Fortinash: Psychiatric Mental Health Nursing, 4th Edition
Chapter 9: Anxiety and Anxiety Disorders
1. The nurse who follows the social psychiatry model of etiology of anxiety
understands that the four stages of anxiety are explainable as:
1. Individual responses to the environment ranging along a continuum from adaptive
to formation of symptoms of mental or physical illness
2. A generalization from an earlier traumatic experience to a benign setting or object
that can be modified by new learning
3. A genetically predetermined response to environmental stress
4. Related to degrees of warning to the ego that it is in peril from internal threats
ANS: 1
This theory speaks of anxiety existing along a continuum, a feature that corresponds to the four
stages of anxiety. Option 2 is an explanation based on behavioral theory. Option 3 is a biologic
theory. Option 4 is an inaccurate statement derived from the psychodynamic model.
2. The nurse designing a teaching plan for family members of clients with
agoraphobia should make it a priority to plan to:
1. Discuss the importance of supporting client independence
2. Advise family members to avoid discussing the client’s progress
3. Include signs and symptoms of impending relapse of the phobia
4. Teach strategies for promoting improved hygiene and grooming
ANS: 1
Clients with agoraphobia need positive reinforcement and support for becoming more
independent relative to leaving the home unaccompanied. Families are apt to assume the roles of
the compromised member and take on that member’s tasks, such as shopping. They must support
the independence afforded by recovery. 2. There is no need to restrict discussion of progress; in
fact, positive feedback is warranted. 3. The signs and symptoms of relapse are obvious, because
the client becomes more reluctant to leave the home. 4. Hygiene and grooming deficits are not
associated with agoraphobia.
3. A week ago an individual witnessed the explosion of a fuel tanker, after which a
“ball of fire” came directly at her. She literally “ran for her life.” She now reports feeling numb
and not being able to respond spontaneously to others. She feels estranged and detached from
others. Whenever anyone mentions the experience, she responds, “I need to avoid thinking about
it.” The nurse taking her history would assess that the client’s risk for developing posttraumatic
stress syndrome is:
1. High to moderate
2. Moderate
3. Low to moderate
4. Nonexistent
,ANS: 1
The client’s coping mechanisms are characterized by avoidance. These defenses are not
conducive to resolution. Unless the experience can be detoxified and integrated, PTSD is likely
to develop.
4. What is the significant advantage of planning to use the humanistic nursing model
in providing care to clients with anxiety disorders? The nurse:
1. Remains detached and has less opportunity to become anxious
2. Is expected to be fully available and in relationship with the client
3. Uses techniques derived from classical and operant conditioning
4. Is primarily concerned with milieu management
ANS: 2
The humanistic nursing theory sees nursing as an interactive process occurring between two
persons—one needing help and one willing to give help. The nurse is identified as being part of,
rather than an observer of, the interactive helping process.
*5. A client has been treated with medication and psychotherapy for generalized
anxiety disorder. Discharge from treatment is being contemplated. To obtain an objective
measure of treatment success, the nurse will:
1. Elicit informtion about client satisfaction with treatment
2. Ask the client whether he is experiencing anxiety at or below the mild level
3. Administer the Hamilton Anxiety Scale
4. Use the Yale-Brown Obsessive-Compulsive Scale
ANS: 3
A rating scale will give the most objective measure of the degree to which anxiety has been
effectively treated. The Hamilton Anxiety Scale would be the more appropriate to use since the
scale mentioned in option 4 is specific for OCD. Options 1 and 2 are more subjective in nature.
6. A client comes for treatment for persistent, severe anxiety. An appropriate nursing
diagnosis to validate would be:
1. Disturbed sensory perception related to narrowed perceptual field
2. Risk for injury related to closed perception
3. Hopelessness related to total loss of control
4. Risk for other-directed violence related to combative behavior
ANS: 1
A narrowed perceptual field occurs with severe anxiety; therefore this diagnosis should be
considered. Data are not present to support the other diagnoses.
, 7. The client was an awkward child who was ridiculed by his father for his inability
to catch a ball. As an adult, the client developed panic attacks at the time his company
established after-work team sporting activities. The advanced practice nurse determines that the
client’s anxiety occurs in relation to:
1. A signal that predicts a feared event
2. His physiologic responses to sports
3. A genetic deficiency of neurotransmitters
4. An unresolved desire to be a baseball player
ANS: 1
This scenario illustrates the behavioral model, which attributes the etiology of anxiety disorders
to an earlier traumatic experience. 2. The symptoms are not related to a physiologic cause. 3.
There is no evidence of a deficiency. 4. This is not supported by data in the scenario.
8. The nurse is working with the family of a client with obsessive-compulsive
disorder. Which of the following should the nurse incorporate in the teaching plan?
1. The thoughts, images, and impulses are voluntary.
2. The family should pay immediate attention to symptoms.
3. The thoughts, images, and impulses worsen with stress.
4. OCD is a chronic disorder and not responsive to treatment.
ANS: 3
Stress is known to increase the intensity of OCD symptoms. Families should be taught this
relationship and the need to reduce stress in the client’s life as much as possible. 1. The
symptoms are not under the client’s voluntary control. 2. This is nontherapeutic because it
contributes to secondary gain. 4. OCD responds well to medication and therapy.
9. Which question should the nurse ask to determine whether the client has been
experiencing anxiety?
1. "Have you had more difficulty concentrating lately?"
2. "Have you been feeling sad and lonely?"
3. "Do you have a history of nerves?"
4. "Do you frequently feel angry and upset?"
ANS: 1
Concentration difficulties occur when moderate or greater levels of anxiety are present. Option 2
assesses mood. Option 3 is a misnomer and would not necessarily provide accurate data. Option
4 assesses aggressive or anger symptoms.
10. An advanced practice nurse has identified a nursing diagnosis of impaired social
interaction for a client with obsessive-compulsive disorder. An appropriate outcome for this
problem would be that the client will:
1. Convince peers to join in the performance of the rituals
, 2. Speak of the baselessness of her obsessions in group
3. Avoid obsessing while interacting with the nurse
4. Describe increasing control over intrusive thoughts
ANS: 4
It is desirable for the client to experience a sense of being able to control the obsessive thinking.
1. This would be inappropriate. 2. Clients with OCD often speak of their obsessions as being
“silly and senseless,” so this outcome shows no progress. 3. This is too short-term to be of
enduring value to the client.
11. An evening staff nurse was raped 6 months ago while walking to the train station.
She immediately returned to work and did not focus on the incident. Recently, the nurse has been
having nightmares and difficulty communicating with her boyfriend. An appropriate outcome for
treatment is that the nurse will:
1. Develop improved coping skills
2. Participate in a zsupport group
3. Verbalize her anger toward her boyfriend
4. Learn how to protect herself from rape
ANS: 2
Participation in a support group is recommended for clients experiencing PTSD. 1. There is no
evidence that the nurse has poor coping skills. 3. There is no evidence that the nurse is angry
with her boyfriend. 4. This outcome implies that the nurse is, in part, responsible for the rape.
12. The nurse has been working with a client who experiences anxiety. The goal is
that the client will identify early symptoms of anxiety. Which outcome would the nurse evaluate
as indicative that the client is making progress toward this goal? The client:
1. Retrospectively connects stress situations and anxiety
2. Reports no symptoms of anxiety for 1 week
3. Practices relaxation techniques daily
4. Recognizes that others also experience anxiety
ANS: 1
This indicates growth in learning the precipitants of anxiety. Option 2 is not realistic. Option 3 is
beneficial but not related to the goal. Option 4 reduces egocentricity but is not related to the goal.
13. Which strategy should the nurse incorporate in the nursing care plan for a client
with generalized anxiety disorder?
1. Tell the client to calm down when anxiety is apparent
2. Encourage the client to discuss painful childhood issues
3. Teach the importance of limiting caffeine, nicotine, and CNS stimulants
4. Inform the client that he will need to remain calm if he wishes to attend group
therapy
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller anyiamgeorge19. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $13.99. You're not tied to anything after your purchase.
