Chapter 15: Anxiety and Obsessive-Compulsive Disorders

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first?

a. Verify the patient’s learning style.

b. Lower the patient’s current anxiety.

c. Create outcomes and a teaching plan.

d. Assess how the patient uses defense mechanisms.

ANS: B

A patient experiencing severe anxiety has a markedly 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. Use of defense mechanisms does not apply.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 15-4, 5, 64 (Table 15-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Social anxiety disorder b. Body dysmorphic disorder c. Separation anxiety disorder d. Obsessive-compulsive disorder due to a medical condition

2. A woman is 5'7", 160 lbs. and wears a size 8 shoe. She says, “My feet are huge. I’ve asked three orthopedists to surgically reduce my feet.” This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely?

ANS: B

Body dysmorphic disorder refers to a preoccupation with an imagined defect in appearance in a normal-appearing person. The patient’s feet are proportional to the rest of the body. In obsessive-compulsive or related disorder due to a medical condition, the individual’s symptoms of obsessions and compulsions are a direct physiological result of a medical condition. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others. People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 15-28, 29 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

3. A patient experiencing moderate anxiety says, “I feel undone.” An appropriate response for the nurse would be: a. “What would you like me to do to help you?” b. “Why do you suppose you are feeling anxious?” c. “I’m not sure I understand. Give me an example.” d. “You must get your feelings under control before we can continue.”

ANS: C

Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarifying helps the patient identify thoughts and feelings. Asking the patient why he or she feels anxious is nontherapeutic; the patient likely does not have an answer. The patient may be unable to determine what he or she would like the nurse to do in order to help. Telling the patient to get his or her feelings under control is a directive the patient is probably unable to accomplish.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 15-39, 40, 83 (Table 15-9) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

4. A patient fearfully runs from chair to chair crying, “They’re coming! They’re coming!” The patient does not follow the staff’s directions or respond to verbal interventions. The initial nursing intervention of highest priority is to a. provide for the patient’s safety. b. encourage clarification of feelings. c. respect the patient’s personal space. d. offer an outlet for the patient’s energy.

ANS: A

Safety is of highest priority because the patient experiencing panic is at high risk for self-injury related to increased non-goal-directed motor activity, distorted perceptions, and disordered thoughts. Offering an outlet for the patient’s energy can occur when the current panic level subsides. Respecting the patient’s personal space is a lower priority than safety. Clarification of feelings cannot take place until the level of anxiety is lowered.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 15-18, 40, 72 (Table 15-4) TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. Fear b. Risk for injury c. Self-care deficit d. Disturbed thought processes

5. A patient fearfully runs from chair to chair crying, “They’re coming! They’re coming!” The patient does not follow the staff’s directions or respond to verbal interventions. Which nursing diagnosis has the highest priority?

ANS: B