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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 that a house fire is not likely. This counseling demonstrates the principles of which cognitive-based therapy?
- A. Flooding
- B. Desensitization
- C. Controlled relaxation
- D. Thought restructuring
Correct Answer: D
Rationale: Cognitive restructuring involves the patient in testing automatic thoughts and drawing new conclusions. Desensitization involves a graduated exposure to a feared object. Relaxation training teaches the patient to produce the effects of calmness. Flooding exposes the patient to a large number of undesirable stimuli in an effort to extinguish the anxiety response.
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Which assessment finding indicates that a patient with moderate-to-severe anxiety has successfully lowered the anxiety level to mild?
- A. Patient asks, 'What's the matter with me?'
- B. Patient stays in a room alone and paces rapidly.
- C. Patient successfully concentrates on what the nurse is saying.
- D. Patient states, 'I don't want anything to eat. My stomach is upset.'
Correct Answer: C
Rationale: The ability to concentrate and attend to reality is increased slightly in mild anxiety and decreased in moderate-, severe-, and panic-level anxiety. Patients with high levels of anxiety often ask, 'What's the matter with me?' Staying in a room alone and pacing suggest moderate anxiety. Expressing a lack of hunger is not necessarily a criterion for evaluating anxiety.
Which assessment questions are most relevant to ask a patient with possible obsessive-compulsive disorder?
- A. Have you been a victim of a crime or seen someone badly injured or killed?
- B. Are there certain social situations that cause you to feel especially uncomfortable?
- C. Do you have to do things in a certain way to feel comfortable?
- D. Is it difficult to keep certain thoughts out of awareness?
- E. Do you do certain things over and over again?
Correct Answer: C,D,E
Rationale: The correct questions refer to obsessive thinking and compulsive behaviors. The incorrect responses are more pertinent to a patient with suspected posttraumatic stress disorder or with suspected social anxiety disorder (social phobia).
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.
A student says, 'Before taking a test, I feel a heightened sense of awareness and restlessness.' What nursing intervention is most helpful for assisting the student?
- A. Explaining that the symptoms are the result of mild anxiety and discussing the helpful aspects
- B. Advising the student to discuss this experience with a health care provider
- C. Encouraging the student to begin antioxidant vitamin supplements
- D. Listening without comment
Correct Answer: A
Rationale: Teaching about the symptoms of anxiety, their relation to precipitating stressors, and, in this case, the positive effects of anxiety serves to reassure the patient. Advising the patient to discuss the experience with a health care provider implies that the patient has a serious problem. Listening without comment will do no harm but deprives the patient of health teaching. Antioxidant vitamin supplements are not useful in this scenario.
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.