Chapter 27: Anxiety-Related, Obsessive-Compulsive, Trauma- and Stressor-Related, Somatic, and Dissociative Disorders Practice questions

Which intervention should the nurse use first when caring for a patient experiencing anxiety?
a. Assist the patient to problem solve.
b. Provide support and understanding.
c. Reorient the patient.
d. Provide privacy.
b. Provide support and understanding.

Patients with anxiety disorders experience discomfort from the anxiety. The patient must feel safe, acknowledged, and cared for before problem solving can begin. The nurse’s first priority is to provide support and understanding. Allowing the patient to remain alone fosters social withdrawal and may allow anxiety to increase. Patients with anxiety seldom lose contact with reality.

A patient diagnosed with obsessive-compulsive disorder (OCD) experiences improvement after beginning treatment with a selective serotonin reuptake inhibitor (SSRI). This phenomenon supports the theory that OCD is associated with:
a. norepinephrine deficiency.
b. serotonin dysregulation.
c. dopamine excess.
d. GABA deficiency.
b. serotonin dysregulation.

Serotonin dysregulation is hypothesized to play a part in OCD. Relief associated with SSRIs supports this hypothesis. The other theories are nonrelated.

A patient says, “I have the same continuous and intrusive thoughts that my house is contaminated with lethal bacteria. I spend hours cleaning the walls, floors, and furniture.” These symptoms are most consistent with which diagnosis?
a. Social phobia
b. Panic disorder
c. Somatoform disorder
d. OCD
d. OCD

The patient’s persistent intrusive thoughts are obsessions, and the need to continually clean is a compulsion. Hence, the patient’s disorder can be identified as OCD. The symptoms are not consistent with any of the other options.

A patient’s family member died in the 9/11 World Trade Center explosion. The patient says, “I can’t go into tall buildings because I get sweaty, my heart races, and I can’t breathe. I get terrifying feelings the building will explode.” These symptoms suggest which diagnosis?
a. OCD
b. Generalized anxiety disorder
c. Acute stress disorder
d. Specific phobia
d. Specific phobia

The patient has a severe and persistent fear of entering tall buildings. The extreme physical and emotional reactions are consistent with panic-level anxiety. The scenario does not suggest any of the other options as diagnoses.

When working with a patient diagnosed with dissociative amnesia, the nurse should begin by:
a. setting mutual goals for behavioral changes.
b. instituting measures to prevent identity diffusion.
c. identifying and supporting the patient’s strengths.
d. helping the patient develop a realistic self-concept.
c. identifying and supporting the patient’s strengths.

Strengths serve as the foundation for later therapeutic work to promote more adaptive coping, so identifying and supporting strengths is a fundamental initial intervention. The other options are useful but are not fundamental.

A patient diagnosed with OCD paces up and down the corridor counting every tile. Select the nurse’s best action.
a. Offer to play cards with the patient in the dayroom.
b. Ask the patient, “Why are you pacing and counting?”
c. Take the patient’s arm and escort the patient to a quiet area.
d. Permit the patient to pace and count until feeling more comfortable.
d. Permit the patient to pace and count until feeling more comfortable.

The performance of the pacing-counting ritual is decreasing the patient’s anxiety. Stopping her will increase anxiety. Rituals should be restricted only when they physically endanger the patient. The other options will not promote anxiety reduction

A driver was trapped in a car for several hours after an earthquake caused a bridge to collapse. A year later this person still has nightmares and reexperiences feelings of fear associated with being trapped in the car. The assessment findings are consistent with symptoms of:
a. agoraphobia.
b. panic attacks.
c. generalized anxiety disorder.
d. posttraumatic stress disorder (PTSD).
d. posttraumatic stress disorder (PTSD).

PTSD follows exposure to a traumatic event. Symptoms include those described in the scenario, as well as persistent symptoms of arousal and avoidance of stimuli associated with the traumatic event. The symptoms presented are inconsistent with the other options.

A patient is hospitalized with blindness of sudden onset. According to the spouse, the patient entered a room and found the spouse in a romantic embrace with a neighbor. The patient is unconcerned about the blindness and says, “I’m sure things will turn out all right.” Which term best describes this reaction?
a. La belle indifference
b. Agoraphobia
c. Dissociation
d. Fugue
a. La belle indifference

La belle indifference refers to an attitude of unconcern or indifference about a symptom when the symptom is unconsciously used to lower anxiety. The other options do not characterize the symptoms described.

Which principle best applies to care of a patient diagnosed with conversion disorder?
a. Structure care to provide time for rituals.
b. Facilitate progressive review of the trauma.
c. Give attention to the patient, not the symptom.
d. Permit dependence while the symptoms are acute.
c. Give attention to the patient, not the symptom.

Often, patients with conversion disorder think that their symptom makes them interesting and that they are not interesting as persons. The nurse should matter-of-factly accept the symptom without focusing on it and direct attention to the person as an individual. Two distracters refer to care of a patient with OCD and care of a patient with PTSD.

A patient with panic attacks awakens from sleep complaining of chest pain. The patient is diaphoretic and breathlessly says, “I feel like I’m going to die.” Select the nurse’s priority action.
a. Have the patient lie flat and relax.
b. Bring the crash cart to the patient’s room.
c. Shake the patient and shout, “Are you okay?”
d. Instruct the patient to breathe into a paper bag.
d. Instruct the patient to breathe into a paper bag.

Hyperventilation should be addressed immediately by having the patient breathe using a paper bag. Bringing breathing under control will help diminish the other symptoms. The calm presence of the nurse is vital to symptom reduction. The other interventions would not be effective in relieving the hyperventilation.

What is the nurse’s initial action when working with a patient with PTSD?
a. Develop trust.
b. Promote problem solving.
c. Encourage verbalization of anger.
d. Have the patient evaluate past behaviors.
a. Develop trust.

Patients with PTSD are often withdrawn and feel suspicious, detached, or estranged from others. Developing a trusting relationship might be difficult for them; however, the development of trust is fundamental to the therapeutic nurse-patient relationship. The other interventions will not be possible until a trusting relationship exists.

Which statement by an individual with PTSD best indicates that treatment was effective?
a. “I’m drinking less now that I’ve faced my problems.”
b. “I feel like the accident happened to someone else.”
c. “I sleep for 3 to 4 hours a night without nightmares.”
d. “My artwork distracts me and eases my anxiety.”
d. “My artwork distracts me and eases my anxiety.”

Treatment has been successful when an individual can use coping mechanisms to move forward and find meaning in the traumatic event. Continued use of drugs and alcohol is maladaptive. Continued sleep disturbances and insomnia as well as dissociation or depersonalization do not indicate that treatment was effective.

After a mass transit disaster many injured patients are expected at the emergency room. The nurse expects victims to have which assessment findings?
a. Dissociative symptoms, numbing, detachment, and derealization
b. Auditory hallucinations and other perceptual distortions
c. Physical symptoms that mimic neurologic disorders
d. Exaggerated mood (either depression or elation)
a. Dissociative symptoms, numbing, detachment, and derealization

Acute stress reactions are marked by dissociative symptoms such as numbing of emotional responsiveness, feelings of detachment, and decreased awareness of surroundings. The other options list behaviors that are atypical of acute stress reactions.

Which statement by a patient diagnosed with somatic symptom disorder indicates that goals for treatment are being achieved?
a. “I need to be very careful about what I eat.”
b. “I can focus on things other than my symptoms.”
c. “I understand that my doctor is not an expert in everything.”
d. “I try to figure out my diagnosis by reading articles on the Internet.”
b. “I can focus on things other than my symptoms.”

This statement suggests that the patient’s preoccupation with physical symptoms has decreased. The other options suggest ongoing concern with his or her physical state.

The nurse would expect which comment from a patient diagnosed with depersonalization disorder?
a. “I feel like I’m outside my body, watching what’s happening.”
b. “I feel as though someone is reading thoughts in my mind.”
c. “I know I have cancer, but the doctors can’t find it.”
d. “When I woke up, my legs were paralyzed.”
a. “I feel like I’m outside my body, watching what’s happening.”

In depersonalization, individuals feel detached from parts of their body or their mental processes. The distracters reflect somatization disorder, conversion disorder, and schizophrenia.

Which symptom would the nurse expect in a patient diagnosed with dissociative fugue?
a. Worry about having a serious disease
b. A feeling of detachment from one’s body
c. Belief that part of the body is ugly or disproportionate
d. Travel away from home and assumption of a new identity
d. Travel away from home and assumption of a new identity

Dissociative fugue involves unplanned travel away from one’s usual home and either confusion about identity or assumption of a new identity. The person does not seem to be wandering but behaves purposefully. The other options relate to body dysmorphic disorder, depersonalization disorder, and hypochondriasis.

A priority focus of milieu management for a patient diagnosed with dissociative identity disorder (DID) should be:
a. ensuring safety.
b. stimulating memory return.
c. insight-oriented group therapy.
d. gathering data about family relationships.
a. ensuring safety.

Patients with DID have a host personality and one or more alternates. It is not unusual for one of the alternate personalities to be depressed and wish to commit suicide or for a personality to wish to harm the others. Safety is the priority concern in care.

Select the most important assessment question to ask a patient suspected of having a dissociative disorder.
a. “Do any members of your family have problems with drugs or alcohol?”
b. “Do you ever find yourself in places with no idea how you got there?”
c. “How would you describe your current level of anxiety?”
d. “How do you think we can be of help to you?”
b. “Do you ever find yourself in places with no idea how you got there?”

The correct response would provide information relevant to dissociative amnesia, dissociative fugue, or dissociative identity disorder, making it a good assessment question. The other questions are of no particular relevance.

Which term describes the final stage in the normal process of anxiety?
a. Panic
b. Crisis
c. Disorganization
d. Coping
d. Coping

The individual moves from experiencing the symptoms of anxiety to the use of coping behaviors to alleviate these symptoms. Panic is a level of anxiety. Crisis involves disorganization, which is not always the end product of anxiety. Disorganization is not always experienced as the product of anxiety.

The effects of stress can be seen by measurement of clinical changes of the body. This statement is a tenet of which theorist?
a. Freud
b. Selye
c. Peplau
d. Sullivan
b. Selye

Selye found that the effects of stress can be seen by objective measurement of structural and clinical changes in the body. Roy’s nursing theory uses this foundation. None of the other options deal with stress.

If a patient’s threshold set point for anxiety is lowered, the nurse can expect subsequent stressors to:
a. have a lesser effect.
b. easily reactivate the anxiety response.
c. produce marked personality disorganization.
d. be easily managed using familiar coping strategies.
b. easily reactivate the anxiety response.

Lowering the threshold set point for anxiety will result in the patient becoming anxious more easily. Thus, lesser effect and ease of handling are incorrect options. Marked personality disorganization would not necessarily occur.

An anxious patient has distorted perceptions and ineffective reasoning. On an anxiety rating scale, the nurse would expect to record the patient’s level of anxiety as:
a. mild, +1.
b. moderate, +2.
c. severe, +3.
d. panic, +4.
c. severe, +3.

Cognitive symptoms of severe anxiety include distorted perceptions, difficulty focusing, and ineffective reasoning. Other symptom constellations relate to the other levels.

A patient is demonstrating severe (+3) anxiety. Nursing interventions will center around:
a. encouraging ventilation and refocusing attention.
b. discussing possible sources of anxiety.
c. taking control to guide the patient.
d. decreasing stimuli and pressure.
d. decreasing stimuli and pressure.

Severe anxiety requires intervention to relieve the heightened tension and discomfort that the patient is experiencing. Perceptions are often distorted, focusing is difficult, and problem solving is impossible, even with help. Environmental simplification and kind, firm directions are approaches to decreasing stimuli and pressure. The other options will not be as effective.

A nurse is assigned to care for a patient diagnosed with moderate (+2) anxiety. Which assessment findings are most likely?
a. Distorted perceptions, disorientation, and defensiveness.
b. Poor concentration, narrow perceptions, and irritability.
c. Irrational reasoning and loss of contact with reality.
d. Alertness, attentiveness, and accurate perceptions.
b. Poor concentration, narrow perceptions, and irritability.

In moderate anxiety states, the body is preparing for protective action. Cognitive symptoms include difficulty concentrating, distractibility, narrowed perceptions, short attention span, tangentiality or circumstantiality, and decreased problem-solving ability. Alertness is associated with mild anxiety. Distorted perceptions are associated with severe anxiety. Irrational reasoning is associated with panic.

The nurse is assigned to care for a patient with moderate anxiety (+2). The most effective nursing intervention will be:
a. use of time-out.
b. initiation of problem solving.
c. providing firm guidance and control.
d. administering a parenteral antianxiety drug.
b. initiation of problem solving.

Using problem solving is an appropriate goal for a patient experiencing moderate anxiety, because these patients are capable of problem solving with assistance. Use of time-out, providing firm guidance and control, and giving parenteral medication are interventions more often used for severe and panic-level anxiety.

A patient diagnosed with PTSD has frequent flashbacks and persistent hyperarousal symptoms. Which nursing interventions should be planned? Select all that apply.
a. Offer empathy and support.
b. Encourage relaxation activities.
c. Encourage verbalization of anger.
d. Set limits when the patient begins to tell of the story of the traumatic incident.
e. Help the patient associate current feelings and behaviors with trauma experience.
a. Offer empathy and support.
b. Encourage relaxation activities.
c. Encourage verbalization of anger.
e. Help the patient associate current feelings and behaviors with trauma experience.

These measures are designed to help reduce PTSD symptoms. Anger should be expressed and accepted. Patients with PTSD should learn that their feelings are commonly experienced by others with the same disorder. Recounting the traumatic event helps patients integrate the feelings of distress, so limiting such behavior is not therapeutic.

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