Deck 15: Anxiety and Obsessive Compulsive Related Disorders

Question 1

A patient experiences a sudden episode of severe anxiety.Of these medications in the patient's medical record,which is most appropriate to give as a prn anxiolytic?

A) buspirone (BuSpar)
B) lorazepam (Ativan)
C) amitriptyline (Elavil)
D) desipramine (Norpramin)

Answer 1

lorazepam (Ativan)

Question 2

An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic.Which defense mechanism is evident?

A) Rationalization
B) Compensation
C) Introjection
D) Regression

Answer 2

Rationalization

Question 3

A patient fearfully runs from chair to chair crying,"They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions.The initial nursing intervention of highest priority is to:

A) provide for the patient's safety.
B) encourage clarification of feelings.
C) respect the patient's personal space.
D) offer an outlet for the patient's energy.

Answer 3

provide for the patient's safety.

Question 4

A person has minor physical injuries after an auto accident.The person is unable to focus and says,"I feel like something awful is going to happen." This person has nausea,dizziness,tachycardia,and hyperventilation.What is the person's level of anxiety?

A) Mild
B) Moderate
C) Severe
D) Panic

Question 5

A patient undergoing diagnostic tests says,"Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes,coughs daily,lost 15 pounds,and is easily fatigued.Which defense mechanism is the patient using?

A) Displacement
B) Regression
C) Projection
D) Denial

Question 6

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?

A) Altruism
B) Suppression
C) Intellectualization
D) Reaction formation

Question 7

A patient tells a nurse,"My new friend is the most perfect person one could imagine: kind,considerate,and good-looking.I can't find a single flaw." This patient is demonstrating:

A) denial.
B) projection.
C) idealization.
D) compensation.

Question 8

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder.Which question would be most appropriate for the nurse to ask?

A) "Have you been a victim of a crime or seen someone badly injured or killed?"
B) "Do you feel especially uncomfortable in social situations involving people?"
C) "Do you repeatedly do certain things over and over again?"
D) "Do you find it difficult to control your worrying?"

Question 9

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety.Which action should the nurse perform first?

A) Verify the patient's learning style.
B) Lower the patient's current anxiety.
C) Create outcomes and a teaching plan.
D) Assess how the patient uses defense mechanisms.

Question 10

A person speaking about a rival for a significant other's affection says in an emotional,syrupy voice,"What a lovely person.That's someone I simply adore." The individual is demonstrating:

A) reaction formation.
B) repression.
C) projection.
D) denial.

Question 11

Two staff nurses applied for a charge nurse position.After the promotion was announced,the nurse who was not promoted said,"The nurse manager had a headache the day I was interviewed." Which defense mechanism is evident?

A) Introjection
B) Conversion
C) Projection
D) Splitting

Question 12

A patient in the emergency department shows disorganized behavior and incoherence after a friend suggested a homosexual encounter.In which room should the nurse place the patient?

A) An interview room furnished with a desk and two chairs
B) A small, empty storage room with no windows or furniture
C) A room with an examining table, instrument cabinets, desk, and chair
D) The nurse's office, furnished with chairs, files, magazines, and bookcases

Question 13

A patient fearfully runs from chair to chair crying,"They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions.Which nursing diagnosis has the highest priority?

A) Fear
B) Risk for injury
C) Self-care deficit
D) Disturbed thought processes

Question 14

A person who feels unattractive repeatedly says,"Although I'm not beautiful,I am smart." This is an example of:

A) repression.
B) devaluation.
C) identification.
D) compensation.

Question 15

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down.The nurse and patient explore the likelihood of an actual fire.The patient states this event is not likely.This counseling demonstrates principles of:

A) flooding.
B) desensitization.
C) relaxation technique.
D) cognitive restructuring.

Question 16

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information.Which nursing intervention is most appropriate?

A) Reassure the patient that all nurses are skilled in providing postoperative care.
B) Present the information again in a calm manner using simple language.
C) Tell the patient that staff is prepared to promote recovery.
D) Encourage the patient to express feelings to family.

Question 17

A patient is experiencing moderate anxiety.The nurse encourages the patient to talk about feelings and concerns.What is the rationale for this intervention?

A) Offering hope allays and defuses the patient's anxiety.
B) Concerns stated aloud become less overwhelming and help problem solving begin.
C) Anxiety is reduced by focusing on and validating what is occurring in the environment.
D) Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.

Question 18

A patient with an abdominal mass is scheduled for a biopsy.The patient has difficulty understanding the nurse's comments and asks,"What do you mean? What are they going to do?" Assessment findings include tremulous voice,respirations 28,and pulse 110.What is the patient's level of anxiety?

A) Mild
B) Moderate
C) Severe
D) Panic

Question 19

A patient experiencing moderate anxiety says,"I feel undone." An appropriate response for the nurse would be:

A) "What would you like me to do to help you?"
B) "Why do you suppose you are feeling anxious?"
C) "I'm not sure I understand. Give me an example."
D) "You must get your feelings under control before we can continue."

Question 20

A woman is 5'7",160 lbs,and wears a size 8 shoe.She says,"My feet are huge.I've asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look smaller and,in social settings,conceals both feet under a table or chair.Which health problem is likely?

A) Social anxiety disorder
B) Body dysmorphic disorder
C) Separation anxiety disorder
D) Obsessive-compulsive disorder due to a medical condition

Question 21

A patient experiencing panic suddenly began running and shouting,"I'm going to explode!" Select the nurse's best action.

A) Ask, "I'm not sure what you mean. Give me an example."
B) Capture the patient in a basket-hold to increase feelings of control.
C) Tell the patient, "Stop running and take a deep breath. I will help you."
D) Assemble several staff members and say, "We will take you to seclusion to help you regain control."

Question 22

The nurse assesses a patient who complains of loneliness and episodes of anxiety.Which statement by the patient is mostly likely if this patient also has agoraphobia?

A) "I'm sure I will get over not wanting to leave home soon. It takes time."
B) "Being afraid to go out seems ridiculous, but I can't go out the door."
C) "My family says they like it now that I stay home most of the time."
D) "When I have a good incentive to go out, I can do it."

Question 23

For a patient experiencing panic,which nursing intervention should be implemented first?

A) Teach relaxation techniques.
B) Administer an anxiolytic medication.
C) Prepare to implement physical controls.
D) Provide calm, brief, directive communication.

Question 24

A cruel and abusive person often uses rationalization to explain the behavior.Which comment demonstrates use of this defense mechanism?

A) "I don't know why I do mean things."
B) "I have always had poor impulse control."
C) "That person should not have provoked me."
D) "I'm really a coward who is afraid of being hurt."

Question 25

A student says,"Before taking a test,I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student?

A) Explain that the symptoms result from mild anxiety and discuss the helpful aspects.
B) Advise the student to discuss this experience with a health care provider.
C) Encourage the student to begin antioxidant vitamin supplements.
D) Listen attentively, using silence in a therapeutic way.

Question 26

A person who has been unable to leave home for more than a week because of severe anxiety says,"I know it does not make sense,but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate?

A) Help the person use online video calls to provide interaction with others.
B) Advise the person to accept the situation and use a companion.
C) Ask the person to explain why the fear is so disabling.
D) Teach the person to use positive self-talk techniques.

Question 27

A nurse assesses an individual who commonly experiences anxiety.Which comment by this person indicates the possibility of obsessive-compulsive disorder?

A) "I check where my car keys are eight times."
B) "My legs often feel weak and spastic."
C) "I'm embarrassed to go out in public."
D) "I keep reliving a car accident."

Question 28

When alprazolam (Xanax)is prescribed for a patient who experiences acute anxiety,health teaching should include instructions to:

A) report drowsiness.
B) eat a tyramine-free diet.
C) avoid alcoholic beverages.
D) adjust dose and frequency based on anxiety level.

Question 29

A patient performs ritualistic hand washing.Which action should the nurse implement to help the patient develop more effective coping?

A) Allow the patient to set a hand-washing schedule.
B) Encourage the patient to participate in social activities.
C) Encourage the patient to discuss hand-washing routines.
D) Focus on the patient's symptoms rather than on the patient.

Question 30

A patient diagnosed with obsessive-compulsive disorder has this nursing diagnosis: Anxiety related to __________ as evidenced by inability to control compulsive cleaning.Which phrase correctly completes the etiological portion of the diagnosis?

A) feelings of responsibility for the health of family members
B) approval-seeking behavior from friends and family
C) persistent thoughts about bacteria, germs, and dirt
D) needs to avoid interactions with others

Question 31

A student says,"Before taking a test,I feel very alert and a little restless." The nurse can correctly assess the student's experience as:

A) culturally influenced.
B) displacement.
C) trait anxiety.
D) mild anxiety.

Question 32

Which assessment questions would be most appropriate for the nurse to ask a patient with possible obsessive-compulsive disorder? Select all that apply.

A) "Are there certain social situations that cause you to feel especially uncomfortable?"
B) "Are there others in your family who must do things in a certain way to feel comfortable?"
C) "Have you been a victim of a crime or seen someone badly injured or killed?"
D) "Is it difficult to keep certain thoughts out of your awareness?"
E) "Do you do certain things over and over again?"

Question 33

The nurse assesses an adult who is socially withdrawn and hoards.Which nursing diagnoses most likely apply to this individual? Select all that apply.

A) Ineffective home maintenance
B) Situational low self-esteem
C) Chronic low self-esteem
D) Disturbed body image
E) Risk for injury

Question 34

A child was placed in a foster home after being removed from abusive parents.The child is apprehensive and overreacts to environmental stimuli.The foster parents ask the nurse how to help the child.Which interventions should the nurse suggest? Select all that apply.

A) Use a calm manner and low voice.
B) Maintain simplicity in the environment.
C) Avoid repetition in what is said to the child.
D) Minimize opportunities for exercise and play.
E) Explain and reinforce reality to avoid distortions.

Question 35

A nurse plans health teaching for a patient with generalized anxiety disorder who begins a new prescription for lorazepam (Ativan).What information should be included? Select all that apply.

A) Caution in use of machinery
B) Foods allowed on a tyramine-free diet
C) The importance of caffeine restriction
D) Avoidance of alcohol and other sedatives
E) Take the medication on an empty stomach