Mood, Adjustment, and Dementia Disorders PrepU

A client with bipolar disorder, manic phase, states to the nurse, "You're looking good. I'm taking you out to dinner." What reply by the nurse is most therapeutic?

"I'm Chris Smith, a nurse working on this unit."

During a group session, a client who is depressed tells the group, "I just lost my job." Which response by the nurse is best?

"It must have been very upsetting for you."

A client who has begun taking lithium carbonate has nausea, dry mouth, and thirst. What should the nurse tell the client?

"These common side effects of lithium will go away after 6 weeks."

After the nurse teaches a client about lorazepam, which client statement(s) would indicate the need for further instruction? Select all that apply.

-"I can adjust the dosage when I feel more anxious." -"I can stop taking lorazepam immediately if I need to."

The nurse develops appropriate assignments for the staff. Which client should the nurse judge to be at highest risk for suicide completion?

85-year-old White man who lives alone after their spouse's death

A client with dementia who prefers to stay in their room has been brought to the dayroom. After 10 minutes, the client becomes agitated and retreats to their room again. The nurse decides to assess the conditions in the dayroom. What is the most likely occurrence that is disturbing to this client?

A relaxation tape is playing in one corner of the room, and a television airing a special on crime is playing in the opposite corner.

Which statement should be included when teaching clients about monoamine oxidase (MAO) inhibitors?

Don't take any prescribed or over-the-counter medications without consulting a physician and pharmacist.

A client with bipolar disorder, manic phase, is scheduled for a chest x-ray. What should the nurse do before taking the client to the radiology department?

Explain the procedure in simple terms.

A physician orders a tricyclic antidepressant for a client who has suffered an acute myocardial infarction (MI) within the previous 6 months. Which action should the nurse take?

Question the physician about the order.

The nurse attempts to interact with a client who barely responds with yes or no. The client states, "Don't bother me. I want to die." What action should the nurse take?

Sit with the client.

A client with major depression and suicidal ideation is suddenly calmer and more energetic. Which conclusion should the nurse reach?

The client is imminently suicidal.

A client diagnosed with major depression and substance use disorder is being admitted to the concurrent disorder treatment unit. In explaining the focus of this program, the nurse should provide which information to the client?

There will be simultaneous treatment of the addiction and the depression.

A nurse is caring for a severely depressed client who is barely functioning. The priority nursing goal for this client would be to:

assess for and maintain adequate nutrition and hydration.

A client with major depression is frequently irritable, abrasive, and uncooperative and refuses to participate in group activities. When working with this client, the nurse should use which approach?

firmness

A nurse is monitoring a client receiving tranylcypromine sulfate. Which serious adverse reaction can occur with high dosages of this monoamine oxidase (MAO) inhibitor?

hypertensive crisis

The nurse assesses a client who is receiving tricyclic antidepressant therapy. The nurse should be alert for which finding that could suggest the client is experiencing anticholinergic effects?

urine retention and blurred vision

A client with diagnosed borderline personality disorder tells the nurse, "You're the best nurse here. I can talk to you and you listen. You're the only one here who can help me." Which response by the nurse is most therapeutic?

"All of the nurses here provide good care."

A client has been taking imipramine, 125 mg by mouth daily, for 1 week. Now the client reports wanting to stop taking the medication because of continuing feelings of depression. At this time, what is the nurse's best response?

"Because imipramine must build to a therapeutic level, it may take 2 to 3 weeks to reduce depression."

During the nurse's conversation with a depressed client, the client states, "I have no reason to be sad. I have a great job and a wonderful spouse and family." Which comment would be best for the nurse to make at this time?

"Depression can be caused by a chemical imbalance in the brain."

A client with a diagnosis of major depression and a history of several suicide attempts tells a nurse, "I have no reason to live. Nobody cares about me." Which response by the nurse is most therapeutic?

"How long have you been feeling like this?"

During family teaching, the caregiver of a client with dementia mentions to the nurse that the client distorts things. The nurse understands that the caregiver needs further teaching about dementia when they make which statement?

"I tell them they're wrong, and then I tell them what's right."

A nurse is counseling an adolescent client for depression. The client's father died 2 months ago of cancer, and the client's mother died when the client was 11 years old. During the interview the client states, "I just feel like I can't do anything." Which of the following would be most appropriate response to this client?

"I will stay here with you."

The nurse is working with a client with depression and suicidal ideation. The nurse heard the client say, "I am disappointed because thought I'd be feeling better by now since I started medication and therapy a week ago." What would be the primary nurse therapist's most therapeutic response?

"It takes time and can be frustrating to experience the physical and emotional symptoms of depression all while you learn more about yourself and try new strategies as your medication takes effect."

The nurse teaches a client with bipolar disorder about lithium therapy. Which client statement indicates the need for additional teaching?

"It's okay to double my next dose of lithium if I forget a dose."

The nurse teaches the client with anxiety about the appropriate use of lorazepam. Which statement indicates that the client understands the nurse's teaching?

"My medicine isn't for the everyday stress of life."

An adolescent has just begun taking an antidepressant. Which statement by the teenager would indicate the need for further teaching?

"Now that I've been taking my antidepressant for a week, I'm going to feel better about myself."

The nurse is assigned to care for a client admitted with depression as well as a dependent personality disorder. Which statement by the client is indicative of this personality disorder?

"Please don't forget to wait for me to go to dinner. I don't want to go by myself."

A client with acute mania brings six suitcases and three shopping bags of personal belongings on admission to the unit. When informed that some of the suitcases and bags need to be returned home because of a lack of storage space, the client begins to use profanity against the nurse. Which response by the nurse is most therapeutic?

"Swearing and profanity are unacceptable here."

A client with bipolar disorder has been taking lithium carbonate for the past 2 years. Recently, the client has been experiencing a recurrence of manic symptoms approximately once a month. The client's psychiatrist has added clonazepam to help manage the client's mood swings. Which statement should the nurse include in medication teaching?

"This medication will help steady your moods by reducing the overstimulation of chemical messengers in your brain."

A client was admitted to an inpatient psychiatric unit with a diagnosis of major depression. The client expresses feelings of worthlessness and of being abandoned by significant persons in their life. Which response by the nurse would convey empathy to the client?

"This must be a difficult time for you."

A client was found wandering in a local park, unable to state who or where the client is or where the client lives. The client is brought to the emergency department, where an identification is eventually made. The client's spouse states that client was diagnosed with Alzheimer's disease 3 years earlier and has experienced increasing memory loss. The spouse reports worry about how to continue to care for the client. Which response by the nurse is most helpful?

"What aspect of caring for your spouse is causing you the greatest concern?"

The nurse is caring for a severely depressed client. Which statement by the nurse is best when talking to the client on the patient care unit?

"You're wearing a new shirt today."

The child of a client with Alzheimer disease excitedly tells the nurse, "My parent was singing a favorite old song. I think they're getting their memory back!" What response by the nurse is most appropriate?

"Your parent still has long-term memory, but short-term memory will not return."

The nurse identifies that there are several concerning symptoms. Based on these symptoms, the nurse should ask which additional question(s)?

-"How would you describe your mood lately?" -"Are you having any thoughts to harm yourself?" -"How much are you sleeping per day?" -"How has your appetite been?" -"Do you have any history of taking psychiatric medications?"

Which three (3) nursing actions are indicated?

-Develop a negotiable plan of care with the client. -Assess the client's frustration tolerance. -Advise the client of the consequences of unacceptable behavior.

A client is newly diagnosed with Alzheimer's disease. When planning this client's care, the nurse should include which aspects of care? Select all that apply.

-Help the client organize his room. -Provide a safe environment. -Instruct the family regarding the disease progression. -Assess the client's nutritional status.

A 10-year-old client with conduct disorder is hospitalized for aggressive behaviors at home and school. The client threw furniture and yelled at staff members when told it was time for a group meeting. Which of the following nursing interventions would be appropriate for this client? Select all that apply.

-Teach the client the benefits of expressing anger in nonviolent ways. -Minimize the amount of attention given for negative behavior.

A client is prescribed sertraline, a selective serotonin reuptake inhibitor. Which adverse effects would the nurse review when creating a medication teaching plan? Select all that apply.

-agitation -sleep disturbance -dry mouth

A 72-year-old client is brought by ambulance to the hospital's psychiatric unit from a nursing home where they have been a client for 3 months. Transfer data indicate that the client has become increasingly confused and disoriented. In which way should the hospital admission process be modified for the client?

Allow the client sufficient time in which to gain an understanding of what is happening to them.

A client has severe dementia and motor apraxia. The nurse understands that the client may be able to perform which action?

Brush the teeth when handed a toothbrush.

A client with dementia is eating off of other clients' meal trays. After the client with dementia is asked to stop, which action should be taken?

Distract the client.

The client with bipolar disorder, manic phase, appears at the nurse's station wearing a transparent shirt, miniskirt, high heels, 10 bracelets, and 8 necklaces. The client's makeup is overdone and they are not wearing underwear. What should the nurse do?

Escort the client to their room and assist with choosing appropriate attire.

While assessing a client diagnosed with dementia, the nurse notes that the client's spouse is concerned about what they should do when the client uses vulgar language with them. What should the nurse tell the spouse?

Ignore the vulgarity and distract the client.

The mental health unit provides a unit landline for clients to use for telephone calls. A client with bipolar disorder is monopolizing the use of the telephone by making several calls each day, interfering with the ability of other clients to use the telephone. What should the nurse do?

Limit the amount of calls the client can make each day.

The nurse creates a plan of care for a client with delirium. What is a realistic short-term goal to be accomplished in 2 to 3 days?

Regain orientation to time and place.

A client has been taking 30 mg of duloxetine hydrochloride twice daily for 2 months because of depression and vague aches and pains. While interacting with the nurse, the client discloses a pattern of drinking a 6-pack of beer daily for the past 10 years to help with sleep. What should the nurse do first?

Report the client's beer consumption to the health care provider (HCP).

A nurse is caring for a client who has been diagnosed with somatic symptom disorder. The client attributes a cough to tuberculosis. A chest X-ray and skin test are negative for tuberculosis. The client begins to complain about the sudden onset of chest pain. How should the nurse react initially?

Report the client's complaint of chest pain to a physician.

A client was admitted with a diagnosis of schizophrenia and exhibiting behaviors of hostility, paranoia, and isolation. The student nurse discussed with the nurse what the most therapeutic approach to take with the client would be. Which would indicate to the nurse that the student understands the best approach?

Respect the client's need for personal space and avoid physical contact with the client.

The nurse is working in a psychiatric facility on an anxiety disorder unit. The unit is locked and clients have scheduled group and family therapy sessions. Which other standard is maintained on this unit for a client diagnosed with panic disorder?

Suicide precautions are instituted.

A client takes lithium carbonate daily, and their most recent lithium carbonate level is 1.8 mEq/L. What response by the nurse is best for this client?

Tell the client to hold his/her intake of lithium and to call the physician.

A client who is taking fluoxetine 20 mg at bedtime tells the nurse the drug is interfering with their sleep. What conclusion should the nurse make?

The client should take fluoxetine in the morning.

The nurse discusses the possibility of a client attending day treatment for those with early Alzheimer disease. What is the best rationale for encouraging day treatment?

The client would benefit from increased social interaction.

A nurse is prioritizing care for four new admissions to the inpatient psychiatric unit. Which client should the nurse assess first?

a client with new-onset confusion and disorientation.

The client who routinely takes sertraline presents to the emergency department reporting muscle rigidity and tremors. The client also states that they had a cough last week that was treated with dextromethorphan. What is the appropriate nursing intervention?

administer intravenous diazepam

The health care provider prescribes risperidone for a client with Alzheimer disease. The nurse anticipates administering this medication to help decrease which behavior?

agitation and aggression

Which foods are contraindicated for a client taking tranylcypromine?

chicken livers, Chianti wine, and beer

The client with mania is skipping up and down the hallway, nearly running into other clients. The nurse should include which activity in the client's plan of care?

cleaning the dayroom tables

A nurse is assigned to a client who, after a medication teaching session, began receiving amitriptyline hydrochloride to treat depression. One week after starting this drug, the client refuses to take the medication, reporting that it has caused blurred vision, dry mouth, and constipation, but it hasn't improved the client's mood. Which nursing diagnosis is appropriate for this client?

deficient knowledge (treatment regimen) related to inadequate understanding of teaching

A client with severe depression states, "My heart has stopped and my blood is black ash." The nurse interprets this statement to be evidence of which problem?

delusion

A nurse is frustrated by inability to make much progress establishing a therapeutic relationship with a client with bipolar disorder. The nurse's most professional response would be to:

discuss the situation with a more experienced peer.

A client with breast cancer is concerned that their spouse is depressed by their diagnosis. Which change in their spouse's behavior may confirm their fears?

disturbance in sleep patterns

The nurse cares for a client with changes in cognition. Which characteristic would make the nurse suspect that a client has delirium?

disturbances in cognition and consciousness that fluctuate during the day

A client hospitalized for depression remains extremely depressed and expresses increasing suicidal ideation to the client's primary nurse. What should be the nurse's priority intervention?

ensuring that the client is not permitted to use anything that would be potentially dangerous

Which nursing action is most appropriate when trying to defuse a client's impending violent behavior?

helping the client identify and express feelings of anxiety and anger

A client has been severely depressed since the client's partner died 6 months earlier. The physician orders amitriptyline hydrochloride, 50 mg by mouth daily. Before administering amitriptyline, the nurse reviews the client's medical history. Which preexisting condition requires cautious use of this drug?

hepatic disease

An elderly client's lithium level is 1.4 mEq/L. The client complains of diarrhea, tremors, and nausea. The nurse should:

hold the lithium and notify the physician.

A client is in the manic phase of chronic bipolar disorder. The client has stopped taking the prescribed lithium carbonate 3 weeks ago and has not been eating or sleeping for 3 days. Which behaviors will be of priority concern as the nurse begins a care plan for this client?

hyperactivity, ignoring eating and sleeping

The nurse is admitting a client with a history of bipolar mania. Which assessment finding is the priority when developing a plan of care?

hyperactivity, ignoring eating, and sleeping

A client who has paranoid personality disorder is participating in a treatment group. Which behavior should the nurse observe for as the client participates in the group?

hypervigilance

A client with dementia must be temporarily hospitalized. The family wants to take proactive measures to assure the client does not experience further confusion. Which measure if suggested by the family would the nurse discourage?

keeping lights dimmed during daylight hours

A physician orders lithium carbonate for a client who has just been diagnosed with bipolar disorder. The nurse is teaching the client about signs and symptoms of lithium toxicity, which include:

lethargy, vomiting, and diarrhea.

A nurse notices that a depressed client who has been taking amitriptyline hydrochloride for 2 weeks has become very outgoing, cheerful, and talkative. The nurse suspects that the client:

may be experiencing increased energy and is at increased risk for suicide.

A client is in the manic phase of bipolar disorder. To help the client maintain adequate nutrition, the nurse should plan to:

offer finger foods and sandwiches.

A client and their partner come to the clinic stating they have been unable to have sexual intercourse. The female client states they have pain and their "vagina is too tight." The client was raped at 15 years of age. Which nursing diagnosis is most appropriate for this client?

sexual dysfunction related to sexual trauma

A 40-year-old executive who was unexpectedly laid off from work 2 days earlier complains of fatigue and an inability to cope. The client admits drinking excessively over the previous 48 hours. This behavior is an example of:

situational crisis.

A client is admitted with severe depression after the loss of a child. The nurse documents what findings as supporting the diagnosis of depression?

slow physical movements and slow speech

A nurse is assessing a client who has just been admitted to the emergency department. Which signs suggest an overdose of an antianxiety agent?

slurred speech, dyspnea, and impaired coordination

A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication?

sodium

The nurse is teaching a client and family about phenelzine. Which food should the nurse instruct the client to avoid?

sour cream

A client who is very depressed exhibits psychomotor deficits, a flat affect, and apathy. The nurse observes that the client needs grooming and hygiene. Which nursing action is most appropriate?

stating to the client that it's time for them to take a shower

A client with stage 1 Alzheimer's disease is diagnosed with terminal lung cancer. The client wonders about "reaching the end" asks the nurse what to do. How should the nurse respond?

"An advance directive will help to make sure that your wishes are carried out."

During the discharge planning teaching process, a client who has been prescribed tranylcypromine states that they enjoy a beer or two in the evenings. Which is the nurse's most appropriate response?

"Beer contains tyramine which must be avoided when on this medication."

A nurse is assessing a client with a history of mania who wants to stop taking their mood-stabilizing medication because the client is "feeling good," has a high energy level, and reports being productive at work. Which response by the nurse is most appropriate?

"I believe you were hospitalized the last time you stopped your medication."

The family caregiver of a client with Alzheimer disease tells the nurse that the client thinks someone is stealing their things. Which response by the nurse would be most helpful?

"We asked the health care provider to evaluate the client for paranoid delusions, which are common in people with Alzheimer's disease."

The nurse is about to administer lithium carbonate to a client with bipolar disorder in a mania state. What is the nurse's action after assessing the client's lithium level to be 1.0 mEq/L (mmol/L)?

Administer the lithium carbonate.

The nurse cares for a client who is breathing rapidly, is pacing back and forth across the room, and has their lips tightly closed and their arms crossed tightly across their chest. What should the nurse do first?

Assist the client to a safe, calm environment.

A client will be discharged to home with imipramine. Which information would be most important for the nurse to include when instructing the client about the medication?

Avoid alcohol.

The client with rapid-cycling bipolar disorder who is about to receive the 1700 hours dose of carbamazepine reports a sore throat and chills. What should the nurse do next?

Call the health care provider (HCP) immediately to report changes.

A nurse meets frequently with a depressed client. The client stays mostly in their room and speaks only when addressed, answering briefly and abruptly while keeping their eyes on the floor. Initially, the nurse should focus on the client's ability to do which function?

Express themself verbally.

A 14-year-old adolescent tells the nurse about being in love with a 22-year-old neighbor and that they've had sex on several occasions. The client doesn't want the parents to know because the client is in love and is afraid the parents will be angry. What is the nurse's best course of action?

Tell the adolescent that the law requires the nurse to report the sexual contact because of the age difference.

A nurse is coordinating outpatient care for a 38-year-old client who is homeless and has a history of chronic schizophrenia. Which one intervention would be best for the nurse to suggest for this client?

a life and social skills group

An adolescent client took 300 acetaminophen tablets in an attempt to kill themself after a relationship breakup. The client is admitted to the adolescent psychiatric unit and is refusing to talk with the nurse. What is the most important nursing approach at this stage of the helping relationship?

supporting suicide precautions and safety measures for the client on the unit

The client with a diagnosis of bipolar disorder, manic phase, states to the nurse, "I am the Queen of England. Bow before me." The nurse interprets this statement as important to document in which area of the mental status examination?

thought content

A client admitted to the nursing unit with bipolar disorder, manic phase, is accompanied by their spouse. The spouse states that the client has been overly energetic and happy, talking constantly, purchasing many unneeded items, and sleeping about 4 hours a night for the past 5 days. When completing the client's daily assessment, the nurse should be especially alert for which finding?

exhaustion

A nurse on the geropsychiatric unit receives a call from the caregiver of a recently discharged client. The caregiver reports that the client just got a prescription for memantine to take "on top of their donepezil." The caregiver then asks, "Why do they have to take extra medicines?" What should the nurse tell the son?

"Memantine and donepezil are commonly used together to slow the progression of dementia."

During a home visit to an older adult with mild dementia, the client's adult child reports that they have one major problem with their parent. The child says, "They sleep most of the day and are up most of the night. I can't get a decent night's sleep anymore." Which suggestion(s) should the nurse make to the client's child? Select all that apply.

-Establish a set routine for rising, hygiene, meals, short rest periods, and bedtime. -Engage the client in simple, brief exercises or a short walk when they get drowsy during the day. -Promote relaxation before bedtime with a warm bath or relaxing music.

The family of a client diagnosed with Alzheimer disease wants to keep the client at home. They say that they have the most difficulty in managing the client's wandering. What should the nurse instruct the family to do? Select all that apply.

-Install motion and sound detectors. -Have the client wear a medical alert bracelet. -Install door alarms and high door locks.

One day after being admitted with bipolar disorder, a client becomes verbally aggressive during a group therapy session. Which response by the nurse is most therapeutic?

"Your behavior is disturbing to other clients. I'll walk with you to help you release some energy."

A client is admitted to the local psychiatric facility with bipolar disorder in the manic phase. The physician decides to start the client on lithium carbonate therapy. One week after this therapy starts, the nurse notes that the client's serum lithium level is 1 mEq/L. What should the nurse do?

Continue to administer the medication as ordered.