Mh Test 3 cH12 part 2

wipimebe's version from 2015-10-06 21:37


21. Agoraphobia is broadly defined in the DSM-IV-TR as fear of:


a. any setting from which there is trouble escaping
b. open fields and forests
c. being home alone and dying by oneself
d. panic attacks and related symptoms


The DSM-IV-TR broadly defines agoraphobia as fear of any setting from which


22. The link between agoraphobia and panic disorder is:


a. strong
b. moderate
c. weak
d. nonexistent


The link between agoraphobia a panic disorder is strong. In some studies, 95% of individuals with agoraphobia also have panic disorder, and up to half of all individuals with panic disorder also suffer from agoraphobia.


23. Clients with the diagnosis of agoraphobia who receive exposure therapy daily would be exposed to which of the following?


a. cold sheets in a cold bath
b. the room air while being completely undressed
c. special rays from a machine similar to an X-ray
d. the stimulus that brings on their symptoms


For simple phobias the evidence strongly supports the effectiveness of Òexposure therapy.Ó This form of therapy exposes the person experiencing phobia to the inciting factor under supervised conditions. The exposure is conducted under supervision of a trained therapist.


24. When you perform your nursing assessment on your medical acute-care client, she seems calm and relaxed. She readily discusses her medical condition and concerns and asks you questions. You refer her to discuss these issues in more depth with her provider. The next day you discover that she said, ÒI just couldnÕt open my mouth to say anything when the provider came in with all those medical students.Ó Your next intervention is MOST appropriately to:


a. do nothing, because the client will eventually get used to all the medical students and talk to the provider without further intervention on your part
b. refer the client for a psychiatric diagnostic workup
c. relieve the client of this chore by relaying the clientÕs questions and concerns to the provider
d. assess the client for social anxiety disorder


The most appropriate response would be to assess the client for social anxiety disorders. Social anxiety disorder is a disorder in which a person has a strong and irrational fear of social situations (often involving strangers). It is one of the most common anxiety disorders in the United States. In this case, the client has been able to talk to the nurse with whom she has established a rapport with. However, when a large number of people, most of whom she doesnÕt know, are present (the medical students), her anxiety manifests itself.


25. The obsessions in obsessive-compulsive disorder refer to:


a. dreams, nightmares, or ÒflashbacksÓ
b. words, phrases, or idiomatic expressions
c. thoughts, images, or impulses
d. objects, food, or famous people


Obsessions in obsessive-compulsive disorder are recurrent thoughts, images, or impulses that are experienced as intrusive and inappropriate. The obsessions cause marked anxiety or distress, which is only relieved be performing a compulsive act.


26. Compulsions are BEST defined as:


a. extreme nausea that persists over time
b. wanting something that you cannot have
c. repetitive behaviors or mental acts
d. not liking anything or anyone


Compulsions are repetitive behaviors or acts. The compulsions serve as a method of reducing the anxiety that the person experiences from the obsessive thoughts.


27. You are discussing the incidence of obsessive-compulsive disorder (OCD) with a client. You would teach the client that OCD:


a. is extremely rare
b. seldom occurs in women
c. occurs as commonly as diabetes and asthma
d. occurs only among alcoholics and drug abusers


Obsessive-compulsive disorder is said to occur about as commonly as diabetes and asthma, and yet clients frequently hide their symptoms from family and health care providers. Most cases of this disorder begin in quite young individuals, often during young adulthood or before.


28. Your home health client insists that you place four sheets of newspaper beneath your nursing bag and that all wound-care dressing supplies be returned to their special box in a specific order after being counted three times. You suspect that the client suffers from a particular anxiety disorder. You ask the client a series of questions to determine if subjective thoughts and feelings correspond to your observations. These questions would MOST likely include which of the following?


a. Are there certain objects that you find frightening or intensely bothersome to the point that you go out of your way to avoid seeing or being near them?Ó
b. Do you find yourself troubled by unwanted, persistent, or recurrent thoughts that you canÕt easily stop thinking about?Ó
c. Have you ever felt trapped or very uncomfortable in a public place by yourself?Ó
d. Do you have recurring nightmares about a very traumatic event such as a fire, flood, or severe car accident?Ó


To determine if a subjectÕs feelings correspond to the nurseÕs observations, the nurse would ask the client if he or she is experiencing unwanted, persistent, or recurrent thoughts that cannot be controlled. This would indicate that the client is experiencing obsessive thinking.


REF: Anxiety Disorders| Obsessive-Compulsive Disorder| Epidemiology


29. In working with persons who have a diagnosis of post-traumatic stress disorder (PTSD), you would MOST often find that they experience which of the following signs or symptoms?


a. a sense that nothing can hurt them
b. recurring memories, dreams, or flashbacks of the event
c. total amnesia and fugue states
d. a loss of inhibition and judgment


Clients with post-traumatic stress disorder reexperience the traumatic event through recurrent recollections, dreams, or hallucinatory-like flashbacks. Additionally, the client may exhibit impairment of social functioning, the presence of specific anxiety symptoms, and Òpersistent avoidance of stimuli associated with the trauma and numbing of general responsiveness.Ó


30. In comparison to people with very little trait anxiety, you would expect clients with high levels of trait anxiety to:


a. have developed adaptive defense mechanisms that make developing anxiety disorders less likely
b. deny feeling anxious while continuing to evidence physiologic anxiety
c. appraise anxiety-inducing events as being low in perceived adversity
d. admit to feeling more anxious than those with low trait anxiety


The expectation would be that clients with high levels of trait anxiety would most likely admit to feeling more anxious than those with low trait anxiety. Trait anxiety is a concept based on the observation that some individuals seem to experience higher levels of anxiety than others. Trait anxiety is often combined with the concept of adversity, which is a measure of how strong of a stimulus for anxiety a given event is. Together these two concepts form a model for perceived anxiety.


31. You are called in to the emergency department as the nurse for the psychiatric emergency team to evaluate a client. Your assessment reveals that 3 months ago the client watched several TV news reports about a local disaster involving the drowning of several children while on a camping trip, as well as heard numerous radio reports and discussions, read several articles with pictures in the local newspaper, and overheard others at work discuss the incident. Earlier today, the client went swimming at the local community pool. Your nursing assessment is correctly guided by the knowledge that for psychologically traumatized clients:


a. psychological distress is not limited to only those directly involved in a traumatic event
b. PTSD involves voluntarily obsessing with the event and symbolically reenacting the event for others
c. the psychological distress indicates guilty involvement in the event in some way
d. only clients with a preexisting mental disorder will develop PTSD


Individuals may be psychologically traumatized even though they may not be directly involved with a traumatic event. Research data has shown that the consequences of large-scale trauma may extend into the general population because individuals are exposed to the event via mass media such as radio, television, or newspapers.


32. Psychological treatments for anxiety disorders, such as psychoanalysis, cognitive behavioral therapy, relaxation training, and exposure therapy, all assist the client with anxiety disorder to:


a. develop insight into the deep psychological causes of anxiety disorders
b. learn to identify common stimuli of anxiety or fear responses
c. learn to tolerate and live with ongoing high levels of anxiety or fear
d. learn ways to avoid or minimize exposure to known anxiety or fear stimuli


Psychological treatments for anxiety disorders focus on assisting the client to learn to identify common stimuli of anxiety or fear responses. Treatment can help the client to develop plans to respond to those stimuli with nonanxious responses and problem solve when unanticipated anxiety-provoking situations arise.


33. Brief emergency intervention for acute psychological trauma can result in all EXCEPT which of the following?


a. prevention of development of post-traumatic stress disorder
b. a paradoxically higher incidence of post-traumatic stress symptoms
c. social stigmatization as permanently traumatized
d. reframing of cognitive appraisal from helpless to no longer helpless


Brief emergency intervention for acute psychological trauma does not result in social stigmatization as permanently traumatized. The intention, and in some cases the result, is to prevent the development of PTSD. When a support system is in place for the client to include education regarding PTSD, stress management advice, advice about seeking further treatment, and a telephone helpline, oftentimes additional treatment sessions are unneeded. However, when the session is limited to a single ÒdebriefingÓ after the traumatic event, it is not only unhelpful, but may increase the incidence of PTSD.


34. A client asks about how various medications are prescribed to treat anxiety disorders. You base your reply on which of the following statements?


a. Benzodiazepines are the treatment of choice for short-term management of acute anxiety.
b. Selective serotonin reuptake inhibitor antidepressants are used primarily for acute management of panic attacks.
c. Beta blockers are usually prescribed on a regularly scheduled daily basis for long-term to manage generalized anxiety disorder.
d. Buspirone is the medication of choice to treat obsessive-compulsive disorder.


Benzodiazepines have established short-term effectiveness in the control of anxiety symptoms. They are the treatment of choice for acute episodes of anxiety, such as during crises.


35. Your client has a degree in accounting and worked as an accountant prior to getting married and having children. She has recently been widowed and is now a single parent who has to return to the workforce after 15 years as a mother and housewife. She is diagnosed with generalized anxiety disorder. Autonomous generalist nursing interventions MOST appropriate for her would include:


a. conducting individual psychotherapy
b. administering antianxiety medications prn
c. teaching her about her newly prescribed antianxiety medications
d. conducting exposure therapy


Teaching the client about her antianxiety medications would be an important part of an autonomous generalist nursing intervention. In addition, the nurse could also assess the level of anxiety and the degree of interference with normal nursing activities. Teaching skills of cognitive restructuring and initiating supportive therapy are also options for the nurse.


36. A client suffering from an extremely severe form of obsessive-compulsive disorder (OCD) wants to know whether the physician-recommended neurosurgical procedure is likely to help alleviate his symptoms. The nurse should inform him that:


a. the procedure has a very low likelihood of success, but is the client's last hope
b. although used in less than 0.5% of OCD cases, the results have proven to be extremely positive, with the majority of clients experiencing no further symptoms and the rest being significantly improved
c. due to the procedureÕs high rate of success, it has become one of the preferred methods of treating OCD of all levels of severity
d. the client should trust the physicianÕs judgment and learn not to question the recommendations of medical professionals


Neurosurgical treatment is extremely rare for cases of obsessive-compulsive disorder. Such treatment is typically reserved for only the most severe cases of the disease. The surgery involves making a series of lesions to interrupt the efferent tracks from the frontal cortex to the limbic and basal ganglia structures. In a recent study 65% of people who underwent this procedure were completely symptom free of obsessive-compulsive disorder, with no further need for treatment.


37. The nurse is developing a treatment plan for a client with a specific phobia. The nurse understands that the BEST treatment is usually:


a. behavioral therapy
b. a neurological surgery procedure
c. large doses of various medications
d. there is no known effective treatment for specific phobias


Behavior therapy has been shown to be the best treatment of specific phobias. In particular, some form of controlled exposure therapy has proven to be very effective. Medications, unless being used to treat a related illness such as depression, have not been conclusively shown to be effective.