The client then becomes confused and has difficulty remembering the proper sequence of her routines, which causes great distress. A nurse understands that the client's behavioral rituals served the purpose of: A) Blocking delusions and hallucinations from awareness. B) Providing temporary and partial relief from her anxiety. C) Drawing attention and approval from significant others. D) Increasing the inhibitory powers of her superego.

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6. Which statement about the treatment of clients with panic disorder is inaccurate? A) Benzodiazepines (e.g., Valium) are the long-term pharmacological treatment of choice because of their nonaddicting quality. B) Treatment includes identification of triggers that escalate anxiety symptoms. C) A select group of antidepressants (selective serotonin reuptake inhibitors [SSRIs]) has been found helpful in long-term treatment. D) Relaxation exercises, guided imagery, and meditation are effective in preventing or reducing anxiety symptoms. 7. In treating a client with obsessivecompulsive disorder, a nurse should allow the client to spend ____________ time on the ritual at the beginning of treatment, and encourage the client to spend ____________ time on the ritual later in the treatment. A) the same amount of; more B) more; less C) less; incrementally less D) the same amount of; incrementally less 8. While stuck in traffic, a cab driver unexpectedly begins to feel lightheaded, tremulous, and sweaty. His heart begins pounding and his breathing becomes rapid and labored. He thinks that he is having a heart attack. Driving on the shoulder of the road, he immediately heads for an emergency department. An extensive cardiac workup reveals no abnormalities. Which diagnosis should a nurse anticipate that a physician will assign to this client? A) Generalized anxiety disorder B) A specific phobia C) Posttraumatic stress disorder D) A panic attack 9. A client presents to an emergency department while having a panic attack. The client asks a nurse, Am I going crazy? Which is the most appropriate nursing response? A) Although it may feel that way during an attack, you actually suffer from panic disorder. B) Thank goodness it's only in your head and not a real heart attack. C) Let me get the psychiatrist to explain it to you. D) We're all a little crazy at times. You'll be fine. 10. After receiving treatment for a panic attack, a client asks a nurse, What can be done about this disorder? I need to go to work! I need to make a living! Which components should the nurse include in the teaching plan for this client? Select all that apply. A) Medication management B) Relaxation techniques C) Identification of signs, symptoms, and triggers of escalating anxiety D) Referral to a social worker to assist in filing a disability claim

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11. A nurse is conducting a psychoeducational group about anxiety in an inpatient unit. Which teaching by the nurse is accurate? A) Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning. B) Anxiety is a purely psychological phenomenon and can be overcome using mind over matter. C) Anxiety is the third most common psychological disorder in the United States. D) Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications. 12. A psychiatric nurse is working with a client with generalized anxiety disorder (GAD). Which phenomenon best describes the cognitive theory of GAD? A) Overuse or ineffective use of ego defense mechanisms results in maladaptive responses to anxiety. B) When an individual feels vulnerable in a given situation, distorted thinking results in an irrational appraisal, fostering a negative outcome. C) The elevations in cortisol that occur during the fight-or-flight response. D) Worry is a learned response to anxiety and serves to keep it within the control of the individual. 13. A nurse therapist is using cognitive therapy to address anxiety. This entails encouraging the client to face frightening situations to be able to view them: A) In a positive manner. B) In a cautious manner. C) In a realistic manner. D) In an individualized manner. 14. A nurse therapist is using systematic desensitization to address a client's severe test anxiety. How should the nurse describe this process to the client? A) Using your imagination, we will attempt to achieve a state of relaxation. B) Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response. C) Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety. D) In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate. 15. A nurse therapist is using systematic desensitization to address a client's severe test anxiety. The client wants to see faster progress because the client is facing expulsion from school. Which technique should the nurse therapist choose to use next? A) Imagery B) Counter-conditioning C) Cognitive therapy D) Implosion therapy

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16. For clients taking a benzodiazepine, which teaching by a nurse would be considered inaccurate? A) Do not eat foods containing tyramine while taking this medication. B) Do not stop taking this medication abruptly because serious complications may arise. C) Do not use this medication in combination with alcohol or any other central nervous system depressant. D) Take only the dose your doctor has prescribed and for the period of time the doctor has indicated because addiction can occur. 17. A nursing instructor states, Recently, the biochemical theory of the etiology of obsessive compulsive disorder (OCD) has been given an increasing amount of credibility. Which neurotransmitter has been associated with this disorder? Which is the most accurate response by the instructor's students? A) Norepinephrine B) Dopamine C) Serotonin D) Acetylcholine 18. A client with a diagnosis of obsessivecompulsive disorder (OCD) has been folding and unfolding her clothes and arranging and rearranging them in the drawers for an hour. How should the nurse interpret this client's behavior? A) It relieves the client's anxiety. B) Her mother taught her to be very neat. C) She is too shy to go out in the dayroom. D) It makes her feel good about herself. 19. On admission to a psychiatric unit, a client with obsessivecompulsive disorder (OCD) folds and unfolds her clothes and arranges and rearranges them in the drawers for an hour. What is the most appropriate nursing intervention for this client? A) Explain to the client that she must come out of her room and join the others in the dayroom. B) Give the client a task to complete to get her mind off the ritual. C) Allow the client as much time as she wants to perform the ritual. D) Take the client by the hand and say, It's time to go to group therapy now. 20. A nurse is caring for a client with obsessivecompulsive disorder (OCD). The client walks around the unit, checking and rechecking the lock on each door. Which is the most appropriate nursing intervention for this client? A) Distract the client with other activities whenever she tries to check the locks. B) Report the behavior to the physician every time she begins the ritual. C) Lock the client's room so that she cannot engage in the ritualistic behavior. D) Help the client to identify what is causing the anxiety that leads to the ritualistic behavior.

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21. A nurse is caring for a client with obsessivecompulsive disorder (OCD) who has been on the unit for several days. The client is becoming more comfortable and is beginning to interact with others. What change, if any, should the nurse make in her initial plan of care? A) Begin to set limits on the amount of time that the client can engage in the ritualistic behavior. B) Give negative reinforcement to the behavior by pointing it out. C) Establish firm consequences if the client performs the ritualistic behavior. D) Do not make any change in the plan of care. 22. A nurse notifies a health-care provider to obtain a new prescription for a client with obsessivecompulsive disorder (OCD). Which is an appropriate prescription for a client with OCD? A) Diazepam (Valium) B) Fluvoxamine (Luvox) C) Propranolol (Inderal) D) Alprazolam (Xanax) 23. When caring for a client who is experiencing a panic attack, which nursing interventions are most appropriate? Select all that apply. A) Leaving the client alone to maintain privacy B) Reducing stimuli in the immediate environment C) Speaking loudly and forcefully to gain client's attention D) Administering anti-anxiety medication as ordered 24. A nurse is caring for a newly admitted client with obsessivecompulsive disorder (OCD) who performs a 15-minute ritual with his dietary tray before eating. Which nursing actions are most appropriate for this client? Select all that apply. A) Allowing the client sufficient time to perform ritual B) Requiring the client to eat in his room C) Arranging the tray for the client D) Supporting the client's efforts to understand the meaning of this behavior E) Removing the tray when the client performs the ritual F) Giving positive reinforcement for nonritualistic behaviors 25. A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. Which behavioral therapies are most commonly used for phobias? Select all that apply. A) Contracting about avoiding phobic stimuli B) Systematic desensitization C) Imploding (flooding) D) Token economy E) Aversion stimulus

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26. A nurse is caring for a military veteran with posttraumatic stress disorder (PTSD). When planning care, which realistic goals should be included in this client's plan of care? Select all that apply. A) The client will not have flashbacks. B) The client will participate in a support group for veterans. C) The client will not need hypnotics to obtain adequate sleep. D) The client will refrain from discussing the traumatic event. E) The client will verbalize the ability to feel a wider range of emotions. 27. A nurse is caring for a client who is being evaluated for panic attacks. The client experiences an episode. Which symptoms, reported by the client, would support the diagnosis of panic attacks? Select all that apply. A) Palpitations B) Nausea C) Powerlessness D) Headache E) Dizziness F) Tinnitus 28. A nurse has been caring for a client with generalized anxiety disorder. The nurse should evaluate that the care has been effective when the client is able to: Select all that apply. A) Recognize signs of escalating anxiety. B) Avoid any situation that causes stress. C) Utilize relaxation techniques to limit anxiety. D) Maintain anxiety at a manageable level without the use of medications. E) Discuss plans to handle panic attacks if they occur. 29. A nurse is caring for a client who is 9 years old. At this developmental stage, this client's fearfulness would most likely be related to which condition? A) Loud noises B) Strangers and darkness C) Death D) Social rejection 30. A nurse is caring for a client who is 14 years old. At this developmental stage, this client's fearfulness would most likely be related to which condition? A) Loud noises B) Strangers and darkness C) Death D) Social rejection

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31. A nurse is caring for a client who is 2 years old. At this developmental stage, this client's fearfulness would most likely be related to which condition? A) Loud noises B) Strangers and darkness C) Death D) Social rejection 32. A nurse is caring for a client who is 6 months old. At this developmental stage, this client's fearfulness would most likely be related to which condition? A) Loud noises B) Strangers and darkness C) Death D) Social rejection

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Answer Key
1. D 2. C 3. B 4. B, C, D 5. B 6. A 7. D 8. D 9. A 10. A, B, C 11. A 12. B 13. C 14. C 15. D 16. A 17. C 18. A 19. C 20. D 21. A 22. B 23. B, D 24. A, D, F 25. B, C 26. B, C, E 27. A, B, C, E 28. A, C, D, E 29. C 30. D 31. B 32. A

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