Varcarolis Ch 15 Anxiety & Obsessive -
Compulsive Disorders
A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety.
Which action should the nurse perform first?
a. Verify the patient's learning style.
b. Lower the patient's current anxiety.
c. Create outcomes and a teaching plan.
d. Assess how the patient uses defense mechanisms. - Answer- B. Lower the patient's current
anxiety.
A patient experiencing severe anxiety has a markedly narrowed perceptual field and difficulty
attending to events in the environment. A patient experiencing severe anxiety will not learn readily.
Determining preferred modes of learning, devising outcomes, and constructing teaching plans are
relevant to the task but are not the priority measure. The nurse has already assessed the patient's
anxiety level. Use of defense mechanisms does not apply.
A woman is 5'7", 160 lbs, and wears a size 8 shoe. She says, "My feet are huge. I've asked three
orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look
smaller and, in social settings, conceals both feet under a table or chair. Which health problem is
likely?
a. Social anxiety disorder
b. Body dysmorphic disorder
c. Separation anxiety disorder
d. Obsessive-compulsive disorder due to a medical condition - Answer- B. Body dysmorphic
disorder
Body dysmorphic disorder refers to a preoccupation with an imagined defect in appearance in a
normal-appearing person. The patient's feet are proportional to the rest of the body. In obsessive-
compulsive or related disorder due to a medical condition, the individual's symptoms of obsessions
and compulsions are a direct physiological result of a medical condition. Social anxiety disorder,
also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a
social or a performance situation that will be evaluated negatively by others. People with
separation anxiety disorder exhibit developmentally inappropriate levels of concern over being
away from a significant other.
A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the
nurse would be:
, a. "What would you like me to do to help you?"
b. "Why do you suppose you are feeling anxious?"
c. "I'm not sure I understand. Give me an example."
d. "You must get your feelings under control before we can continue." - Answer- C. "I'm not sure I
understand. Give me an example."
Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarifying helps
the patient identify thoughts and feelings. Asking the patient why he or she feels anxious is non-
therapeutic; the patient likely does not have an answer. The patient may be unable to determine
what he or she would like the nurse to do in order to help. Telling the patient to get his or her
feelings under control is a directive the patient is probably unable to accomplish.
A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient
does not follow the staff's directions or respond to verbal interventions. The initial nursing
intervention of highest priority is to:
a. provide for the patient's safety.
b. encourage clarification of feelings.
c. respect the patient's personal space.
d. offer an outlet for the patient's energy. - Answer- A. provide for the patient's safety.
Safety is of highest priority because the patient experiencing panic is at high risk for self-injury
related to increased non-goal-directed motor activity, distorted perceptions, and disordered
thoughts. Offering an outlet for the patient's energy can occur when the current panic level
subsides. Respecting the patient's personal space is a lower priority than safety. Clarification of
feelings cannot take place until the level of anxiety is lowered.
A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient
does not follow the staff's directions or respond to verbal interventions. Which nursing diagnosis
has the highest priority?
a. Fear
b. Risk for injury
c. Self-care deficit
d. Disturbed thought processes - Answer- B. Risk for injury
A patient experiencing panic-level anxiety is at high risk for injury related to increased non-goal-
directed motor activity, distorted perceptions, and disordered thoughts. Data are not present to
support a nursing diagnosis of self-care deficit or disturbed thought processes. The patient may
have fear, but the risk for injury has a higher priority.
Compulsive Disorders
A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety.
Which action should the nurse perform first?
a. Verify the patient's learning style.
b. Lower the patient's current anxiety.
c. Create outcomes and a teaching plan.
d. Assess how the patient uses defense mechanisms. - Answer- B. Lower the patient's current
anxiety.
A patient experiencing severe anxiety has a markedly narrowed perceptual field and difficulty
attending to events in the environment. A patient experiencing severe anxiety will not learn readily.
Determining preferred modes of learning, devising outcomes, and constructing teaching plans are
relevant to the task but are not the priority measure. The nurse has already assessed the patient's
anxiety level. Use of defense mechanisms does not apply.
A woman is 5'7", 160 lbs, and wears a size 8 shoe. She says, "My feet are huge. I've asked three
orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look
smaller and, in social settings, conceals both feet under a table or chair. Which health problem is
likely?
a. Social anxiety disorder
b. Body dysmorphic disorder
c. Separation anxiety disorder
d. Obsessive-compulsive disorder due to a medical condition - Answer- B. Body dysmorphic
disorder
Body dysmorphic disorder refers to a preoccupation with an imagined defect in appearance in a
normal-appearing person. The patient's feet are proportional to the rest of the body. In obsessive-
compulsive or related disorder due to a medical condition, the individual's symptoms of obsessions
and compulsions are a direct physiological result of a medical condition. Social anxiety disorder,
also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a
social or a performance situation that will be evaluated negatively by others. People with
separation anxiety disorder exhibit developmentally inappropriate levels of concern over being
away from a significant other.
A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the
nurse would be:
, a. "What would you like me to do to help you?"
b. "Why do you suppose you are feeling anxious?"
c. "I'm not sure I understand. Give me an example."
d. "You must get your feelings under control before we can continue." - Answer- C. "I'm not sure I
understand. Give me an example."
Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarifying helps
the patient identify thoughts and feelings. Asking the patient why he or she feels anxious is non-
therapeutic; the patient likely does not have an answer. The patient may be unable to determine
what he or she would like the nurse to do in order to help. Telling the patient to get his or her
feelings under control is a directive the patient is probably unable to accomplish.
A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient
does not follow the staff's directions or respond to verbal interventions. The initial nursing
intervention of highest priority is to:
a. provide for the patient's safety.
b. encourage clarification of feelings.
c. respect the patient's personal space.
d. offer an outlet for the patient's energy. - Answer- A. provide for the patient's safety.
Safety is of highest priority because the patient experiencing panic is at high risk for self-injury
related to increased non-goal-directed motor activity, distorted perceptions, and disordered
thoughts. Offering an outlet for the patient's energy can occur when the current panic level
subsides. Respecting the patient's personal space is a lower priority than safety. Clarification of
feelings cannot take place until the level of anxiety is lowered.
A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient
does not follow the staff's directions or respond to verbal interventions. Which nursing diagnosis
has the highest priority?
a. Fear
b. Risk for injury
c. Self-care deficit
d. Disturbed thought processes - Answer- B. Risk for injury
A patient experiencing panic-level anxiety is at high risk for injury related to increased non-goal-
directed motor activity, distorted perceptions, and disordered thoughts. Data are not present to
support a nursing diagnosis of self-care deficit or disturbed thought processes. The patient may
have fear, but the risk for injury has a higher priority.
