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EAQ Week 6- Anxiety
Psychiatric/Mental Health Nursing (N129)
Samuel Merritt University
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Performance
Mental Health Week 6: Anxiety
Due Feb 16, 2022 by 11:59 pm
Final Score
100%
103 out of 127 questions answered correctly
Completed on Feb 19, 2022 11:07 am
Incorrect (24)
Which behavior would the nurse expect when caring for a hospitalized
4-year-old child?
Refusing to cooperate with nurses during the parents’ absence Demonstrating despair if the parents do not visit at least once a week Crying when the parents leave and return but not during their absence Avoiding interacting and playing with peers in the playroom if other parents are present
Rationale
Preschoolers can tolerate brief periods of separation from their parents; however, emotions associated with separation and perhaps anger at being left are difficult to hide when the parents arrive or leave. Preschoolers usually are quite docile and cooperative because they are afraid of being totally abandoned. The child will demonstrate despair long before the week is over. The presence of other children’s parents in the playroom does not discourage them from playing with their peers.
Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer.
The nurse understands which as the primary reason oxazepam is given
during detoxification?
Rationale
Oxazepam potentiates the actions of gamma-aminobutyric acid, especially in the limbic system and reticular formation, and thus it minimizes withdrawal symptoms. This medication helps reduce the risk for seizures but does not prevent injury during a seizure. Enabling the client to sleep better during periods of agitation is not the purpose of the medication. The ability of the client to accept treatment depends on the person’s readiness to accept the reality of the problem.
Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 AM, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point
Prevents injury when seizures occur Enables the client to sleep better during periods of agitation Encourages the client to accept treatment for alcoholism Minimizes withdrawal symptoms the client may experience
of ipecac is no longer advised, and the substance is not in most homes. Activated charcoal is given in an emergency facility.
Despite the nurse’s best efforts, a young client continuously complains
about the nursing care. Which defense mechanism is the nurse using by
discussing stages of young adult development with a colleague?
Rationale
The nurse is using facts and knowledge to detach herself from the emotional effect of the client's rejecting comments and to ease the anxiety it is causing. Sublimation is the channeling of unacceptable thoughts or feelings into acceptable activity. Substitution is similar to displacement; anxiety is reduced with a transfer of the emotions associated with an object or person to another, safer, object or person. Identification is trying to unconsciously imitate the behavior of another who is considered important in an attempt to incorporate the relevant aspects of this individual into the self.
Which physical manifestation would the nurse expect to observe if a
client is anxious?
Sublimation Substitution Identification Intellectualization
Constricted pupils Narrowed bronchioles Decreased blood pressure Increased blood glucose level
Rationale
The fight-or-flight response of the sympathetic nervous system is stimulated, causing an increase in blood glucose through glycogenolysis and gluconeogenesis. The pupils dilate, not constrict, to facilitate the entry of visual stimuli. The bronchioles dilate, not constrict, to facilitate gas exchange. The blood pressure increases, not decreases, to shunt blood to vital centers.
A client with the diagnosis of panic disorder refuses to take the
prescribed alprazolam because of fears of addiction. Which action would
the nurse perform first?
Rationale
Before deciding how to ease the client’s fears of addiction, the nurse must explore the full extent of the client’s knowledge and beliefs about taking this medication. Information may or may not be helpful; the client’s beliefs must be addressed. The nurse may eventually ask the health care provider to consider changing the medication or to speak with the client about safety and risk.
Which initial intervention would the nurse perform for a client recently
admitted with pacing, aloofness, and suspicion who says that other
people have all the control?
Give verbal and written information about alprazolam. Assess the client’s beliefs and knowledge of alprazolam. Ask the health care provider to change the medication. Ask the health care provider to explain addiction risks.
Reviewing the client’s history Setting limits on the client’s inappropriate behavior Accepting the client’s behavior
Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action.
Before signing a consent form for a total laryngectomy, a client asks,
'Because part of my throat will be taken out and I will breathe through a
hole in my neck, will I be able to talk like I did before I had the surgery?'
How would the nurse respond?
Rationale
The nurse should strive to clarify misconceptions and fears before a client signs a consent form; this response ('You seem very concerned. Tell me what you know about your surgery.') promotes further communication and begins where the client is. The fact that others have had the surgery provides little solace; the remainder of the response is false reassurance and does not truthfully answer the client's question. The response 'That's a good question. I'll have the health care provider talk with you' avoids assuming the responsibility of answering the client's question; the client needs an immediate clarification. The response 'You will not be able to talk like before, but there is nothing to worry about' denies the client's feelings and cuts off communication.
Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions.
When a nurse needs to administer oxygen at a fraction of inspired
oxygen (FiO ) of about 40% to keep a client’s oxygen saturation greater
than 94%, which method would be best?
'Several clients have had this operation, and many of them can talk again.' 'That’s a good question. I will have the health care provider talk with you.' 'You seem very concerned. Tell me what you know about your surgery.' 'You will not be able to talk like before, but there is nothing to worry about.'
2
Face tent
Rationale
All of the oxygen delivery methods are capable of delivering an FiO of 40%, but the nasal cannula is the most comfortable and least intrusive. A face tent would provide humidification, but is more intrusive and there is no indication that the client needs additional humidification. A Venturi mask is more intrusive and uncomfortable for the client. A simple face mask would be more uncomfortable for the client.
Which safety intervention would the nurse include in a plan of care for a
client with somatic disorder who reports loss of vision? Select all that
apply. One, some, or all responses may be correct.
Rationale
A client with a somatic disorder who reports being unable to see is at high risk for injury due to new surroundings. Therefore, the nurse would provide safety and security by placing the call light within reach and orienting the client to the surroundings. Restraints are used only as a last resort to manage combative behavior. Sedatives are not needed if the client is not anxious. Therapeutic communication would be used but is not specific to providing safety.
Venturi mask Nasal cannula Simple face mask
2
Apply restraints. Administer sedatives. Put the call light within reach. Orient the client to surroundings. Use therapeutic communication.
Rationale
An exacerbation of Graves disease leads to signs of hyperthyroidism such as weight loss, fast-paced speech, hyperactive bowel sounds, tachycardia, and hypertension. A heart rate of 120 beats/min and a blood pressure of 170/86 mm Hg reflect these vital sign changes.
Which symptom might the nurse identify when assessing a client with
hyperthyroidism?
Rationale
Excessive metabolic activity associated with hyperthyroidism causes fatigue. Warm, moist skin is expected because of increased peripheral perfusion associated with increased metabolism. Increased appetite is expected because of the increased metabolism associated with hyperthyroidism. Tachycardia is expected because of the increased metabolism associated with hyperthyroidism.
Parents reports that their 4-year-old child partially awakens from sleep,
A 10-pound weight loss Very fast-paced talking Hyperactive bowel sounds Heart rate 120 beats/min Blood pressure 170/86 mm Hg
Fatigue Dry skin Anorexia Bradycardia
sweats profusely, and screams in the night. Which is the best action in
this situation?
Rationale
Sleep terrors are characterized by partially awakening from sleep accompanied by screaming, perspiration, and increased heart rate. The child screams during the terror but calms down later. The nurse advises the parents to avoid disturbing the child and to watch carefully until the child is calm. A child will generally not have trouble returning to sleep after a night terror and will not remember the details, so it is not necessary to bring the child into the parents' bed, and it would be of no benefit to ask the child to describe the dream or accept it as real.
Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.
When assessing the development of a school-age child, the nurse
concludes that the child has normal development according to Fowler’s
spiritual development. Which behavior would have been observed?
Recommend that the parents take their child into their own bed. Ask the child to describe the dream that he or she saw last night. Instruct the parents to accept the child’s dream as a real fear for the child. Advise the parents to observe their child for a few minutes until the child is calm.
The child imitates the religious gestures of elders. The child does not differentiate between right and wrong actions. The child has spiritual disappointment and modifies religious practices. The child believes God will punish bad behavior and reward good behavior.
may be performed; however, a closed, high-magnet scanner may produce more significant results than will be produced by an open, low-magnet scanner. Although the response 'We will make sure that all metal objects are removed from the immediate area to avoid injury' is a true statement, this response may increase the client’s anxiety and does not address the concern of a small space. The response 'You will be able to communicate with us by an intercom system, so you have nothing to worry about' dismisses the client’s concerns and provides false reassurance.
Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you see how correct your 'guessing' can be. Remember: on the licensure examination you must answer each question before moving on to the next question.
Which characteristic of the milieu is essential for clients with the
diagnosis of bulimia nervosa?
Rationale
Realistic guidelines reduce anxiety, increase feelings of security, and increase adherence to the therapeutic regimen. A controlling environment and focusing on food set up power struggles between these clients and the nurses. These clients need realistic rules and regulations that they identify as helpful, not as empathetic.
Which therapy would have the highest success rate for people with
phobias?
Control enforced by staff Focus on healthy food Empathy from the nurses Realistic guidelines
Rationale
The highest success rate for phobia therapy is desensitization involving relaxation techniques. The most successful therapy for people with phobias consists of behavior modification techniques involving desensitization. Insight into the origin of the phobia will not necessarily help the client overcome the problem. Psychotherapy may increase understanding of the phobia but may not help the client cope with the fear; there is no maladaptive thought process associated with phobias. Psychoanalysis may increase understanding of the phobia but may not help the client cope successfully with the unreasonable fear.
STUDY TIP: Try to decrease your workload and maximize your time by handling items only once. Most of us spend a lot of time picking up things we put down rather than putting them away when we have them in hand. Going straight to the closet with your coat when you come in instead of throwing it on a chair saves you the time of hanging it up later. Discarding junk mail immediately and filing the rest of your bills and mail as they come in rather than creating an ever-growing stack saves time when you need to find something quickly. Filing all items requiring further attention in some fashion helps you remember to take care of things on time rather than being so engrossed in your schoolwork that you forget about them. Many nursing students have had their power or telephone service cut off because the bill simply was forgotten or buried in a pile of old mail.
During the initial assessment phase, which parameter would the nurse
focus on for a client with panic disorder and agoraphobia?
Desensitization involving relaxation techniques Insight therapy to determine the origin of the fear Psychotherapy aimed at rearranging the maladaptive thought processes Psychoanalytic exploration of repressed conflicts of an earlier developmental phase
Easing the client’s anxiety so further interviewing may be done
panic attack. Crying is an outlet and would not be discouraged; telling someone not to cry usually worsens the crying and the anxiety.
Which goal would cognitive therapy accomplish for a client who
experiences panic attacks?
Rationale
The goal of cognitive therapy for panic attacks is to decrease the fear of having panic attacks. It is the fear of having an attack as much as the panic attack itself that is debilitating. Once the client’s fear of future attacks is diminished, the number of attacks usually decreases as well. Prevention of future attacks is desirable but not always possible with cognitive therapy. Hiding the attacks is not a goal of cognitive therapy. Assisting the client to cope would be more helpful. It usually is impossible to stop a panic attack once it starts.
STUDY TIP: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group.
Which action would the nurse take after finding a young client with
panic disorder masturbating in her or his own room?
Prevent future panic attacks. Help the client hide the panic attacks. Stop the panic attacks once they begin. Decrease the fear of having panic attacks.
Apologize and leave the room. Tactfully assess why the client needs to masturbate. In a calm, quiet manner say, 'This behavior is inappropriate in the hospital.'
Rationale
The nurse would apologize and leave the room. The client has the right to privacy; this behavior is acceptable in the privacy of the client’s own room. Masturbation is a sexual outlet; assessment is unnecessary unless the act is practiced to excess. Masturbation is acceptable in the privacy of the client’s own room; therefore saying, 'This behavior is inappropriate in the hospital' is incorrect and inaccurate. Pretending not to have seen the client and carrying out whatever task needs to be done may cause needless embarrassment to the client and close off further communication.
Pretend not to have seen the masturbation and carry out whatever task needs to be done.
Correct (103)
Which level of anxiety enhances the client's learning abilities?
Rationale
Mild anxiety motivates one to action, such as learning or making changes. Higher levels of anxiety tend to blur the individual's perceptions and interfere with functioning. Attention is severely reduced by panic. The perceptual field is greatly reduced with severe anxiety and narrowed with moderate anxiety.
Test-Taking Tip: Read the question carefully before looking at the answers: (1) determine what the question is really asking; look for key words; (2) read each answer
Mild Panic Severe Moderate
Rationale
The client has overwhelming feelings of anxiety. The ritual reduces anxiety; when not permitted to complete the ritual, a client with an obsessive-compulsive disorder will experience increased anxiety, frustration, and anger, and he or she may act out. The client is experiencing anxiety not related to the nurse’s manner, personality clash, or an aggressive characteristic.
Which action would the nurse take for a client with an obsessive-
compulsive disorder who continually walks up and down the hall,
touching every other chair and becomes upset if interrupted?
Rationale
The nurse would allow the behavior to continue for a specified time, letting the client help set the time limits. It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long the client desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching
Reflects an aggressive characteristic
Distract the client, which will help the client forget about touching the chairs. Encourage the client to continue touching the chairs as long as the client wants until fatigue sets in. Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one. Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed.
every other one, will increase the client’s anxiety because the client uses the ritual as a defense against anxiety.
Which nursing intervention would help a client who exhibits physical
symptoms when stressed?
Rationale
The nurse would assist the client in developing new coping mechanisms. Until the client learns new ways of coping with stress and anxiety, this pattern of behavior will continue. Learning new ways of coping with stress will help break this physiological pattern. Limiting discussion will avoid the problem. Providing information about medical care will reinforce the sick role. A certain amount of stress is present in everyday family situations; the elimination of stress is impossible.
Which intervention would the nurse add to the plan of care for a client
who engages in ritualistic behavior?
Limiting discussions about the problem Providing information regarding medical care Teaching the client how to eliminate stress at home Assisting the client in developing new coping mechanisms
Redirect the client’s energy into activities to help others. Teach the client that the behavior is not serving a realistic purpose. Administer antianxiety medications that block out the memory of internal fears. Help the client understand that the behavior is caused by maladaptive coping with increased anxiety.
EAQ Week 6- Anxiety
Course: Psychiatric/Mental Health Nursing (N129)
University: Samuel Merritt University
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