Anxiety & OCD
A nurse is assessing a patient who is tapping their foot, biting their nails, and experiencing slight restlessness before an examination. The patient is able to concentrate and answer questions appropriately. Which level of anxiety is the patient most likely experiencing?
Mild anxiety may cause restlessness, nail biting, and fidgeting while the patient retains effective perception and problem-solving ability.
A nursing student is reviewing the body's physiological response to stress. Which hormone-related process should the student identify?
A. The hypothalamus releases CRH, which is associated with cortisol release.
B. The parasympathetic nervous system releases cortisol to promote sleep.
C. The amygdala releases cytokines to stop the stress response.
D. The prefrontal cortex prevents all hormonal responses to stress.
A - The notes describe the hypothalamus releasing corticotropin-releasing hormone (CRH), which is associated with cortisol release.
A nurse is caring for a patient with moderate anxiety. Which communication technique is most appropriate?
A. Use firm commands and avoid allowing the patient to ask questions.
B. Ask open-ended questions and explore the patient's concerns.
C. Avoid discussing anxiety-provoking situations.
D. Provide all education at once so the patient has complete information.
B - With mild to moderate anxiety, patients can still participate in problem-solving. Open-ended questions, exploration, and clarification encourage communication.
A therapist uses an exposure technique in which a patient confronts the most intense fear-provoking stimulus directly and remains in the situation until anxiety naturally decreases. Which technique is being described?
Flooding is an intensive exposure method involving direct confrontation with the most feared stimulus until anxiety decreases naturally.
A patient is prescribed alprazolam (Xanax) for anxiety. The nurse explains that the medication promotes the activity of which neurotransmitter?
A. Dopamine
B. Serotonin
C. Gamma-aminobutyric acid (GABA)
D. Acetylcholine
C - Alprazolam is a benzodiazepine that promotes GABA activity, producing anxiolytic and sedative effects.
A patient reports feeling anxious and begins experiencing tachycardia, increased respirations, shaking, and difficulty concentrating. The patient can still learn when given simple instructions. Which level of anxiety should the nurse identify?
Moderate anxiety narrows the perceptual field and makes concentration harder. Tachycardia, increased respirations, shaking, and other physical symptoms may occur, but learning and problem-solving remain possible.
A patient has an upsetting interaction with their supervisor at work. Later, the patient goes home and yells at a family member who was not involved in the incident. Which defense mechanism is the patient demonstrating?
A. Denial
B. Displacement
C. Projection
D. Regression
B - Displacement occurs when a person redirects an emotional reaction from its original source to a safer person or object.
A patient experiencing severe anxiety says, "I cannot think straight. Everything feels out of control." Which nursing response is best?
A. "Why do you think you are reacting this way?"
B. "You need to calm down before we can talk."
C. "You are safe here. Let's move to a quiet area."
D. "Let's discuss several possible solutions to your problems."
C - A calm, reassuring approach and a quiet environment are appropriate. Asking complex questions or demanding problem-solving can overwhelm a severely anxious patient.
A nurse is discussing flooding with a patient who has severe anxiety about a particular situation. Which action is essential before implementing this technique?
A. Begin exposure immediately to prevent avoidance.
B. Ensure the patient is ready and that the therapeutic environment is safe.
C. Avoid monitoring the patient during the exposure.
D. End the exposure as soon as the patient reports anxiety.
B - Flooding requires careful assessment of readiness, a safe therapeutic environment, monitoring during and after exposure, and processing of the experience.
A patient who takes alprazolam regularly tells the nurse, "I am going to stop taking this medication today because I feel better." Which response is most appropriate?
A. "Stopping suddenly is safe if your anxiety has improved."
B. "You should gradually taper the medication under your prescriber's guidance."
C. "Take twice your usual dose tomorrow to compensate."
D. "Replace the medication with alcohol when anxiety occurs."
B - Abrupt discontinuation after prolonged benzodiazepine use can cause withdrawal, including anxiety, insomnia, muscle tension, and seizures. Tapering should be guided by the prescriber.
A patient repeatedly thinks, "My hands are contaminated with germs," and experiences intense anxiety. The patient washes their hands repeatedly to reduce the anxiety. Which statement correctly identifies these behaviors?
A. The contamination thought is a compulsion, and handwashing is an obsession.
B. Both the thought and the handwashing are obsessions.
C. The contamination thought is an obsession, and handwashing is a compulsion.
D. Neither behavior is associated with OCD.
C - An obsession is the intrusive contamination thought. The compulsion is the repetitive handwashing performed to reduce the anxiety.
Which situation best represents eustress?
A. A patient feels overwhelmed by debt and believes they cannot cope.
B. A patient experiences exhaustion after prolonged stress.
C. A patient feels motivated and excited while preparing for a new job.
D. A patient feels hopeless following several stressful events.
C - Eustress is positive stress that can motivate effective coping, adaptation, growth, and development.
A nurse is developing a patient-centered plan of care for anxiety. Which action best reflects a patient-centered approach?
A. Selecting interventions based solely on the nurse's preferences.
B. Asking the patient which coping strategies have helped in the past.
C. Assuming that all patients from the same culture respond to stress similarly.
D. Limiting family involvement regardless of the patient's preferences.
B - Patient-centered care recognizes the patient's experience and asks what has helped previously. Care planning should also consider cultural background, expectations, and desired family involvement.
A nurse teaches a patient to imagine a peaceful beach while focusing on pleasant sensory details to reduce stressful feelings. Which technique is the nurse teaching?
Guided imagery directs attention toward pleasant images or sensory experiences to replace negative or stressful feelings.
A nurse is monitoring a patient receiving clonidine for sedation in critical care. Which assessment findings are priority concerns associated with this medication?
A. Hypertension and tachycardia
B. Hypotension and bradycardia
C. Hyperactivity and insomnia
D. Increased appetite and weight gain
B - Clonidine can cause hypotension and bradycardia. Blood pressure and heart rate should be monitored, along with sedation and symptom relief.
A patient experiencing panic-level anxiety is pacing, screaming, and appears unaware of their surroundings. Which action should the nurse take first?
A. Encourage the patient to discuss the source of the anxiety.
B. Ensure the safety of the patient and others.
C. Teach the patient progressive muscle relaxation.
D. Explain the physiological causes of the panic response.
B - Safety is the priority during panic-level anxiety, when the patient may lose awareness of the environment and act impulsively.
Select all that apply. A nurse is teaching a patient about techniques for managing stress. Which strategies should the nurse include?
A. Deep breathing
B. Guided imagery
C. Progressive muscle relaxation
D. Mindfulness meditation
E. Increased caffeine intake
F. Cognitive reframing
A, B, C, D, F – Deep breathing, guided imagery, progressive muscle relaxation, mindfulness, and cognitive reframing are stress-management strategies. Increasing caffeine intake is not recommended.
A patient says, "If I make one mistake during my presentation, everyone will think I am incompetent." The nurse helps the patient challenge this thought and replace it with a more realistic interpretation. Which intervention is the nurse using?
A. Flooding
B. Cognitive restructuring
C. Displacement
D. Progressive muscle relaxation
B - Cognitive restructuring identifies anxious or irrational thoughts, challenges them, and replaces them with more realistic appraisals.
A patient deliberately tenses each muscle group for approximately eight seconds and then releases the tension, beginning with the feet and progressing toward the face. Which technique is the patient practicing?
Progressive muscle relaxation involves deliberately tensing muscle groups and then releasing the tension, often beginning at the feet and progressing upward.
A patient taking alprazolam reports consuming alcohol at a social gathering. Which concern is most important for the nurse to recognize?
A. Increased CNS depression and sedation
B. Reduced risk of respiratory depression
C. Improved coordination and alertness
D. Prevention of medication dependence
A - Alcohol and alprazolam can both depress the central nervous system. Their combined effects can increase sedation and potentially cause dangerous respiratory depression.
A nurse is explaining the sympathetic nervous system to a patient. Which statement accurately describes its role during a stress response?
A. It promotes rest and digestion.
B. It decreases the body's alertness during stressful events.
C. It activates the fight-or-flight response.
D. It prevents the release of stress hormones.
C - The sympathetic nervous system produces the fight-or-flight response, increasing physiological arousal during stress.
A patient with a history of repeated trauma asks why prolonged stress may affect physical health. Which response by the nurse is most appropriate?
A. "Chronic stress affects emotions but does not influence the immune system."
B. "Repeated stress activation can elevate stress hormones and influence immune and inflammatory processes."
C. "Stress permanently prevents the body from releasing cortisol."
D. "Stress only affects the body when the person experiences panic-level anxiety."
B - Repeated activation of the stress response can elevate stress hormone levels and influence immune and inflammatory systems.
A patient with a fear of elevators is working with a therapist. The patient first practices relaxation while imagining an elevator, then gradually progresses to standing near and eventually riding in one. Which intervention is being used?
Systematic desensitization uses gradual exposure to a feared stimulus combined with relaxation techniques.
Select all that apply. A nurse is caring for a patient experiencing panic-level anxiety. Which interventions are appropriate?
A. Provide for the safety of the patient and others.
B. Use firm, short, and simple statements.
C. Guide the patient to a quiet environment.
D. Provide fluids and rest to help prevent exhaustion when appropriate.
E. Require the patient to participate in a lengthy problem-solving discussion.
F. Consider restrictive interventions only after less restrictive interventions fail.
A, B, C, D, F - Severe-to-panic anxiety requires safety, a quiet environment, simple statements, and attention to physical needs. Less restrictive interventions are tried before restraint or seclusion; lengthy problem-solving is inappropriate during panic.
A patient experiencing opioid withdrawal is prescribed clonidine. Which explanation best describes how clonidine helps the patient?
A. It directly replaces the opioid and prevents all withdrawal symptoms.
B. It blocks neurotransmitters that trigger sympathetic nervous system activity, helping relieve withdrawal symptoms.
C. It increases sympathetic activity to improve alertness.
D. It works primarily by increasing GABA activity.
B - Clonidine is a central alpha-adrenergic agonist that reduces sympathetic nervous system activity and can ease symptoms such as sweating, restlessness, watery eyes, hot flashes, and anxiety during opioid withdrawal.