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Varcarolis's Canadian Psychiatric Mental Health Nursing 2nd Edition Halter Tes Bank J




Chapter 12: Anxiety and Related Disorders
Halter: Varcarolis’s Canadian Psychiatric Mental Health Nursing, 2nd Edition


MULTIPLE CHOICE

1. A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety.
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Which action should the nurse perform first?
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a. Verify the patient’s learning style. J J J J



b. Lower the patient’s current anxiety. J J J J



c. Create outcomes and a teaching plan. J J J J J



d. Assess how the patient uses defence mechanisms.J J J J J J




ANS: B J



A patient experiencing severe anxiety has a markedly narrowed perceptual field and difficulty
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attending to events in the environment. A patient experiencing severe anxiety will not learn
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readily. Determining preferred modes of learning, devising outcomes, and constructing
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teaching plans are relevant to the task, but are not the priority measure. The nurse has already
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assessed the patient’s anxiety level. Use of defence mechanisms does not apply.
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2. Which is an intermediate indicator of the nursing outcome of anxiety self-control?
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a. Maintains adequate sleep J J




b. Monitors intensity of a nNx i eR
c. Controls anxiety response
Ut ySIGNB.C
T M o J



J
J



J
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d. Uses relaxation techniques to lower anxiety
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ANS: C J



Intermediate indicators of the nursing outcome anxiety self-control are controls anxiety
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response and maintains role performance. Maintains adequate sleep, monitors intensity of
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anxiety and uses relaxation techniques to lower anxiety, are short term indicators of the
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outcomes of anxiety self-control. J J J




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3. A patient experiencing moderate anxiety says, “I feel undone.” An appropriate response for
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the nurse would be which of the following?
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a. “What would you like me to do to help you?”J J J J J J J J J



b. “Why do you suppose you are feeling anxious?”
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c. “I’m not sure I understand. Give me an example.”
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d. “You must get your feelings under control before we can continue.”
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ANS: C J

,Varcarolis's Canadian Psychiatric Mental Health Nursing 2nd Edition Halter Tes Bank J




Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarifying
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helps the patient identify thoughts and feelings. Asking the patient why he or she feels anxious
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is nontherapeutic; the patient likely does not have an answer. The patient may be unable to
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determine what he or she would like the nurse to do in order to help. Telling the patient to get his
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or her feelings under control is a directive the patient is probably unable to accomplish.
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DIF: Cognitive Level: Apply (Application) J J J



TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity J J J J J J




4. A patient fearfully runs from chair to chair, crying, “They’re coming! They’re coming!” The
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patient does not follow the staff’s directions or respond to verbal interventions. The initial
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nursing intervention of highest priority is to do which of the following?
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a. Provide for the patient’s safety J J J J



b. Encourage clarification of feelings J J J



c. Respect the patient’s personal space J J J J



d. Offer an outlet for the patient’s energy J J J J J J




ANS: A J



Safety is of highest priority because the patient experiencing panic is at high risk for
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self-injury related to increased nongoal-directed motor activity, distorted perceptions, and
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disordered thoughts. Offering an outlet for the patient’s energy can occur when the current
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panic level subsides. Respecting the patient’s personal space is a lower priority than safety.
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Clarification of feelings cannot take place until the level of anxiety is lowered.
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DIF: Cognitive Level: Analyze (Analysis) J J J




TOP: Nursing Process: PlNanUnR g I NG TB.C oM
inS J J



MSC: Client Needs: Safe Effective Care Environment
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5. A patient fearfully runs from chair to chair, crying, “They’re coming! They’re coming!” The
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patient does not follow the staff’s directions or respond to verbal interventions. Which nursing
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diagnosis has the highest priority? J J J J



a. Fear
b. Risk for injury J J



c. Self-care deficit J



d. Disturbed thought processes J J




ANS: B J



A patient experiencing panic-level anxiety is at high risk for injury related to increased
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nongoal-directed motor activity, distorted perceptions, and disordered thoughts. Data are not J J J J J J J J J J J



present to support a nursing diagnosis of self-care deficit or disturbed thought processes.
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The patient may have fear, but the risk for injury has a higher priority.
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DIF: Cognitive Level: Analyze (Analysis) J J J J



TOP: Nursing Process: Diagnosis/Analysis J J



MSC: Client Needs: Safe Effective Care Environment
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,Varcarolis's Canadian Psychiatric Mental Health Nursing 2nd Edition Halter Tes Bank J




6. A patient checks and rechecks electrical cords related to an obsessive thought that the house
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may burn down. The nurse and patient explore the likelihood of an actual fire. The patient
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states this event is not likely. This counselling demonstrates principles of which of the
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following?
a. Flooding
b. Desensitization
c. Relaxation technique J



d. Cognitive restructuring J




ANS: D J J



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

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TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity J J J J J J




7. A patient undergoing diagnostic tests says, “Nothing is wrong with me except a stubborn
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chest cold.” The spouse reports the patient smokes, coughs daily, lost 15 pounds, and is
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easily fatigued. Which defence mechanism is the patient using?
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a. Displacement
b. Regression
c. Projection
d. Denial
ANS: D J
NURSINGTB.CoM
J



Denial is an unconscious blocking of threatening or painful information or feelings.
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Regression involves using behaviours appropriate at an earlier stage of psychosexual
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development. Displacement shifts feelings to a more neutral person or object. Projection
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attributes one’s own unacceptable thoughts or feelings to another.
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DIF: Cognitive Level: Understand (Comprehension) J J J



TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity J J J J J J




8. A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty
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understanding the nurse’s comments and asks, “What do you mean? What are they going toJ J J J J J J J J J J J J J J



do?” Assessment findings include tremulous voice, respirations 28, and pulse 110. What is
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the patient’s level of anxiety?
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a. Mild
b. Moderate
c. Severe
d. Panic
ANS: B J



Moderate anxiety causes the individual to grasp less information and reduces
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problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and J J J J J J J J J J J



enhances problem solving. Severe anxiety causes great reduction in the perceptual field.
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Panic-level anxiety results in disorganized behaviour. J J J J J

, Varcarolis's Canadian Psychiatric Mental Health Nursing 2nd Edition Halter Tes Bank J




DIF: Cognitive Level: Understand (Comprehension)
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TOP: Nursing Process: Assessment
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9. A patient preparing for surgery has moderate anxiety and is unable to understand
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preoperative information. Which nursing intervention is most appropriate? J J J J J J J



a. Reassure the patient that all nurses are skilled in providing postoperative care. J J J J J J J J J J J



b. Present the information again in a calm manner using simple language.
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c. Tell the patient that staff is prepared to promote recovery.
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d. Encourage the patient to express feelings to family. J J J J J J J




ANS: B J J



Giving information in a calm, simple manner will help the patient grasp the important facts.
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Introducing extraneous topics as described in the distracters will further scatter the patient’s
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attention.

DIF: Cognitive Level: Apply (Application)
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TOP: Nursing Process: Implementation
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10. A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about
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feelings and concerns. What is the rationale for this intervention?
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a. Offering hope allays and defuses the patient’s anxiety. J J J J J J J



b. Concerns stated aloud become less overwhelming and help problem solving begin. J J J J J J J J J J



c. Anxiety is reduced by focusing on and validating what is occurring in the
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environment.
d. Encouraging patients to explore alternatives increases the sense of control and J J J J J J J J J J



lessens anxiety. J




ANS: B J



All principles listed are valid, but the only rationale directly related to the intervention of
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assisting the patient to talk about feelings and concerns is the one that states that concerns
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spoken aloud become less overwhelming and help problem solving begin.
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DIF: Cognitive Level: Understand (Comprehension)
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TOP: Nursing Process: Implementation
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11. A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which
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question would be most appropriate for the nurse to ask?
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a. “Have you been a victim of a crime or seen someone badly injured or killed?”
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b. “Do you feel especially uncomfortable in social situations involving people?”
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c. “Do you repeatedly do certain things over and over again?”
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d. “Do you find it difficult to control your worrying?”
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ANS: D J



Patients with generalized anxiety disorder frequently engage in excessive worrying. They are
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less likely to engage in ritualistic behaviour, fear social situations, or have been involved in a
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highly traumatic event. J J




DIF: Cognitive Level: Apply (Application) J J J



TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity J J J J J J