EAQ - Anxiety, Mood & Affect
Which symptom would the nurse identify when assessing a client with Graves disease? 1. Constipation 2. Lethargy 3. Exophthalmos 4. Weight gain
3. Exophthalmos Graves disease is a common cause of hyperthyroidism. Exophthalmos occurs because of peribulbar edema in hyperthyroidism. Constipation, lethargy, weight gain are all associated with hypothyroidism because of the decreased metabolic rate.
When a client expresses anxiety about being given anesthesia, which team member should sit with the person and provide comfort during the induction? 1. Circulating nurse 2. Surgical assistant 3. Registered nurse first assistant 4. Certified registered nurse anesthetist
1. Circulating nurse The circulating, or nonsterile, nurse would sit with the client to provide comfort during induction. The surgical assistant and registered nurse first assistant will be assisting the surgeon during the procedure and will be scrubbed and sterile. The certified registered nurse anesthetist will be focused on providing medications to the client and cannot sit with the client during induction.
The nurse is teaching a client about tricyclic antidepressants. Which potential side effects would the nurse include? Select all that apply. One, some, or all responses may be correct. 1. Dry mouth 2. Drowsiness 3. Constipation 4. Severe hypertension 5. Orthostatic hypotension
1. Dry mouth 2. Drowsiness 3. Constipation 5. Orthostatic hypotension Dry mouth is a common anticholinergic side effect of tricyclic antidepressants. Drowsiness can be a common side effect but usually decreases with continued treatment. Constipation is a common side effect that usually can be managed with stool softeners and a high-fiber diet. Orthostatic hypotension is a common side effect of tricyclic antidepressants; the client should be instructed to rise slowly from a sitting to a standing position. Hypertension of any type is not a side effect of tricyclic antidepressants.
Which feeling would the nurse anticipate a manic client with bipolar 1 disorder is likely experiencing? 1. Guilt 2. Grandeur 3. Worthlessness 4. Self-deprecation
2. Grandeur The nurse would anticipate the client experience feelings of grandeur. During a manic episode a client has an inflated self-esteem. Feelings of guilt, worthlessness, and self-deprecation are not associated with bipolar disorder, manic episode; these occur during the depressive phase
Which behavior is an early sign of an abusive personality? Select all that apply. One, some, or all responses may be correct. 1. Verbal abusive 2. Jealous, controlling 3. Enforces rigid sex roles 4. Hypersensitive, easily insulted 5. Isolates partner from family and friends 6. Makes other responsible for their feelings
ALL OF THE ABOVE Abuser behavior has several characteristics. A typical abuser has poor emotional control, a superior attitude towards women, a history of substance abuse, high levels of jealousy and insecurity, and hypersensitivity. Other characteristics include making others responsible for their feelings and suing threats such as verbal abuse, punishment, and physical violence, to control another's behavior. Control may extend to enforcing rigid sex roles and isolating a partner from family and friends. Early recognition of the characteristics of potential violence allows for effective intervention.
A client has terminal cancer after 7 years of chemotherapy and surgeries. The nurse enters the client's room and finds the client crying. Which is the correct intervention by the nurse? 1. Sit down quietly next to the bed and allow her or him to cry 2. Pull the curtain and leave the room to provide privacy for the client. 3. Explain to the client that her or his feelings are expected and they will pass with time. 4. Observe the length of time the client cries and document her or his difficulty accepting her or his impending death.
1. Sit down quietly next to the bed and allow her or him to cry. Sitting down quietly next to the bed and allowing the client to cry demonstrates acceptance of the client's behavior and provides an opportunity for the client to verbally express feelings if desired. Pulling the curtain and leaving the room to provide privacy for the client may make the client feel the behavior is wrong or is annoying others. Also, it abandons the client when support is needed. Explaining to the client that her or his feelings are expected and they will pass with time closes off communication and does not provide an opportunity for the client to talk about feelings. Also, it provides false reassurance. The length of time the client cries is unimportant at this time. Assuming that the client is having difficulty accepting her or his impending death is a conclusion without enough information.
Which consistent approach would the nurse use for a client with an antisocial personality disorder? 1. Warm and firm without being punitive 2. Indifferent and detached but nonjudgmental 3. Conditionally acquiescent to client demands 4. Clearly communicative of personal disapproval
1. Warm and firm without being punitive The nurse would be warm and firm without being punitive. The client needs positive relationships with other adults, but clear consistent limits must be presented to minimize attempts at manipulation. Acting indifferent and detached but nonjudgmental is not a therapeutic approach. Being indifferent and detached gives the impression that the nurse does not care. Being conditionally acquiescent to client demands is not a therapeutic approach because clear, consistent limits are necessary to prevent manipulation. Being clearly communicative of personal disapproval is a judgmental attitude that should be avoided.
Which medication worsens uncontrolled angle-closure glaucoma when used for the treatment of generalized anxiety disorder? 1. Buspirone 2. Duloxetine 3. Chlorpromazine 4. Lithium carbonate
2. Duloxetine Duloxetine is an antidepressant medication used in the treatment of generalized anxiety order. A contraindication is that it can worsen uncontrolled angle-closure glaucoma. Lithium carbonate is used to treat manic episodes but is contraindicated in clients with renal disease. Buspirone is an antidepressant medication contraindicated in clients with known allergic reactions to this medication. Chlorpromazine is an antipsychotic medication contraindicated in clients with blood dycrasias.
For a hyperactive, manic client who exhibits flight of ideas, which rationale explains why the client is not eating? 1. Feels underserving of the food 2. Is too busy to take time to eat 3. Wishes to avoid others in the dining area 4. Believes that the food in poisoned
2. Is too busy to take time to eat Hyperactive clients frequently will not take the time to eat because they are overinvolved with everything in their environment. Feeling undeserving of the food is characteristic of a depressive episode. The client is unable to sit long enough with the other clients to eat a meal; this is not conscious avoidance. The client probably gives no thought to food because of overinvolvement with the activities in the environment.
The nurse suspects that the client has shift-work sleep disorder (SWSD). Which medication is indicated to treat this disorder? 1. Caffeine 2. Modafinil 3. Atomoxetine 4. Methylphenidate
2. Modafinil Modafinil is a unique non-amphetamine stimulant used to treat SWSD. This medication promotes wakefulness in clients suffering from excessive sleepiness associated with SWSD. Caffeine is a central nervous stimulant used to promote wakefulness, but this medication is not as effective in the treatment of SWSD. Atomoxetine is a non stimulant used to treat attention deficit/hyperactivity disorder (ADHD). Methylphenidate is considered a first-choice medication for the treatment of ADHD.
A client with hepatic cirrhosis begins to exhibit slurred speech, confusion, drowsiness, and a flapping tremor. Based upon this assessment, which prescribed diet would the nurse anticipate? 1. No protein 2. Moderate protein 3. High protein 4. Strict protein restriction
2. Moderate protein Because the liver is unable to detoxify ammonia to urea and the client is experiencing clinical manifestations leading to an impending hepatic encephalopathy coma, protein intake should be moderate. Strict protein and no-protein restrictions are not required because the client needs protein for healing. The hepatic encephalopathy diagnosis contradicts high-protein intake because protein breaks down into ammonia.
Which action would the nurse take for a client with major depression who is tearful and refuses to eat dinner after a visit with a friend? 1. Allow the client to skip the meal 2. Offer an opportunity to discuss the visit 3. Reinforce the importance of adequate nutrition 4. Provide the client with adequate nutrition
2. Offer an opportunity to discuss the visit The nurse would offer an opportunity to discuss the visit. Offering to discuss the visit shows support and provides the client with an opportunity to discuss feelings. Allowing the client to skip dinner does not address the client's depression. Teaching about the importance of adequate nutrition is inappropriate when a client is emotionally distressed. Providing quiet thinking time will limit further communication and may imply rejection.
Which initial action would the nurse take for a newly admitted client who reports memory loss, nervousness, insomnia, and fear of leaving the house? 1. Evaluate the client's adjustment to the unit. 2. Provide the client with a sense of security and safety. 3. Explore the client's memory loss and fear of going out. 4. Assess the client's perception of reasons for the hospitalization.
2. Provide the client with a sense of security and safety. The initial action is to provide the client with a sense of security and safety. The client is anxious and afraid of leaving home; the priority is the client's safety and security needs. It is too early to evaluate the client's adjustment to the unit. Additionally, if the client is not provided with a sense of security, adjustment probably will be unsatisfactory, because the anxiety will most likely escalate. Exploring the client's memory loss and fear of going out cannot be done until anxiety is reduced. The client is experiencing memory loss and may not be able to remember what precipitated admission to the hospital; some memory loss may be a result of high anxiety and thought blocking.
In light of a nurse hearing a depressed client telling another client, "I'll be feeling better soon," which initial parameter would the nurse assess for in the depressed client? 1. Ability to sleep 2. Suicidal thinking 3. Current feelings of depression 4. Subjective ideas about treatment progress
2. Suicidal thinking The nurse would assess the client's suicidal thinking. The client's comment reflects the possibility of suicide; further assessment and protection of the client are necessary. Although sleep is affected by depression, the overheard comment does not make this a priority at this time. Although feelings of depression could be getting better and subjective ideas about treatment progress could be improving, neither is the priority at this time. These assessments can be addressed after the assessment for suicide.
On the day after admission, which response would the nurse make to a suicidal client who asks, "Why am I being watched around the clock, and why can't I walk around the whole unit?" 1. "Why do you think we're observing you?" 2. What makes you think we're observing you?" 3. "We're concerned that you might try to harm yourself." 4. "We're following orders, so there must be a reason."
3. "We're concerned that you might try to harm yourself." The statement "We're concerned that you might try to harm yourself" is honest and helps establish trust. Also, it may help the client realize that the staff members care. "Why do you think we're observing you?" will put the client on the defensive, and asking "why" should be avoided. "What makes you think we're observing you?" is an inappropriate response when the answer is so obvious. The response "We're following orders, so there must be a reason" is evasive.
Which response would the nurse make to a client scheduled for electroconvulsive therapy (ECT) who says, "I'm scared that I'll lose my memory forever after the treatment"? 1. "Your memory loss may be permanent, but usually it's just temporary." 2. "You won't experience a permanent memory loss, so there's no need to be frightened." 3. "You'll experience a temporary loss of memory, and feeling frightened about it is expected." 4. Your memory loss will be temporary, and it will help block out many of your painful past experiences."
3. "You'll experience a temporary loss of memory, and a feeling frightened about it is expected." The nurse would respond with, "You'll experience a temporary loss of memory, and feeling frightened about it is expected." Giving the client simple facts and assuring the client that being frightened is expected may help ease the client's fears. Memory loss affects recently learned information such as the ECT experience; the response that it may be permanent may unnecessarily worry the client. Although it is a true statement that memory loss is not permanent and there is no need to worry, this response negates the client's feelings. ECT does not selectively block out painful experiences.
Which behavior is most commonly used by an individual with a phobic disorder? 1. Rumination 2. Desensitization 3. Avoidance 4. Confrontation
3. Avoidance The person transfers anxieties to activities or objects, usually inanimate objects, which are then avoided to decrease anxiety. Rumination (continuously rethinking about an issue) is more common in depression. Desensitization is a therapy that is used to treat phobias by systematically exposing the individual to the phobic object using a series of small steps. People with phobias fear confrontation with the phobic object and are less likely to attempt this without the help of a therapist.
The nurse would identify which medication as a high-potency medication used to treat schizophrenia? 1. Loxapine 2. Thioidazine 3. Fluphenazine 4. Perphenazine
3. Fluphenazine Fluphenazine is a high potency medication used for schizophrenia. Loxapine and perphenazine are medium-potency medications used to treat schizophrenia. Thioridazine is a low-potency medication used to treat schizophrenia.
A client tells the nursing assistant "I am so worried about the results of the biopsy they took today." The nurse overhears the nursing assistant reply, "Don't worry. I'm sure everything will come out all right." Which conclusion would the nurse make about the nursing assistant's answer? 1. It shows empathy 2. It uses distraction 3. It gives false reassurance 4. It makes a value judgment
3. It gives false reassurances A person cannot know the results of the biopsy until it is examined under a microscope. The response does not allow the client to voice concerns, shuts off communication, and provides reassurance that may be accurate. This answer does not empathize with the client; it minimizes the client's concerns. This response is not a form of distraction; it minimizes the client's concern and shuts off communication. This response does not contain any value statements.
Which action by the school nurse would be most important when monitoring an adolescent who has just returned to high school after a suicide attempt? 1. Observe the adolescent interacting with friends. 2. Request that teachers and friends report any changes in the client's behavior. 3. Speak with the adolescent regarding feelings about returning to school. 4. Tell the teachers what happened and ask them whether there are any problems.
3. Speak with the adolescent regarding feelings about returning to school. The most important action is speaking to the adolescent because the best person to obtain data from is the adolescent. Speaking with the adolescent regarding feelings about returning to school shows the adolescent that the nurse is available and is interested and concerned. Observing the adolescent interacting with friends is appropriate, but it is not the most important because this does not provide the best information; the adolescent would provide the best information. Requesting that teachers and friends report any changes in behavior will place responsibility on others and may interfere with the adolescent's relationship with them. Also, it violates the adolescent's right to privacy. Telling the teachers what happened and asking whether there are any problems violates the adolescent's right to privacy.
A client has been diagnosed with generalized anxiety disorder (GAD). Which behavior would the nurse expect to observe? 1. Making huge efforts to avoid "any kind of bug or spider" 2. Experiencing flashbacks to an event that involved a sexual attack 3. Spending hours each day worrying about something "bad happening" 4. Becoming suddenly tachycardic and diaphoretic for no apparent reason
3. Spending hours each day worrying about something "bad happening" Using worrying as a coping mechanism is a behavior characteristic of GAD. Avoiding bugs and spiders would indicate a phobia. Flashbacks to traumatic events are characteristic of post-traumatic stress disorder (PTSD). Experiencing an accelerated heart rate and perfuse sweating for no apparent reason is consistent with a panic attack.
Which action would the nurse take when a confused and anxious client voids on the floor in the sitting room of the mental health unit? 1. Make the client mop the floor 2. Restrict the client's fluids for the rest of the day 3. Toilet the client more frequently with supervision 4. Withhold the client's privileges each time the client voids on the floor
3. Toilet the client more frequently with supervision The nurse would toilet the client more frequently with supervision. The client is voiding on the floor not to express hostility but because of confusion. Taking the client to the toilet frequently reduces the risk of voiding in inappropriate places Making the client mop the floor is a form of punishment for something the client cannot control. Restricting the client's fluids for the rest of the day is not realistic; it will have no effect on the problem and may leas to physiological problems. If the client were doing this to express hostility, withholding privileges might be effective, but not when the client is unable to control the behavior.
Which nursing intervention would help a client who exhibits physical symptoms when stressed? 1. Limiting discussions about the problem 2. Providing information regarding medical care 3. Teaching the client how to eliminate stress at home 4. Assisting the client in developing new coping mechanisms
4. Assisting the client in developing new coping mechanisms The nurse would assist the client in developing new coping mechanisms. Until the client learns new ways of coping with stress and anxiety, this pattern of behavior will continue. Learning new ways of coping with stress will help break this physiological pattern. Limiting discussion will avoid the problem. Providing information about medical care will reinforce the sick role. A certain amount of stress is present in everyday family situations; the elimination of stress is impossible.
Which statement is accurate for adolescent suicide behavior? 1. Boys account for more attempts compared with girls 2. Girls use more dramatic methods compared with boys 3. Girls talk more about suicide before attempting it 4. Boys are more likely to use lethal methods than are girls
4. Boys are more likely to use lethal methods than are girls The finding that boys are more likely to use lethal methods than are girls is supported by research; girls account for 90% of suicide attempts, but boys are three times more successful because of the methods they use. Statistics do not support the assertion that girls talk more about suicide before attempting it than do boys or that girls use more dramatic methods than do boys.
Which medication is contraindicated in clients with blood dycrasias? 1. Duloxetine 2. Bupropion 3. Mirtazapine 4. Chlorpromazine
4. Chlorpromazine Chlorpromazine is an antipsychotic medication contraindicated in clients with blood dyscrasias. Duloxetine is an antidepressant medication contraindicated in clients with uncontrolled angle-closed glaucoma. Bupropion is an antidepressant medication contraindicated in clients with anorexia nervosa. Mirtazapine is an antidepressant medication contraindicated in clients who have allergic reactions due to medications and concurrent use of monoamine oxidase inhibitors.
Which term describes the disturbance in mood and affect seen in clients who are depressed? 1. Euphoric 2. Labile 3. Expansive 4. Dysphoric
4. Dysphoric Dysphoric describes feelings of hopelessness and sadness, which are symptomatic of depression. Euphoric is a feeling of elation and joyfulness; this is often seen in the early manic phase of bipolar disorder. A labile mood describes a rapid change in mood, for example, clients with dementia may be easily upset and then happy. An expansive (talkative, exaggerated friendliness) mood is usually associated with the manic phase of bipolar disorder.
According to Erikson's psychosocial stages of development, which developmental conflict is a college student attempting to resolve as he struggles with indecision about an academic major? 1. Initiative versus guilt 2. Integrity versus despair 3. Industry versus inferiority 4. Identity versus role confusion
4. Identity versus role confusion The client is demonstrating a search for self and has not resolved the developmental conflict of adolescence, identity versus role confusion. Initiative versus guilt is the developmental conflict of early childhood. Integrity versus despair is the developmental conflict of old age. Industry versus inferiority is the developmental conflict of middle childhood.
A client who recently was diagnosed as having myelocytic leukemia discusses the diagnosis by referring to statistics, facts, and figures. The nurse determines that the client is using which defense mechanism? 1. Projection 2. Sublimation 3. Identification 4. Intellectualization
4. Intellectualization Intellectualization is the use of reasoning and thought processes to avoid the emotional aspects of a situation; this is a defense against anxiety. Projection is denying unacceptable traits and regarding them as belonging to another person. Sublimation is a defense wherein the person redirects the energy of unacceptable impulses into socially acceptable behaviors or activities. Identification is the reduction of anxiety by imitating someone respected or feared.
The nurse observes a child fail to make eye contact with parents and has poor impulse control. Upon further investigation, the child is found to have a father with a current behavior of alcohol abuse and child neglect. Which would the nurse conclude? 1. Recommend screening for autism. 2. Understand the child is experiencing separation anxiety. 3. The child is probably solitary because of the parent's behavior. 4. The child has developed reactive attachment disorder (RAD).
4. The child has developed reactive attachment disorder (RAD). RAD is psychological and developmental disorder that occurs in children who are neglected by their primary caregivers. Children with RAD are not cuddly with parents and fail to make eye contact. They also exhibit poor impulse control and may be destructive to themselves and others. Poor eye contact is seen is autistic children as well, but in this case there is a parental neglect that indicates RAD. Separation anxiety is indicated by crying and screaming when the parent leaves the child. Feelings of solitariness do not result in poor impulse or eye contact.
Which substance is considered addictive in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)? Select all that apply. One, some, or all responses may be correct. 1. Alcohol 2. Caffeine 3. Cannibis 4. Gambling 5. Hallucinogens 6. Antianxiety medications
ALL OF THE ABOVE Alcohol, caffeine, cannibis, hallucinogens, and anti anxiety medications are all considered substances of abuse in the DSM-5. Tobacco, opioids, inhalants, sedatives, hypnotics, and stimulants are also listed. Behaviors are gradually being recognized as addictive. For example, gambling was officially declared a disorder in 2013.
