The document appears to be a questionnaire to assess anxiety levels in nursing students doing clinical rotations in a psychiatric ward, with 20 questions rated on a scale of 1 to 4 about physical symptoms, cognitive functioning, and comfort interacting with psychiatric patients.

1. ANXIETY LEVEL SCALE
This test questionnaire is use to determine the anxiety level of nursing students
expose in the psychiatric ward.
Code No:_________
PROFILE:
Name: ____________________________Gender: Male ( ) Female ( ) Age: _________
Instructions:
1. Please read and understand the questions carefully.
2. Do not leave any questions unanswered.
3. Answer the question honestly by checking the box on the desired rating you have
chosen; with a rating scale from 1 to 4 that describes as follows;
1 - None
2 - A little bit or somewhat
3 - Very much
4 – Extremely
QUESTIONS 1 2 3 4
1. Do you feel any muscular aches or pain?
2. Do you have any visual disturbances?
3. Do you have any chest pain, shortness of breath, chest
pressure or chocking sensation?
4. Do you feel uncontrollable muscles trembling?
5. Do you feel nauseous, any abdominal fullness, any urge to
vomit?
6. Do you feel any uncontrollable urge to urinate?
7. Do you feel dryness in your mouth, sweating or pallor?
8. Do you have difficulty of concentration on task or instructions?
9. Do you experience any memory problems towards your task?
10. Do you have any feeling of decreased interest or
apprehension in your psychiatric exposure?
11. Do you find it is difficult to interact with your assigned
psychiatric client?
QUESTIONS 1 2 3 4
12. Do you find it hard to familiarize the different activities or
functions during psychiatric exposure?
13. Do you have a hard time performing the things you had
learned and studied during your psychiatric orientation?
14. Do you feel always worried if something will happen to you or
any of your classmates during activities with your clients?
15. Do you anticipate the worst scenario with any of the
psychiatric client?

2. 16. Do you feel tensioned & restless in handling psych client
when they will have delusions, hallucinations or agitated during
psychiatric exposure?
17. Do you have fear of having a conflict, doubt of your skill when
interacting with the client at any time?
18. Do you feel stressed out when discussing regarding your
psychiatric exposure?
19. Do you have difficulty in expressing your concerns to your
Clinical Instructor or to any members of the heath care team?
20. Do you feel anxious when any psychiatric client near you
manifest out from reality?