Anxiety, Anxiety Disorders, and Obsessive-Compulsive Disorders

MULTIPLE CHOICE

1. 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.
ANS: C
A patient experiencing severe anxiety has a significantly narrowed perceptual field and difficulty attending to events in the environment. A patient experiencing severe anxiety will not learn readily. Determining preferred modes of learning, devising outcomes, and constructing teaching plans are relevant to the task but are not the priority measure. The nurse has already assessed the patient’s anxiety level. Using defense mechanisms does not apply.

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 166-168
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

2. 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
ANS: A
The patient is experiencing anxiety. The nurse has closed off patient-centered communication by changing the subject. The introduction of an irrelevant topic makes the nurse feel better. The nurse may be uncomfortable dealing with the patient’s severe anxiety. The nurse has not responded to the patient’s physical needs. There is no evidence of false cognition. Focusing is a therapeutic communication technique used to concentrate attention on a single issue.

DIF: Cognitive Level: Application (Applying) REF: Pages: 181-183
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

3. 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.”
ANS: C
Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarification helps the patient identify his or her thoughts and feelings. Asking the patient why he or she feels anxious is nontherapeutic, and the patient will not likely have an answer. The patient may be unable to determine what he or she would like the nurse to do to help. Telling the patient to get his or her feelings under control is a directive the patient is probably unable to accomplish.

DIF: Cognitive Level: Application (Applying) REF: Page: 169
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

4. 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.
ANS: A
Safety is of highest priority; the patient who is experiencing panic is at high risk for self-injury related to an increase in non–goal-directed motor activity, distorted perceptions, and disordered thoughts. The goal should be to decrease the environmental stimuli. Respecting the patient’s personal space is a lower priority than safety. The clarification of feelings cannot take place until the level of anxiety is lowered.

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 180-181
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

5. 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
ANS: A
A patient who is experiencing panic-level anxiety is at high risk for injury, related to an increase in non–goal-directed motor activity, distorted perceptions, and disordered thoughts. Existing data do not support the nursing diagnoses of Self-care deficit or Disturbed energy field. This patient has disturbed thought processes, but the risk for injury has a higher priority.

DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 181
TOP: Nursing Process: Diagnosis| Nursing Process: Analysis
MSC: NCLEX: Safe, Effective Care Environment

6. 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.
ANS: D
A passive-aggressive person deals with emotional conflict by indirectly expressing aggression toward others. Compliance on the surface masks covert resistance. Resistance is expressed through procrastination, inefficiency, and stubbornness in response to assigned tasks. Acting out refers to behavioral expression of conflict. Projection is a form of blaming. Suppression is the conscious denial of a disturbing situation or feeling.

DIF: Cognitive Level: Application (Applying) REF: Page: 171
TOP: Nursing Process: Assessment MSC: NCLEX: Safe, Effective Care Environment

7. 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
ANS: D
Denial is an unconscious blocking of threatening or painful information or feelings. Regression involves using behaviors appropriate at an earlier stage of psychosexual development. Displacement shifts feelings to a more neutral person or object. Projection attributes one’s own unacceptable thoughts or feelings to another.

DIF: Cognitive Level: Application (Applying) REF: Pages: 172-173
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

8. 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
ANS: B
Moderate anxiety causes the individual to grasp less information and reduces his or her problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem-solving abilities. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior.

DIF: Cognitive Level: Application (Applying) REF: Pages: 167-168
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

9. 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.
ANS: B
Providing information in a calm, simple manner helps the patient grasp the important facts. Introducing extraneous topics as described in the incorrect options will further scatter the patient’s attention.

DIF: Cognitive Level: Application (Applying) REF: Pages: 167-169
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

10. 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.
ANS: B
All principles listed are valid, but the only rationale directly related to the intervention of assisting the patient to talk about feelings and concerns is the one that states that concerns spoken aloud become less overwhelming and help problem solving to begin.

DIF: Cognitive Level: Application (Applying) REF: Page: 168
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

11. 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?”
ANS: D
Patients with GAD frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event.

DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 177
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

12. A patient in the emergency department has no physical injuries but exhibits disorganized behavior and incoherence after 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
ANS: A
Individuals who are experiencing severe to panic-level anxiety require a safe environment that is quiet, nonstimulating, structured, and simple. A room with a desk and two chairs provides simplicity, few objects with which the patient could cause self-harm, and a small floor space around which the patient can move. A small, empty storage room without windows or furniture would be like a jail cell. The nurse’s office or a room with an examining table and instrument cabinets may be overstimulating and unsafe.

DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 170
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

13. 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
ANS: C
The person whose anxiety is severe is unable to solve problems and may have a poor grasp of what is happening in the environment. Somatic symptoms such as those described are usually present. The individual with mild anxiety is only mildly uncomfortable and may even find his or her performance enhanced. The individual with moderate anxiety grasps less information about a situation and has some difficulty with problem solving. The individual in panic-level anxiety demonstrates significantly disturbed behavior and may lose touch with reality.

DIF: Cognitive Level: Application (Applying) REF: Pages: 167-168
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

14. 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
ANS: C
Projection is the hallmark of blaming, scapegoating, thinking prejudicially, and stigmatizing others. Conversion involves the unconscious transformation of anxiety into a physical symptom. Introjection involves intense, unconscious identification with another person. Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.

DIF: Cognitive Level: Application (Applying) REF: Pages: 172-173
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

15. 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.
ANS: C
Idealization is an unconscious process that occurs when an individual attributes exaggerated positive qualities to another. Denial is an unconscious process that calls for the nurse to ignore the existence of the situation. Projection operates unconsciously and results in blaming behavior. Compensation results in the nurse unconsciously attempting to make up for a perceived weakness by emphasizing a strong point.

DIF: Cognitive Level: Application (Applying) REF: Pages: 172-173
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

16. 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)
ANS: B
Lorazepam is a benzodiazepine medication used to treat anxiety; it may be administered as needed. Buspirone is long acting and not useful as an as-needed drug. Amitriptyline and desipramine are tricyclic antidepressants and considered second- or third-line agents.

DIF: Cognitive Level: Application (Applying) REF: Pages: 185-187
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

17. 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
ANS: A
Altruism is the mechanism by which an individual deals with emotional conflict by meeting the needs of others and vicariously receiving gratification from the responses of others. The nurse’s reaction is conscious, not unconscious. No evidence of aggression is exhibited, and no evidence of conscious denial of the situation exists. Passive aggression occurs when an individual deals with emotional conflict by indirectly and unassertively expressing aggression toward others.

DIF: Cognitive Level: Application (Applying) REF: Page: 170
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

18. 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.
ANS: D
Compensation is an unconscious process that allows an individual to make up for deficits in one area by excelling in another area to raise self-esteem. Repression unconsciously puts an idea, event, or feeling out of awareness. Identification is an unconscious mechanism calling for an imitation of the mannerisms or behaviors of another. Devaluation occurs when the individual attributes negative qualities to self or to others.

DIF: Cognitive Level: Application (Applying) REF: Page: 173
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

19. 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.
ANS: A
Reaction formation is an unconscious mechanism that keeps unacceptable feelings out of awareness by using the opposite behavior. Instead of expressing hatred for the other person, the individual gives praise. Denial operates unconsciously to allow an anxiety-producing idea, feeling, or situation to be ignored. Projection involves unconsciously disowning an unacceptable idea, feeling, or behavior by attributing it to another. Repression involves unconsciously placing an idea, feeling, or event out of awareness.

DIF: Cognitive Level: Application (Applying) REF: Pages: 171-173
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20. 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
ANS: A
Rationalization involves unconsciously making excuses for one’s behavior, inadequacies, or feelings. Regression involves the unconscious use of a behavior from an earlier stage of emotional development. Compensation involves making up for deficits in one area by excelling in another area. Introjection is an unconscious, intense identification with another person.

DIF: Cognitive Level: Application (Applying) REF: Pages: 171-173
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

21. 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.
ANS: D
Mild anxiety is rarely obstructive to the task at hand. It may be helpful to the patient because it promotes study and increases awareness of the nuances of questions. The incorrect responses have different symptoms.

DIF: Cognitive Level: Application (Applying) REF: Pages: 166-167
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

22. 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.
ANS: A
Teaching about the symptoms of anxiety, their relation to precipitating stressors, and, in this case, the positive effects of anxiety serves to reassure the patient. Advising the patient to discuss the experience with a health care provider implies that the patient has a serious problem. Listening without comment will do no harm but deprives the patient of health teaching. Antioxidant vitamin supplements are not useful in this scenario.

DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 167
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

23. 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.”
ANS: C
Rationalization consists of justifying one’s unacceptable behavior by developing explanations that satisfy the teller and attempt to satisfy the listener. The abuser is suggesting that the abuse is not his or her fault; it would not have occurred except for the provocation by the other person.

DIF: Cognitive Level: Application (Applying) REF: Pages: 171-173
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24. 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.”
ANS: D
The safety needs of the patient and other patients are a priority. The patient is less likely to cause self-harm or hurt others when several staff members take responsibility for providing limits. The explanation given to the patient should be simple and neutral. Simply being told that others can help provide the control that has been lost may be sufficient to help the patient regain control. Running after the patient will increase the patient’s anxiety. More than one staff member is needed to provide physical limits if they become necessary. Asking the patient to give an example is futile; a patient in panic processes information poorly.

DIF: Cognitive Level: Application (Applying) REF: Pages: 168-170
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

25. 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.
ANS: A
This intervention, a form of cognitive restructuring, replaces negative thoughts such as “I can’t leave my apartment” with positive thoughts such as “I can control my anxiety.” This technique helps the patient gain mastery over the symptoms. The other options reinforce the sick role.

DIF: Cognitive Level: Application (Applying) REF: Page: 183
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26. 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.”
ANS: A
Recurring doubt (obsessive thinking) and the need to check (compulsive behavior) suggest obsessive-compulsive disorder. The repetitive behavior is designed to decrease anxiety but fails and must be repeated. The statement, “My legs feel weak most of the time,” is more in keeping with a somatoform disorder. Being embarrassed to go out in public is associated with an avoidant personality disorder. Reliving a traumatic event is associated with post-traumatic stress disorder.

DIF: Cognitive Level: Application (Applying) REF: Pages: 178-179
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

27. 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.
ANS: C
Drinking alcohol or taking other anxiolytic medications along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Tyramine-free diets are necessary only with monoamine oxidase inhibitors (MAOIs). Drowsiness is an expected effect and needs to be reported only if it is excessive. Patients should be taught not to deviate from the prescribed dose and schedule for administration.

DIF: Cognitive Level: Application (Applying) REF: Pages: 185-189
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

28. 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.”
ANS: A
Individuals who are agoraphobic generally acknowledge that the behavior is not constructive and that they do not really like it. Patients state they are unable to change the behavior. Patients with agoraphobia are not optimistic about change. Most families are dissatisfied when family members refuse to leave the house.

DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 176
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

29. 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
ANS: C
Many compulsive rituals accompany obsessive thoughts. The patient uses these rituals to relief anxiety. Unfortunately, the anxiety relief is short lived, and the patient must frequently repeat the ritual. The other options are unrelated to the dynamics of compulsive behavior.

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 176-177
TOP: Nursing Process: Diagnosis| Nursing Process: Analysis
MSC: NCLEX: Psychosocial Integrity

30. 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.
ANS: B
Because patients diagnosed with obsessive-compulsive disorder become overly involved in rituals, promoting involvement with other people and activities is necessary to improve the patient’s coping strategies. Daily activities prevent the constant focus on anxiety and its symptoms. The other interventions focus on the compulsive symptom.

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 181-183
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

31. 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.
ANS: C
Calm, brief, directive verbal interaction can help the patient gain control of the overwhelming feelings and impulses related to anxiety. Patients experiencing panic-level anxiety are unable to focus on reality; thus learning relaxation techniques is virtually impossible. Administering an anxiolytic medication should be considered if providing calm, brief, directive communication is ineffective. Although the patient is disorganized, violence may not be imminent, ruling out the intervention of preparing for physical control until other, less-restrictive measures are proven ineffective.

DIF: Cognitive Level: Application (Applying) REF: Page: 170
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

32. 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.”
ANS: C
The ability to concentrate and attend to reality is increased slightly in mild anxiety and decreased in moderate-, severe-, and panic-level anxiety. Patients with high levels of anxiety often ask, “What’s the matter with me?” Staying in a room alone and pacing suggest moderate anxiety. Expressing a lack of hunger is not necessarily a criterion for evaluating anxiety.

DIF: Cognitive Level: Application (Applying) REF: Pages: 166-168
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

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. Post-traumatic stress disorder (PTSD).
ANS: C
The fear of a potentially embarrassing situation represents social anxiety disorder (social phobia). Acrophobia is the fear of heights. Agoraphobia is the fear of a place in the environment. Post-traumatic stress disorder is associated with a major traumatic event.

DIF: Cognitive Level: Application (Applying) REF: Pages: 176-177
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

34. 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.
ANS: D
Cognitive restructuring involves the patient in testing automatic thoughts and drawing new conclusions. Desensitization involves a graduated exposure to a feared object. Relaxation training teaches the patient to produce the opposite of the stress response. Flooding exposes the patient to a large amount of undesirable stimuli in an effort to extinguish the anxiety response.

DIF: Cognitive Level: Application (Applying) REF: Page: 183
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

35. 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
ANS: A
Beta-blockers, such as propranolol, are often effective in preventing symptoms of anxiety associated with social phobias. Neuroleptic medications are major tranquilizers and not useful in treating social phobias. Tricyclic antidepressants are rarely used because of their side effect profile. MAOIs are administered for depression and only by individuals who can observe the special diet required.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 176-177 | Page: 186
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

36. 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.
ANS: B
Buspirone is considered effective in the long-term management of anxiety because it is not habituating. Because it is long acting, buspirone is not valuable as an as-needed or as a fast-acting medication. The fact that buspirone does not produce blood dyscrasias is less relevant in the decision to prescribe buspirone.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 186
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. 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.
ANS: A, B, E
The child can be hypothesized to have moderate-to-severe anxiety. A calm manner calms the child. A simple, structured, predictable environment is less anxiety provoking and reduces overreaction to stimuli. Calm, simple explanations that reinforce reality validate the environment. Repetition is often needed when the child is unable to concentrate because of elevated levels of anxiety. Opportunities for play and exercise should be provided as avenues to reduce anxiety. Physical movement helps channel and lower anxiety. Play also helps by allowing the child to act out concerns.

DIF: Cognitive Level: Application (Applying) REF: Pages: 166-169
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2. 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.
ANS: A, C, D
Caffeine is a central nervous system stimulant that acts as an antagonist to the benzodiazepine lorazepam. Daily caffeine intake should be reduced to the amount contained in one cup of coffee. Benzodiazepines are sedatives, thus the importance of exercising caution when driving or using machinery and the importance of not using other central nervous system depressants such as alcohol or sedatives to avoid potentiation. Benzodiazepines do not require a special diet. Food will reduce gastric irritation from the medication.

DIF: Cognitive Level: Application (Applying) REF: Page: 189
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

3. 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?”
ANS: C, D, E
The correct questions refer to obsessive thinking and compulsive behaviors. The incorrect responses are more pertinent to a patient with suspected post-traumatic stress disorder or with suspected social anxiety disorder (social phobia).

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 178-179
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity