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MH TEST 3 ch 12 part 1

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wipimebe's version from 2015-10-06 21:36

Section

1. Mark sees a snake while raking leaves in his yard. He immediately feels his heart start pounding rapidly, feels his hair Òstand on end,Ó and breaks into a sweat. The aspect of MarkÕs reaction that distinguishes anxiety from fear is that in MarkÕs case the response is:

 

a. anxiety triggered by sustained physical exertion
b. fear triggered by an attempt to go outside into a public place
c. anxiety triggered by reexperiencing a previously frightening event
d. fear triggered by a known, specific object or event

 

ANS: D
MarkÕs response is an example of fear because it is triggered by a known, specific object, the snake. His autonomic responses of the pounding heart and his hairs standing on end are directly related to the sight of the snake. A person experiencing anxiety would have a sense of dread without having a specific source or reason for the emotion.

 

2. When a person is made anxious during positron emission tomography (PET) scanning, what changes in brain functioning can be found on the PET scan?

 

a. decreased blood flow to all parts of the cortex
b. increased blood flow to the limbic system
c. stasis of blood flow through the midbrain
d. no change in blood flow, only in electrical activity

 

ANS: B
A PET scanner can identify and precisely localize rapid changes in blood flow that occur as the result of various mental and emotional stimuli. When susceptible persons are made anxious during PET scanning, blood flow increases significantly both in the limbic system and in several specific areas of the cerebral cortex.

 

3. Which of the following produces the MOST striking physical manifestations of anxiety?

 

a. inhibition of the pituitary
b. limbic connections to the autonomic nervous system
c. understimulation of the singular gyrus
d. temporal lobe activities

 

ANS: B
Limbic connections to the autonomic nervous system produces the most striking physical manifestations of anxiety. These changes include heart rate changes, pallor, sweating, and hair Òstanding on end.Ó Other responses directly patterned by connections from the limbic area to affected muscles (including crouching, yawning, and raising arms) are also part of the fear pattern.

 

4. What are the MOST striking physical manifestations of anxiety that a nurse might expect to find when assessing a client with anxiety?

 

a. heart rate changes, pallor, sweating, hair standing on end
b. chills, fever, diarrhea, flushing
c. paresthesias, dry mouth, nasal congestion, headaches
d. confusion, agitation, syncope, depressed blood systolic pressure

 

ANS: A
The most striking physical manifestations that the nurse might expect to find when assessing an anxious client include heart rate changes, pallor, sweating, and hair standing on end. Other responses that the nurse might assess include crouching, yawning, and raising arms.

 

5. The manifestation of anxiety can BEST be described as:

 

a. culturally idiosyncratic
b. distortions of reality
c. happening mostly during adulthood
d. occurring along a continuum

 

ANS: D
Manifestations of anxiety occur along a continuum. The levels of anxiety include mild anxiety, moderate anxiety, severe anxiety, and panic.

 

6. When you are trying to learn something and you have mild anxiety, you will:

 

a. need to postpone learning until you have no anxiety
b. be so anxious that you cannot learn at all
c. have an alert perceptual field and can learn
d. need to find some way to relax

 

ANS: C
In mild anxiety, the person experiences day-to-day tensions and is alert. Learning can occur because the individual is alert and the perceptual field increases.

 

7. You are assigned to teach your client how to give his or her own insulin. You assess the clientÕs level or stage of anxiety. At what stage of anxiety will your client BEST pay attention to your instructions?

 

a. mild
b. moderate
c. severe
d. panic

 

ANS: A
The client will best pay attention to instructions if the client is experiencing mild anxiety. With mild anxiety, the client is alert and there is an increase in the perceptual field.

 

8. According to the DSM-IV-TR, anxiety is considered excessive when it:

 

a. occurs more than once a day
b. is present more days than not for a period of 6 months or more
c. causes the person to change his or her plans one or more times per week
d. results in a person staying at home

 

ANS: B
According to the DSM-IV-TR, anxiety is considered excessive when it is present more days than not for a period of 6 months or more. Anxiety over this long period of time will begin to interfere with the individuals ability to function appropriately.

 

9. You are working with an anxious client who states that she is experiencing terror and feeling a loss of control, and you find that her thoughts are disorganized as reflected in her speech. Your assessment is that this client is at which one of the following levels of anxiety?

 

a. mild
b. moderate
c. severe
d. panic

 

ANS: D
In a panic state, the person has feelings of dread or terror and is unable to control her behavior. The individual will experience a sense of awe. She will lose control and become disorganized.

 

10. You are assigned to work with a client who has selective inattention, is focused on immediate concerns, and has a narrowed perceptual field. Identify the level of anxiety that BEST reflects your clientÕs level of anxiety.

 

a. mild
b. moderate
c. severe
d. panic

 

ANS: B
In moderate anxiety, the person focuses only on the immediate concerns. The perceptual field is narrowed and the individual exhibits selective inattention.

 

11. You are ready to give your first injection to a client. You are worried about drawing the insulin up correctly. Your instructor asks you a question. You do not answer, so the instructor speaks louder to repeat the question. You look up, apologize, and state, ÒI didnÕt hear what you said!Ó In thinking about this, you recognize that you had which of the following levels of anxiety?

 

a. mild
b. moderate
c. severe
d. panic

 

ANS: B
You are experiencing moderate anxiety as demonstrated by your selective inattention. Your perceptual field has narrowed causing you to be unable to focus on what the instructor is saying to you.

 

12. When you make a distinction between anxiety in health and anxiety in illness, you find that anxiety is classified as an anxiety disorder (an illness) when it is of such a degree of severity that it:

 

a. causes the individual to be unable to participate in usual activities
b. requires immediate hospitalization
c. interferes with the ability to function in everyday life
d. all of the above

 

ANS: D
Anxiety in illness is demonstrated as an anxiety disorder. There are fourteen subtypes that have been identified. Six of these are particularly important, distinct, and common. These anxiety disorders cause the individual to be unable to participate in usual activities. They require immediate hospitalization, because they interfere with the ability to function in everyday life.

 

13. The MOST common phobia is thought to be which of the following types of phobias?

 

a. agoraphobia
b. arachnophobia
c. obsessive-compulsive disorder
d. social anxiety disorder

 

ANS: D
Social anxiety disorder may be the most common phobia, with lifetime incid

 

14. You are a psychiatric nurse clinical specialist working with a client who has been diagnosed as having social anxiety disorder. Your nursing care plan appropriately includes providing therapy that will assist the client to change his responses to:

 

a. being in situations where the client is alone
b. speaking or performing in public, meeting new people, or taking tests
c. being surrounded by other people in crowded places
d. having to shake hands and be exposed to othersÕ germs

 

ANS: B
The client experiencing a social anxiety disorder is suffering from a social phobia. This type of phobia is a profound fear of public speaking. The nursing care plan would focus on social skills training and exposure to social situations. Interventions would be directed at assisting the client with developing skills with speaking or performing in public, meeting new people, or taking tests.

 

15. You are working with a client who tells you that she periodically awakes at night and recalls dreaming about her experience of sexual abuse. She talks about flashbacks in which she visualizes the abuse and even smells the aftershave of her abuser. She also is having difficulties associating with friends and is isolating. She complains of feeling numb inside. This client is likely suffering from which of the following?

 

a. panic disorder
b. phobia
c. post-traumatic stress disorder
d. obsessive-compulsive disorder

 

ANS: C
The client is most likely suffering from a post-traumatic stress disorder. Individuals with this disorder have been exposed to an event that threatened the personÕs physical integrity. In this situation, the experience of sexual abuse was seen as a threat to the clientÕs physical integrity. Flashbacks are often experiences when the individual suffers from this disorder.

 

16. You are assessing a client who tells you that he is not getting much sleep at night because he checks the door to see if it is locked up to 300 times before he finally goes to bed. This checking and rechecking of the lock on the door also occurs before he leaves the house for any length of time. This client MOST likely is suffering from which of the following disorders?

 

a. panic disorder
b. phobia
c. post-traumatic stress disorder
d. obsessive-compulsive disorder

 

ANS: D
The client is most likely suffering from an obsessive-compulsive disorder. The act of checking the door to see if it is locked up to 300 times before he goes to bed is considered the compulsive act. Compulsive act are an attempt to reduce anxiety related to some obsessive thought.

 

17. A hallmark of several anxiety disorders, including generalized anxiety disorder, phobias, agoraphobia, and obsessive-compulsive disorder, is that people with these disorders:

 

a. believe that they are ÒnormalÓ in every way and that they do not need treatment
b. do not present with visible objective signs of distress
c. choose to engage in disorder behaviors to get out of social obligations
d. recognize that their symptoms are out of proportion to any real threat

 

ANS: D
The majority of anxious people can identify one or more factors that bring on their anxiety responses. Most of these persons recognize that their feelings of anxiety are far out of proportion to any real dangers, but they are unable to control the anxiety they feel. Both fear and anxiety are common and have likely been part of the human experience for thousands of years.

 

18. People correctly diagnosed with panic disorder can expect to:

 

a. be able to control the physiologic changes and sensations during the attacks
b. experience advance warning ÒauraÓ symptoms prior to an attack
c. experience little or no residual anxiety between attacks
d. not experience very much psychological distress during the attacks

 

ANS: C
Most persons who experience panic attacks have little or residual anxiety between attacks. In some individuals, the panic attacks are reproducibly provoked by exposure to certain stimuli (e.g., seeing a snake). In others, they may appear out of the blue or be most likely to occur in specific settings (such as the dentistÕs office).

 

19. Panic disorder is MOST common in which of the following groups?

 

a. children and preteens
b. adolescents and young adults
c. middle-aged adults
d. the elderly

 

ANS: B
Panic disorder tends to occur in relatively young persons, with onset common sometime between adolescence and the mid-30s. There is a significant correlation between panic disorder and substance abuse. In many cases, the abuse problem may occur because the individuals with panic disorder treat their symptoms with alcohol or other substances. There is also a possible genetic component to panic disorder in that persons are more likely to develop the disorder if their identical twin also has it. There is also a significant increased risk for panic disorder in children of individuals with the condition.

 

20. Client A lives alone and has become room-bound in her bedroom, which is the only place she feels calm and relaxed. She experiences extreme panic if circumstances force her to leave her room. Client B experiences extreme panic when alone and insists on accompanying family members on their errands to avoid staying at home alone. He feels calm and relaxed while he is out with family. Your nursing care interventions for these two clients are correctly based on what knowledge?

 

a. Both clients are manifesting the same disorder based on fear of becoming helpless and incurring a panic attack.
b. Client A is manifesting a disorder based on unreasonable fear of specific objects, while Client B is manifesting a disorder based on feeling an overwhelming need to perform ritualistic behaviors.
c. Neither client is manifesting an anxiety disorder, as each is choosing his or her behavior within the range of normalcy.
d. Client A is manifesting agoraphobia, but Client B is manifesting generalized anxiety. disorder.

 

ANS: A
Nursing interventions would be based on the fact that both clients are manifesting the same disorder based on fear of becoming helpless and incurring a panic attack. Client AÕs panic is related to the anxiety of being in public places, while client BÕs panic is related to being alone.