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Test Bank For Ackley And Ladwig’s Nursing Diagnosis Handbook, 13th - 2023 All Chapters - 9780323776837
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Test Bank For Ackley And Ladwig’s Nursing Diagnosis Handbook, 13th - 2023 All Chapters
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Test Bank For Ackley and Ladwig’s Nursing Diagnosis Handbook 13th Edition Chapter 01 - Anxiety Chapter 01 - Anxiety 1. A client presents to the urgent care clinic complaining of a feeling of unease and anxiety without a known cause. While conducting the assessment, what other finding should the nurse be most alert for? *a. Diarrhea b. Heart failure c. Diabetes d. Excessive salivation General Feedback: Diarrhea is a common manifestation of anxiety resulting from activation of the sympathetic nervous system. The other assessment findings are not related to anxiety. DIF: Cognitive Level: Know ledge/Remembering TOP: Nursing Process: Assessment MSC: Psychosocial Integrity Feedback: *a) Diarrhea is a common manifestation of anxiety resulting from activation of the sympathetic nervous system. The other assessment findings are not related to anxiety. DIF: Cognitive Level: Knowledge/Remembering TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2. A nurse has provided discharge teaching to a client with moderate anxiety. Which statement by the client indicates the teaching has been effective? a. “If I practice my breathing exercises, I will never be anxious again.” *b. “I will keep the phone number for the anxiety hotline with me.” c. “I can double my medications if I feel really anxious sometimes.” d. “It’s OK to have 1-2 drinks a day to help relieve my anxiety.” General Feedback: The use of appropriate community resources is an important teaching topic for the client with anxiety. Breathing exercises may help but will not “cure” the client. Doubling medications on one ’s own can be dangerous and is not advised. Drinking, or using other substances to relieve anxiety, is not recommended and can lead to substance misuse. DIF: Cognitive Level: Comprehension/Understanding TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity Feedback: *b) The use of appropriate community resources is an important teaching topic for the client with anxiety. Breathing exercises may help but will not “cure” the client. Doubling medications on one’s own can be dangerous and is not ad vised. Drinking, or using other substances to relieve anxiety, is not recommended and can lead to substance misuse. DIF: Cognitive Level: Comprehension/Understanding TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity 1 Test Bank For Ackley and Ladwig’s Nursing Diagnosis Handbook 13th Edition Chapter 01 - Anxiety 3. The nurse’s aide is tak ing vital signs on a client admitted with severe anxiety. The aide reports a blood pressure of 90/58 mm Hg, a pulse of 56 beats per minute, and respirations of 10 breaths per minute. Which statement by the nurse is most accurate? a. “The client must be l ess anxious than previously.” b. “Vital signs do not give accurate information about anxiety.” c. “If he were anxious, his blood pressure would be sky -high.” *d. “Lowered blood pressure and pulse can be a sign of anxiety.” General Feedback: Defining characteristics for this diagnosis include changes in vital signs from either sympathetic or parasympathetic input. A lowered blood pressure and pulse result from parasympathetic input. DIF: Cognitive Level: Knowledge/Remembering TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity Feedback: *d) Defining characteristics for this diagnosis include changes in vital signs from either sympathetic or parasympathetic input. A lowered blood pressur e and pulse result from parasympathetic input. DIF: Cognitive Level: Knowledge/Remembering TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity 4. Which of the following does the nurse understand about anxiety? a. The client never knows the source of the anxiety. b. The client always knows the source of the anxiety. *c. Often the source of the anxiety is not known to the client. d. There are no physical manifestations of anxiety. General Feedback: The source of a client’s anxiety may not be known to the client and results in a vague, uneasy sense of dread that is hard to pinpoint. DIF: Cognitive Level: Knowledge/Remembering TOP: Nursing Process: Assessment MSC: Psychosocial Integrity Feedback: *c) The source of a client’s anxiety may not be known to the client and results in a vague, uneasy sense of dread that is hard to pinpoint. DIF: Cognitive Level: Knowledge/Rem embering TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 2 Test Bank For Ackley and Ladwig’s Nursing Diagnosis Handbook 13th Edition Chapter 01 - Anxiety 5. A client presents to the emergency department with symptoms of severe anxiety. Which question or statement by the nurse would be most important? a. “Does anyone else in your family have anxiety?” *b. “Have you been using alcohol or other drugs recently?” c. “You look fine to me. Why are you so anxious?” d. “What problems are you having in your life right now?” General Feedback: Withdrawal from cigarettes, alcohol, or ot her drugs can precipitate anxiety. A family history may be contributory but should not be prioritized before the possibility of withdrawal. Telling a client that he or she looks fine is patronizing and minimizes the client’s concerns, while asking the clie nt “why” presents a communication block Asking the client about problems may not yield a useful answer as the cause of anxiety is often unknown. DIF: Cognitive Level: Application/Applying TOP: Nursing Process: Assessment MSC: Psychosocial Integrity Feedback: *b) Withdrawal from cigarettes, alcohol, or other drugs can precipitate anxiety. A family history may be contributory but should not be prioritized before the possibility of withdrawal. Telling a client that he or she looks fine is patronizing and minimizes the client’s concerns, while asking the client “why” presents a communication block Asking the client about problems may not yield a useful answer as the cause of anxiety is often unknown. DIF: Cognitive Level: Application/Applying TOP: Nursing Process: Assessment MSC: Psychosocial Integrity 3The benefits of buying summaries with Stuvia:
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