Nursing A Concept Based Approach to Learning Volume II 2e Test bank

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Nursing A Concept Based Approach to Learning Volume II 2e Test bank

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Nursing: A Concept-Based Approach to Learning, 2e (Pearson)
Module 31 Stress and Coping

The Concept of Stress and Coping

1) After a mammogram, a client is told that she needs a fine needle aspirate of a breast mass. What demonstrates that the client is engaging in a primary appraisal of the stressful situation?
A) The client holds her breath while the nurse is talking.
B) The client sits in the dressing room and cries.
C) The client asks the nurse if she has cancer.
D) The client schedules the procedure in 6 weeks, which is the earliest possible appointment.
Answer: C
Explanation: A) In primary appraisal, the client assesses the potential for benefit, harm, loss, threat, or challenge in a situation. The client asking the nurse if she has cancer is engaging in a primary appraisal. The client holding her breath while the nurse is talking is evaluating coping resources and options. This is a secondary appraisal. The client who sits in the dressing room and cries is applying a coping resource. This is coping. The client who schedules the procedure at the earliest possible appointment is engaging in reappraisal, which is an ongoing reinterpretation of the situation based on new information.
B) In primary appraisal, the client assesses the potential for benefit, harm, loss, threat, or challenge in a situation. The client asking the nurse if she has cancer is engaging in a primary appraisal. The client holding her breath while the nurse is talking is evaluating coping resources and options. This is a secondary appraisal. The client who sits in the dressing room and cries is applying a coping resource. This is coping. The client who schedules the procedure at the earliest possible appointment is engaging in reappraisal, which is an ongoing reinterpretation of the situation based on new information.
C) In primary appraisal, the client assesses the potential for benefit, harm, loss, threat, or challenge in a situation. The client asking the nurse if she has cancer is engaging in a primary appraisal. The client holding her breath while the nurse is talking is evaluating coping resources and options. This is a secondary appraisal. The client who sits in the dressing room and cries is applying a coping resource. This is coping. The client who schedules the procedure at the earliest possible appointment is engaging in reappraisal, which is an ongoing reinterpretation of the situation based on new information.
D) In primary appraisal, the client assesses the potential for benefit, harm, loss, threat, or challenge in a situation. The client asking the nurse if she has cancer is engaging in a primary appraisal. The client holding her breath while the nurse is talking is evaluating coping resources and options. This is a secondary appraisal. The client who sits in the dressing room and cries is applying a coping resource. This is coping. The client who schedules the procedure at the earliest possible appointment is engaging in reappraisal, which is an ongoing reinterpretation of the situation based on new information.
Page Ref: 1898
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 1. Summarize the physiologic response to stress and the psychodynamics of coping.
2) A client says that learning how to use the blood glucose machine will have to wait until holiday events are planned first. Which cognitive indication of stress is the client demonstrating?
A) Problem solving
B) Suppression
C) Self-control
D) Structuring
Answer: B
Explanation: A) The client is demonstrating suppression, which is the conscious and willful act of putting a thought or feeling out of mind. The client is focusing on other needs and not the need to learn how to use the blood glucose machine. Problem solving involves thinking through the threatening situation, using specific steps to arrive at a solution. Structuring is the arrangement or manipulation of a situation so that threatening events do not occur. Self-control is assuming a manner and facial expression that convey a sense of being in control or in charge.
B) The client is demonstrating suppression, which is the conscious and willful act of putting a thought or feeling out of mind. The client is focusing on other needs and not the need to learn how to use the blood glucose machine. Problem solving involves thinking through the threatening situation, using specific steps to arrive at a solution. Structuring is the arrangement or manipulation of a situation so that threatening events do not occur. Self-control is assuming a manner and facial expression that convey a sense of being in control or in charge.
C) The client is demonstrating suppression, which is the conscious and willful act of putting a thought or feeling out of mind. The client is focusing on other needs and not the need to learn how to use the blood glucose machine. Problem solving involves thinking through the threatening situation, using specific steps to arrive at a solution. Structuring is the arrangement or manipulation of a situation so that threatening events do not occur. Self-control is assuming a manner and facial expression that convey a sense of being in control or in charge.
D) The client is demonstrating suppression, which is the conscious and willful act of putting a thought or feeling out of mind. The client is focusing on other needs and not the need to learn how to use the blood glucose machine. Problem solving involves thinking through the threatening situation, using specific steps to arrive at a solution. Structuring is the arrangement or manipulation of a situation so that threatening events do not occur. Self-control is assuming a manner and facial expression that convey a sense of being in control or in charge.
Page Ref: 1904
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 2. Examine the relationship between stress and coping and other concepts/systems.

3) A client worries every day about personal health and that they may not have enough medication should the weather take a turn for the worse. The nurse is concerned that the client might be developing which of the following?
A) Generalized anxiety disorder
B) Phobia
C) Obsessive-compulsive disorder
D) Panic disorder
Answer: A
Explanation: A) Generalized anxiety disorder is excessive worry about everyday problems, with the anxiety being more intense than the situation warrants. The client is demonstrating signs of generalized anxiety disorder. A phobia is an intense, persistent, irrational fear of a simple thing or social situation that compels the individual to avoid the stressor that elicits the fear. Panic disorder is a sudden attack of terror, accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. Obsessive-compulsive disorder is characterized by obsessive thoughts and compulsive repetitive behaviors formed in response to the obsessive thoughts to lower the level of anxiety experienced.
B) Generalized anxiety disorder is excessive worry about everyday problems, with the anxiety being more intense than the situation warrants. The client is demonstrating signs of generalized anxiety disorder. A phobia is an intense, persistent, irrational fear of a simple thing or social situation that compels the individual to avoid the stressor that elicits the fear. Panic disorder is a sudden attack of terror, accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. Obsessive-compulsive disorder is characterized by obsessive thoughts and compulsive repetitive behaviors formed in response to the obsessive thoughts to lower the level of anxiety experienced.
C) Generalized anxiety disorder is excessive worry about everyday problems, with the anxiety being more intense than the situation warrants. The client is demonstrating signs of generalized anxiety disorder. A phobia is an intense, persistent, irrational fear of a simple thing or social situation that compels the individual to avoid the stressor that elicits the fear. Panic disorder is a sudden attack of terror, accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. Obsessive-compulsive disorder is characterized by obsessive thoughts and compulsive repetitive behaviors formed in response to the obsessive thoughts to lower the level of anxiety experienced.
D) Generalized anxiety disorder is excessive worry about everyday problems, with the anxiety being more intense than the situation warrants. The client is demonstrating signs of generalized anxiety disorder. A phobia is an intense, persistent, irrational fear of a simple thing or social situation that compels the individual to avoid the stressor that elicits the fear. Panic disorder is a sudden attack of terror, accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. Obsessive-compulsive disorder is characterized by obsessive thoughts and compulsive repetitive behaviors formed in response to the obsessive thoughts to lower the level of anxiety experienced.
Page Ref: 1908
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 3. Identify commonly occurring alterations in coping and their related therapies.
4) Which assessment finding or findings indicate to the nurse that a client is experiencing stress?
Select all that apply.
A) Chewing on a finger nail
B) Checking cellular phone
C) Reading a magazine
D) Talking with others
E) Tapping foot
Answer: A, E
Explanation: A) The client is experiencing both behavioral (nail chewing) and physical (foot tapping) indications of stress. Reading a magazine, checking a phone, and talking with others are not indications of stress.
B) The client is experiencing both behavioral (nail chewing) and physical (foot tapping) indications of stress. Reading a magazine, checking a phone, and talking with others are not indications of stress.
C) The client is experiencing both behavioral (nail chewing) and physical (foot tapping) indications of stress. Reading a magazine, checking a phone, and talking with others are not indications of stress.
D) The client is experiencing both behavioral (nail chewing) and physical (foot tapping) indications of stress. Reading a magazine, checking a phone, and talking with others are not indications of stress.
E) The client is experiencing both behavioral (nail chewing) and physical (foot tapping) indications of stress. Reading a magazine, checking a phone, and talking with others are not indications of stress.
Page Ref: 1912
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 4. Differentiate common assessment procedures used to examine stress levels and coping mechanisms across the life span.

5) The nurse suspects that a healthy client could be experiencing stress because of which laboratory result?
A) Serum sodium of 142 mEq/L
B) Serum glucose of 165 mg/dL
C) Serum potassium of 4.0 mEq/L
D) Serum calcium of 10.2 mEq/L
Answer: B
Explanation: A) Laboratory tests are not routinely done to evaluate anxiety because observation is faster and more accurate. However, they may be necessary to rule out medical conditions that can cause anxiety. The elevated blood glucose level could indicate that the client is experiencing stress because of an increase in adrenal function. One physiological indicator of stress is an increase in blood glucose because of the release of glucocorticoids and gluconeogenesis. The other laboratory values are within normal limits.
B) Laboratory tests are not routinely done to evaluate anxiety because observation is faster and more accurate. However, they may be necessary to rule out medical conditions that can cause anxiety. The elevated blood glucose level could indicate that the client is experiencing stress because of an increase in adrenal function. One physiological indicator of stress is an increase in blood glucose because of the release of glucocorticoids and gluconeogenesis. The other laboratory values are within normal limits.
C) Laboratory tests are not routinely done to evaluate anxiety because observation is faster and more accurate. However, they may be necessary to rule out medical conditions that can cause anxiety. The elevated blood glucose level could indicate that the client is experiencing stress because of an increase in adrenal function. One physiological indicator of stress is an increase in blood glucose because of the release of glucocorticoids and gluconeogenesis. The other laboratory values are within normal limits.
D) Laboratory tests are not routinely done to evaluate anxiety because observation is faster and more accurate. However, they may be necessary to rule out medical conditions that can cause anxiety. The elevated blood glucose level could indicate that the client is experiencing stress because of an increase in adrenal function. One physiological indicator of stress is an increase in blood glucose because of the release of glucocorticoids and gluconeogenesis. The other laboratory values are within normal limits.
Page Ref: 1906
Cognitive Level: Understanding
Client Need: Physiological Integrity
Nursing Process: Assessment
Learning Outcome: 4. Differentiate common assessment procedures used to examine stress levels and coping mechanisms across the life span.

6) A client complains about the stress of having to work so much and missing daily exercise routines. What should the nurse respond to this client?
A) There are other ways to reduce stress, such as meditation.
B) Exercise helps reduce the impact of stress on the body and would be a good thing.
C) Drinking a small glass of wine each day does help reduce stress.
D) Maybe exercising, with all of the work, would be too much for your body anyway.
Answer: B
Explanation: A) The client had been exercising but has not because of additional work, which is causing stress. The nurse should encourage the client to resume daily exercise to reduce the impact of the stress on the body. The nurse should not reinforce the clients not exercising. Meditation might be beneficial, but because the client mentioned initially exercising and not meditating, this suggestion is not as appropriate in addressing the clients needs. The nurse should not suggest using alcohol to deal with stress.
B) The client had been exercising but has not because of additional work, which is causing stress. The nurse should encourage the client to resume daily exercise to reduce the impact of the stress on the body. The nurse should not reinforce the clients not exercising. Meditation might be beneficial, but because the client mentioned initially exercising and not meditating, this suggestion is not as appropriate in addressing the clients needs. The nurse should not suggest using alcohol to deal with stress.
C) The client had been exercising but has not because of additional work, which is causing stress. The nurse should encourage the client to resume daily exercise to reduce the impact of the stress on the body. The nurse should not reinforce the clients not exercising. Meditation might be beneficial, but because the client mentioned initially exercising and not meditating, this suggestion is not as appropriate in addressing the clients needs. The nurse should not suggest using alcohol to deal with stress.
D) The client had been exercising but has not because of additional work, which is causing stress. The nurse should encourage the client to resume daily exercise to reduce the impact of the stress on the body. The nurse should not reinforce the clients not exercising. Meditation might be beneficial, but because the client mentioned initially exercising and not meditating, this suggestion is not as appropriate in addressing the clients needs. The nurse should not suggest using alcohol to deal with stress.
Page Ref: 1914
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 6. Explain management of stress to facilitate healthy coping and prevent stress-related illness.

7) Which intervention would help a client who is demonstrating stress about being hospitalized and concerned about the needs of the children at home?
A) Ask the client if there is anything that is needed once discharged to home.
B) Ask the client if there is anyone who would be able to help with the family needs at home during recuperation.
C) Find out if the children can be sent to a grandparents home until the client fully recovers.
D) Suggest the client be transferred to a long-term care facility to ensure a full recovery.
Answer: B
Explanation: A) The best way that the nurse can help the client who is stressed with a new illness and family responsibilities is to ask if there is anyone who can help the client at home. Transferring the client to a long-term care facility will not help the client with the stress of caring for a family at home. Sending the children to a grandparents home might not work if the children are in school and the grandparent lives far away. Asking the client if there is anything that is needed once discharged is not enough. The nurse needs to do something else.
B) The best way that the nurse can help the client who is stressed with a new illness and family responsibilities is to ask if there is anyone who can help the client at home. Transferring the client to a long-term care facility will not help the client with the stress of caring for a family at home. Sending the children to a grandparents home might not work if the children are in school and the grandparent lives far away. Asking the client if there is anything that is needed once discharged is not enough. The nurse needs to do something else.
C) The best way that the nurse can help the client who is stressed with a new illness and family responsibilities is to ask if there is anyone who can help the client at home. Transferring the client to a long-term care facility will not help the client with the stress of caring for a family at home. Sending the children to a grandparents home might not work if the children are in school and the grandparent lives far away. Asking the client if there is anything that is needed once discharged is not enough. The nurse needs to do something else.
D) The best way that the nurse can help the client who is stressed with a new illness and family responsibilities is to ask if there is anyone who can help the client at home. Transferring the client to a long-term care facility will not help the client with the stress of caring for a family at home. Sending the children to a grandparents home might not work if the children are in school and the grandparent lives far away. Asking the client if there is anything that is needed once discharged is not enough. The nurse needs to do something else.
Page Ref: 1914
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 6. Demonstrate the nursing process in providing culturally competent and caring interventions across the life span for individuals with common alterations in coping.

8) Which of the following should the nurse instruct a client prescribed diazepam (Valium) for anxiety and stress?
A) This medication will be good to take for a long time.
B) Take this medication every time feelings of stress become overwhelming.
C) This medication works best if taken with a meal.
D) This medication is good to use for the short term only.
Answer: D
Explanation: A) Diazepam (Valium) is a benzodiazepine that is typically used for short-term treatment during an acute phase of an anxiety disorder. It may be effective in quickly lowering the severity of a clients anxiety but is generally not recommended for use beyond a few weeks because of its addictive properties. The nurse should instruct the client that the medication is good to use for the short term only. There is no indication that this medication needs to be taken with a meal. Instructing the client to take the medication every time feelings of stress become overwhelming could lead to an overdose and should not be done.
B) Diazepam (Valium) is a benzodiazepine that is typically used for short-term treatment during an acute phase of an anxiety disorder. It may be effective in quickly lowering the severity of a clients anxiety but is generally not recommended for use beyond a few weeks because of its addictive properties. The nurse should instruct the client that the medication is good to use for the short term only. There is no indication that this medication needs to be taken with a meal. Instructing the client to take the medication every time feelings of stress become overwhelming could lead to an overdose and should not be done.
C) Diazepam (Valium) is a benzodiazepine that is typically used for short-term treatment during an acute phase of an anxiety disorder. It may be effective in quickly lowering the severity of a clients anxiety but is generally not recommended for use beyond a few weeks because of its addictive properties. The nurse should instruct the client that the medication is good to use for the short term only. There is no indication that this medication needs to be taken with a meal. Instructing the client to take the medication every time feelings of stress become overwhelming could lead to an overdose and should not be done.
D) Diazepam (Valium) is a benzodiazepine that is typically used for short-term treatment during an acute phase of an anxiety disorder. It may be effective in quickly lowering the severity of a clients anxiety but is generally not recommended for use beyond a few weeks because of its addictive properties. The nurse should instruct the client that the medication is good to use for the short term only. There is no indication that this medication needs to be taken with a meal. Instructing the client to take the medication every time feelings of stress become overwhelming could lead to an overdose and should not be done.
Page Ref: 1916
Cognitive Level: Understanding
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 7. Compare and contrast common independent and collaborative interventions for clients with alterations in coping.

9) The nurse is assessing a client who is demonstrating physiologic manifestations of a stress response. Which physiologic manifestations are the result of the inhibition of the parasympathetic nervous system?
Select all that apply.
A) Dry oral mucous membranes
B) Hypoactive bowel sounds
C) Increased heart rate
D) Increased respiratory rate
E) Increased depth of respirations
Answer: A, B
Explanation: A) Dry mouth is secondary to inhibition of the parasympathetic nervous system; therefore assessment findings would reveal dry oral mucous membranes. Inhibition of the parasympathetic nervous system leads to decreased peristalsis; therefore assessment findings would indicate hypoactive bowel sounds. Increased heart rate, respiratory rate, and depth of respirations are all due to sympathetic nervous system stimulation.
B) Dry mouth is secondary to inhibition of the parasympathetic nervous system; therefore assessment findings would reveal dry oral mucous membranes. Inhibition of the parasympathetic nervous system leads to decreased peristalsis; therefore assessment findings would indicate hypoactive bowel sounds. Increased heart rate, respiratory rate, and depth of respirations are all due to sympathetic nervous system stimulation.
C) Dry mouth is secondary to inhibition of the parasympathetic nervous system; therefore assessment findings would reveal dry oral mucous membranes. Inhibition of the parasympathetic nervous system leads to decreased peristalsis; therefore assessment findings would indicate hypoactive bowel sounds. Increased heart rate, respiratory rate, and depth of respirations are all due to sympathetic nervous system stimulation.
D) Dry mouth is secondary to inhibition of the parasympathetic nervous system; therefore assessment findings would reveal dry oral mucous membranes. Inhibition of the parasympathetic nervous system leads to decreased peristalsis; therefore assessment findings would indicate hypoactive bowel sounds. Increased heart rate, respiratory rate, and depth of respirations are all due to sympathetic nervous system stimulation.
E) Dry mouth is secondary to inhibition of the parasympathetic nervous system; therefore assessment findings would reveal dry oral mucous membranes. Inhibition of the parasympathetic nervous system leads to decreased peristalsis; therefore assessment findings would indicate hypoactive bowel sounds. Increased heart rate, respiratory rate, and depth of respirations are all due to sympathetic nervous system stimulation.
Page Ref: 1986
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Physiological Adaptation
Nursing Process: Assessment
Learning Outcome: 1. Summarize the physiologic response to stress and the psychodynamics of coping.

10) A client has just started taking risperidone (Risperdal) as ordered by the physician. Which would be a priority nursing consideration for this client?
A) Assess blood pressure and heart rate.
B) Monitor for increased agitation.
C) Assess for drowsiness.
D) Monitor for neuroleptic syndrome.
Answer: D
Explanation: A) Monitoring for neuroleptic syndrome is a priority nursing consideration for a client taking risperidone (Risperdal). The nurse must monitor for signs and symptoms of neuroleptic malignant syndrome and tardive dyskinesia and immediately report signs and symptoms of these conditions. Monitoring for increased agitation and assessing for drowsiness are nursing considerations for clients taking Risperdal, but they are not the priority diagnosis. Assessing blood pressure and heart rate would be a priority nursing consideration for the client taking Inderal.
B) Monitoring for neuroleptic syndrome is a priority nursing consideration for a client taking risperidone (Risperdal). The nurse must monitor for signs and symptoms of neuroleptic malignant syndrome and tardive dyskinesia and immediately report signs and symptoms of these conditions. Monitoring for increased agitation and assessing for drowsiness are nursing considerations for clients taking Risperdal, but they are not the priority diagnosis. Assessing blood pressure and heart rate would be a priority nursing consideration for the client taking Inderal.
C) Monitoring for neuroleptic syndrome is a priority nursing consideration for a client taking risperidone (Risperdal). The nurse must monitor for signs and symptoms of neuroleptic malignant syndrome and tardive dyskinesia and immediately report signs and symptoms of these conditions. Monitoring for increased agitation and assessing for drowsiness are nursing considerations for clients taking Risperdal, but they are not the priority diagnosis. Assessing blood pressure and heart rate would be a priority nursing consideration for the client taking Inderal.
D) Monitoring for neuroleptic syndrome is a priority nursing consideration for a client taking risperidone (Risperdal). The nurse must monitor for signs and symptoms of neuroleptic malignant syndrome and tardive dyskinesia and immediately report signs and symptoms of these conditions. Monitoring for increased agitation and assessing for drowsiness are nursing considerations for clients taking Risperdal, but they are not the priority diagnosis. Assessing blood pressure and heart rate would be a priority nursing consideration for the client taking Inderal.
Page Ref: 1916
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing Process: Assessment
Learning Outcome: 8. Compare and contrast common independent and collaborative interventions for clients with alterations in coping.

11) A nurse on the behavioral health unit is caring for a client diagnosed with depression, who just lost his spouse in a motor-vehicle accident. The client states to the nurse, my wife would not have wanted to live if she were disabled. This statement indicates to the nurse that the client is using which defense mechanism?
A) Identification
B) Denial
C) Intellectualization
D) Displacement
Answer: C
Explanation: A) Intellectualization is a mechanism by which an emotional response that normally would accompany an uncomfortable or painful incident is evaded by the use of rational explanations that remove from the incident any personal significance and feelings. Identification is an attempt to manage anxiety by imitating the behavior of someone feared or respected. Denial is an attempt to screen or ignore unacceptable realities by refusing to acknowledge them. Displacement is the transferring or discharging of emotional reactions from one object or individual to another object or individual.
B) Intellectualization is a mechanism by which an emotional response that normally would accompany an uncomfortable or painful incident is evaded by the use of rational explanations that remove from the incident any personal significance and feelings. Identification is an attempt to manage anxiety by imitating the behavior of someone feared or respected. Denial is an attempt to screen or ignore unacceptable realities by refusing to acknowledge them. Displacement is the transferring or discharging of emotional reactions from one object or individual to another object or individual.
C) Intellectualization is a mechanism by which an emotional response that normally would accompany an uncomfortable or painful incident is evaded by the use of rational explanations that remove from the incident any personal significance and feelings. Identification is an attempt to manage anxiety by imitating the behavior of someone feared or respected. Denial is an attempt to screen or ignore unacceptable realities by refusing to acknowledge them. Displacement is the transferring or discharging of emotional reactions from one object or individual to another object or individual.
D) Intellectualization is a mechanism by which an emotional response that normally would accompany an uncomfortable or painful incident is evaded by the use of rational explanations that remove from the incident any personal significance and feelings. Identification is an attempt to manage anxiety by imitating the behavior of someone feared or respected. Denial is an attempt to screen or ignore unacceptable realities by refusing to acknowledge them. Displacement is the transferring or discharging of emotional reactions from one object or individual to another object or individual.
Page Ref: 1905
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 6. Explain management of stress to facilitate healthy coping and prevent stress-related illness.

Exemplar 31.1 Anxiety Disorders

1) A client who has been experiencing slight anxiety is now trembling and communicating in a manner that makes it difficult for the nurse to understand the clients needs. The nurse is concerned that the client has progressed to which level of anxiety?
A) Panic
B) Severe
C) Moderate
D) Mild
Answer: B
Explanation: A) Changes in verbalization can be indicative of increasing anxiety. Mild anxiety causes an increase in questioning. Moderate anxiety results in voice tremors and pitch changes. At severe levels, communication is difficult to understand and trembling can occur. Communication may not be understandable at all when the client reaches the panic stage.
B) Changes in verbalization can be indicative of increasing anxiety. Mild anxiety causes an increase in questioning. Moderate anxiety results in voice tremors and pitch changes. At severe levels, communication is difficult to understand and trembling can occur. Communication may not be understandable at all when the client reaches the panic stage.
C) Changes in verbalization can be indicative of increasing anxiety. Mild anxiety causes an increase in questioning. Moderate anxiety results in voice tremors and pitch changes. At severe levels, communication is difficult to understand and trembling can occur. Communication may not be understandable at all when the client reaches the panic stage.
D) Changes in verbalization can be indicative of increasing anxiety. Mild anxiety causes an increase in questioning. Moderate anxiety results in voice tremors and pitch changes. At severe levels, communication is difficult to understand and trembling can occur. Communication may not be understandable at all when the client reaches the panic stage.
Page Ref: 1923
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of anxiety disorders.

2) A client tells the nurse about recently being laid off from work and is scheduled for a biopsy to detect a malignancy. What should the nurse include when planning this clients care?
A) Reasons to delay the biopsy
B) Medicate around the clock for pain
C) Interventions to address anxiety
D) Social services to aid with financial planning
Answer: C
Explanation: A) Risk factors for anxiety disorders include multiple stressors such as an illness occurring with a change in employment. The nurse should plan interventions to address anxiety. Social services may or may not be needed for the clients financial planning. Delaying the biopsy will not help reduce anxiety. There is no evidence to suggest the client is experiencing pain.
B) Risk factors for anxiety disorders include multiple stressors such as an illness occurring with a change in employment. The nurse should plan interventions to address anxiety. Social services may or may not be needed for the clients financial planning. Delaying the biopsy will not help reduce anxiety. There is no evidence to suggest the client is experiencing pain.
C) Risk factors for anxiety disorders include multiple stressors such as an illness occurring with a change in employment. The nurse should plan interventions to address anxiety. Social services may or may not be needed for the clients financial planning. Delaying the biopsy will not help reduce anxiety. There is no evidence to suggest the client is experiencing pain.
D) Risk factors for anxiety disorders include multiple stressors such as an illness occurring with a change in employment. The nurse should plan interventions to address anxiety. Social services may or may not be needed for the clients financial planning. Delaying the biopsy will not help reduce anxiety. There is no evidence to suggest the client is experiencing pain.
Page Ref: 1920
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Planning
Learning Outcome: 2. Identify risk factors and prevention methods associated with anxiety disorders.

3) While caring for a critically ill child, the childs mother becomes distraught and begins to cry loudly while stroking the childs face. What is the best nurse response to the mothers behavior?
A) Explain the procedure that will occur with the treatment.
B) Tell the mother that she needs to control herself for the benefit of her child.
C) Take the mother out of the room and comfort her.
D) Distract the mother by having her straighten the linens on the bed.
Answer: C
Explanation: A) In this situation, the nurse must analyze which of the available options would be best for this mother and child. At this level of emotion, the nurse should remove the mother from the room and comfort her. Although the mothers expression of anxiety is understandable, the child should be protected from this strongly upsetting situation. Just telling the mother to control herself discounts the seriousness of her anxiety and may serve to alienate the mother from the nurse. This mother is too upset to distract by smoothing linens. Explaining the procedure may help, but the mother should be removed at least temporarily and be comforted so that she will be able to receive the information.
B) In this situation, the nurse must analyze which of the available options would be best for this mother and child. At this level of emotion, the nurse should remove the mother from the room and comfort her. Although the mothers expression of anxiety is understandable, the child should be protected from this strongly upsetting situation. Just telling the mother to control herself discounts the seriousness of her anxiety and may serve to alienate the mother from the nurse. This mother is too upset to distract by smoothing linens. Explaining the procedure may help, but the mother should be removed at least temporarily and be comforted so that she will be able to receive the information.
C) In this situation, the nurse must analyze which of the available options would be best for this mother and child. At this level of emotion, the nurse should remove the mother from the room and comfort her. Although the mothers expression of anxiety is understandable, the child should be protected from this strongly upsetting situation. Just telling the mother to control herself discounts the seriousness of her anxiety and may serve to alienate the mother from the nurse. This mother is too upset to distract by smoothing linens. Explaining the procedure may help, but the mother should be removed at least temporarily and be comforted so that she will be able to receive the information.
D) In this situation, the nurse must analyze which of the available options would be best for this mother and child. At this level of emotion, the nurse should remove the mother from the room and comfort her. Although the mothers expression of anxiety is understandable, the child should be protected from this strongly upsetting situation. Just telling the mother to control herself discounts the seriousness of her anxiety and may serve to alienate the mother from the nurse. This mother is too upset to distract by smoothing linens. Explaining the procedure may help, but the mother should be removed at least temporarily and be comforted so that she will be able to receive the information.
Page Ref: 1926
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 3. Illustrate the nursing process in providing culturally sensitive care across the life span for individuals with anxiety disorders.

4) While attempting to choose a nursing diagnosis, the nurse must decide whether a client is experiencing anxiety or fear. What key point would help the nurse make this decision?
A) The source of fear is identifiable, but anxiety may be vague.
B) Anxiety is a milder form of fear.
C) Fear results in a physiologic response, whereas anxiety is psychological.
D) Anxiety is generally based in reality, whereas fear is not.
Answer: A
Explanation: A) The source of fear is identifiable, but anxiety is vague. Fear and anxiety can both be based in reality or may not be based in reality. Both fear and anxiety can have physiologic and psychological components. Fear and anxiety are different, so anxiety is not just a milder form of fear.
B) The source of fear is identifiable, but anxiety is vague. Fear and anxiety can both be based in reality or may not be based in reality. Both fear and anxiety can have physiologic and psychological components. Fear and anxiety are different, so anxiety is not just a milder form of fear.
C) The source of fear is identifiable, but anxiety is vague. Fear and anxiety can both be based in reality or may not be based in reality. Both fear and anxiety can have physiologic and psychological components. Fear and anxiety are different, so anxiety is not just a milder form of fear.
D) The source of fear is identifiable, but anxiety is vague. Fear and anxiety can both be based in reality or may not be based in reality. Both fear and anxiety can have physiologic and psychological components. Fear and anxiety are different, so anxiety is not just a milder form of fear.
Page Ref: 1903-1904
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Diagnosis
Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with an anxiety disorder.

5) Which nursing intervention minimizes the stress and anxiety of hospitalization for a client?
A) Explain all procedures in detail before performing them.
B) Control the environment of healing.
C) Demonstrate staff competence by using multiple nurses for care.
D) Let the client make the majority of decisions about the plan of care.
Answer: B
Explanation: A) The nurse is in charge of the environment of healing and should take responsibility for limiting noise, dimming lights at night, using minimal numbers of nurses to care for one client, and keeping the area clean and comfortable. Explaining all procedures in detail may overwhelm the client. Using short, clear sentences and explaining only enough to satisfy the client is a better plan. A client who is ill cannot be expected to make the majority of decisions about the plan of care, but should be allowed as much autonomy and choice as can be arranged and tolerated.
B) The nurse is in charge of the environment of healing and should take responsibility for limiting noise, dimming lights at night, using minimal numbers of nurses to care for one client, and keeping the area clean and comfortable. Explaining all procedures in detail may overwhelm the client. Using short, clear sentences and explaining only enough to satisfy the client is a better plan. A client who is ill cannot be expected to make the majority of decisions about the plan of care, but should be allowed as much autonomy and choice as can be arranged and tolerated.
C) The nurse is in charge of the environment of healing and should take responsibility for limiting noise, dimming lights at night, using minimal numbers of nurses to care for one client, and keeping the area clean and comfortable. Explaining all procedures in detail may overwhelm the client. Using short, clear sentences and explaining only enough to satisfy the client is a better plan. A client who is ill cannot be expected to make the majority of decisions about the plan of care, but should be allowed as much autonomy and choice as can be arranged and tolerated.
D) The nurse is in charge of the environment of healing and should take responsibility for limiting noise, dimming lights at night, using minimal numbers of nurses to care for one client, and keeping the area clean and comfortable. Explaining all procedures in detail may overwhelm the client. Using short, clear sentences and explaining only enough to satisfy the client is a better plan. A client who is ill cannot be expected to make the majority of decisions about the plan of care, but should be allowed as much autonomy and choice as can be arranged and tolerated.
Page Ref: 1926
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Planning
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with an anxiety disorder.

6) The nurse realizes that medication teaching has been ineffective when the client with an anxiety disorder states, Prozac is not working, even though I have been taking it for
A) 4 weeks.
B) 1 week.
C) 8 weeks.
D) 12 weeks.
Answer: B
Explanation: A) Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI). Typically, this classification of medications takes 4 weeks to demonstrate a therapeutic response and up to 8-12 weeks to see a full response to the drug.
B) Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI). Typically, this classification of medications takes 4 weeks to demonstrate a therapeutic response and up to 8-12 weeks to see a full response to the drug.
C) Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI). Typically, this classification of medications takes 4 weeks to demonstrate a therapeutic response and up to 8-12 weeks to see a full response to the drug.
D) Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI). Typically, this classification of medications takes 4 weeks to demonstrate a therapeutic response and up to 8-12 weeks to see a full response to the drug.
Page Ref: 1916
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Evaluation
Learning Outcome: 6. Plan evidence-based care for an individual with an anxiety disorder and his or her family in collaboration with other members of the healthcare team.

7) The nurse is instructing a client with an anxiety disorder on behavioral tools to help with coping. What would the nurse include in this teaching?
Select all that apply.
A) Reading self-help literature
B) Thought stopping
C) Journaling
D) Distraction
E) Practicing yoga
Answer: A, C, E
Explanation: A) Behavioral tools to help with coping include reading self-help literature, practicing relaxation techniques such as yoga, and journaling stressors and emotional responses and alternatives. Thought stopping and distraction are cognitive coping tools.
B) Behavioral tools to help with coping include reading self-help literature, practicing relaxation techniques such as yoga, and journaling stressors and emotional responses and alternatives. Thought stopping and distraction are cognitive coping tools.
C) Behavioral tools to help with coping include reading self-help literature, practicing relaxation techniques such as yoga, and journaling stressors and emotional responses and alternatives. Thought stopping and distraction are cognitive coping tools.
D) Behavioral tools to help with coping include reading self-help literature, practicing relaxation techniques such as yoga, and journaling stressors and emotional responses and alternatives. Thought stopping and distraction are cognitive coping tools.
E) Behavioral tools to help with coping include reading self-help literature, practicing relaxation techniques such as yoga, and journaling stressors and emotional responses and alternatives. Thought stopping and distraction are cognitive coping tools.
Page Ref: 1925
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 7. Evaluate expected outcomes for an individual with an anxiety disorder.

8) What should the nurse do first when a client begins to demonstrate signs of escalating anxiety?
A) Isolate the client in a safe, quiet, and protective environment.
B) Leave the client alone in a room.
C) Provide a benzodiazepine.
D) Phone the physician.
Answer: A
Explanation: A) The nurse should first isolate the severely anxious or panicked client in a safe, quiet, protective environment. The nurse should not leave the client unattended. Phoning the physician may not be helpful to the client. Medications can be provided once the client is in a safe, protective environment.
B) The nurse should first isolate the severely anxious or panicked client in a safe, quiet, protective environment. The nurse should not leave the client unattended. Phoning the physician may not be helpful to the client. Medications can be provided once the client is in a safe, protective environment.
C) The nurse should first isolate the severely anxious or panicked client in a safe, quiet, protective environment. The nurse should not leave the client unattended. Phoning the physician may not be helpful to the client. Medications can be provided once the client is in a safe, protective environment.
D) The nurse should first isolate the severely anxious or panicked client in a safe, quiet, protective environment. The nurse should not leave the client unattended. Phoning the physician may not be helpful to the client. Medications can be provided once the client is in a safe, protective environment.
Page Ref: 1926
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 6. Plan evidence-based care for an individual with an anxiety disorder and his or her family in collaboration with other members of the healthcare team.

9) The nurse is admitting a client with panic anxiety to the behavioral health unit. Which clinical manifestation(s) would indicate that the clients anxiety is at a panic level of severity?
Select all that apply.
A) Inability to focus
B) Dilated pupils
C) Feelings of doom
D) Self-absorption
E) Rapid speech
Answer: A, B, C
Explanation: A) An inability to focus, dilated pupils, and a feeling of doom are clinical manifestations that a client could experience at the panic level of severity of anxiety. Self-absorption and rapid speech could indicate that a client is experiencing anxiety at a moderate level of severity.
B) An inability to focus, dilated pupils, and a feeling of doom are clinical manifestations that a client could experience at the panic level of severity of anxiety. Self-absorption and rapid speech could indicate that a client is experiencing anxiety at a moderate level of severity.
C) An inability to focus, dilated pupils, and a feeling of doom are clinical manifestations that a client could experience at the panic level of severity of anxiety. Self-absorption and rapid speech could indicate that a client is experiencing anxiety at a moderate level of severity.
D) An inability to focus, dilated pupils, and a feeling of doom are clinical manifestations that a client could experience at the panic level of severity of anxiety. Self-absorption and rapid speech could indicate that a client is experiencing anxiety at a moderate level of severity.
E) An inability to focus, dilated pupils, and a feeling of doom are clinical manifestations that a client could experience at the panic level of severity of anxiety. Self-absorption and rapid speech could indicate that a client is experiencing anxiety at a moderate level of severity.
Page Ref: 1923
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of anxiety disorders.

10) A nurse on the behavioral health unit is leading a group regarding risk factors for anxiety. At the completion of group work, which comment made by a client would indicate the need for further teaching?
A) A lack of social interaction places me at risk for anxiety.
B) My personality could place me at risk for anxiety because I am shy.
C) Chronic illness is not a risk factor unless I am also unemployed.
D) I experienced a traumatic event that placed me at risk for having this anxiety disorder.
Answer: C
Explanation: A) Chronic illness is a risk factor for anxiety disorders with or without the unemployment factor. For some clients multiple stressors, such as chronic illness with loss of employment, are risk factors. So this statement indicates a need for further teaching. The other statements are accurate and therefore do not require further teaching.
B) Chronic illness is a risk factor for anxiety disorders with or without the unemployment factor. For some clients multiple stressors, such as chronic illness with loss of employment, are risk factors. So this statement indicates a need for further teaching. The other statements are accurate and therefore do not require further teaching.
C) Chronic illness is a risk factor for anxiety disorders with or without the unemployment factor. For some clients multiple stressors, such as chronic illness with loss of employment, are risk factors. So this statement indicates a need for further teaching. The other statements are accurate and therefore do not require further teaching.
D) Chronic illness is a risk factor for anxiety disorders with or without the unemployment factor. For some clients multiple stressors, such as chronic illness with loss of employment, are risk factors. So this statement indicates a need for further teaching. The other statements are accurate and therefore do not require further teaching.
Page Ref: 1920
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Teaching and Learning
Learning Outcome: 2. Identify risk factors and prevention methods associated with anxiety disorders.

11) The nurse is discharging a client diagnosed with general anxiety disorder (GAD). The client is prescribed a selective serotonin reuptake inhibitor (SSRI). Which statement made by the client would indicate to the nurse a need for further education?
A) This medicine could make me feel like I have the jitters.
B) I may experience some nausea while on this medication.
C) The physician will start me off on a high dose and then decrease the dose.
D) This medicine alters the levels of the neurotransmitter serotonin in the brain.
Answer: C
Explanation: A) SSRIs are generally started at low doses and then increased as their effectiveness becomes apparent; therefore this statement made by the client is inaccurate and does indicate a lack of understanding and the need for further teaching. The other statements are accurate so do not require further teaching.
B) SSRIs are generally started at low doses and then increased as their effectiveness becomes apparent; therefore this statement made by the client is inaccurate and does indicate a lack of understanding and the need for further teaching. The other statements are accurate so do not require further teaching.
C) SSRIs are generally started at low doses and then increased as their effectiveness becomes apparent; therefore this statement made by the client is inaccurate and does indicate a lack of understanding and the need for further teaching. The other statements are accurate so do not require further teaching.
D) SSRIs are generally started at low doses and then increased as their effectiveness becomes apparent; therefore this statement made by the client is inaccurate and does indicate a lack of understanding and the need for further teaching. The other statements are accurate so do not require further teaching.
Page Ref: 1924
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Teaching and Learning
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with an anxiety disorder.

Exemplar 31.2 Crisis

1) A client is in crisis because he has just been fired from his job, his spouse wants a divorce, and he has been sick with a cold for 1 month. Which nursing statement demonstrates understanding of the care of a client in crisis?
A) Experiencing a crisis is never positive, so we must work to relieve your anxiety as soon as possible.
B) People generally find it easier to work through a crisis if someone is working with them.
C) Men often handle crisis better individually, whereas women do better with a counselor.
D) Once you reach the crisis state, you may remain there for several months until you recover.
Answer: B
Explanation: A) In general, people are more successful in working through a crisis if they have someone to help them. This need for help is not gender dependent. A crisis results in such a state of disequilibrium that it is generally self-limiting and not a long-term event. Experiencing a crisis may actually offer the family or individual a potential for growth and change.
B) In general, people are more successful in working through a crisis if they have someone to help them. This need for help is not gender dependent. A crisis results in such a state of disequilibrium that it is generally self-limiting and not a long-term event. Experiencing a crisis may actually offer the family or individual a potential for growth and change.
C) In general, people are more successful in working through a crisis if they have someone to help them. This need for help is not gender dependent. A crisis results in such a state of disequilibrium that it is generally self-limiting and not a long-term event. Experiencing a crisis may actually offer the family or individual a potential for growth and change.
D) In general, people are more successful in working through a crisis if they have someone to help them. This need for help is not gender dependent. A crisis results in such a state of disequilibrium that it is generally self-limiting and not a long-term event. Experiencing a crisis may actually offer the family or individual a potential for growth and change.
Page Ref: 1928
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 1. Describe the physiology, etiology, clinical manifestations, and direct and indirect causes of a crisis response.

2) After an assessment, the nurse determines that an 18-year-old client is experiencing a maturational crisis because of which findings?
Select all that apply.
A) Relationship with significant other ended
B) Inability to focus on school studies
C) Cannot sleep at night and skips classes
D) Recent death of a friend
E) Graduating from high school in 2 months
Answer: B, C, E
Explanation: A) Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. The client is demonstrating stressors unique to progressing to the next level of maturity. The recent death of a friend and having a relationship with a significant other end are situational crises.
B) Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. The client is demonstrating stressors unique to progressing to the next level of maturity. The recent death of a friend and having a relationship with a significant other end are situational crises.
C) Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. The client is demonstrating stressors unique to progressing to the next level of maturity. The recent death of a friend and having a relationship with a significant other end are situational crises.
D) Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. The client is demonstrating stressors unique to progressing to the next level of maturity. The recent death of a friend and having a relationship with a significant other end are situational crises.
E) Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. The client is demonstrating stressors unique to progressing to the next level of maturity. The recent death of a friend and having a relationship with a significant other end are situational crises.
Page Ref: 1928
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 2. Identify risk factors and prevention methods associated with crisis.

3) What is the appropriate nurse response for a client experiencing a situational crisis?
Select all that apply.
A) I know just how you feel.
B) I am sorry this happened to you.
C) Its best to stay busy.
D) Things will get better and you will feel better.
E) It could have been worse.
Answer: B, D
Explanation: A) Stating that the nurse is sorry for what the client has experienced reflects empathy. Saying that things will get better and the client will feel better provides hope. Assessing the clients current emotional state and coping mechanisms that have been effective in the past requires open-ended questions and attentive listening. Stating that the nurse knows how the client feels hinders this communication and takes the focus off the client. Telling the client to stay busy does not empower the client to identify and adopt coping strategies. Telling the client it could have been worse minimizes the clients unique experience.
B) Stating that the nurse is sorry for what the client has experienced reflects empathy. Saying that things will get better and the client will feel better provides hope. Assessing the clients current emotional state and coping mechanisms that have been effective in the past requires open-ended questions and attentive listening. Stating that the nurse knows how the client feels hinders this communication and takes the focus off the client. Telling the client to stay busy does not empower the client to identify and adopt coping strategies. Telling the client it could have been worse minimizes the clients unique experience.
C) Stating that the nurse is sorry for what the client has experienced reflects empathy. Saying that things will get better and the client will feel better provides hope. Assessing the clients current emotional state and coping mechanisms that have been effective in the past requires open-ended questions and attentive listening. Stating that the nurse knows how the client feels hinders this communication and takes the focus off the client. Telling the client to stay busy does not empower the client to identify and adopt coping strategies. Telling the client it could have been worse minimizes the clients unique experience.
D) Stating that the nurse is sorry for what the client has experienced reflects empathy. Saying that things will get better and the client will feel better provides hope. Assessing the clients current emotional state and coping mechanisms that have been effective in the past requires open-ended questions and attentive listening. Stating that the nurse knows how the client feels hinders this communication and takes the focus off the client. Telling the client to stay busy does not empower the client to identify and adopt coping strategies. Telling the client it could have been worse minimizes the clients unique experience.

E) Stating that the nurse is sorry for what the client has experienced reflects empathy. Saying that things will get better and the client will feel better provides hope. Assessing the clients current emotional state and coping mechanisms that have been effective in the past requires open-ended questions and attentive listening. Stating that the nurse knows how the client feels hinders this communication and takes the focus off the client. Telling the client to stay busy does not empower the client to identify and adopt coping strategies. Telling the client it could have been worse minimizes the clients unique experience.
Page Ref: 1928
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 3. Illustrate the nursing process in providing culturally sensitive care across the life span for individuals in crisis.

4) Which nursing diagnosis would be applicable for a client having experienced a situational crisis?
Select all that apply.
A) Ineffective Coping
B) Risk for Self-Directed Violence
C) Spiritual Distress
D) Risk for Loneliness
Answer: A, B, C
Explanation: A) Loneliness may result from an individuals actions following a crisis, but it is not an appropriate nursing diagnosis for situational crisis. The other three answers are among the most common nursing diagnoses for people in crisis.
B) Loneliness may result from an individuals actions following a crisis, but it is not an appropriate nursing diagnosis for situational crisis. The other three answers are among the most common nursing diagnoses for people in crisis.
C) Loneliness may result from an individuals act

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