Chapter 18: Managing Anxiety Nursing School Test Banks

Chapter 18: Managing Anxiety
Test Bank

MULTIPLE CHOICE

1. When a client has a mild level of anxiety, his or her emotional response is:
a. Relaxed and calm
b. Energized
c. Feeling overloaded
d. Helplessness with loss of control
ANS: A
Mild anxiety results in relatively comfortable feelings. An energized emotional response describes feelings of moderate anxiety. Feeling overloaded is characteristic of severe anxiety, and feeling helpless with loss of control refers to the highest level of anxiety, which is panic.

DIF: Cognitive Level: Comprehension REF: p. 203 OBJ: 1
TOP: Continuum of Anxiety Responses KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

2. A female college student is seeking help from the counseling center for test anxiety. She reports that during an exam, she freezes, and says, It feels like the time I have to take the exam is racing by, and I cant answer any of the questions when I know the answers. Which level of anxiety is the client experiencing?
a. Mild
b. Moderate
c. Severe
d. Panic
ANS: C
These are typical symptoms when someone experiences a severe level of anxiety. During mild anxiety, the perceptual field is broad; moderate anxiety is the best state for problem solving and learning because perception is focused; panic results in totally scattered or closed perception, and problem solving is nearly impossible.

DIF: Cognitive Level: Application REF: p. 203 OBJ: 1
TOP: Continuum of Anxiety Responses KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

3. A learned response to an anticipated event, such as when the person who does not like to fly experiences nausea and sweaty palms before boarding the airplane, is best described as:
a. A normal anxiety response
b. Signal anxiety
c. An anxiety state
d. An anxiety trait
ANS: B
This response occurs as the individual anticipates a stress-provoking event. A normal anxiety response does not best meet the description in this situation; an anxiety state refers to a person whose coping abilities have become overwhelmed and the person has lost emotional control; and an anxiety trait is part of an individuals personality that occurs as an overreaction to situations.

DIF: Cognitive Level: Comprehension REF: p. 202 OBJ: 1
TOP: Types of Anxiety KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

4. A client tells the nurse that exercising in the gym helps him keep his stress level reduced. Which type of coping mechanism best describes this situation?
a. Spiritual
b. Emotional
c. Intellectual
d. Physical
ANS: D
Stress release activities such as exercise, jogging, and yoga are considered physical coping mechanisms. Spiritual coping mechanisms include prayer, faith, and rituals. Emotional coping mechanisms consist of crying, talking, and defense mechanisms. Intellectual coping mechanisms are observed when an individual changes his or her perceptions of a threat to make it less meaningful.

DIF: Cognitive Level: Comprehension REF: p. 204 OBJ: 2
TOP: Coping Methods KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

5. A nurse who talks to teens about the dangers of tanning beds in causing skin cancer but loves to tan herself and does so before she goes on vacation is using which defense mechanism?
a. Substitution
b. Restitution
c. Suppression
d. Rationalization
ANS: A
Substitution is defined as disguising motivations by replacing an inappropriate behavior with one that is more acceptable. Restitution is defined as doing something to resolve guilt feelings; suppression is removing anxiety about a conflict from consciousness; and rationalization uses a good, but unreal, reason to make an excuse for an action.

DIF: Cognitive Level: Comprehension REF: p. 205 OBJ: 2
TOP: Defense Mechanisms KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

6. The nurse is aware that several theories have been proposed to explain anxiety. Which theory explains anxiety as a result of interactions with others?
a. Biological model
b. Psychodynamic model
c. Interpersonal model
d. Behavioral model
ANS: C
The basis of this theory is that the anxiety response develops in early childhood as a result of interactions with others. The biological model relates to neurochemicals in the brain. The psychodynamic model is Freuds theory that anxiety results from conflict between the ego and the id. The behavioral model describes anxiety as a learned response.

DIF: Cognitive Level: Knowledge REF: p. 206 OBJ: N/A
TOP: Interpersonal Model KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

7. Adolescents who ineffectively cope with anxiety often express their anxiety through:
a. Inappropriate behaviors
b. Calm behavior
c. Psychotic behavior
d. Suicide
ANS: A
Behaviors such as defiance, experimenting with drugs, aggressiveness, and manipulation are examples of these behaviors. The other options are responses that are not commonly seen among adolescents with ineffective coping skills.

DIF: Cognitive Level: Knowledge REF: p. 207 OBJ: 3
TOP: Anxiety in Adolescence KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

8. What is the term for physical expression of anxiety by an individual in ways such as nausea or headaches?
a. Compensation
b. Somatization
c. Denial
d. Fantasy
ANS: B
Often when an individual denies his or her feelings of anxiety, the anxiety is expressed physically. The other options are examples of defense mechanisms.

DIF: Cognitive Level: Knowledge REF: p. 208 OBJ: 3
TOP: Anxiety in Older Adulthood KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

9. Which term best describes an individuals feelings of anxiety that are broad, long-lasting, and excessive?
a. Generalized anxiety disorder
b. Panic attack
c. Phobic disorder
d. Obsessive-compulsive disorder
ANS: A
This diagnosis is given to individuals with these symptoms. Panic attacks last a short time, phobias relate to excessive fear of a specific object or situation, and obsessive-compulsive disorder is a constant thought and behavior.

DIF: Cognitive Level: Knowledge REF: p. 208 OBJ: 4
TOP: Generalized Anxiety Disorder KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

10. A client has constant thoughts about locking his front door every time he leaves his house. This client is experiencing a(n):
a. Compulsion
b. Phobia
c. Obsession
d. Anxiety reaction
ANS: C
Obsession is constantly thinking about something, and compulsion is acting it out. Phobia is irrational fear, and anxiety reaction is not a used term.

DIF: Cognitive Level: Comprehension REF: p. 210 OBJ: 5
TOP: Obsessive-Compulsive Disorder KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

11. Which is a typical symptom of posttraumatic stress disorder?
a. Constant use of defense mechanisms
b. Flashbacks
c. Distressing persistent thoughts
d. Irrational fear
ANS: B
Flashbacks are vivid recollections of the trauma. Constant use of defense mechanisms is simply a maladaptive way of coping. Distressing, persistent thoughts represent obsession, and irrational fear is a phobia.

DIF: Cognitive Level: Knowledge REF: p. 211 OBJ: 6
TOP: Posttraumatic Stress Disorder KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

12. The treatment team and a male client in whom obsessive-compulsive disorder associated with hand washing has been diagnosed decide on a treatment plan for the disorder. The nurse begins to implement the plan by having the client gradually extend the time between hand washes. This intervention is an example of which type of therapy?
a. Behavior modification
b. Desensitization
c. Flooding
d. Pharmacological therapy
ANS: B
This method gradually desensitizes the anxiety reaction, replacing it with effective coping skills. Behavior modification replaces maladaptive behavior with positive behavior; flooding is the complete opposite of desensitization; and pharmacological therapy is the use of medications.

DIF: Cognitive Level: Comprehension REF: p. 211 OBJ: 9
TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

13. A female client is taking a benzodiazepine for her anxiety disorder. She complains of anorexia and nausea since she started taking the medication a few days ago. What is the nurses best response?
a. Be sure to take the medicine on an empty stomach to avoid these symptoms.
b. It takes a while to get used to the medicine. Give it a couple of weeks.
c. Try taking the medication with food or milk, and see if the symptoms improve.
d. Stop taking the medication immediately, and I will notify your doctor.
ANS: C
Taking the medication with food or milk usually alleviates GI side effects of this class of drugs. An empty stomach will intensify the side effect. It is not true to say that it takes a while to adjust to the medication. Completely stopping the medication is not necessary.

DIF: Cognitive Level: Application REF: p. 211 OBJ: 8
TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity

14. A male client has had agoraphobia for several years. In the past 2 years, he has not left his home and only speaks to people on the phone occasionally. Which nursing diagnosis has the highest priority in this situation?
a. Social isolation
b. Thought processes, disturbed
c. Coping, ineffective individual
d. Powerlessness
ANS: A
All of the nursing diagnoses apply, but given the length of time of isolation, the nursing diagnosis of Social isolation is most appropriate.

DIF: Cognitive Level: Application REF: p. 212 OBJ: 9
TOP: Therapeutic Interventions KEY: Nursing Process Step: Nursing Diagnosis
MSC: Client Needs: Psychosocial Integrity

15. Of individuals who suffer from panic attacks, ____% are women.
a. 20
b. 30
c. 50
d. 70
ANS: D
Other demographics include individuals who are separated or divorced and individuals between the ages of 24 and 44 years.

DIF: Cognitive Level: Knowledge REF: p. 209 OBJ: 4
TOP: Panic Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. Symptoms of obsessive-compulsive disorder can occur in children as young as _____ years old.
a. 3
b. 5
c. 7
d. 9
ANS: A
Symptoms can occur at this age, but in most cases, symptoms either do not occur or are not diagnosed until adolescence.

DIF: Cognitive Level: Knowledge REF: p. 210 OBJ: 5
TOP: Obsessive-Compulsive Disorder KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

17. An adolescent caught stealing a classmates laptop says that he needed it to write his paper and the classmate has enough money to buy another one anyway is demonstrating which of the following defense mechanisms?
a. Denial
b. Restitution
c. Rationalization
d. Conversion
ANS: C
The adolescent is using the reason of the classmates financial advantage as a rationalization for stealing the laptop. Denial is refusal to acknowledge conflict, restitution deals with giving back to resolve guilt, and conversion is the channeling of unbearable anxiety into physical signs and symptoms.

DIF: Cognitive Level: Knowledge REF: p. 204 OBJ: 2
TOP: Common Defense Mechanisms KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

18. On the morning of a final exam, the student is feeling tense and excited, with her heart rate and breathing slightly increased. She is feeling energized and alert with her attention focused on the exam. Based on these findings, what advice can the student be given?
a. Practice deep breathing and do some exercise to stabilize vital signs.
b. Request to take the exam at a later date when anxiety decreases.
c. Take the exam more seriously and treat it with more concern.
d. The level of anxiety described should allow for a positive outcome.
ANS: D
Moderate anxiety provides focus, alertness, and a narrowed perception. It also allows the individual to engage in competitive activity and learn new skills through feelings of readiness and being energized.

DIF: Cognitive Level: Knowledge REF: p. 203 OBJ: 1
TOP: Continuum of Anxiety Responses KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

19. A 6-year-old is preparing to have a dental procedure. His anxious mother is in the room with him. When the child asks if everything will be okay, she assures him it will, but continues to pace and wring her hands. What is the most appropriate action for the dentist to take?
a. Give the mother a seat near the child and continue to assure the mother.
b. Request that the mother wait in the waiting room.
c. Allow the mother to verbalize what her concerns are.
d. Tell the child to ignore his mother.
ANS: B
Children learn to cope with anxiety by imitating and learning from others. In this case, the mother is demonstrating emotional/behavioral manifestations of anxiety. Allowing the mother to remain in the room in her current emotional state, or allowing her to verbalize, provides the child with reinforcement of the behavior.

DIF: Cognitive Level: Knowledge REF: p. 207 OBJ: 1
TOP: Continuum of Anxiety Responses KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

20. The nurse is meeting with a client suffering from agoraphobia who recently moved to the United States from a country where acts of violence and civil unrest are common. The theoretical model that links anxiety to the uncontrollable events the client experienced in his previous country is the ________ model.
a. Behavioral
b. Interpersonal
c. Environmental
d. Psychodynamic
ANS: C
The environmental model ties anxiety with uncontrollable events or situations such as fires, floods, and assaults and human-induced traumas. The behavioral model considers anxiety a learned response, the interpersonal model explains anxiety in terms of interactions with others, and the psychodynamic model states anxiety is a result of conflict between the ego and the id.

DIF: Cognitive Level: Knowledge REF: p. 206 OBJ: 1
TOP: Theories Relating to Anxiety KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

21. Which statements best describe an anxiety disorder? (Select all that apply.)
a. Anxiety is expressed in ineffective ways.
b. Coping mechanisms are used to deal with anxiety.
c. Coping mechanisms do not relieve anxiety.
d. Defense mechanisms are used occasionally.
ANS: A, C
Maladaptive coping mechanisms do not relieve stress, which constitutes an anxiety disorder. Using coping mechanisms to deal with anxiety and using defense mechanisms occasionally are effective ways of dealing with anxiety.

DIF: Cognitive Level: Comprehension REF: p. 208 OBJ: 4
TOP: Anxiety Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

22. Which symptoms may be seen in a person who is having a panic attack? (Select all that apply.)
a. Shortness of breath
b. Fear of dying
c. Recurrent persistent thoughts
d. Palpitations
e. Chills
f. Feelings of depersonalization
ANS: A, B, D, E, F
A person is considered to be having a panic attack if he or she is experiencing intense fear or discomfort that happens suddenly and peaks within 10 minutes. There are 13 possible symptoms, and the diagnosis is made if the client experiences 4 of the 13.

DIF: Cognitive Level: Knowledge REF: p. 209 OBJ: 4
TOP: Panic Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

23. Which of the following activities are examples of addictive behaviors? (Select all that apply.)
a. Gambling
b. Shopping
c. Working
d. Excessive sexual activity
e. Flashbacks
f. Coping
ANS: A, B, C, D
Obsessive-compulsive activities may take the form of certain addictive behaviors such as gambling, shopping, working, or engaging in excessive sexual activity. Flashbacks are vivid recollections of a traumatic event. Coping is not an addictive behavior.

DIF: Cognitive Level: Knowledge REF: p. 210 OBJ: 5
TOP: Behavioral Addictions KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

24. __________ refers to a vague, uneasy feeling of uncertainty and helplessness.

ANS:
Anxiety
This is an emotion that is felt in response to a real or imagined threat or stressor.

DIF: Cognitive Level: Knowledge REF: p. 202 OBJ: 1
TOP: Continuum of Anxiety Responses KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

25. When an individual uses psychological strategies to cope with stressors in an attempt to decrease anxiety, this person is using a __________.

ANS:
defense mechanism
Most defense mechanisms, also called ego mechanisms, are used by most people at some time. Defense mechanisms are not a problem unless they become the only coping skills used by an individual.

DIF: Cognitive Level: Knowledge REF: p. 204 OBJ: 2
TOP: Defense Mechanisms KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

26. __________ is a defense mechanism that is characterized by redirecting ones energy to another person or object.

ANS:
Displacement
An example of this defense mechanism is the teenager who has had a fight with her boyfriend and becomes angry and shouts at her mother for no justified reason.

DIF: Cognitive Level: Knowledge REF: p. 204 OBJ: 2
TOP: Defense Mechanisms KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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