Test Bank for Varcarolis’s Canadian Psychiatric Mental Health Nursing 2nd Edition by Halter Complete Questions and Answers Study Guide for Nursing Students Preparing for Psychiatric Mental Health Nursing Therapeutic Communication Mental Health Assessment

Varcarolis's Canadian Psychiatric Mental Health Nursing 2nd Edition Halter Tes
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Bank
Chapter 12: Anxiety and Related Disorders
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Halter: Varcarolis’s Canadian Psychiatric Mental Health Nursing, 2nd Edition
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MULTIPLE CHOICE Y11




1. A nurse wants to teach alternative coping strategies to a patient experiencing severe
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anxiety. Which action should the nurse perform first?
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a. Verify the patient’s learning style. JY11 JY11 JY11 JY11



b. Lower the patient’s current anxiety. JY11 JY11 JY11 JY11



c. Create outcomes and a teaching plan. JY11 JY11 JY11 JY11 JY11



d. Assess how the patient uses defence mechanisms. JY11 JY11 JY11 JY11 JY11 JY11




ANS: B J Y 1 1




A patient experiencing severe anxiety has a markedly narrowed perceptual field and
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difficulty attending to events in the environment. A patient experiencing severe anxiety
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will not learn readily. Determining preferred modes of learning, devising outcomes,
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and constructing teaching plans are relevant to the task, but are not the priority
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measure. The nurse has already assessed the patient’s anxiety level. Use of defence
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mechanisms does not apply. JY11 JY11 JY11




DIF: Cognitive Level: Apply (Application) JY11 JY11 JY11



TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity JY11 JY1 1 J Y1 1 JY11 JY11 JY11




2. Which is an intermediate indicator of the nursing outcome of anxiety self-control?
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a. Maintains adequate sleep JY11 JY11



b. Monitors intensity of a nNx i eR
t y IGB.CM
c. Controls anxiety response
U S NT o JY11



JY11
JY11



JY11
JY11

Y1 Y1
J Y1

Y1
1
Y
J
1 Y
J
1 Y
J
1




d. Uses relaxation techniques to lower anxiety
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ANS: C J Y 1 1




Intermediate indicators of the nursing outcome anxiety self-control are controls
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anxiety response and maintains role performance. Maintains adequate sleep, monitors
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intensity of anxiety and uses relaxation techniques to lower anxiety, are short term
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indicators of the outcomes of anxiety self-control.
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DIF: Cognitive Level: Understand (Comprehension) JY11 JY11 JY11



TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity JY11 JY11 J Y1 1 JY11 JY11 JY11




3. A patient experiencing moderate anxiety says, “I feel undone.” An appropriate
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response for the nurse would be which of the following?
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a. “What would you like me to do to help you?” JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY1 1



b. “Why do you suppose you are feeling anxious?” JY11 JY1 1 JY11 JY11 JY11 JY11 JY11



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: J Y 1 1 C

,Varcarolis's Canadian Psychiatric Mental Health Nursing 2nd Edition Halter Tes
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Bank
Increased anxiety results in scattered thoughts and an inability to articulate clearly.
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Clarifying helps the patient identify thoughts and feelings. Asking the patient why
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he or she feels anxious is nontherapeutic; the patient likely does not have an
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answer. The patient may be unable to determine what he or she would like the nurse
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to do in order to help. Telling the patient to get his or her feelings under control is
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a directive the patient is probably unable to accomplish.
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DIF: Cognitive Level: Apply (Application) JY11 JY11 JY11



TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity JY11 JY1 1 J Y1 1 JY11 JY11 JY11




4. A patient fearfully runs from chair to chair, crying, “They’re coming! They’re
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coming!” The patient does not follow the staff’s directions or respond to verbal
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interventions. The initial nursing intervention of highest priority is to do which of
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the following?
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a. Provide for the patient’s safety JY11 JY11 JY11 JY11



b. Encourage clarification of feelings JY11 JY11 JY11



c. Respect the patient’s personal space JY11 JY11 JY11 JY11



d. Offer an outlet for the patient’s energy JY11 JY11 JY11 JY11 JY11 JY11




ANS: A J Y 1 1




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,
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and disordered thoughts. Offering an outlet for the patient’s energy can occur when
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the current panic level subsides. Respecting the patient’s personal space is a lower
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priority than safety. Clarification of feelings cannot take place until the level of
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anxiety is lowered. JY11 JY11




DIF: Cognitive Level: Analyze (Analysis) JY11 JY11 JY11



TOP: Nursing Process: PlNanUnR
inSg I NG TB.C oM J Y1 1 J Y1 1




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
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coming!” The patient does not follow the staff’s directions or respond to verbal
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interventions. Which nursing diagnosis has the highest priority? JY11 JY11 JY1 1 JY11 JY11 JY11 JY11



a. Fear
b. Risk for injury JY11 JY11



c. Self-care deficit JY11



d. Disturbed thought processes JY11 JY11




ANS: B J Y 1 1




A patient experiencing panic-level anxiety is at high risk for injury related to
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increased nongoal-directed motor activity, distorted perceptions, and disordered
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thoughts. Data are not present to support a nursing diagnosis of self-care deficit or
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disturbed thought processes. JY11 JY11



The patient may have fear, but the risk for injury has a higher priority.
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DIF: Cognitive Level: Analyze JY11 JY11 JY11



(Analysis) TOP: Nursing Process: JY11 JY11 JY11



Diagnosis/Analysis
MSC: Client Needs: Safe Effective Care Environment
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,Varcarolis's Canadian Psychiatric Mental Health Nursing 2nd Edition Halter Tes
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Bank
6. A patient checks and rechecks electrical cords related to an obsessive thought that the
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house may burn down. The nurse and patient explore the likelihood of an actual
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fire. The patient states this event is not likely. This counselling demonstrates
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principles of which of the following? JY11 JY11 JY11 JY11 JY11



a. Flooding
b. Desensitization
c. Relaxation technique JY11



d. Cognitive restructuring JY11




ANS: D J Y 1 1 J Y 1 1




Cognitive restructuring involves the patient in testing automatic thoughts and
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drawing new conclusions. Desensitization involves graduated exposure to a feared
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object. Relaxation training teaches the patient to produce the opposite of the stress
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response. Flooding exposes the patient to a large amount of an undesirable stimulus
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in an effort to extinguish the anxiety response.
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DIF: Cognitive Level: Understand (Comprehension) JY11 JY11 JY11



TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity JY11 JY1 1 J Y1 1 JY11 JY11 JY11




7. A patient undergoing diagnostic tests says, “Nothing is wrong with me except a
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stubborn chest cold.” The spouse reports the patient smokes, coughs daily, lost
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15 pounds, and is easily fatigued. Which defence mechanism is the patient
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using?
a. Displacement
b. Regression
c. Projection
d. Denial
ANS: D NURSINGTB.CoM
J Y 1 1 J Y 1 1




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.
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Projection attributes one’s own unacceptable thoughts or feelings to another.
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DIF: Cognitive Level: Understand (Comprehension) JY11 JY11 JY11



TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity JY11 JY11 J Y1 1 JY11 JY11 JY11




8. A patient with an abdominal mass is scheduled for a biopsy. The patient has
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difficulty understanding the nurse’s comments and asks, “What do you mean? What
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are they going to do?” Assessment findings include tremulous voice, respirations 28,
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and pulse 110. What is the patient’s level of anxiety?
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a. Mild
b. Moderate
c. Severe
d. Panic
ANS: B J Y 1 1




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 attentionJY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11



and enhances problem solving. Severe anxiety causes great reduction in the
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perceptual field. Panic-level anxiety results in disorganized behaviour.
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, Varcarolis's Canadian Psychiatric Mental Health Nursing 2nd Edition Halter Tes
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Bank

DIF: J Y 1 1 J Y 1 Cognitive Level: Understand (Comprehension)
1 JY11 JY11 JY11



TOP: J Y 1 1 J Y 1 1 Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
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9. A patient preparing for surgery has moderate anxiety and is unable to
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understand preoperative information. Which nursing intervention is most
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appropriate?
a. Reassure the patient that all nurses are skilled in providing postoperative care.
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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. JY11 JY11 JY11 JY11 JY11 JY11 JY11




ANS: B J Y 1 1 J Y 1 1




Giving information in a calm, simple manner will help the patient grasp the important
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facts. Introducing extraneous topics as described in the distracters will further scatter
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the patient’s attention.
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DIF: J Y 1 1 J Y 1 1 Cognitive Level: Apply (Application) JY11 JY11 JY11



TOP: J Y 1 1 J Y 1 1 Nursing Process: Implementation JY11 JY1 1 J Y 1 1 J Y 1 1 MSC: J Y 1 1 Client Needs: Psychosocial JY11 JY11 JY1 1



Integrity

10. A patient is experiencing moderate anxiety. The nurse encourages the patient to talk
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about feelings and concerns. What is the rationale for this intervention?
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a. Offering hope allays and defuses the patient’s anxiety. JY11 JY11 JY11 JY11 JY11 JY11 JY11



b. Concerns stated aloud become less overwhelming and help problem solving begin. JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11



c. Anxiety is reduced by focusing on and validating what is occurring JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11



in the environment.
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d. Encouraging patients to explore alternatives increases the sense of control and JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11 JY11



lessens anxiety. JY11




ANS: B J Y 1 1




All principles listed are valid, but the only rationale directly related to the
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intervention of assisting the patient to talk about feelings and concerns is the one
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that states that concerns spoken aloud become less overwhelming and help
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problem solving begin. JY11 JY11




DIF: J Y 1 1 J Y 1 Cognitive Level: Understand (Comprehension)
1 JY11 JY11 JY11



TOP: J Y 1 1 J Y 1 1 Nursing Process: Implementation MSC: JY11 JY11 J Y 1 1 J Y 1 1 J Y 1 1 Client Needs: Psychosocial JY11 JY11 JY11



Integrity

11. A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder.
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Which 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 Y 1 1




Patients with generalized anxiety disorder frequently engage in excessive worrying.
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They are less likely to engage in ritualistic behaviour, fear social situations, or have
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been involved in a highly traumatic event.
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DIF: Cognitive Level: Apply (Application) JY11 JY11 JY11



TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity JY11 JY11 J Y1 1 JY11 JY11 JY11