Nokea
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.
You may also like to solve these questions
An individual experiencing sexual dysfunction blames it on their partner and suggests the person is both unattractive and unromantic. Which defense mechanism is evident?
- A. Rationalization
- B. Compensation
- C. Introjection
- D. Regression
Correct Answer: A
Rationale: Rationalization involves unconsciously making excuses for one's behavior, inadequacies, or feelings. Regression involves the unconscious use of a behavior from an earlier stage of emotional development. Compensation involves making up for deficits in one area by excelling in another area. Introjection is an unconscious, intense identification with another person.
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.
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.
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.