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Which assessment question would be most appropriate for the nurse to ask a patient who is at risk for developing generalized anxiety disorder (GAD)?
- A. Have you been a victim of a crime or seen someone badly injured or killed?
- B. Do you feel especially uncomfortable in social situations involving people?
- C. Do you repeatedly do certain things over and over again?
- D. Do you find it difficult to control your worrying?
Correct Answer: D
Rationale: Patients with GAD frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event.
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A person who feels unattractive repeatedly says, 'Although I'm not beautiful, I am smart.' This is an example of which defense mechanism?
- A. Repression
- B. Devaluation
- C. Identification
- D. Compensation
Correct Answer: D
Rationale: Compensation is an unconscious process that allows an individual to make up for deficits in one area by excelling in another area to raise self-esteem. Repression unconsciously puts an idea, event, or feeling out of awareness. Identification is an unconscious mechanism calling for an imitation of the mannerisms or behaviors of another. Devaluation occurs when the individual attributes negative qualities to self or to others.
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.
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 supervisor assigns a worker a new project. The worker initially agrees but feels resentful. The next day, when asked about the project, the worker says, 'I've been working on other things.' When asked 4 hours later, the worker says, 'Someone else was using the copier, so I couldn't finish it.' The worker's behavior demonstrates the use of what mechanism?
- A. Acting out
- B. Projection
- C. Suppression
- D. Passive aggression
Correct Answer: D
Rationale: A passive-aggressive person deals with emotional conflict by indirectly expressing aggression toward others. Compliance on the surface masks covert resistance. Resistance is expressed through procrastination, inefficiency, and stubbornness in response to assigned tasks. Acting out refers to behavioral expression of conflict. Projection is a form of blaming. Suppression is the conscious denial of a disturbing situation or feeling.
A patient experiencing severe anxiety suddenly begins running and shouting, 'I'm going to explode!' The nurse should implement which intervention to best maximize the patient's safety?
- A. State, 'I'm not sure what you mean. Give me an example.'
- B. Chase after the patient while giving instructions to stop running.
- C. Retrain the patient in a basket-hold to increase feelings of control.
- D. Assemble several staff members and state, 'We will help you regain control.'
Correct Answer: D
Rationale: The safety needs of the patient and other patients are a priority. The patient is less likely to cause self-harm or hurt others when several staff members take responsibility for providing limits. The explanation given to the patient should be simple and neutral. Simply being told that others can help provide the control that has been lost may be sufficient to help the patient regain control. Running after the patient will increase the patient's anxiety. More than one staff member is needed to provide physical limits if they become necessary. Asking the patient to give an example is futile; a patient in panic processes information poorly.