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Anxiety Disorders Practice Questions NCLEX
Terms in this set (24)
A client is experiencing a severe panic attack. Which nursing intervention would meet this client's immediate need?
A. Teach deep breathing relaxation exercises
B. Place the client in a Trendelenburg position
C. Stay with the client and offer reassurance of safety
D. Administer the ordered PRN buspirone (BuSpar)
The nurse can meet this client's immediate need by staying with the client and offering reassurance of safety and security. The client may fear for his or her life and the presence of a trusted individual provides assurance of personal safety.
A nurse has been caring for a client diagnosed with post-traumatic stress disorder. What short-term, realistic, correctly written outcome should be included in this client's plan of care?
A. The client will have no flashbacks.
B. The client will be able to feel a full range of emotions by discharge.
C. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge.
D. The client will refrain from discussing the traumatic event.
The nurse should include obtaining adequate sleep without zolpidem (Ambien) by discharge as a realistic outcome for this client. Having no flashbacks and experiencing a full range of emotions are long-term not short-term outcomes for this client. Clients are encouraged to discuss the traumatic event.
A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order?
A. History of alcohol dependence
B. History of personality disorder
C. History of schizophrenia
D. History of hypertension
The nurse should question a prescription of alprazolam (Xanax) for acute anxiety if the client has a history of alcohol dependence. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance abuse may be more likely to abuse other addictive substances and/or combine this drug with alcohol.
Which nursing diagnosis would best describe the problems evidenced by the following client symptoms: avoidance, poor concentration, nightmares, hypervigilance, exaggerated startle response, detachment, emotional numbing, and flashbacks?
A. Ineffective coping
B. Post-trauma syndrome
C. Complicated grieving
D. Panic anxiety
Post-trauma syndrome is defined as a sustained maladaptive response to a traumatic, overwhelming event. This nursing diagnosis addresses the problems experienced by clients diagnosed with post-traumatic stress disorder.
How should a nurse best describe the major maladaptive client response to panic disorder?
A. Clients overuse medical care due to physical symptoms.
B. Clients use illegal drugs to ease symptoms.
C. Clients perceive having no control over life situations.
D. Clients develop compulsions to deal with anxiety.
The major maladaptive client response to panic disorder is the perception of having no control over life situations which leads to nonparticipation in decision making and doubts regarding role performance.
A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit? (Select all that apply.)
ANS: A, D, E
The nurse should expect that a client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry.
A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this client's symptoms? (Select all that apply.)
A. Encourage the client to recognize the signs of escalating anxiety.
B. Encourage the client to avoid any situation that causes stress.
C. Encourage the client to employ newly learned relaxation techniques.
D. Encourage the client to cognitively reframe thoughts about situations that generate anxiety.
E. Encourage the client to avoid caffeinated products.
ANS: A, C, D, E
Nursing interventions that address GAD symptoms should include encouraging the client to recognize signs of escalating anxiety, to employ relaxation techniques, to cognitively reframe thoughts about anxiety-provoking situations, and to avoid caffeinated products. Avoiding situations that cause stress is not an appropriate intervention because avoidance does not help the client overcome anxiety. Stress is a component of life and is not easily evaded.
A client who is a veteran of the Gulf War is being assessed by a nurse for post-traumatic stress disorder (PTSD). Which of the following client symptoms would support this diagnosis? (Select all that apply.)
A. The client has experienced symptoms of the disorder for 2 weeks.
B. The client fears a physical integrity threat to self.
C. The client feels detached and estranged from others.
D. The client experiences fear and helplessness.
E. The client is lethargic and somnolent.
ANS: B, C, D
Clients diagnosed with PTSD can experience the following symptoms: fear of a physical integrity threat to self, detachment and estrangement from others, and intense fear and helplessness. Characteristic symptoms of PTSD include re-living the traumatic event, a sustained high level of arousal, and a general numbing of responsiveness.
Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply.
4. Dry mouth.
Diazepam (Valium) is a benzodiazepine. Benzodiazepines are physiologically and psychologically addictive. If a benzodiazepine is stopped abruptly, a rebound stimulation of the central nervous system occurs, and the client may experience insomnia, increased anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium.
1. Insomnia is correct.
2. Tremor is correct.
3. Delirium is correct.
4. Dry mouth is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly.
5. Lethargy is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly.
TEST-TAKING HINT: The test taker must
distinguish between benzodiazepine side effectsand symptoms of withdrawal to answer this
Which of the following would the nurse expect to assess in a client diagnosed with posttraumatic stress disorder? Select all that apply.
1. Dissociative events.
2. Intense fear and helplessness.
3. Excessive attachment and dependence toward others.
4. Full range of affect.
5. Avoidance of activities that are associated with the trauma.
1. A client diagnosed with posttraumatic
stress disorder (PTSD) may have dissociative events in which the client feels
detached from the situation or feelings.
2. A client diagnosed with PTSD may have
intense fear and feelings of helplessness.
5. A client diagnosed with PTSD avoids activities associated with the traumatic event.
TEST-TAKING HINT: To answer this question correctly, the test taker must be aware of the different symptoms associated with the diagnosis of PTSD.
A newly admitted client is diagnosed with posttraumatic stress disorder. Which behavioral symptom would the nurse expect to assess?
1. Recurrent, distressing flashbacks.
2. Intense fear, helplessness, and horror.
3. Diminished participation in significant activities.
4. Detachment or estrangement from others.
3. Diminished participation in significant
activities is a behavioral symptom of
TEST-TAKING HINT: To answer this question correctly, the test taker should take note of the keyword "behavioral," which determines the correct answer. All symptoms may be exhibited in PTSD, but only answer choice "3" is a behavioral
A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed information, which assumption would be correct?
1. The client is exhibiting signs and symptoms of an exacerbation of generalized anxiety
2. The client's signs and symptoms are due to an underlying medical condition.
3. A physical examination is needed to determine the etiology of the client's problem.
4. The client's anxiolytic dosage needs to be increased.
3. Physical problems should be ruled out
before determining a psychological cause
for this client's symptoms.
TEST-TAKING HINT: The test taker needs to remember that although a client may have a history of a psychiatric illness, a complete, thorough evaluation must be done before assuming exhibited symptoms are related to the psychiatric diagnosis. Many medical conditions generate anxiety as a symptom.
Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply.
1. Excessive worry about items difficult to control.
2. Muscle tension.
4. Excessive amounts of energy.
5. Feeling "keyed up" or "on edge."
1. A client diagnosed with generalized anxiety disorder (GAD) would experience excessive worry about items difficult to control.
2. A client diagnosed with GAD would experience muscle tension.
5. A client diagnosed with GAD would
experience an increased startle reflex and
tension, causing feelings of being "keyed
up" or being "on edge."
TEST-TAKING HINT: To answer this question correctly, the test taker would need to recognize the signs and symptoms of GAD.
A newly admitted client diagnosed with posttraumatic stress disorder is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority?
1. Posttrauma syndrome R /T a distressing event AEB flashbacks and nightmares.
2. Social isolation R /T anxiety AEB isolating because of fear of flashbacks.
3. Ineffective coping R /T flashbacks AEB alcohol abuse and dependence.
4. Risk for injury R /T exhaustion because of sustained levels of anxiety.
4. Risk for injury is the priority nursing diagnosis for this client. In the question, the client is exhibiting recurrent flashbacks, nightmares, and sleep deprivation that can cause exhaustion and lead to injury. It is important for the nurse to prioritize the nursing diagnosis that addresses safety.
TEST-TAKING HINT: When the question asks for a priority, it is important for the test taker to understand that all answer choices may be appropriate statements. Client safety always should be prioritized.
When a client experiences a panic attack, which outcome takes priority?
1. The client will remain safe throughout the duration of the panic attack.
2. The client will verbalize an anxiety level less than 2/10.
3. The client will use learned coping mechanisms to decrease anxiety.
4. The client will verbalize the positive effects of exercise by day 2.
1. Remaining safe throughout the duration of the panic attack is the priority outcome for the client.
TEST-TAKING HINT: All outcomes must be appropriate
for the situation described in the question. In the question, the client is experiencing a panic attack; having the client verbalize the positive effects of exercise would be inappropriate. All outcomes must be client-centered, specific, realistic, positive, and measurable, and contain a timeframe.
The nurse has received evening report. Which client would the nurse need to assess first?
1. A newly admitted client with a history of panic attacks.
2. A client who slept 2 to 3 hours last night because of flashbacks.
3. A client pacing the halls and stating that his anxiety is an 8/10.
4. A client diagnosed with generalized anxiety disorder awaiting discharge.
3. A client pacing the halls and experiencing an increase in anxiety commands immediate assessment. If the nurse does not take action on this assessment, there is a potential for client injury to self or others.
TEST-TAKING HINT: When the nurse is prioritizing
client assessments, it is important to note which client might be a safety risk. When asked to prioritize, the test taker must review all the situations presented before deciding which one to address first.
A client diagnosed with generalized anxiety disorder complains of feeling out of control and states, "I just can't do this anymore." Which nursing action takes priority at this time?
1. Ask the client, "Are you thinking about harming yourself?"
2. Remove all potentially harmful objects from the milieu.
3. Place the client on a one-to-one observation status.
4. Encourage the client to verbalize feelings during the next group.
1. The nurse should recognize the statement, "I can't do this anymore," as evidence of hopelessness and assess further the potential for suicidal ideations.
TEST-TAKING HINT: To answer this question correctly, the test taker should apply the nursing process. Assessment is the first step of this process. The nurse initially must assess a situation before determining appropriate nursing interventions.
During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, "I'm thinking about suicide." Which nursing intervention takes priority?
1. Teach the client relaxation techniques.
2. Ask the client, "Do you have a plan to commit suicide?"
3. Call the physician to obtain a PRN order for an anxiolytic medication.
4. Encourage the client to participate in group activities.
2. It is important for the nurse to ask the client about a potential plan for suicide to intervene in a timely manner. Clients who have developed suicide plans are at higher
risk than clients who may have vague suicidal thoughts.
TEST-TAKING HINT: To answer this question correctly, the test taker must understand the importance of assessing the plan for suicide. Interventions would differ depending on the client's plan. The intervention for a plan to use a gun at home would differ from an intervention for a plan to hang oneself during hospitalization.
The nurse teaches an anxious client diagnosed with posttraumatic stress disorder a breathing technique. Which action by the client would indicate that the teaching was successful?
1. The client eliminates anxiety by using the breathing technique.
2. The client performs activities of daily living independently by discharge.
3. The client recognizes signs and symptoms of escalating anxiety.
4. The client maintains a 3/10 anxiety level without medications.
4. A client's ability to maintain an anxiety level of 3/10 without medications indicates that the client is using breathing techniques successfully to reduce
TEST-TAKING HINT: To answer this question correctly, the test taker should understand that anxiety cannot be eliminated from life. This understanding would eliminate "1" immediately.
The nurse is using a cognitive intervention to decrease anxiety during a client's panic attack. Which statement by the client would indicate that the intervention has been successful?
1. "I reminded myself that the panic attack would end soon, and it helped."
2. "I paced the halls until I felt my anxiety was under control."
3. "I felt my anxiety increase, so I took lorazepam (Ativan) to decrease it."
4. "Thank you for staying with me. It helped to know staff was there."
1. This statement is an indication that the cognitive intervention was successful. By remembering that panic attacks are self-limiting, the client is applying the information gained from the nurse's cognitive intervention.
TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand which interventions support which theories of causation. When looking for a "cognitive" intervention, the test taker must remember that the theory involves thought processes.
A client has been diagnosed with PTSD because he experienced childhood sexual abuse by his babysitter and her boyfriend from ages 4-10. He is admitted for the second times after physically assaulting a woman he said was a prostitute. "She is no better than my babysitter and deserves to be dead. I would like to kill the sitter too." With the knowledge of PTSD and CSA, which nursing intervention should be implemented at admission? Select all that apply.
1. Institute precautions for suicide, assault, and escape.
2. Ask him to sign a no-harm contract.
3. Provided safe outlets for his anger and rage.
4. Encourage him to express his attitude, toward prostitutes during unit group sessions.
5. in one-to-one staff talks, encourage him to safely verbalize his anger toward his babysitter and her boyfriend.
An adult client diagnosed with anxiety disorder becomes anxious when she touches fruits and vegetables. What should the nurse do?
1. Instruct the women to avoid touching these foods.
2. Ask the women why she becomes anxious to these situations
3. Assis the woman to make a place for her family to do the food shopping and preparation.
4. Teach the woman to use cognitive-behavioral approaches to manage her anxiety.
A client who is pacing and wringing his hands states,"I just need to walk when questioned by the nurse about what he is feeling. "Which response by the nurse is most therapeutic?"
1. "You need to sit down and relax"
2. "Are you feeling anxious?"
3. "Is something bothering you?"
4. "You must be experiencing a problem now."
While a client is taking alprazolam, which food should the nurse instruct the client to avoid?
THIS SET IS OFTEN IN FOLDERS WITH...
Anxiety Disorders NCLEX
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