Anxiety Disorders Practice Exam/Test (10-19)

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Situation: W., a 20 year old college junior is admitted to a medical-surgical unit in a small community hospital after she has a sudden onset of paralysis in both legs. Extensive examination and testing reveal no physical basis for the paralysis. The medical diagnosis is conversion disorder.

10. The nurse plans interventions for W. based on which correct statement about conversion disorder?

a) the symptoms are a conscious attempt to control others in the environment
b) the patient will exhibit a high level of anxiety in response to the conversion symptom
c) the conversion symptom typically has some symbolic meaning for the patient
d) the patient will respond positively to confrontational approaches by the nurse

11. W. reveals that her boyfriend has been pressuring her to have sex with him. She says, "I love him, but I'm frightened about getting pregnant or getting some disease like AIDS. What should I do?" The nurse best response would be:

a) there are ways to protect yourself against pregnancy and sexually transmitted diseases. I can refer you to the clinic if you like
b) you shouldn't let anyone pressure you into sex. Perhaps he doesn't care about you as much as you think he does
c) it sounds like this problem may be related to your paralysis
d) your concerns are realistic. How do you feel about being pressured by your boyfriend?

12. During her hospitalization, W. develops insight into her response to threatening situations. When she is discharged, she plans to continue psychotherapy that will focus on:

a) preventing further incidents of paralysis
b) learning new strategies for dealing with stress and conflict
c) breaking off her stress-inducing relationship with her boyfriend
d) developing a healthier attitude toward her sexuality


Situation: S., a 19 year old sophomore, makes an appointment at the college health service, where he tells the nurse that he recently has been having trouble concentrating in class. He reports that his grades have suffered because he has been so "out of it." He forgets to do assignments and cannot remember when tests are scheduled. He also reports insomnia, loss of appetite, headaches, and constant fatigue.

13. S. says to the nurse, "I don't know what's wrong. Either there's something seriously wrong with me, or I must be going crazy." What would be the best response in this situation?

a) you look healthy to me. I'm sure there is nothing seriously wrong with you
b) it's best not to jump to conclusions. We'll do some tests that should give us a clearer picture of what the problem is
c) we have an excellent health service here. Whatever the problem is, we will help you
d) tell me more about when you begin experiencing these symptoms and feelings

14. The results of S's physical examination and laboratory tests are negative. Two weeks after his initial visit, S. reports that he continues to suffer from nightmares that cause insomnia. He says, "I don't know what to do. Finals are coming up, and I can't study. I'm so exhausted." Which reply by the nurse is best?

a) you mentioned you are having nightmares. tell me more about hem
b) I understand your frustration. It's terrible not being able to sleep. I can get you a prescription for sleep medications
c) have you talked with your professors? Perhaps if they were aware of your problem, you could get extensions for your homework
d) you're exhausted? In what way?

15. S. reveals that he was in an automobile accident during final exam week in his freshman year. Although he suffered only minor cuts and bruises, a young man in the other car was killed. In light of this information, the nurse suspects that S. is experiencing:

a) conversion disorder
b) panic disorder
c) phobic disorder
d) post-traumatic stress disorder

16. Which therapeutic approach is most effective in helping S.?

a) helping him to relax to pass his final exams
b) asking the physician to prescribe an antianxiety medication
c) providing new coping mechanisms
d) strengthening current coping mechanisms

Situation: Y. periodically has panic attacks. These attacks are unpredictable and do not seem to be associated with any specific object or situation.

17. Y. might experience any of the following symptoms during anacute panic attack except:

a) increased perceptual field
b) increased blood pressure
c) decreased blood pressure
d) impaired attention

18. Which intervention would be most helpful for Y. when she experience a panic attack?

a) encouraging her to identify what precipitated the attack
b) promoting interaction with others to reduce her anxiety through diversion
c) staying with her and remaining calm, confident, and reassuring
d) reducing intolerable stimuli by encouraging her to stay in her room alone until she feels less anxious

19. Which medications have recently been found helpful in reducing or eliminating panic attacks?

a) antidepressants
b) anticholinergics
c) antipsychotics
d) mood stabilizers



ANSWERS AND RATIONALE

10) C
- a conversion disorder, sometimes called hysteria, is a type of somatoform disorder in which the patient exhibits a symptom (such as tic, tremor, or paralysis) that symbolically represents a conflict the patient is experiencing. The manifested symptom is not a conscious attempt to control others. Instead of being anxious, the patient characteristically exhibits indifference to the symptoms. This reaction initially represent's an unconscious control of anxiety. Confrontation threatens the patient's defense against anxiety and is therefore nontherapeutic.

11) D
- because conversion disorders commonly arise from conflicts and tension associated with sexual drives. W. must be encouraged to explore her concerns about having sex with her boyfriend. The nurse should acknowledge the patient's feelings and encourage her to discuss them. The other options may helpful, but they do not promote exploration of the realistic aspects of the patient's conflict.

12) B
- the patient needs to learn new and more adaptive coping strategies, such as talking about her feelings and not denying them, to help her deal with life's many stressors. Paralysis is only a symptom of W.'s underlying problem and would not be the focus of psychotherapy. Unless W. learns to cope with the conflict associated with her sexual drives, her next relationship also will result in stress. Her problem is not her sexuality but the stress associated with it.

13) D
- the nurse needs to find out more about the onset of the patient's symptoms. To fully assess the patient, she should determine how long the symptoms have been present, when it started, and whether there were any precipitating events, such as breakup with girlfriend. Options A and B may be true, but they cut off further exploration of the patient's symptoms. They also may be viewed as false reassurance and an attempt to deny the validity of the patient's feelings. Option C focuses on the health service and not on S's problem.

14) A
- exploring the content of S.'s nightmare can provide clues to his underlying conflict. For example, a veteran may have recurring nightmares related to his war experiences. Acknowledging the patient's feelings without exploring them further is not enough. Offering sleep medication is inappropriate because this is only a temporary measure; S. should be encouraged to explore the underlying stressors and to find effective ways of coping rather than dismiss his symptoms with medication. Focusing on S.'s exhaustion is not as helpful as exploring its possible causes. Although talking with his professors may help S. to get an extension on his school work, doing so will not address his underlying problems or help him to sleep better.

15) D
- post-traumatic stress disorder (PTSD) is a form of anxiety disorder in which an individual relives an extremely stressful experience with accompanying guilt and dysfunction. PTSD can cause a delayed response to a traumatic event -- in S.'s case, the fatal automobile accident. In a conversion disorder, the patient's anxiety is temporarily managed by his symptoms, and distress is not apparent. In a panic disorder, the patient typically experiences severe anxiety resulting in feelings of impending death. In a phobic disorder, the patient characteristically experiences fear of an object or situation that presents no real danger.

16) C
- to deal with his traumatic memories, S. needs to learn new coping strategies -- for instance, systematic desensitization. Helping S. to relax enough so that he can pass his final exams may or may not be realistic and is secondary to the overall treatment goals. Medication should be used only if necessary; although drugs can relieve some of the symptoms of anxiety, they do not remove its underlying causes. The inadequacy of S.'s current coping skills has led him to seek help.

17) A
- panic is the most severe level of anxiety. During a panic attack, the patient experiences a decrease, not increase, in perceptual field. She becomes more focused on herself and is less aware of what is happening around her. The patient becomes unable to process information from her environment. The decreased perceptual field contributes to impaired attention and the inability to concentrate. Increased blood pressure related to stimulation of the sympathetic nervous system or decreased blood pressure related to stimulation of the parasympathetic nervous system can also occur.

18) C
- a panic-stricken patient requires the assistance of a calm person who can provide support and direction. This is particularly important because the patient already feels frightened and out of control. Having someone remain with the patient prevents feelings of isolation and desertion. Encouraging the patient to identify what precipitated the attack is futile because the patient is too anxious to focus on precipitating factors. When the patient feels extremely anxious, interaction with others is difficult. Reducing stimuli can be helpful, but having the patient stay alone may increase her anxiety.

19) A
- tricyclic and MAO inhibitor antidepressants have been found effective in treating patients with panic attacks. Why these drugs control the attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, help relieve the physical symptoms of anxiety but do not relieve the anxiety itself. Patients who experience panic attacks are not psychotic, so antipsychotic drugs are inappropriate. Mood stabilizers are not indicated because mood changes are not usually associated with panic attacks.


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