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A patient experiencing panic suddenly began running and shouting, “I’m going to explode!” Select the nurse’s best action.
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A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask?
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Anxiety
| Question | Answer |
|---|---|
| A patient experiencing panic suddenly began running and shouting, “I’m going to explode!” Select the nurse’s best action. | Tell the patient, “Stop running and take a deep breath. I will help you.” |
| A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask? | Do you find it difficult to control your worrying? |
| For a patient experiencing panic, which nursing intervention should be implemented first? | Provide brief, calm, directive communication |
| A person has minor physical injuries after an auto accident. The person is unable to focus and says, “I feel like something awful is going to happen.” This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person’s level of anxiety? | Severe |
| A student says, “Before taking a test, I feel very alert and a little restless.” Which nursing intervention is most appropriate to assist the student? | Explain that the symptoms result from mild anxiety and discuss the helpful aspects |
| The nurse assesses a patient who complains of loneliness and episodes of anxiety. Which statement by the patient is mostly likely if this patient also has agoraphobia? | "I just hate going out and seeing all those people, my family gets all my meds and groceries and drops them off." |
| A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? | Present the information again in a calm manner using simple language. |
| A patient fearfully runs from chair to chair crying, “They’re coming! They’re coming!” The patient does not follow the staff’s directions or respond to verbal interventions. The initial nursing intervention of highest priority is to | provide for the patient’s safety. |
| A person who feels unattractive repeatedly says, “Although I’m not beautiful, I am smart.” This is an example of | compensation. |
| A patient tells a nurse, “My best friend is a perfect person. She is kind, considerate, good-looking, and successful with every task. I could have been like her if I had the opportunities, luck, and money she’s had.” This patient is demonstrating | rationalization |
| A patient experiences a sudden episode of severe anxiety. Of these medications in the patient’s medical record, which is most appropriate to give as a prn anxiolytic? | lorazepam |
| A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder? | "I check where my car keys are eight times." |
| A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping? | Encourage the patient to participate in social activities |
| A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of | cognitive restructuring. |
| A patient undergoing diagnostic tests says, “Nothing is wrong with me except a stubborn chest cold.” The spouse reports the patient smokes, coughs daily, lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using? | Denial |
| A cruel and abusive person often uses rationalization to explain the behavior. Which comment demonstrates use of this defense mechanism? | “That person should not have provoked me. |
| When alprazolam is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to | avoid alcoholic beverages. |
| A child was placed in a foster home after being removed from abusive parents. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. Which interventions should the nurse suggest? | Use a calm manner and low voice. |
| A woman is 5'7", 160 lbs. and wears a size 8 shoe. She says, “My feet are huge. I’ve asked three orthopedists to surgically reduce my feet.” This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? | Body dysmorphic disorder |
| A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first? a.Verify the patient's learning style. b.Lower the patient's current anxiety. c.Create outcomes and a teaching plan. d.Assess how the patient uses defense mechanisms. | A patient experiencing severe anxiety has a markedly narrowed perceptual field and difficulty attending to events in the environment. A patient experiencing severe anxiety will not learn readily. Determining preferred modes of learning, devising outcomes, and constructing teaching plans are relevant to the task but are not the priority measure. The nurse has already assessed the patient's anxiety level. Use of defense mechanisms does not apply. |
| A nurse plans health teaching for a patient diagnosed with generalized anxiety disorder who begins a new prescription for lorazepam. What information should be included? | Importance of caffeine restriction, to avoid alcohol and other sedatives, and to use caution in use of machinery |
| Claustrophobia | Fear of closed spaces |
| First line defense medications in most anxiety and OCD Disorders | SSRIs |
| Used for treatment resistant conditions due to potential for life-threatening hypertensive crisis | MAOIs |
| Dietary Restrictions for MAOIs | Foods containing Tyramine: Aged Cheese, Smoked Meats, Beer, Wine |
Created by:
KimSchrandt