Chapter 22
Based on recent signs and symptoms, an adult client is strongly suspected of having depression. Which findings from the client's admission interview support a clinical diagnosis of major depression? Select all that apply. The client typically sleeps between 11 and 12 hours a day. The client states, "I have to admit, my eating has gotten out of control." The client admits being impatient, and even hostile, with coworkers. The client has always been an avid golfer, but no longer golfs. The client describes having nearly no interest in sex anymore.
The client typically sleeps between 11 and 12 hours a day. The client states, "I have to admit, my eating has gotten out of control." The client describes having nearly no interest in sex anymore. The client has always been an avid golfer, but no longer golfs. Explanation: Diagnostic criteria for depression include hypersomnia, increased appetite, decreased libido, and anhedonia. Hostility and aggression are not typically associated with depression.
A client who is receiving care for schizophrenia has been experiencing an exacerbation of negative symptoms in recent days. Which aspect of the client's behaviour is most consistent with this trend? The client describes a conspiracy in which the police and government are a threat. The client is mixing up words when describing delusions to the nurse. The client claims to be hearing people talking even when this is not happening. The client's statements and expressions show an absence of emotion.
The client's statements and expressions show an absence of emotion. Explanation: The negative symptoms of schizophrenia reflect the absence of normal social and interpersonal behaviours and include alogia (tendency to speak very little), avolition (lack of motivation for goal-oriented activity), apathy, affective flattening (lack of emotional expression), and anhedonia (an inability to experience pleasure in things that ordinarily are pleasurable). Positive symptoms are those that reflect the presence of abnormal behaviours and include disorganized, incomprehensible speech; delusions (e.g., that one is being controlled by an outside force); hallucinations (hearing voices is the most common); and grossly disorganized or catatonic behaviour.
A first episode of depression that occurs after what age can be a precursor to dementia? 65 45 55 75
65 Explanation: A first episode of depression that occurs after 65 years of age can be a precursor to dementia and should precipitate both assessment and treatment of the depression, as well as a thorough evaluation for dementia. Early intervention often greatly retards the progression of dementia, maintaining the person's independence and quality of life.
The patient tells a nurse that "many voices in his head are telling him what he should do." The nurse thinks he may be experiencing which of the following? Catatonic features A delusion Bipolar disorder A hallucination
A hallucination Explanation: A variety of psychiatric disorders are accompanied by auditory hallucinations, such as the sound of voices. Delusions are characterized by a false belief and the persistent, unshakable acceptance of the false belief. Catatonic features, a subclassification of depression, are seen when symptoms include excessive mobility or motoric immobility. The patient with bipolar depression may exhibit hallucinations.
What is the term used to identify a person's inability to experience pleasure in things that use to result in pleasure? Alogia Anhedonia Avolition Affective flattening
Anhedonia Explanation: Anhedonia is the inability to experience pleasure, while alogia is the tendency to speak very little. Avolition is the lack of motivation towards goals, and affective flattening is the lack of emotional expression.
A nurse is on a psychiatric floor caring for a patient with severe bipolar disorder who has received several electroconvulsive therapy (ECT) treatments. Following the information the nurse received in the shift report, the nurse suspects that the patient is suffering from an episode of mania manifested by which of the following symptoms? Select all that apply. Attentiveness Talking fast Irritability Insomnia Anorexia
Anorexia Irritability Insomnia Talking fast Explanation: People with bipolar disorders can experience mania secondary to medications and other therapies employed to treat the depression, including ECT. Mania presents with a decreased desire or need for sleep or food, labile moods, racing thoughts, irritability, distractibility, rapid or pressured speech, and an inflated self-esteem.
Psychopharmacology has become a popular and effective treatment for mood disorders. The nurse will include which information to her client to explain how antidepressants alleviate depressive symptoms? Antidepressants decrease serotonin Antidepressants increase epinephrine. Antidepressants decrease epinephrine Antidepressants increase norepinephrine.
Antidepressants increase norepinephrine. Explanation: Antidepressants alleviate depressive symptoms by increasing the activity of norepinephrine and serotonin at postsynaptic membrane receptors.
A patient in the hospital following a third heart attack shows a lack of interest in the treatment plan. The patient states that "it really doesn't matter anyway because I just sit around all day, eat and sleep." The nurse is concerned that the patient might be suffering from which of the following? Atypical depression Chronic depression Apathetic depression Bipolar disorder
Atypical depression Explanation: Atypical depression presents with an increase in depression as the day progresses over eating and excessive sleeping. Bipolar involves both mania and depression, and there is no information in this question to support mania. Chronic depression lasts two or more years and there is no supporting information in the question as to the duration.
A patient has an abrupt onset of mental slowing and depression. Which of the following conditions in the patient's history would indicate vascular dementia as a cause of these changes? Select all that apply. Cerebrovascular accident Cigarette smoking Diabetes insipidus Cardiac dysrhythmias Peptic ulcer
Cerebrovascular accident Cardiac dysrhythmias Cigarette smoking Explanation: The hallmarks of vascular dementia are mental slowing and depression. They usually occur as a result of brain injury from hemorrhage or occlusion. Common disorders associated with this diagnosis are cerebrovascular accident, cardiac dysrhythmias, cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus, and autoimmune disorders.
Bipolar disorder, also called manic-depressive disorder, has a variety of subclassifications based on the manic episodes of the disorder. What is the severity of manic symptoms called? Mania Cyclothymia Specifier Kindling
Cyclothymia Explanation: The severity of manic symptoms runs the gamut from a condition called cyclothymia, in which mood fluctuates between mild elation and depression to severe delusional mania. Mania is the overall term for mood fluctuations between mild elation and depression. Specifier has nothing to do with bipolar disorder. Kindling is a hypothesized phenomenon in which a stressor creates an electrophysiologic vulnerability to future stressful events by causing long-lasting changes in neuronal function.
What are the clinical manifestations of mania? Select all that apply. Decreased need for sleep Irritability Increased need for food Labile mood Fatigue
Decreased need for sleep Labile mood Irritability Explanation: The clinical manifestations of mania include decreased need for food and sleep, labile mood, irritability. Other manifestations racing thoughts, high distractibility, rapid and pressured speech, inflated self-esteem, and excessive involvement with pleasurable activities, some of which may be high risk.
Depression has various subclassifications distinguished by symptom patterns. Which is that key clinical manifestation of depression with psychotic features? Hypersomnia Delusions or hallucinations Excessive mobility Overeating
Delusions or hallucinations Explanation: Depression with psychotic features involves the presence of delusions or hallucinations that may or may not be mood congruent. The classification of depression with catatonic features is applied when symptoms include excessive mobility.
The nurse is evaluating a client for possible signs of depression. What are clinical manifestations of major depressive disorder? Select all that apply. Depressed mood Decreased concentration Increased libido Anhedonia
Depressed mood Anhedonia Decreased concentration Explanation: Major depressive disorder is characterized by the following: depressed mood, anhedonia (inability to experience pleasure), feelings of worthlessness or excessive guilt, decreased concentration, psychomotor agitation or retardation, insomnia or hypersomnia, decreased libido, change in weight or appetite, and thoughts of death or suicidal ideation.
A 90-year-old patient who is experiencing an increased difficulty with memory since his spouse died last year tells the nurse that he must be getting dementia. The nurse anticipates that the physician will initially rule out which of the following before considering dementia Alzheimer's disease Organic brain disease Depression Cerebral tumors
Depression Explanation: Depression can present like dementia and is treatable; therefore, depression should be ruled out first to ensure that treatment can be instituted that may return cognition to baseline. This patient lost his wife recently, which is a likely contributing factor to the developing depression.
Depression has various subclassifications distinguished by symptom patterns. What are the clinical manifestations of atypical depression? Select all that apply. Depression that becomes worse as the day progresses Anorexia Hypersomnia Delsuions Overeating
Depression that becomes worse as the day progresses Hypersomnia Overeating Explanation: The symptoms of atypical depression are opposite those of melancholic depression. Atypical depression is characterized by a depression that becomes worse as the day progresses, overeating, and hypersomnia (excessive sleep).
A female client has been experiencing insomnia, depression that is worse in the morning, loss of appetite, feelings of guilt, inability to respond to pleasurable stimuli, and loss of interest in normal activities for over 2 weeks. What type of depression does the nurse expect this patient is experiencing? Atypical depression Postpartum depression Depression with catatonic features Depression with melancholic features
Depression with melancholic features Explanation: The symptoms described best fit the diagnosis of depression with melancholic features. Atypical depression worsens in the evening rather than the morning. There is no reason to believe the client has recently given birth. Catatonic is generally associated with a type of schizophrenia.
chizophrenia is a complex disease that strikes men and women equally. What is a common sign or symptom of schizophrenia in its early stages? Using invented words Enhancement of senses Visual hallucinations Catatonic behavior
Enhancement of senses Explanation: An enhancement or a blunting of the senses is very common in the early stages of schizophrenia. Sounds may be experienced as louder and more intrusive; colors may be brighter and sharper. The other answers are later signs or symptoms of schizophrenia.
The spouse of a patient with schizophrenia is participating in a support group for families of people with schizophrenia. The spouse asks the nurse who is the group moderator why their spouse states that the patient hears bad voices when no one is around. The most accurate response is that the patient is most likely undergoing which of the following? Experiencing auditory delusions Experiencing auditory hallucinations Experiencing auditory hallucinations Experiencing loneliness and needs some attention
Experiencing auditory hallucinations Explanation: Hallucinations are sensory perceptions that are not based in reality; however, they present as real. Hallucinations can be caused by any of the five senses, and in this situation the patient is demonstrating auditory hallucinations. Delusions involve thought disturbances, not sensory perception disturbances, and may present as feelings of grandeur or superiority.
The nurse is working with a family regarding a family member with schizophrenia. What would be some treatment goals the nurse would help set for this family? Select all that apply Improve physiological function Prevent a recurrence Induce a remission Improve behavioral function
Induce a remission Prevent a recurrence Improve behavioral function Explanation: The goals of treatment for schizophrenia are to induce a remission, prevent a recurrence, and improve behavioral, cognitive, and psychosocial functions. Early intervention programs are associated with a better treatment.
Which of the following is an expected outcome when unipolar and bipolar disorders are treated with an SRI antidepressant? Blocking the degradation of norepinephrine Blocking the degradation of serotonin Inhibiting the re-uptake of serotonin Inhibiting the re-uptake of norepinephrine
Inhibiting the re-uptake of serotonin Explanation: The result of SRI therapy is the delayed reuptake of the neurotransmitter serotonin. The other options do not accurately describe the outcome of SSRI therapy.
Depression has various subclassifications distinguished by symptom patterns. What are the clinical manifestations of melancholic depression? Select all that apply. Depression which becomes worse in the evening Psychomotor retardation or agitation Anorexia with significant weight loss Insomnia with early morning awakening
Insomnia with early morning awakening Anorexia with significant weight loss Psychomotor retardation or agitation Explanation: Depression with melancholic features is characterized by depression that is worse in the morning, insomnia with early morning awakening, anorexia with significant weight loss, and psychomotor retardation or agitation.
Which of the following statements is true regarding schizophrenia? Diagnosis is usually confirmed after middle age. There is no evidence to support a family history. It presents with disorganized positive and negative symptoms. Negative symptoms respond well to antipsychotic drug therapy.
It presents with disorganized positive and negative symptoms. Explanation: Schizophrenia is a chronic debilitating psychotic disorder with disorganized, positive, and negative symptoms. The onset of the disorder typically occurs in young adulthood and is rarely diagnosed before adolescence or after middle age. First-degree relatives of a person with schizophrenia have a 10-fold greater prevalence of the illness than the population at large. Pharmacological treatment with antipsychotics is often helpful, particularly with the positive symptoms of schizophrenia
Anticonvulsive medications are used in the treatment of bipolar depression. What other drug is used to treat bipolar disorder? Flexeril Valium Restoril Lithium
Lithium Explanation: Lithium and several anticonvulsant agents are used in the treatment of bipolar depression. Valium is a sedative and antianxiety agent. Flexeril is a muscle relaxant. Restoril is a hypnotic agent.
A nurse is teaching a patient and family about best practice to minimize the cycling of bipolar disorder. Which of the following instructions should be given? Participate in exercise in the evening. Take antidepressant medications regularly. Maintain a steady pattern of sleep and activity. Drink alcoholic beverages in moderation.
Maintain a steady pattern of sleep and activity. Explanation: To minimize disruptions of the bipolar cycle, the patient should maintain a routine for sleep and activity. Strenuous physical activity should be in the morning so the client can relax before bedtime. Because antidepressants have been known to trigger mania, they are not encouraged unless there is profound unrelieved depression. Alcohol increases the risk of another manic episode, and so should be avoided.
A patient who experienced a myocardial infarction two weeks ago reports awakening early, loss of appetite, difficulty sitting still or concentrating, and loss of interest in personal hobbies. What mental health disorder do these manifestations represent? Bbipolar disorder Schizophrenia Major depression Panic disorder Obsessive-compulsive disorder
Major depression Explanation: Characteristics of major depression include loss of appetite, early morning awakening with anorexia and weight loss, psychomotor retardation or agitation, excessive guilt, loss of interest in activity, or inability to respond to pleasurable stimuli. About 20% of patients with coronary disease experience major depression.
A patient being treated for schizophrenia has paucity of speech, flat affect, and lack of motivation. For which medication does the nurse anticipate receiving an order? Lithium (Lithmax) Benztropine (Cogentin) Olanzapine (Zyprexa) Haloperidol (Haldol)
Olanzapine (Zyprexa) Explanation: Patients with schizophrenia may receive either typical or atypical antipsychotic agents if they have positive symptoms. However, atypical antipsychotic agents, such as olanzapine (Zyprexa), are more effective for negative symptoms. The anticholinergic drug, benztropine (Cogentin), is used to treat the extrapyramidal symptoms that occur as a side effect of the typical antipsychotics. It does not directly treat schizophrenia. Lithium is used to treat mania.
A patient states, "I am the most famous rock star in the country and all the other stars are trying to kill me." What type of distorted thinking is the patient likely experiencing? Paranoid Disorganized Random Catatonic
Paranoid Explanation: The patient is exhibiting paranoia with grandiose delusions. Catatonia and disorganized behavior are other types of schizophrenia. The other options do not accurately identify the distortions of thought described in the question.
A patient is being evaluated for schizophrenia. Which assessment data are consistent with the diagnosis? Select all that apply. Blood analysis shows hyponatremia. Patient reports hearing voices criticizing personal actions. Patient stands with hands in the air for one hour. Patient speaks very rapidly in response to questions. Patient states that the wall clock ticks too loudly.
Patient states that the wall clock ticks too loudly. Patient stands with hands in the air for one hour. Patient reports hearing voices criticizing personal actions. Explanation: Patients with schizophrenia exhibit positive and negative symptoms along with disorganized behavior. Positive symptoms include hallucinations and delusions, catatonic behavior, changes in speech that include inventing new words, loose associations, and incoherence. Negative symptoms include lack of facial expression, paucity of speech, lack of motivation, and blunt response to pain. Patients commonly complain that environmental stimuli are too loud or too bright. Psychiatric diagnoses are not validated with physical examination or laboratory tests. Rapid or pressured speech is characteristic of mania.
There is some evidence that the most powerful predictor of psychosis and diagnosis of schizophrenia is what factor? Poverty Loss Viruses Childhood trauma
Poverty Explanation: There is some evidence that the most powerful predictor of psychosis and the diagnosis of schizophrenia is poverty.
A 21-year-old male college student has just been brought to the emergency department by police. He is agitated and talking about how someone is going to find him and appears to experiencing hallucinations, though there is no evidence of substance use. His mother accompanies him and states that he has a history of similar episodes. The care team should screen this client for which disease? Schizophrenia Mania Panic disorder Bipolar disorder
Schizophrenia Explanation: The psychopathology of schizophrenia involves both positive and negative symptoms. Positive symptoms reflect the presence of abnormal behaviors and include incomprehensible speech, delusions, hallucinations, and grossly disorganized behaviour. Mania is marked by episodes of elation and irritability as well as delusions. Bipolar disorder involves a swing between mania and depression. Panic disorder does not involve hallucinations.
Which type of depression is triggered for people in the winter by the shortening of daylight hours? Cyclothymia Melancholic Seasonal affective Atypical
Seasonal affective Explanation: A specific type of depression know as seasonal affective disorder (SAD) is triggered for people in the winter by the shortening of daylight hours as fall commences, with symtoms of depression usually resolving in the spring when daylight hours again lengthen. Cyclothymia is a symptom of manic depression in which mood fluctuates between mild elation and depression. Melancholic features, a subclass of depression, is characterized by depression that is worse in the morning, insomnia with early morning awakening, anorexia, etc. Atypical depression, the opposite of melancholic, is characterized by a depression that becomes worse as the day progresses, overeating and excessive sleep.
Hallucinations are abnormalities of perception, whereas delusions are abnormalities of thought. What have delusions been associated with? Sensory overload Sensory deprivation Disorders of speech Disorders of information management
Sensory deprivation Explanation: Interestingly, delusions have been associated with conditions that produce sensory deprivation, such as hearing loss. The other answers have not been associated with delusions.
Newly developed imaging techniques allow practitioners to map brain anatomy and to estimate brain activity. What can this information be used for? To find indications of schizophrenia To measure intelligence To better understand the workings of the brain To make a diagnosis of mental illness
To better understand the workings of the brain Explanation: These brain imaging techniques give valuable information about the structure and function of the brain and the way it works. However, such techniques remain research tools and have not yet been applied clinically, which means that imaging cannot be used to make a diagnosis of mental illness.
A client with a diagnosis of bipolar disorder has chosen to discontinue her medication. She is now not eating or sleeping, very irritable, has racing thoughts, and is easily distracted. The nurse should understand that the client is now experiencing: psychosis. a manic episode. positive symptoms of her disease. negative symptoms of her disease.
a manic episode. Explanation: The manifestations of mania include decreased need for food and sleep, labile mood, irritability, racing thoughts, high distractibility, rapid and pressured speech, inflated self-esteem, and excessive involvement with pleasurable activities, some of which may be high risk. In its minor forms, the subjective experience of mania can be quite pleasurable to the individual, with a heightened sense of well-being and increased alertness. Positive/negative symptoms are referring to schizophrenia, and psychosis is more closely associated with this disease.