Question 1

A patient tells the nurse,"My new friend is the most perfect person one could imagine! I can't find a single flaw.He is kind,considerate,handsome-and he puts me before anyone or anything else." The nurse should hypothesize that this patient may be demonstrating:

Accepted Answer

Splitting is an unconscious process that occurs when the individual defines a person as entirely positive or entirely negative;it is a form of distortion used to reduce the anxiety that accompanies the sometimes conflicting nature of human behavior.Denial is an unconscious process that would call for the nurse to ignore the existence of the situation.Projection operates unconsciously and would result in blaming behavior.Compensation would result in the nurse unconsciously attempting to make up for a perceived weakness by emphasizing a strong point.

Question 2

A patient complains of tension,indigestion,and difficult concentrating;his resting pulse is 110/minute.An appropriate nursing response would be:

Accepted Answer

The patient is exhibiting a moderate level of anxiety.Although his perceptual field and concentration are reduced at this level,the patient can benefit from discussing his situation in simple terms.Identifying what was happening (or what the patient was thinking about)as his anxiety was escalating can be helpful in identifying and addressing specific stressors.The patient does not require seclusion or safety.Isolation would deny him the opportunity to process and address his anxiety.Although it is often helpful to collaborate with the patient in identifying possible solutions,it is likely that his moderate level of anxiety may make problem solving very challenging,adding to his frustration.Antianxiety medication could be beneficial,but verbal interventions are often effective at lower levels of anxiety and do not have the abuse potential or side effects of medications.

Question 3

A rather unattractive woman seems to work diligently to be an excellent mother and a bright,exceptional employee,striving to please her husband and her boss,sometimes to the point that she sacrifices her own needs to assure that their needs are met.This is an example of:

Accepted Answer

Compensation is an unconscious process that allows us to make up for perceived deficits in one area by excelling in other areas to raise self-esteem.Intellectualization is a defense mechanism wherein a person avoids focusing on the distressing emotional aspects of a situation by focusing on its intellectual or factual aspects instead.Identification is an unconscious mechanism calling for assuming the desirable characteristics or behaviors of another.Undoing reduces anxiety by using positive behaviors to make up for unacceptable actions or thoughts.

Question 4

A patient who is a university student states that before taking an examination he feels a heightened sense of awareness,a sense of restlessness,and a mild degree of apprehension.Which nursing intervention is most therapeutic?

Accepted Answer

Teaching about symptoms of anxiety,their relation to precipitating stressors,and the positive effects of anxiety will serve to reassure the patient.Mild anxiety,as suggested by the symptoms noted here,is not pathological and is rarely disruptive to functioning.It can serve to sharpen perceptual focus and lead a person to attend to important matters at hand.Medications and psychotherapy are important treatment modalities of more severe forms of anxiety,especially for disabling anxiety disorders such as panic disorder with agoraphobia,but are not indicated for mild anxiety.

Question 5

A patient reports that nothing is wrong with him except a chest cold he's had for a couple weeks and "hasn't been able to shake off." His wife is very worried and says he smokes,coughs a lot,has lost 15 pounds,and is easily fatigued.Which of the following statements best describes this situation?

Accepted Answer

Denial is an unconscious blocking of threatening or painful information or emotions and can be used adaptively to help a person cope with an overwhelming circumstance for a short period of time until more effective methods of coping can be utilized.

Question 6

A patient who is a university student states that before taking an examination he feels a heightened sense of awareness and a sense of restlessness.The nurse should assess the patient's situation as:

Accepted Answer

Mild anxiety is rarely obstructive to the task at hand.It may be helpful to the patient by promoting study and making him more aware of the nuances of questions.The other problems mentioned have quite different symptoms.

Question 7

An anxious patient who receives anxiolytic medication every 6 hours PRN is in the corridor pacing.He grabs the arms of anyone who comes along and asks "When can I have medication?" His voice is high pitched and shaky.His respiratory rate is rapid.His assigned nurse should intervene by:

Accepted Answer

This scenario is consistent with a severe level of anxiety.Medication should be given promptly when a patient is experiencing severe anxiety that may carry potential safety risks for the patient and others.The patient should be told when he can have his next dose of medication and be reassured that it will be given promptly.Sending the patient away to lie down will not lower his anxiety and might increase risk.The preferred intervention would be to stay with the patient instead.Joking is inappropriate because the severely anxious patient has difficulty processing information and will be unable to differentiate joking from fact.Although it could be helpful to guide him to try relaxation-promoting options (such as deep breathing)in the meantime,board games or television,while distracting,are probably beyond his ability to engage in,given his anxiety level.

Question 8

A patient,just laid off from his job of 15 years,is pacing rapidly in the waiting room.His behavior is disorganized,he is trembling,and he can be heard admonishing himself that he should have worked harder.He told the triage nurse that he would like to get some medication to calm him down so he can "think straight." Which of the following would constitute a therapeutic rationale for the use of antianxiety medication as his initial treatment?

Accepted Answer

Antianxiety medications are useful in severe levels of anxiety because they can quickly reduce the patient's anxiety to a more manageable level that allows the patient to participate more meaningfully in further assessment and treatment.The patient's belief that it would be beneficial should be considered but is not itself rationale for choosing this treatment modality.It would likely help calm the patient but by itself would not be adequate treatment and thus would not be sufficient to permit his release from care.Most antianxiety medications are subject to abuse and when misused can be addictive;very few antidepressant medications are addictive.

Question 9

While working with an anxious patient,the nurse begins to feel tense and jittery and notices that she is having difficulty concentrating on what the patient is telling her.How can this be explained? The nurse is experiencing:

Accepted Answer

Anxiety can be "contagious," in that it is transmissible from one person to another.The outward indications of anxiety in the first person (e.g. ,tremor,restlessness,apprehension)are noted by others,who respond empathetically and/or sympathetically.Introjection is a defense mechanism that would not lead to increased anxiety in others.Secondary anxiety is associated with a physical disorder.Maturational anxiety arises from a situation in which a threat is present to achievement of a maturational or developmental task.

Question 10

A secretary is asked by her boss to take on additional work.She initially agrees but feels resentful.A day later when the boss asks for the completed work,the secretary explains that she has been working on another priority job and hasn't been able to complete it.When asked several hours later,she states someone else was using the files,so she hasn't been able to do the necessary research before typing the report.The secretary's behavior demonstrates:

Accepted Answer

The secretary resents the assignment and does not complete the work.Faced with the anxiety of having disobeyed her boss,she provides explanations designed to explain and justify her failure to complete the assignment,a defense mechanism known as rationalization.Intellectualization involves coping by ignoring the distressing emotional aspects of a situation and instead focusing solely on the facts.Projection is the attribution of unacceptable impulses or characteristics to others instead of recognizing them in oneself.Sublimation is the substitution of acceptable or even laudable behaviors for unacceptable impulses.

Question 11

The nurse plans to encourage an anxious patient to talk about his feelings and concerns.The rationale for this intervention is that:

Accepted Answer

Assisting the patient to talk about feelings and concerns can reduce isolation and facilitate problem solving.Distraction can temporarily aid in reducing anxiety levels but is not the intent of exploring one's feelings.Identifying and validating events in the environment can increase self awareness but is not the intention of exploring feelings.Exploring feelings,particularly those for which there is no ready solution,can intensify powerlessness rather than reduce it.

Question 12

The nurse wishes to teach an alternative coping strategy to a patient who is currently experiencing severe anxiety.The nurse will first need to:

Accepted Answer

A patient experiencing severe anxiety has a markedly narrowed perceptual field and difficulty attending to events in the environment.Thus a patient experiencing severe anxiety will not learn readily,and the patient's anxiety level must be lowered before education about stress management and coping techniques can begin.Determining the preferred mode of learning and constructing a teaching plan are relevant to the task but are not the priority measures.Diagnosing a particular anxiety disorder is not necessarily required in intervening to reduce a patient's level of anxiety.

Question 13

A patient accompanied her boyfriend to the emergency department after the two had been in a motorcycle accident.The boyfriend was badly hurt,but the patient had only minor cuts and bruises and was discharged.She mentioned to the nurse that since she was driving,she should have been the one to be injured.Twenty-four hours later,while visiting her boyfriend,the patient reported that she was unable to move from her chair and unable to walk.Diagnostic workup revealed no physical reason for the problem.The anxiety relief behavior the patient is demonstrating is:

Accepted Answer

Conversion is a defense mechanism that involves converting anxiety into a physical symptom that does not have an organic cause.In this instance,the patient is experiencing anxiety related to having injured her boyfriend without herself having been seriously injured.Her conversion involves "creating" a serious injury of her own,which in turn reduces her anxiety about the disparity in their respective injuries.Projection involves attributing unacceptable aspects of oneself (feelings,impulses)to others instead.Sublimation is a constructive defense mechanism that substitutes acceptable behaviors for unacceptable ones.Reframing is rewording a thought to make it more accurate or consistent with reality.

Question 14

A college student who usually gets "straight-A" grades scored a C on a difficult examination.When he received the grade,he began to shake,sweat profusely,and feel sick to his stomach.The best explanation for the student's reaction is that:

Accepted Answer

The operational definition of anxiety suggests that an expectation or need is unmet,causing anxiety and prompting relief behavior.No information provided suggests that the student was experiencing anger or believing that the C would result in course failure.The release or enhancement of GABA tends to increase one's sense of calm,not induce symptoms of anxiety.

Question 15

A patient who asked for and was refused a pass to leave the unit left the nurse's station and went to his room,where he slammed his closet door several times while looking for a sweater.This behavior is an example of __________ use of __________ .

Accepted Answer

Displacement unconsciously transfers emotions associated with a person,object,or situation to another less threatening person,object,or situation.The patient slammed doors instead of discharging his feelings of anger against the individual who refused to give him the pass.Such behavior is adaptive in that it prevented aggression toward the source of his frustration.Sublimation is the unconscious process of substituting constructive activity for unacceptable impulses and by definition is an adaptive mechanism.Slamming of closet doors cannot be considered a constructive activity.Repression involves the unconscious blocking or exclusion of unacceptable thoughts or urges.In this case,the unacceptable impulses (to strike the nurse)are not blocked but redirected (displaced)instead.Reaction formation keeps unacceptable feelings or behaviors out of awareness by substituting the opposite feeling or behavior;reaction formation here would have involved the patient behaving protectively toward the nurse.

Question 16

A patient who asked for and was refused a pass to leave the unit left the nurse's station and went to his room,where he slammed his closet door several times while looking for a sweater.A nurse came into the room and remarked,"You seem pretty angry." The patient replied that he was not the least bit angry.What defense mechanism is the patient demonstrating?

Accepted Answer

Denial involves an unconscious process of escaping an unpleasant reality by ignoring its existence;in this case the patient ignores his true feelings.Splitting involves avoiding the anxiety-provoking task of reconciling conflicting feelings or aspects of another person by seeing that person as either "all good" or "all bad";in this case,the patient would have been splitting had he characterized the nurse in a completely negative way.Rationalization involves justifying illogical or unreasonable ideas,actions,or feelings by developing acceptable explanations that satisfy the listener and the self.Compensation requires unconsciously making up for perceived deficits by excelling in another area to maintain self-esteem.

Question 17

The husband who is sexually inadequate and blames it on his partner,saying that her expectations are unrealistic and that no man could meet them,may be demonstrating:

Accepted Answer

Rationalization involves unconsciously making excuses for one's behavior,inadequacies,or feelings.Regression involves the unconscious use of a behavior from an earlier stage of emotional development.Compensation involves making up for deficits in one area by excelling in another area.Introjection is an unconscious,intense identification with another person.

Question 18

Two staff nurses were considered for promotion.The promotion was announced by a memo on the unit bulletin board.When the nurse who was not promoted first read the memo and learned that the other nurse had received the promotion,she left the room in tears.This behavior is an example of:

Accepted Answer

Crying is a regressive behavior.The ego returned to an earlier,comforting,and less mature way of behaving in the face of disappointment.Conversion involves the unconscious transformation of anxiety into a physical symptom.Introjection involves intense,unconscious identification with another person.Rationalization involves the unconscious process of developing acceptable explanations to justify unacceptable ideas,actions,or feelings.

Question 19

A patient with severe anxiety has been pacing the hall and suddenly begins to run,shouting "I'm going to explode!" over and over.The nurse who has been walking with him should:

Accepted Answer

Safety needs of the patient and other patients are a priority.The patient is less likely to hurt himself or others when several staff take responsibility for providing limits and instilling a sense of safety so that the patient is less frightened.The explanation given the patient should be simple and neutral.Simply being told that others can provide the control he is losing may be sufficient to help the patient regain control.Running and calling after the patient is stimulating and will increase his anxiety.More than one staff member will be needed to provide physical limits safely if they become necessary,and manually controlling the patient could be misperceived as an assault,further frightening him and intensifying his anxiety.Attempting to explore or clarify what is happening would be nontherapeutic: a patient in panic processes information poorly and likely would be further frustrated if asked to do so.

Question 20

A patient is noted to have a high level of non-goal-directed motor activity,running from chair to chair in the solarium.He is wide eyed and seems terror stricken.He cries,"They're coming! They're coming!" He neither follows staff direction nor responds to verbal efforts to calm him.Which nursing response should be the highest priority?

Accepted Answer

Safety is of highest priority because the patient experiencing panic is at high risk for self-injury related to increased non-goal-directed motor activity,distorted perceptions,and disordered thoughts.Option B: The goal should be to decrease environmental stimuli.Option C is a lower priority than safety.Option D: Clarification of feelings cannot take place until the level of anxiety is lowered.

Quiz 12: Anxiety and Anxiety Disorders