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22. A student says, “Before taking a test, I feel very alert and a little restless.” Which nursing intervention is most appropriate to assist the student?

a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects.

b. Advise the student to discuss this experience with a health care provider.

c. Encourage the student to begin antioxidant vitamin supplements.

d. Listen attentively, using silence in a therapeutic way.

ANS: A

Teaching about symptoms of anxiety, their relation to precipitating stressors, and, in this case, the positive effects of anxiety will serve 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.

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

REF: Pages 15-4, 64 (Table 15-1) | Pages 15-39, 40 (Table 15-9)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. “I don’t know why I do mean things.” b. “I have always had poor impulse control.” c. “That person should not have provoked me.” d. “I’m really a coward who is afraid of being hurt.”

23. A cruel and abusive person often uses rationalization to explain the behavior. Which comment demonstrates use of this defense mechanism?

ANS: C

Rationalization consists of justifying one’s unacceptable behavior by developing explanations that satisfy the teller and attempt to satisfy the listener. The abuser is suggesting that the abuse is not his or her fault; it would not have occurred except for the provocation by the other person. The distracters indicate some measure of acceptance of responsibility for the behavior.

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

REF: Pages 15-12, 66 (Table 15-2) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Ask, “I’m not sure what you mean. Give me an example.” b. Capture the patient in a basket-hold to increase feelings of control. c. Tell the patient, “Stop running and take a deep breath. I will help you.” d. Assemble several staff members and say, “We will take you to seclusion to help you regain control.”

24. A patient experiencing panic suddenly began running and shouting, “I’m going to explode!” Select the nurse’s best action.

ANS: C

Safety needs of the patient and other patients are a priority. Comments to the patient should be simple, neutral, and give direction to help the patient regain control. Running after the patient will increase the patient’s anxiety. More than one staff member may be needed to provide physical limits, but using seclusion or physically restraining the patient prematurely is unjustified. Asking the patient to give an example would be futile; a patient in panic processes information poorly.

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

REF: Pages 15-6 (Case Study and Nursing Care Plan), 64 (Table 15-1), 72 (Table 15-4), 85 (Table 15-10) TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. Help the person use online video calls to provide interaction with others. b. Advise the person to accept the situation and use a companion. c. Ask the person to explain why the fear is so disabling. d. Teach the person to use positive self-talk techniques.

25. 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?

ANS: D

Positive self-talk, 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.

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

REF: Pages 15-51, 72 (Table 15-4) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. “I check where my car keys are eight times.” b. “My legs often feel weak and spastic.” c. “I’m embarrassed to go out in public.” d. “I keep reliving a car accident.”

26. A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder?

ANS: A

Recurring doubt (obsessive thinking) and the need to check (compulsive behavior) suggest obsessive-compulsive disorder. The repetitive behavior is designed to decrease anxiety but fails and must be repeated. Stating “My legs feel weak most of the time” is more in keeping with a somatic disorder. Being embarrassed to go out in public is associated with an avoidant personality disorder. Reliving a traumatic event is associated with posttraumatic stress disorder.

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

REF: Pages 15-25 to 27, 79 (Table 15-7)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment

27. When alprazolam is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to a. report drowsiness. b. eat a tyramine-free diet. c. avoid alcoholic beverages. d. adjust dose and frequency based on anxiety level.

ANS: C