Mental Health NCLEX Anxiety

A patient who was savagely attacked by a bear has no memory of the event. Which statement best explains the patient’s inability to remember the attack?

a. The woman lost consciousness and was not cognitively aware of what happened during the attack
b. The brain has produced a chemical anemia that will repress the memories of the attack indefinitely.
c. The patient is unconsciously using a defense mechanism to protect against the repeated memory of the attack.
d. It is a temporary suppression of the attack; her memory will return when she is physically and emotionally ready to handle the memories.

Which assessment finding exhibited by a patient being assessed for posttraumatic stress disorder (PTSD) would be considered a defining behavior and support such a diagnosis?

a. Can describe the attack in great detail
b. Experiences dramatic swings in affect
c. Describes vivid “flashbacks” of being attacked
d. Is preoccupied with the need to “tell someone about the attack”

What is the basis for assessing a male patient who is agoraphobic for panic attacks?

a. Men are more likely to experience panic attacks.
b. An overwhelming number of agoraphobic patients also have panic attacks.
c. Patients are often unaware that the symptoms they are experiencing are those of panic.
d. Panic attacks are generally the cause of a patient developing phobias like agoraphobia.

Discharge preparation for a patient includes the administration of the Hamilton Anxiety Scale (HAS). When asked by the patient to explain the purpose of the assessment the nurse responds:

a. “It is an assessment tool used to evaluate the symptoms of anxiety.”
b. “The tool is used to help confirm the diagnosis of anxiety disorder.”
c. “This tool helps determine if your symptoms have improved with treatment.”
d. “It helps identify the presence of any other disorder associated with anxiety.”

A patient is admitted for treatment for persistent, severe anxiety. Which nursing diagnosis would help effectively direct patient care?

a. Disturbed sensory perception related to narrowed perceptual field
b. Risk for injury related to closed perception
c. Hopelessness related to total loss of control
d. Risk for other-directed violence related to combative behavior

The patient was an awkward child who was ridiculed by his father for his inability to catch a ball. As an adult, the patient developed panic attacks at the time his company established after-work team sporting activities. Which data discussed during the nursing interview provides insight to the possible cause of this anxiety disorder when applying the behavioral model?

a. He always avoids sports because “I’m short and not the least bit athletic.”
b. When in fifth grade, the patient caused his team to “lose the big softball game.”
c. The company he works for places tremendous emphasis of successful team work.
d. As a child he wore a leg brace that prevented him from participating in school sports.

The nurse is working with the family of a patient with obsessive-compulsive disorder (OCD). Which concept should the nurse incorporate in the teaching plan?

a. The thoughts, images, and impulses are voluntary.
b. The family should pay immediate attention to symptoms.
c. The thoughts, images, and impulses tend to worsen with stress.
d. OCD is a chronic disorder that does not respond to treatment.

Which question would assist the nurse in determining whether the patient has been experiencing anxiety?

a. “Have you had difficulty concentrating lately?”
b. “Have you been feeling sad and especially lonely?”
c. “Do you have a history of failed personal relationships?”
d. “Do you frequently experience difficulty controlling your anger?”

The nurse working with patients diagnosed with posttraumatic stress disorder (PTSD) is aware of the need to intervene early in order to de-escalate a patient’s increasing anxiety level. Which patient behavior is likely an early indication of escalating anxiety?

a. Talking rapidly
b. Pacing around the unit
c. Staring out the window
d. Refusing to go to therapy

The nurse has been working with a patient who experiences anxiety. Which intervention should the nurse implement initially when the patient is observed pacing and wring her hands?

a. Asking how she has managed anxiety effectively in the past
b. Distracting her by offering to help her make a telephone call
c. Asking her what she believes is causing her increased anxiety
d. Teaching her to take deep, relaxing breaths to manage the anxiety

The nurse is working with a patient with an anxiety disorder whose treatment includes cognitive behavioral therapy. Which statement by the patient gives the nurse reason to assume that the patient has an understanding of the basis of this type of therapy?

a. “My abusive childhood has resulted in my overreaction to stress.”
b. “My delusional thoughts of extreme anxiety are what cause my panic attacks.”
c. “My brain chemistry causes me to overreact to common stress by getting so anxious.”
d. “I’ve learned to react to my daily stress by having anxious thoughts and panic attacks.”

12. Which verbal intervention would the nurse use when helping a patient who is experiencing severe to panic-level anxiety?
    a. “I will stay with you to make sure you remain safe.”
    b. “First, you must stop pacing and wringing your hands.”
    c. “How can I help you get control of yourself and this anxiety?”
    d. “Can you tell me what was happening just before you got upset?”

The nurse notes that a patient being treated for an anxiety disorder is becoming more anxious sitting in a congested, noisy room waiting to see the therapist. Which intervention will the nurse implement initially to assist the patient in de-escalating his anxiety?

a. Offering to reschedule the patient’s appointment
b. Taking the patient to an unoccupied interview room
c. Notifying the therapist of the need to see the patient stat
d. Requesting oral prn anxiolytic medication for the patient

A patient is ordered medication therapy to manage the symptoms of anxiety disorder. Which statement by the patient indicates an understanding of the typical classification of medication prescribed for this disorder?

a. “Tricyclic antidepressants are particular good for panic attacks.”
b. “I have to give up beer while taking monamine oxidase inhibitors (MAOIs).”
c. “Selective serotonin reuptake inhibitors (SSRIs) help with panic attacks as well.”
d. “Benzodiazepines are usually effective when taken for chronic anxiety like mine.”

A patient with OCD tells the nurse, “Thinking these thoughts and doing all my rituals is beyond being silly. I have few friends and I know others laugh behind my back. I sometimes think I can control things, but I always find I can’t. I don’t know if I can continue to live this way.” Which assessment question shows the nurse has an understanding of this patient’s priority risk?

a. “Are you feeling hopeless?”
b. “Do you think you are socially isolated?”
c. “Have you been thinking about hurting yourself?”
d. “Do the rituals affect how you feel about yourself?”

The head nurse in the ED has received word that a major fire in a high-rise office tower will result in many injured persons being brought to the hospital within the next few minutes. The head nurse tells the staff, “You will need to assess for acute stress reactions as well as treating physical problems.” Which patient is exhibiting symptoms characteristic of acute stress reaction?

a. A male whose moods swing between mania and depression
b. A female who reports still hearing her daughter’s pleas for help
c. A male who keeps repeating “I don’t understand what’s going on?”
d. A female who is rocking her young son and repeating “it will be okay.”

A nurse is reprimanded by the nurse manager. Shortly thereafter, a patient’s family member reports that the nurse curtly told them “You can’t come in now. You know you need to wait until visiting hours.” The incidence should be discussed based on the knowledge that the defense mechanism the nurse used was:

a. Displacement
b. Projection
c. Sublimation
d. Suppression

During a nursing assessment, a teenage patient smiles and states, “I don’t care what you say. I want to be just like Mike, the leader of our gang.” The nurse understands the defense mechanism being used is:

a. Denial
b. Humor
c. Splitting
d. Identification

A young, married female patient is attracted to a male nurse. When the nurse sets clear boundaries, the patient falsely accuses him of sexual harassment. The nursing supervisor recognizes the defense mechanism of:

a. Projection
b. Splitting
c. Suppression
d. Displacement

A college-aged patient complains that, “when I begin to take a test, I freeze up and my mind goes blank.” The nurse will react based on the understanding that this patient’s anxiety level is:

a. Mild
b. Moderate
c. Severe
d. Panic

A college student diagnosed with high levels of anxiety is being prepared for discharge. Which discharge criteria is appropriate for this patient?

a. The patient will avoid situations that cause anxiety.
b. The patient will use learned anxiety-reducing strategies.
c. The patient will return to living at home with supportive parents.
d. The patient will state, “I know medication is what I need to control my anxiety.”

A patient is being evaluated for a possible diagnosis of panic disorder with agoraphobia. Which nursing assessment findings support this diagnosis? Select all that apply.

a. Patient states, “I’ve had these fears for more than 6 years.”
b. Patient describes having a “panic attack” several times a month.
c. Patient is embarrassed by the limitations the disorder causes.
d. Stated, “I never even think about going shopping in a crowded mall.”
e. Condition began after beginning treatment for a chronic intestinal problem.

The nurse has identified a nursing diagnosis of disturbed thought processes for a patient with obsessive-compulsive disorder. What abilities displayed by the patient would be related to an appropriate outcome for this problem? Select all that apply.

a. Can identify when obsessions are worsening
b. Speaks of obsessions as being embarrassing behaviors
c. Describes lessening anxiety when compulsive rituals are interrupted
d. Plans to ignore obsessive thoughts and so minimizes resulting stress
e. Limits time focusing on obsessive thoughts to 15 minutes, 4 times a day

Which lifestyle changes should the nurse incorporate in the nursing care plan for a patient with generalized anxiety disorder? Select all that apply.

a. Stop smoking.
b. Limit caffeine intake.
c. Eliminate stress from your life.
d. Practice a relaxation technique daily.
e. Limit worrying to specific times each day.

A nursing interview for a patient being admitted for depression reveals that the patient has been taking a benzodiazepine for anxiety for 3 years. Which actions by the nurse reflect an understanding of the effects of this classification of drugs? Select all that apply.

a. The nurse asks how much of the drug the patient takes daily.
b. The admitting physician is notified of the patient’s medication history.
c. The nurse prepares to discuss the process of detoxification with the patient.
d. The nurse suggests to the patient that the dosage is likely to be increased.
e. The patient is interviewed regarding how well the anxiety has been controlled.

A patient comes to the ED exhibiting severe physical and emotional symptomology. When no physical cause can be found for the symptoms, the patient is diagnosed with severe anxiety with panic attack symptoms. Which assessment data supports this diagnosis? Select all that apply.

a. Blood pressure 158/90; 15 minutes later 130/80
b. Claims that she feels like she going to die
c. Random but controlled thoughts
d. Unable to follow instructions
e. Dry, flushed skin

Which considerations should a nurse include when conducting a mental health assessment on a culturally diverse patient Select all that apply.

a. Men and women are equally likely to seek psychiatric health care.
b. The role that spirits and magic play in a patient’s belief system is cultural based.
c. Rituals are only deemed obsessive when applied to the patient’s cultural standards.
d. Agoraphobia is more difficult to assess in cultures that restrict female socialization.
e. The nurse should consider the universal application of the Diagnostic and Statistical Manual (DSM-IVTR).