Deck 11: Anxiety, Anxiety Disorders, and Obsessive-Compulsive and Related Disorders

Question 1

A supervisor assigns a worker a new project. The worker initially agrees but feels resentful. The next day, when asked about the project, the worker says, "I've been working on other things." When asked 4 hours later, the worker says, "Someone else was using the copier, so I couldn't finish it." The worker's behavior demonstrates:

A) acting out.
B) projection.
C) suppression.
D) passive aggression.

Answer 1

passive aggression.

Question 2

A person has minor physical injuries after an automobile 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 this person's level of anxiety?

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

Answer 2

Severe

Question 3

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

Answer 3

Projection

Question 4

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

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

Question 5

A person who is speaking about a contender for a significant other's affection says in a gushy, 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 6

A patient with a mass in the left upper lobe of the lung is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What are they going to do?" Assessment findings include a tremulous voice, respirations 28 breaths per minute, and pulse rate 110 beats per minute. What is the patient's level of anxiety?

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

Question 7

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 8

A patient experiences an episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to administer as an as-needed (PRN) anxiolytic medication?

A) Buspirone (BuSpar)
B) Lorazepam (Ativan)
C) Amitriptyline (Elavil)
D) Desipramine (Norpramin)

Question 9

Which assessment question would be most appropriate for the nurse to ask a patient who has possible generalized anxiety disorder (GAD)?

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 10

A patient in the emergency department has no physical injuries but exhibits disorganized behavior and incoherence after a minor traffic accident. In which room should the nurse place the patient?

A) Interview room furnished with a desk and two chairs
B) Small, empty storage room with no windows or furniture
C) Room with an examining table, instrument cabinets, desk, and chair
D) Nurse's office, furnished with chairs, files, magazines, and bookcases

Question 11

A patient approaches the nurse and impatiently blurts out, "You've got to help me! Something terrible is happening. My heart is pounding." The nurse responds, "It's almost time for visiting hours. Let's get your hair combed." Which approach has the nurse used?

A) Bringing up an irrelevant topic
B) Responding to physical needs
C) Addressing false cognitions
D) Focusing

Question 12

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

Question 13

A nurse encourages an anxious 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 to 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 14

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 15

Two staff nurses applied for promotion to nurse manager. Initially, the nurse not promoted 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) Sublimation
C) Suppression
D) Passive aggression

Question 16

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

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

Question 17

A nurse wishes to teach alternative coping strategies to a patient experiencing severe anxiety. The nurse will first need to:

A) verify the patient's learning style.
B) create outcomes and a teaching plan.
C) lower the patient's current anxiety level.
D) assess how the patient uses defense mechanisms.

Question 18

A patient with a high level of motor activity runs from chair to chair and cries, "They're coming! They're coming!" The patient is unable to follow instructions or respond to verbal interventions from staff. Which nursing diagnosis has the highest priority?

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

Question 19

A patient with a high level of motor activity runs from chair to chair and cries, "They're coming! They're coming!" The patient does not follow instructions or respond to verbal interventions from staff. The initial nursing intervention of highest priority is to:

A) provide for patient safety.
B) increase environmental stimuli.
C) respect the patient's personal space.
D) encourage the clarification of feelings.

Question 20

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

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

Question 21

A student says, "Before taking a test, I feel a heightened sense of awareness and restlessness." The nursing intervention most suitable for assisting the student is to:

A) explain that the symptoms are the result of 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 without comment.

Question 22

A student says, "Before taking a test, I feel a heightened sense of awareness and restlessness." The nurse can correctly assess the student's experience as:

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

Question 23

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) Teach the person to use positive self-talk.
B) Assist the person to apply for disability benefits.
C) Ask the person to explain why the fear is so disabling.
D) Advise the person to accept the situation and use a companion.

Question 24

A patient tells the nurse, "I wanted my health care provider to prescribe diazepam (Valium) for my anxiety disorder, but buspirone (BuSpar) was prescribed instead. Why?" The nurse's reply should be based on the knowledge that buspirone:

A) does not produce blood dyscrasias.
B) does not cause dependence.
C) can be administered as needed.
D) is faster acting than diazepam.

Question 25

A patient performs ritualistic hand washing. What should the nurse do to help the patient develop more effective coping strategies?

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 26

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

A) Teach relaxation techniques.
B) Administer an anxiolytic medication.
C) Provide calm, brief, directive communication.
D) Gather a show of force in preparation for gaining physical control.

Question 27

A patient has the nursing diagnosis anxiety, related to _______________________________________, as evidenced by an inability to control compulsive cleaning. Which phrase correctly completes the etiologic portion of the diagnosis?

A) ensuring the health of household members
B) attempting to avoid interactions with others
C) having persistent thoughts about bacteria, germs, and dirt
D) needing approval for cleanliness from friends and family

Question 28

A patient experiencing severe anxiety suddenly begins running and shouting, "I'm going to explode!" The nurse should:

A) say, "I'm not sure what you mean. Give me an example."
B) chase after the patient, and give instructions to stop running.
C) capture the patient in a basket-hold to increase feelings of control.
D) assemble several staff members and state, "We will help you regain control."

Question 29

A child is placed in a foster home after being removed from parental contact because of abuse. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. What should the nurse recommend? (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 30

Alprazolam (Xanax) is prescribed for a patient experiencing 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 31

Which assessment questions are most appropriate to ask a patient with possible obsessive-compulsive disorder? (Select all that apply.)

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

Question 32

If a cruel and abusive person rationalizes this behavior, which comment is most characteristic of this person?

A) "I don't know why it happens."
B) "I have always had poor impulse control."
C) "That person should not have provoked me."
D) "Inside I am a coward who is afraid of being hurt."

Question 33

A patient tells the nurse, "I don't go to restaurants because people might laugh at the way I eat, or I could spill food and be laughed at." The nurse assesses this behavior as consistent with:

A) acrophobia.
B) agoraphobia.
C) social anxiety disorder (social phobia).
D) posttraumatic stress disorder (PTSD).

Question 34

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

A) Use caution when operating machinery.
B) Allow only tyramine-free foods in diet.
C) Restrict intake of caffeine.
D) Avoid using alcohol and other sedatives.
E) Take the medication on an empty stomach.

Question 35

Which finding indicates that a patient with moderate-to-severe anxiety has successfully lowered the anxiety level to mild? The patient:

A) asks, "What's the matter with me?"
B) stays in a room alone and paces rapidly.
C) can concentrate on what the nurse is saying.
D) states, "I don't want anything to eat. My stomach is upset."

Question 36

Which statement is mostly likely to be made by a patient diagnosed with agoraphobia?

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

Question 37

A patient has a fear of public speaking. The nurse should be aware that social anxiety disorders (social phobias) are often treated with which type of medication?

A) Beta blockers
B) Antipsychotic medications
C) Tricyclic antidepressant agents
D) Monoamine oxidase inhibitors

Question 38

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 that a house fire is not likely. This counseling demonstrates the principles of:

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

Question 39

Which comment by a person experiencing severe anxiety 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 the car accident."