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Mod 31 Stress and Coping
Terms in this set (49)
The nurse who cares for older adult patients in an assisted living facility is discussing common types of stress with the unlicensed assistive personnel (UAP).
Which information should the nurse include?
A. Older adults like to discuss their feelings of stress and anxiety.
B. Changes due to stress are clearly seen because coping becomes less effective as a person ages.
C. Advancement of normal technology can be a stressor for older adults.
D. Due to the multiple medications that many older adults take, it can be difficult to discern signs of stress.
For older adults, advancement of technology such as cell phones can be a stressor. The statement that changes due to stress are often clearly seen because coping becomes less effective as a person ages is not accurate. Older adults often have better emotional and coping strategies, making alterations due to stress and anxiety harder to identify. Older adults generally will not report mental or cognitive issues, so the statement that they like to discuss their feelings of stress and anxiety is not accurate. The statement that it is difficult to discern signs of stress due to multiple medications is not a valid statement describing older adults.
The nurse is counseling a college student who indicates that they are feeling constantly stressed.
Which information provided by the student should indicate a possible biogenic source of stress?
A. The student is currently eating more than normal, which they have done throughout their life when feeling stressed.
B. Final exams week has just begun, and the student must pass the exams to be successful this semester.
C. The student has recently suffered a severe foot strain while running, limiting the ability to exercise.
D. The student drinks several cups of coffee throughout the day to stay alert.
A biogenic stressor directly triggers the stress response without any necessary cognitive process on the part of the individual and includes caffeine, amphetamines, and extreme temperatures. Feeling stressed by exams, a strained foot (resulting in inability to exercise), and eating too much food would be examples of psychosocial stressors.
A patient reports, "I can't get myself out of the house. I touch the door, and then I have to go wash my hands. Then I touch the door again, and I have to go back and wash my hands again."
The nurse recognizes that this patient is experiencing symptoms associated with which anxiety disorder?
A. Panic disorder
B. Generalized anxiety disorder (GAD)
C. Posttraumatic stress disorder (PTSD)
D. Obsessive-compulsive disorder
The patient is suffering from obsessive-compulsive disorder. They are experiencing obsessive thoughts about germs and contamination, which are creating anxiety and fear. The obsession takes the form of recurrent thoughts or mental images that are caused by existing anxiety and contribute to increased anxiety. The compulsion is manifested by repetitive acts (washing the hands) and behaviors that are used to reduce the anxiety. Obsessive-compulsive disorder, GAD, panic disorder, and PTSD all involve irrational or excessive fear, but only obsessive-compulsive disorder involves obsessions and compulsions, such as repetitive acts.
An older woman who recently moved into an assisted living facility reports that she feels uneasy in the new setting, and is depressed and angry because she did not want to move to the facility. She also states that she is having difficulty addressing problems.
Which indicator described by the patient should be considered a cognitive indicator of stress?
B. Feelings of unease
C. Difficulty problem solving
Cognitive indicators of stress include changes in mental processes such as problem solving. Feelings of unease, depression, and anger would all be psychologic indicators.
The parents of a patient with agoraphobia have accompanied the patient to family therapy. Now the nurse therapist wants to recommend an outside organization that they can all join to get more support.
Which is the most relevant resource for the nurse to recommend?
A. National Alliance on Mental Illness (NAMI)
B. National Institute of Mental Health (NIMH)
C. Alcoholics Anonymous (AA)
D. American Association of Retired Persons (AARP)
The most relevant resource is NAMI. This organization provides a platform for individuals to work collaboratively. Further, it is the largest national organization for individuals experiencing mental illness and their families. NIMH, AA, AARP are not as relevant to the patient's and family's needs.
The healthcare provider has recommended that a patient who is experiencing panic attacks be referred for exposure-based cognitive-behavioral therapy (CBT).
How should the nurse describe this therapy to the patient?
A. "Your mental health counselor will help you to learn how to stop destructive thoughts by visualizing a specific image, sensation, or circumstance."
B. "Mindfulness strategies will be used to help you deal with the situation that causes your panic attacks."
C. "You will be exposed to the situation that causes you anxiety under the supervision of the mental health counselor."
D. "A contract will be developed that outlines the behavioral changes that you and the mental health professional agree should take place."
Exposure-based CBT combines the techniques used in CBT with exposure of the patient to a controlled version of the situation that triggers the anxiety. By inducing mild anxiety under the supervision of a mental health expert, exposure-based CBT can help an individual with panic disorder learn that panic attacks are not heart attacks, for example. Thought stopping, not exposure-based CBT, involves helping the patient to learn how to stop destructive thoughts by visualizing a specific image, sensation, or circumstance. A behavioral contract, not exposure-based CBT, outlines the behavioral changes that the patient and mental health professional agree should take place. Acceptance and mindfulness strategies help to increase psychologic flexibility, but this is not referred to as exposure-based CBT.
A patient who is diagnosed with panic disorder has been placed on an atypical antipsychotic medication. The patient questions the prescription, saying, "I don't have hallucinations. Why did you put me on this drug?"
Which reply by the nurse is accurate?
A. "Atypical antipsychotics potentiate the effect of the neurotransmitter GABA, leading to promotion of relaxation."
B. "Atypical antipsychotics selectively reduce effects of sympathetic nervous system stimulation."
C. "Atypical antipsychotics act as a dopamine agonist in the brain and inhibit serotonin reuptake, producing an antianxiety effect."
D. "Atypical antipsychotics promote reduction of compulsive behaviors and decrease agitation."
Atypical antipsychotics, in conjunction with other therapies, may be used in the treatment of patients with panic disorders. Nonbenzodiazepines (dopamine agonists), benzodiazepines (potentiators of GABA), and beta blockers (selective antagonists of cardiac and bronchial beta receptors) are also used in treating symptoms of anxiety, but are not primary therapies for panic disorder.
A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) for a recent diagnosis of obsessive-compulsive disorder (OCD). The patient asks the nurse why they are being prescribed an antidepressant.
Which statement by the nurse provides an accurate response?
A. "SSRIs don't directly address the OCD. It deals with the depression that underlies OCD behavior."
B. "As is often the case, it's the unintended effects of SSRIs that address OCD behaviors."
C. "Antidepressants have been found to be effective for disorders such as OCD as well."
D. "SSRIs potentiate the effect of the naturally occurring inhibitory neurotransmitter GABA, promoting relaxation."
SSRIs have been found to be effective for OCD, so this information should be shared with the patient. The statements that SSRIs don't directly address the OCD and that it's the unintended effects of SSRIs that address OCD behaviors are not valid statements. Benzodiazepines, not SSRI antidepressants, potentiate the effect of the naturally occurring inhibitory neurotransmitter GABA, promoting relaxation.
A patient tells the nurse, "If only the rest of my family could step up to the plate and do their share, I would not feel so stressed."
Which defense mechanism is the patient using?
D. Cognitive structuring
This patient is using the defense mechanism of projection (blaming others for unacceptable thoughts, shortcomings, or mistakes). They are not using suppression (conscious process of denying unacceptable emotions). They are not using cognitive structuring (making sense of stimuli). They are not using self-control (restraining from acting on impulse or delaying gratification).
The nurse is working with a long-term patient who has struggled through many issues, including homelessness. The patient reports finding subsidized housing. The nurse responds, "You persisted until you found an apartment. Congratulations!"
Which kind of independent intervention is the nurse implementing?
A. Implementing cognitive-behavioral therapy (CBT) interventions
B. Validating the patient's feelings
C. Identifying strategies to meet the patient's goals
D. Reinforcing positive coping efforts
The nurse reinforced the patient's positive coping efforts and identified success in life tasks. The nurse did not validate the patient's feelings, implement cognitive-behavioral therapy (CBT) interventions, or identify strategies to meet patient goals.
A new nurse becomes very anxious and experiences a pounding heart when thinking about being alone to care for high-acuity patients due to a staffing shortage.
According to Selye's general adaptation syndrome (GAS), which stage is the nurse experiencing?
According to the GAS, an increased heart rate would occur in the alarm stage. This stage consists of two parts, shock and countershock. In the countershock phase, the body's defenses are triggered and include increased myocardial activity, bronchial dilation, and increased fat mobilization. Thus, the feeling that the heart is pounding would be characteristic of the alarm stage. An increased heart rate does not reflect homeostasis. This would not be a symptom of the resistance or exhaustion stages.
Which strategies should the nurse teach to a group of teens to help them cope with elevated levels of stress?
A. Setting realistic expectations for oneself
B. Taking antianxiety medications if needed
C. Cognitive-behavioral therapy
D. Meeting with the school counselor as needed
When adolescents are experiencing elevated levels of stress, setting realistic expectations can help them to manage the stress. Cognitive-behavioral therapy is a treatment method, not a strategy for coping with stress. Antianxiety and antidepressant medications are not a preferred option for teens because some are not approved for use with teens and some may increase the risk of depression and suicide. While meeting with the school counselor may be helpful, it is not an effective option for helping teens to deal with stress.
A first-year nursing student who goes to the university's counseling services hopes that anxiety levels experienced during tests can be reduced. The nurse counselor asks the student about first thoughts when a test is announced.
Which kind of appraisal is the counselor having the student consider?
A. Cognitive appraisal
B. Secondary appraisal
C. Primary appraisal
D. Anxiety appraisal
Primary appraisal happens immediately upon knowledge of the stressor, the upcoming test. Secondary appraisal takes place after that, when deciding how to react. Cognitive appraisal is the combination of both primary and secondary appraisal. There is no model called "anxiety appraisal."
A new nurse is finding it difficult to adapt to the acute care unit where they are working. They perceive that the ability to control the stress created by the unit is beyond their control.
Which type of coping should the nurse use to deal with this stress?
A. Meaning-focused coping
B. Problem-focused coping
C. Approach coping
D. Emotion-focused coping
Emotion-focused coping is used most when the stressor is perceived to be beyond the individual's control; thus, in this situation, the nurse would most likely use emotion-focused coping, which is directed at regulating the emotional response to the distress. In problem-focused coping, the general perception is that the stressor can be changed. Approach coping involves confronting and trying to change the stressor by taking direct action. Meaning-focused coping involves re-evaluation to reduce the appraisal of a threat.
The school nurse is especially concerned about a specific first-grade student.
Which personality-related characteristic should the nurse identify as increasing the risk for development of an anxiety disorder?
A. Being overweight
B. Being shy
C. Being short
D. Being nearsighted
Being shy increases the risk of a child developing an anxiety disorder. Weight, height, and nearsightedness are not personality characteristics.
The nurse manager reports feeling drained and having little energy left after guiding the staff nurses through several difficult times, including high turnover.
The nurse manager suspects she is experiencing which condition?
A. Posttraumatic stress disorder (PTSD)
D. Generalized anxiety disorder (GAD)
Nurses are at particularly high risk of burnout, which can result in adverse emotional and physical effects. The manager does not report symptoms of anxiety disorder, posttraumatic stress disorder (PTSD), or hypochondriasis.
A patient indicates that they have been having trouble sleeping, difficulty concentrating, and feeling excessive anxiety every day.
Which question should the nurse ask to help to determine if the patient meets the DSM-5 criteria for generalized anxiety disorder?
A. "Does the anxiety occur in relation to use of any specific substances such as marijuana?"
B. "Have you also been experiencing panic attacks?"
C. "Do you believe that your anxiety is excessive in proportion to your circumstances?"
D. "How long have you been experiencing excessive anxiety about everyday problems?"
The nurse decides that they need to advocate for more mental health services for the homeless population.
Which national organization should be most helpful to the nurse?
A. Centers for Disease Control and Prevention (CDC)
B. National Alliance for the Mentally Ill (NAMI)
C. National Coalition for the Homeless
D. National Alliance to End Homelessness
The home care nurse is visiting a 78-year-old patient who reports problems with severe anxiety and who is currently taking an antidepressant. The patient asks the nurse, "I'm not happy. Is there anything I can do to feel better?"
Which approach should the nurse discuss that could improve the patient's chances of successful coping?
A. Adding psychotherapy to pharmacologic therapy
B. Adding another medication to maximize the medication effect
C. Substituting psychotherapy for the patient's current antidepressant
D. Changing to another antidepressant medication
The parents of a 5-year-old child tell the school nurse that they believe their child has developed a phobia.
Which information shared with the school nurse should support a possible phobia?
A. The child has told them that the child believes a monster lives in their closet and comes out at night.
B. The child has refused to sleep with the lights off, expressing fear of the dark for the past 7 months.
C. The child worries and frets whenever the mother is away for even short spans of time.
D. The child is irritable and very tired most of the time.
The nurse is completing a chart audit for a patient hospitalized for treatment of a panic disorder.
Which documentation in the patient's chart should meet the criteria for this anxiety disorder diagnosis?
A. The therapist reports that the patient indicated that they have been experiencing excessive anxiety about everyday problems for the last year.
B. The patient indicated to a staff nurse that the panic attacks generally occur after use of recreational marijuana.
C. The patient discussed recent trouble concentrating, difficulty falling asleep, and difficulty relaxing during group therapy.
D. The patient reports that the most recent panic attack was approximately 1 month ago, and they are very concerned that another may occur soon.
According to the DSM-5 criteria for panic disorders, recurrent panic attacks, when at least one of those attacks is followed by 1 month of persistent concern about another attack occurring, would classify this patient's anxiety disorder as a panic disorder. Trouble concentrating, difficulty falling asleep, difficulty relaxing, and excessive anxiety about everyday problems for the last year meet the criteria for diagnosis of generalized anxiety disorder. Panic attacks that occur related to substance abuse do not meet the criteria for a panic disorder.
The nurse is completing an assessment of an older adult patient whose husband recently died. The patient states she had to move in with her daughter due to financial concerns.
Which coping strategies should the nurse recognize as being the most effective for reducing stress and anxiety for this patient?
A. Social coping strategies
B. Emotion-focused strategies
C. Personal coping strategies
D. Individual coping strategies
Social coping strategies tend to have a greater effect in reducing stress and anxiety in older adults than individual or personal coping strategies, including emotion-focused strategies. Older adults who maintain their social circles and remain physically active have better mental and physical health than those who isolate themselves.
The school nurse is concerned that an adolescent may be facing normal stressors along with some unexpected stressors due to the recent death of a parent.
Which assessment tool should help to identify the impact of both normative and nonnormative stressors?
A. Revised Children's Anxiety and Depression Scale (RCADS)
B. Spence Children's Anxiety Scale (SCAS)
C. Anxiety Disorders Interview Schedule for children and parents (ADIS-C/P)
D. Feel Bad Scale (FBS)
The FBS is a 20-item list containing 17 normative stressors and 3 nonnormative stressors and would be most useful in this situation. The ADIS-C/P, RCADS, and SCAS do not assess these normative and nonnormative stressors directly.
The nurse is speaking with the unit director concerning the unit's requirement of obtaining some type of professional certification to maintain employment.
Which statement by the nurse indicates a primary appraisal of this requirement?
A. "While this is stressful to me, I think I can find one that will fit my experience and it will not be as difficult as I imagined."
B. "I am very stressed by this requirement. Why do we have to obtain a certification?"
C. "Can you help me to find some possible options that may be a good fit for me to meet this requirement?"
D. "I do not agree with this requirement, but once I complete it, at least it will alleviate my current stress."
Primary appraisal is the "first impression," which occurs immediately on exposure to a stressor; the demand is categorized by the individual as (1) irrelevant, (2) benign-positive, or (3) stressful. The nurse's statement that they find the requirement for certification stressful would characterize primary appraisal. Indicating that they think they can find a certification that will work for them, acknowledging that they will try to find a way to meet it, and asking for assistance in finding a certification that would be a good fit are all aspects of secondary appraisal.
The nurse is working with a patient who has recently been experiencing high levels of stress due to suspected drug use issues with their teenage daughter.
Which statement by the patient should indicate to the nurse that they may be using the defense mechanism of projection?
A. "I know everyone thinks she is using drugs, but I know she isn't. It upsets me that people think she is doing drugs."
B. "While I don't like it, it's just marijuana. It's not like she's abusing the hard stuff."
C. "I know she wouldn't do drugs if her friends didn't encourage her to do so."
D. "My husband and I have been constantly fighting about this. I don't think he takes it seriously."
Projection involves blaming others for unacceptable desires, thoughts, shortcomings, or mistakes; in this situation, the mother is blaming the friends of the teen, which would be projection. Transferring emotional reactions from one person to another, in this case from the daughter to the husband, would be displacement. Stating that the mother doesn't believe that the teen has a drug problem would reflect denial or refusing to accept the fact that the daughter may be using drugs. Stating that it is okay since it is just marijuana would be rationalization.
The nurse has completed an admission history for a patient with an anxiety disorder.
According to DSM-5, the patient should be classified as having a generalized anxiety disorder based on which criterion?
A. Intense tension and worry, even in absence of external stressors
B. Anxiety about a stressor that is out of proportion to the actual threat or stressor
C. Intense, persistent, irrational fear of a situation that compels avoidance of the stressor
D. Recurrent unexpected panic attacks
The criteria for generalized anxiety disorder include intense tension and worry, even in the absence of external stressors. Recurrent unexpected panic attacks are a criterion for panic disorder. Anxiety about a stressor that is out of proportion to the actual threat or stressor or intense, persistent, irrational fear of a situation that compels avoidance of the stressor are both criteria for a phobia.
A patient reports that they feel as if they are dying, they feel numb, and they fear that they are losing control. The family states that this episode started as they prepared to drive to an appointment that was an hour away.
Which anxiety disorder should the nurse suspect the patient is most likely experiencing?
A. Social anxiety disorder
B. Generalized anxiety disorder
C. Panic disorder
D. Somatic anxiety disorder
A patient diagnosed with a panic disorder is being treated with an antidepressant, but reports that it is not helping him.
The nurse anticipates that the healthcare provider may next order which medication?
A. Atypical antipsychotic
D. Selective serotonin reuptake inhibitor (SSRI)
In this situation, the patient has tried an antidepressant and is reporting that it is not effective. An atypical antipsychotic may also be used to treat panic disorder and may be tried next by the healthcare provider. An SSRI is an antidepressant and would not be a valid alternative since prior therapy has failed. Nonbenzodiazepines and benzodiazepines are not used specifically long-term to treat panic disorder.
The nurse working with a mental health provider is discussing possible medications for a patient with obsessive-compulsive disorder (OCD).
Which medication should the nurse discuss as possibly being effective?
C. Selective serotonin reuptake inhibitors (SSRIs)
D. Beta blockers
SSRIs, a class of antidepressant drugs, are effective in the treatment of patients with OCD. Patients and families must be instructed that administration of SSRIs is accompanied by an increased risk of suicidality. Nonbenzodiazepines, benzodiazepines, and beta blockers are not indicated for use with patients with OCD.
Which statement demonstrates an understanding of Maslow's hierarchy of needs, when a client prioritizes a choice to react to a stressor?
Self-esteem is the most important level of need.
Coping with stressors is a part of safety needs.
Everyone chooses to satisfy basic requirements first.
Individuals might have their own priorities.
Individuals might have their own priorities. Not everyone chooses to satisfy the same basic requirements first. Coping with stressors can be part of any level, and there is no most important level of need.
A group of students who are studying for final exams are talking about ways to better deal with stressful events in life. One student suggests, "During the finals week, we should avoid biogenic stressors." How should the students follow that advice? (Select all that apply.)
Don't stay up all night studying.
Don't worry about the test results.
Don't drink fluids with caffeine in them.
Don't smoke cigarettes.
Don't go outside into freezing temperatures.
C, D, E
Biogenic stressors directly trigger the stress response, without the individual needing to know about their presence. This is true of caffeine, nicotine, and extreme temperatures. The student staying up all night knows the effect of delayed sleep and can choose to end a study session. Students can choose to worry about the test results, or they can choose to be confident about the outcome.
A client has presented to the healthcare provider with symptoms of hypertension. The client tells the nurse that for the past year they have been dealing with the legal ramifications of an accident that they caused while under the influence of alcohol. According to Selye's general adaptation syndrome (GAS), the client is in which stage of adaptation?
Your answer is correct.
During the second stage of GAS, the stage of resistance, the body attempts to restore homeostasis while continuing to respond to the stressor. With chronic exposure to a stressor such as in this situation, the body may maintain resistance to the primary stressor, and resistance to other stressors may be diminished and result in hypertension. This scenario does not reflect the stages of alarm or exhaustion. Homeostasis is not a stage in GAS.
A client reports a series of stressful events. They also report that they feel very hopeless and empty, are having difficulty solving even minor problems, and are fantasizing about what it would be like if all of these things had not happened. Which of these indicators of stress should be considered psychologic indicators? (Select all that apply.)
Difficulty solving minor problems
B, D, E
Psychologic indicators of stress include hopelessness, helplessness, and feeling empty. Fantasizing and having difficulty solving problems are cognitive indicators of stress.
A college student presents to the counseling center because they are having difficulty dealing with having been informed that, due to continued poor grades, they are being dismissed from the college. Which statement by the student to the nurse counselor should indicate the use of the ego defense mechanism projection?
"I don't think that all of the grades are accurate. If they aren't, then I can stay in school."
"It's really not all my fault. The major I was in and the number of credit hours I was taking would be difficult for anyone to be successful."
"If my instructor had let me retake an exam I missed when I was sick, I wouldn't be in this situation."
"While I'm very upset and my parents will be angry, I can just transfer to another school and still get my degree."
Projection involves blaming others for shortcomings. In this case, the student is blaming an instructor for the failure, which would be projection. Stating that the student doesn't think the grades are accurate would be rationalization or denial, not projection. Stating that they can just transfer to another school would be minimization. Stating that it is really not their fault would be rationalization.
The nurse presents information about the "fear worry center" in the brain. Which information should the nurse include about how the fear center affects the risk for anxiety disorders?
Hormone secretion blocks the risk of anxiety disorders.
Hypersensitivity increases the risk of anxiety disorders.
Perfusion balances the risk of anxiety disorders.
Oxygenation decreases the risk of anxiety disorders.
Hypersensitivity of the fear center (amygdala) in the brain increases the risk of anxiety disorders. It is not a matter or perfusion, oxygenation, or hormone secretion.
The nurse is presenting to a community group about mental disorders that are more common among women than among men. Which disorder should the nurse include? (Select all that apply.)
Generalized anxiety disorder
C, D, E
Anxiety disorders and generalized anxiety disorder are more common among women than among men. Phobia also strikes women twice as often as it does men. Obsessive-compulsive disorder is equally common among men and women. Insomnia is a symptom, not a disorder.
A client contacts the nurse asking to see the healthcare provider due to fears that they have "something terribly wrong." This client frequently professes the same fear that something is wrong in one body system or another, and has had multiple types of diagnostic testing over the years, which has not identified any medical issue. The client also reports vague symptoms such as difficulty sleeping, headache, muscle tension, feeling out of breath, and digestive issues. Which anxiety disorder should the nurse most likely expect that the client is experiencing?
Generalized anxiety disorder
The somatic symptoms described by this client are characteristic of generalized anxiety disorder. Manifestations of generalized anxiety disorder include preoccupation with health issues, difficulty relaxing, trouble sleeping, and various somatic complaints. These are not clinical manifestations of phobias, panic disorder, or obsessive-compulsive disorder.
The family of a client share with the nurse that the client has always been a hoarder, but since their father died, the behavior has now gotten to the point where the home is no longer safe. Which classification of disorders related to stress and coping does the client's behavior fit?
Depression and depression-related disorders
Obsessive-compulsive and related disorders
Trauma- and stressor-related disorders
Hoarding is classified as an obsessive-compulsive and related disorder. It is not classified as an anxiety disorder or trauma- and stressor-related disorder. There is not a classification labeled depression and depression-related disorders.
The parent of a young child shares with the nurse that the child refuses to play outside, go to parks, or participate in family gatherings where a dog may be present for fear of getting bitten. Which question should the nurse ask to determine if this behavior meets the DSM-5 criteria for phobias?
"Does your child have a panic attack if a dog is nearby?"
"How long has your child been exhibiting this phobia?"
"Is your child frightened of all dogs?"
"Does your child worry constantly about possibly encountering a dog?"
To be diagnosed as a phobia, the symptoms must persist for at least 6 months, regardless of the client's age, so asking how long the symptoms have been present would elicit information to support diagnosis. Asking if the child is frightened of all dogs or if the child has a panic attack when a dog is nearby would not provide information to support definitive diagnosis. Asking if the child worries constantly about encountering a dog would provide information to support diagnosis of generalized anxiety disorder, not a phobia.
A mother has brought her 12-year-old daughter for therapy. The daughter witnessed a horrific motor vehicle crash in which several people, including children, were killed. The mother, who was with the child at that time, says, "I don't understand why she still seems affected by the crash. I'm not." Which statement by the nurse is most appropriate to help the mother better understand the daughter's situation?
"A young person's memory bank is much more detailed than an adult's."
"A young person's negative experience can be erased by piling on positive events."
"A young person's response can vary significantly from that of an adult."
"A young person's coping responses are part of the skills they are born with."
The therapist should let the mother know that a young person's response can vary significantly from that of an adult. It is not a matter of detailed memories or piling on positive events. Coping responses are learned, rather than being present at birth.
The nurse therapist is assessing an older adult. The client and the nurse are from different cultures. Which factor could complicate the nurse's assessment of the client? (Select all that apply.)
The client's age difference from the therapist
The client's cognitive changes
The client's work experience
The client's physical illness
The client's normal, healthy cultural response
B, D, E
The client's physical illness, cognitive changes, and normal, healthy cultural response might complicate the assessment. The client's age difference and work experience should not complicate the assessment.
The nurse is preparing a teaching material for parents regarding symptoms of anxiety in children and adolescents. Which symptom, common to both age groups, should the nurse include? (Select all that apply.)
Headaches and body aches
Frequent need to urinate
A, B, D, F
Stomachaches, muscle tension, excessive worrying, and headaches and body aches are symptoms of anxiety common to both adolescents and children. Shyness can be a symptom of anxiety in children. Frequent need to urinate can be symptom common in adolescents.
The prenatal nurse is completing an assessment on a client who is currently at 20 weeks of gestation. The client indicates that she is struggling with an overwhelming sense of anxiety and fears that she is becoming depressed. Prior to becoming pregnant, the client had been taking a selective serotonin reuptake inhibitor (SSRI) but stopped the medication due to the pregnancy. Which intervention should the nurse suggest initially to help the client deal with the anxiety?
Asking the healthcare provider about resuming the SSRI but at a lower dose
Recommending cognitive-behavioral therapy
Encouraging the client to find a good support system that can help her manage the anxiety
Asking the healthcare provider to prescribe another SSRI that has been found not to increase the risk of birth defects
During pregnancy, women need to be careful concerning use of medications, particularly SSRIs. The safest approach would be to try
therapy initially. Another SSRI may have less of a risk, but should not be the initial approach. While a support system may be helpful, the client is indicating being overwhelmed and possibly depressed, so
therapy would be the best approach.
An older adult client is asking the healthcare provider for a medication to deal with the anxiety they are feeling due to the recent deaths of two very close friends. They indicate that they used a benzodiazepine when they were younger and it worked fairly well. Which response by the nurse should address the client's request?
"A benzodiazepine is a good choice when you are older, so I'll try to get that prescribed for you."
"Benzodiazepines can cause a decrease in cognition, so we need to avoid the use of these medications if possible."
"Thank you for letting me know. I will see if the provider wants to prescribe a benzodiazepine."
"What dose of the medication did you take when you were younger, and how long did you take the medication?"
Use of medications for anxiety with older adults can be problematic due to differences in drug absorption, excretion, action, and metabolism as compared with younger adults. Benzodiazepines should be avoided since they can cause a decrease in cognition; this would be the correct response to the client.
The nurse is working with an older adult who is having side effects from medications for an anxiety disorder. The nurse wants to refer the client for psychotherapy, but the client is adamant and states, "I don't want to see a psychiatrist; that's for crazy people!" Which reassurance should the nurse give the client? (Select all that apply.)
"Therapists see many people who do not have mental disorders."
"Therapy can help manage the symptoms of anxiety."
"Therapy added to medications has more success than medications alone."
"With therapy, you can stop taking your medications right away."
"Other professionals offer therapy besides psychiatrists."
A, B, C, E
Other professionals offer therapy besides psychiatrists. Therapy added to medications has more success than medications alone. Therapy can help manage the symptoms of anxiety. Therapists see many people who do not have mental health disorders. Therapy and medications are not an either-or situation; the client can continue taking the medications.
The nurse believes that a client with severe anxiety will benefit from cognitive-behavioral therapy (CBT). Which characteristic of CBT should the nurse consider? (Select all that apply.)
The client can do CBT exercises.
The client can remove stressors.
The client can change unhealthy thoughts.
The client can discontinue medications.
The client can safely confront fears.
A, C, E
In CBT, the client can safely confront fears, change unhealthy thoughts, and do CBT exercises. It does not mean that the client can discontinue medications or remove stressors.
The nurse is teaching a client who is experiencing anxiety about possible medications that can be used to manage the symptoms of anxiety. Which medication should the nurse discuss with the client? (Select all that apply.)
A, B, C, E
Antidepressants, antipsychotics, benzodiazepines, or beta blockers can be used to manage symptoms of anxiety. Cortisol is a glucocorticosteroid hormonal stress mediator; its pharmaceutical forms may be used to treat inflammation, not anxiety.
A client is discussing recent difficulties with mild anxiety due to stress at work. They ask the nurse about ways that they can manage the anxiety, because they really do not want to take medication. Which intervention should the nurse include? (Select all that apply.)
Speaking slowly and using a low-pitched voice with the client
Teaching the client how to differentiate between different levels of stress
Encouraging the client to use self-management and diversion techniques to cope with stress
Instructing the client to reduce environmental stimuli
Teaching the client how to recognize stress triggers
B, C, E
Interventions for mild anxiety include: 1) teaching clients how to recognize stress triggers so that they can respond using healthy coping strategies before anxiety levels rise; 2) teaching clients how to differentiate between different levels of stress to help them determine if their response is appropriate or inappropriate; and 3) encouraging clients to use self-management and diversion techniques to cope with stress. The interventions of speaking slowly using a low-pitched voice and instructing the client to reduce environmental stimuli are appropriate to address panic, not mild anxiety.
The nurse is working with a client who is having a panic attack. The client has been pacing back and forth in the back hallway for the past 45 minutes. How should the nurse immediately respond to this behavior?
Allowing the client to pace to help diffuse energy
Administering anxiolytics as prescribed
Attempting to divert the client with another type of activity
Contacting the unit counselor to meet with the client immediately to discuss the cause of the panic
Allowing pacing or harmless repetitive physical tasks for the client who is experiencing a panic attack can help diffuse negative energy. While an anxiolytic may ultimately be needed, it would not be the immediate response. Asking the client to take a break or participate in another activity would likely increase anxiety and would not be the correct immediate response.
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