Nokea
A nurse wishes to teach alternative coping strategies to a patient experiencing severe anxiety. The nurse will first need to:
- A. verify the patient's learning style.
- B. create outcomes and a teaching plan.
- C. lower the patient's current anxiety level.
- D. assess how the patient uses defense mechanisms.
Correct Answer: C
Rationale: A patient experiencing severe anxiety has a significantly 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. Using defense mechanisms does not apply.
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Two staff nurses applied for promotion to nurse manager. Initially, the nurse not promoted had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse's response?
- A. Altruism
- B. Sublimation
- C. Suppression
- D. Passive aggression
Correct Answer: A
Rationale: Altruism is the mechanism by which an individual deals with emotional conflict by meeting the needs of others and vicariously receiving gratification from the responses of others. The nurse's reaction is conscious, not unconscious. No evidence of aggression is exhibited, and no evidence of conscious denial of the situation exists. Passive aggression occurs when an individual deals with emotional conflict by indirectly and unassertively expressing aggression toward others.
A patient reports having a fear of public speaking. The nurse should be aware that social anxiety disorders (social phobias) are often treated with which type of medication?
- A. Beta blockers
- B. Antipsychotic medications
- C. Tricyclic antidepressant agents
- D. Monoamine oxidase inhibitors
Correct Answer: A
Rationale: Beta blockers, such as propranolol, are often effective in preventing symptoms of anxiety associated with social phobias. Neuroleptic medications are major tranquilizers and not useful in treating social phobias. Tricyclic antidepressants are rarely used because of their side effect profile. MAOIs are administered for depression and only by individuals who can observe the special diet required.
For a patient experiencing panic, which nursing intervention should be implemented first?
- A. Teaching relaxation techniques
- B. Administering an anxiolytic medication
- C. Providing calm, brief, directive communication
- D. Gathering a show of force in preparation for gaining physical control
Correct Answer: C
Rationale: Calm, brief, directive verbal interaction can help the patient gain control of the overwhelming feelings and impulses related to anxiety. Patients experiencing panic-level anxiety are unable to focus on reality; thus, learning relaxation techniques is virtually impossible. Administering an anxiolytic medication should be considered if providing calm, brief, directive communication is ineffective. Although the patient is disorganized, violence may not be imminent, ruling out the intervention of preparing for physical control until other, less-restrictive measures are proven ineffective.
A patient is undergoing diagnostic tests. The patient says, 'Nothing is wrong with me except a stubborn chest cold.' The spouse reports that the patient smokes, coughs daily, has recently lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?
- A. Displacement
- B. Regression
- C. Projection
- D. Denial
Correct Answer: D
Rationale: Denial is an unconscious blocking of threatening or painful information or feelings. Regression involves using behaviors appropriate at an earlier stage of psychosexual development. Displacement shifts feelings to a more neutral person or object. Projection attributes one's own unacceptable thoughts or feelings to another.
A person who has been unable to leave home for more than a week because of severe anxiety says, 'I know it does not make sense, but I just can't bring myself to leave my apartment alone.' Which nursing intervention is appropriate when implementing cognitive restructuring?
- A. Teach the person to use positive self-talk.
- B. Assist the person to apply for disability benefits.
- C. Ask the person to explain why the fear is so disabling.
- D. Advise the person to accept the situation and use a companion.
Correct Answer: A
Rationale: This intervention, a form of cognitive restructuring, replaces negative thoughts such as 'I can't leave my apartment' with positive thoughts such as 'I can control my anxiety.' This technique helps the patient gain mastery over the symptoms. The other options reinforce the sick role.