Nokea
While caring for an older adult client, the nurse notices the client is exhibiting increased episodes of forgetfulness, restlessness, and anxiety. Which assessment data is most significant for this client?
- A. Age at retirement
- B. Hobbies and activities
- C. Recent loss of spouse
- D. Ability to care for own ADLs
Correct Answer: C
Rationale: Determining the client has suffered the recent loss of spouse may be the cause of increased anxiety.Anxiety may manifest in the older adult as confusion or change in behavior. Loss in functioning and ability to care for own ADLs can also bring about added anxiety and concern. Age at time of retirement is not significant. Involvement in activities and hobbies can help determine the coping used to deal with stress.
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Which is the primary effect of central-acting sympatholytics in a client who exhibits hypertension and anxiety?
- A. Vasoconstriction and reduction of blood pressure and heart rate
- B. Central-acting sympatholytics induce sedation and fatigue
- C. Affects kidneys and reduces activity of renin
- D. Block receptors for norepinephrine in the brain
Correct Answer: D
Rationale: Central-acting sympatholytics block alpha-2 receptors for norepinephrine in the brain stem. Consequently, heart rate and blood pressure are reduced, which adds to the beneficial effects in anxious clients with hypertension. Vasoconstriction will result in higher blood pressure. Central-acting sympatholytics may induce sedation and reduce renin activity in the kidneys but this is not the primary effect.
Clients with obsessive-compulsive disorder (OCD) may exhibit what sign or symptom?
- A. Fear of situations in which they may capture the attention of others
- B. Delayed anxiety response
- C. Psychic numbing
- D. Performing ritualistic behaviors
Correct Answer: D
Rationale: Clients with OCD may feel compelled to perform the same act repeatedly for a specific number of times or in a prescribed sequence and acknowledge performing ritualistic behaviors. Persons with social phobia experience fear of situations in which they may capture the attention of others. Post-traumatic stress disorder (PTSD) is a condition that involves a delayed anxiety response. Initially, the affected person avoids dealing with the tragedy and detaches from others using a technique that is referred to as psychic numbing.
To develop a therapeutic relationship with an anxious client, the nurse looks for ways to build trust. What nursing intervention is most likely to help the nurse gain the client's trust?
- A. Leaving the client alone during a new experience.
- B. Giving support in nonverbal ways.
- C. Being available and attentive to the client's requirements.
- D. Giving detailed explanations and do not repeat them frequently.
Correct Answer: C
Rationale: Building trust is especially critical to developing a therapeutic relationship with an anxious client. Being available and attentive to the client's requirements contributes to this trust. The nurse should not leave an anxious client alone, especially during a new or potentially frightening experience. To manage an anxious client's restricted attention and concentration, directions or explanations must be simple, brief, and repeated frequently to implement adjusting teaching.
The client recounts to the nurse an instance of jumping onto the hood of a car to avoid an approaching dog, and reports feeling embarrassed by this reaction. The client discloses suffering from a severe dog bite in childhood. The nurse classifies this symptom as which of the following?
- A. Generalized anxiety
- B. Panic disorder
- C. Phobic disorder
- D. Post-traumatic stress disorder
Correct Answer: C
Rationale: Phobic disorders are those conditions in which a person manifests an exaggerated fear. When a person with a phobic disorder is exposed to the fear-causing stimuli, the symptom of anxiety can reach panic levels. Generalized anxiety is related to chronic worrying. Panic disorder can lead to intense fear that precipitates escaping to a safer place but is less specific to phobic disorder in this case. PTSD is not indicated.
Which level of anxiety is constructive and prepares a person to take action in appropriate situations?
- A. Moderate
- B. Severe
- C. Mild
- D. Panic
Correct Answer: C
Rationale: Mild anxiety is constructive and prepares a person to take action in appropriate situations. In moderate anxiety, the person is more easily distracted. The attention span decreases in severe anxiety. In panic anxiety, the person exaggerates details.