Mood adjustment and Dementia Disorders

A nurse notices that a client admitted for treatment of major depression is pacing, agitated, and becoming verbally aggressive toward other clients. What is the immediate care priority? Ensuring the safety of this client and other clients on the unit (x) A client admitted to the nursing unit with bipolar disorder, manic phase, is accompanied by his wife. The wife states that her husband 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 (x) A health care provider (HCP) has prescribed valproic acid for a client with bipolar disorder who has achieved limited success with lithium carbonate. Which information should the nurse teach the client about taking valproic acid? Follow-up blood tests are necessary while on this medication A client taking disulfiram (Antabuse) during alcohol rehabilitation therapy reports to the nurse that he has a mild cold and plans to use a cough medicine. Which statement made by the client indicates understanding of the nurse's teaching? "I may experience vomiting and an upset stomach if I take cough medicine while taking this medicine." 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: is responding appropriately to the antipsychotic. is experiencing a split personality. is ready to be discharged from treatment. may be experiencing increased energy and is at increased risk for suicide. (x) A client with stage 1 Alzheimer's disease is diagnosed with terminal lung cancer. He asks the nurse what he should do when he "reaches the end." How should the nurse respond? "An advance directive will help to make sure that your wishes are carried out." "You need to discuss this issue with your family; they will help you decide what to do." "Have you considered putting together a living trust that states your desires?" "An advance directive will allow others to make decisions about your care." A client states that her "life has gone down the tubes" since her divorce 6 months ago. Then, after she lost her job and apartment, she took an overdose of barbiturates so she "could go to sleep and never wake up." Which statement by the nurse should be made first? d"Helplessness is common after losing a job. Are you having trouble making decisions?" "It seems as if your self-esteem has been affected by all your losses." "You sound hopeless about the future since your divorce." "I know you took an overdose of barbiturates. Are you thinking of suicide now?" Which food should the nurse tell the client to avoid while taking phenelzine? salami A nurse discovers that a hospitalized client with stage 4 esophageal cancer and major depression has a gun in the home. What is the best nursing intervention to help the client remain safe after discharge? Talk with the health care provider (HCP) about requiring gun removal as a condition of discharge. (x) The nurse is assigned to care for a client admitted with depression as well as a dependent personality disorder. Which of the following statements by the client is indicative of this personality disorder? "When I walked out the door, there were all of these people that were staring at me and talking about me." "It is hard for me to go and eat dinner when everyone wants to be with me. They all love me!" "Please don't forget to wait for me to go to dinner. I don't want to go by myself." "I don't want to go in there. Don't want to talk to anyone because anything I say makes them think I'm stupid." A client attends a follow-up visit to a clinic after being diagnosed with atypical depression. The practitioner prescribed tranylcypromine sulfate, 10 mg by mouth twice a day during the last visit 14 days ago. Which of the following would be the priority action by the nurse for this client? Screen the client for new, worsened, or increased depression Remind the client to stay out of sunlight and tanning booths Take the client's heart rate Ask the client if he or she has been taking any over-the-counter medications After teaching a client about lorazepam, which client statement indicates the need for further teaching? Select all that apply. "I can adjust the dosage when I feel more anxious." "I can stop taking lorazepam immediately if I need to." good teaching for this drug: "I can take lorazepam with food if I get nauseous." "I can chew sugarless gum if my mouth feels dry." "I should not drink alcohol."

Level 4 to 5

A nurse is caring for a client in an acute manic state. What is the most effective nursing action she can take on behalf of this client? Helping him express his feelings Assisting him with self-care Assigning him to group activities Reducing stimuli (x) A client was found unconscious on the floor of his bathroom with self-inflicted wrist lacerations. An ambulance was called and the client was transferred to the inpatient psychiatric unit for observation and treatment with antidepressants. Which nursing intervention is most appropriate? Explore precipitating factors for the suicide attempt. Observe for EPS. Begin a therapeutic relationship. Continue suicide precautions. (x) Which behavior if exhibited by a client with a depressive disorder should lead the nurse to determine that the client is ready for discharge? statements of dissatisfaction over not being able to perform at work interactions with staff and peers sleeping for 4 hours at a time verbalization of feeling in control of self and situations (x) The nurse answers a call on a telephone hotline from a man who was at the crisis center once in the past when he made a suicide threat. The client says, "Do not try to help me anymore. This is it. I have had enough and I have a gun in front of me now." Then he hangs up the telephone. Which call should the nurse make first? client's wife at work, to suggest she hurry home client, to make an attempt to calm him neighbor, to request he go to the client's home immediately police, to request their intervention (x) A depressed client on a psychiatric unit asks the nurse to call the hospital lawyer to discuss writing out a will. What is the nurse's priority intervention? Discuss thoughts and explore intent for suicide with the client. (x) Inform the physician first, and place the client on suicide watch. Call a lawyer as requested by the client. Offer the client medication for anxiety. A depressed client tells a nurse, "I want to die. Life just isn't worth living." Which response by the nurse is most appropriate? "This must be a very difficult time for you." "Why do you want to die?" "Of course life is worth living. You'll feel better soon." "No one really wants to die." 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 (x) After the nurse administers haloperidol 5 mg PO to a client with acute mania, the client refuses to lie down on her bed, runs out on the unit, pushes clients in her vicinity out of the way, and screams threatening remarks to the staff. What should the nurse do next? Tell the client to lie down on the sofa in the community room. Follow the client and ask her to calm down. Tell the staff to ignore the client's remarks. Seclude the client and use restraints if necessary. (x) A client with depression states, "I am still feeling nauseous after I take venlafaxine (prozac). Maybe I need something else." The nurse should tell the client to: take the medication at mealtime. cut the dose in half. take venlafaxine before bedtime. take venlafaxine only in the morning.

level 3 to 4

The nurse is caring for a client whose somatic symptom disorder is characterized by frequent descriptions of pain. What statement is true of this client's pain? The pain is real to the client, even though the pain may not have an organic etiology. The unlicensed assistive personnel (UAP) approaches the nurse and states, "The client does not know what caused him to be so depressed. He must not want to tell me because he does not trust me yet." In responding to this staff member, which statement by the nurse will help the UAP understand the client's illness? "Endogenous depression is biochemical and is not caused by an outside stressor or problem. The client cannot tell you why he is depressed because he really does not know." A 72-year-old female client is brought by ambulance to the hospital's psychiatric unit from a nursing home where she has been a client for 3 months. Transfer data indicate that she has become increasingly confused and disoriented. In which way should the hospital admission process be modified for the client? Allow her sufficient extra time in which to gain an understanding of what is happening to her. A client begins clozapine therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The client is instructed to return to the office laboratory weekly for 6 months to have blood drawn. Which of the following laboratory results would be of concern to the nurse after the third test? White blood count (WBC) of 3000 An 83-year-old woman is admitted to the unit after being examined in the emergency department (ED) and diagnosed with delirium. After the admission interviews with the client and her grandson, the nurse explains that there will be more laboratory tests and x-rays done that day. The grandson says, "She has already been stuck several times and had a brain scan or something. Just give her some medicine and let her rest." What should the nurse tell the grandson? Select all that apply. 1. "I agree she needs to rest, but there is no one specific medicine for your grandmother's condition." 2. "The doctor will look at the results of those tests in the ED and decide what other tests areneeded." 3. "Delirium commonly results from underlying medical causes that we need to identify and correct." A 62-year-old female client with severe depression and psychotic symptoms is scheduled for electroconvulsive therapy (ECT) tomorrow morning. The client's daughter asks the nurse, "How painful will the treatment be for Mom?" The nurse should respond with which statement? "Your mother will be able talk to us and tell us if she is in pain." The nurse is counseling a client regarding treatment of the client's newly diagnosed depression. The nurse emphasizes that full benefit from antidepressant therapy usually takes how long? 2 to 4 weeks 1 week 8 weeks 5 to 7 weeks When assessing a client who is receiving tricyclic antidepressant therapy, which finding should alert the nurse to the possibility that the client is experiencing anticholinergic effects? urine retention and blurred vision The daughter of a client with Alzheimer's disease tells the nurse that her mother thinks someone is stealing her things. Which response by the nurse would be most helpful? "We asked the health care provider to evaluate your mother for paranoid delusions, which are common in people with Alzheimer's disease."

level 6 to 7

A client visits the mental health clinic and tells the nurse that she is lethargic, experiences pain in her back, cannot concentrate, and is depressed. The nurse observes patches of hair loss on the client's scalp. Which referral should the nurse make first? occupational therapist physical therapist psychologist a health care provider (HCP) The client with recurring depression will be discharged from the psychiatric unit. Which suggestion to the family is most important to include in the plan of care? client in usual at-home activities. A client diagnosed with major depression has started taking amitriptyline hydrochloride, a tricyclic antidepressant. What is a common adverse effect of this drug? Dry mouth A client with depression and suicidal ideation voices feelings of self-doubt and powerlessness and is very dependent on the nurse for most aspects of her care. According to Erikson's stages of growth and development, the nurse determines the client to be manifesting problems in which stage? autonomy versus shame/doubt The health care provider (HCP) prescribes mirtazapine 30 mg PO at bedtime for a client diagnosed with depression. The nurse should: give the medication as prescribed. The nurse is evaluating the test results of a client undergoing testing for depression. Which of the following results of from a dexamethasone suppression test (DST) would the nurse interpret as indicative of depression? Elevated afternoon serum cortisol

5 to 6

A client has been severely depressed since her husband died 6 months earlier. Her 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? Hypernatremia Hypokalemia Hiatal hernia Hepatic disease (x) After a period of unsuccessful treatment with amitriptyline (a TCA), a woman diagnosed with depression is switched to tranylcypromine. Which statement by the client indicates the client understands the side effects of tranylcypromine (MAO-Inhibitor)? "I need to increase my intake of sodium." "I must refrain from strenuous exercise." "I must refrain from eating aged cheese or yeast products." (x) "I should decrease my intake of foods containing sugar." A female 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 with her husband 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." (x) "We do not want to put you in seclusion yet." "I will not tolerate your talking to me like that." "You are acting inappropriately." A client was hospitalized for 1 week with major depression with suicidal ideation. He is taking venlafaxine (effexor) 75 mg (an SNRI) three times a day and is planning to return to work. The nurse asks the client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it anymore and would not do anything to hurt myself." The nurse should make which judgment about the client? The client needs an adjustment or increase in his dose of antidepressant. The presence of suicidal ideation warrants a telephone call to the client's healthcare provider. The depression is improving, and the suicidal ideation is lessening. (x) The client is decompensating and in need of being readmitted to the hospital. A client begins clozapine therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The client is instructed to return to the office laboratory weekly for 6 months to have blood drawn. Which of the following laboratory results would be of concern to the nurse after the third test? Hemoglobin of 13.2 Blood urea nitrogen (BUN) of 18 mg/dL Creatinine clearance of 88 mL/min White blood count (WBC) of 3000 (x)

LvL 2 to 3

Family members of a client with bipolar disorder tell a nurse that they are concerned that the client is becoming manic. The nurse knows that the manic phase is marked by: flight of ideas and inflated self-esteem. (x) decreased self-esteem and increased physical restlessness. increased sleep and greater distractibility. obsession with following rules and maintaining order. A man found wandering in a local park is unable to state who or where he is or where he lives. He is brought to the emergency department, where his identification is eventually discovered. The client's wife states that he was diagnosed with Alzheimer's disease 3 years earlier and has experienced increasing memory loss. She tells a nurse she is worried about how she'll continue to care for him. Which response by the nurse is most helpful? "Do you have any children or friends who could give you a break from his care every now and then?" "What aspect of caring for your husband is causing you the greatest concern?" "You may benefit from a support group called Mates of Alzheimer's Disease Clients." "Because of the nature of your husband's disease, you should start looking into nursing homes for him." A nurse is assigned to care for a recently admitted client who has attempted suicide. What should the nurse do? Search the client's belongings and his room carefully for items that could be used to attempt suicide. (x) Respect the client's privacy by not searching his belongings. Express trust that the client won't harm himself while in the facility. Remind all staff members to check on the client frequently. A 42-year-old client with breast cancer is concerned that her husband is depressed by her diagnosis. Which change in her husband's behavior may confirm her fears? increase in social interactions disturbance in his sleep patterns (x) problem-focused coping style increased decisiveness The client with acute mania has been admitted to the inpatient unit voluntarily. The nurse approaches the client with medication to be taken orally as prescribed by the health care provider (HCP). The client states, "I do not need that stuff." Which response by the nurse is best? "You cannot refuse to take this medication." "If you do not take it orally, I will give you a shot." "I will get you some written information about the medication." "The medication will help you feel calmer." (x) A client has been transferred to the hospital's psychiatric unit from a nursing home for increasing confusion. The client's behavior is found to be the result of cerebral arteriosclerosis. Which nursing staff actions should positively influence the client's behavior? Select all that apply. accepting the client as he is limiting the client's choices acting nonchalantly allowing the client to do as he wishes explaining to the client what he needs to do step-by-step An elderly woman's husband died. When her brother arrives for the funeral, he notices her short-term memory problems and occasional disorientation. A few weeks later, she calls him to say that her husband just died. She says, "I didn't know he was so sick. Why did he die now?" She also complains of not sleeping, urinary frequency and burning, and seeing rats in the kitchen. A home care nurse is sent to evaluate her situation and finds the woman reclusive and passive, but pleasant. The nurse calls the woman's primary care physician to discuss the client's situation and background, and give his assessment and recommendations. The nurse concludes that the woman: 1. Is experiencing the onset of Alzheimer's disease. 2. Is having trouble adjusting to living alone without her husband. 3. Is having delayed grieving related to her Alzheimer's disease. 4. Is experiencing delirium and a urinary tract infection. 4. Delirium is commonly due to a medical condition such as a UTI in the elderly. Delirium often involves memory problems, disorientation, and hallucinations. It develops rather quickly. There is not enough data to suggest Alzheimer's disease especially given the quick onset of symptoms. Delayed grieving and adjusting to being alone are unlikely to cause hallucinations. In or the discharge of a client with a cognitive disorder, it is important to assess the client's caregiver support system. Which aspects are the most crucial to assess? Select all that apply. 1. Availability of resources for caregiver support. 2. Ability to provide the level of care and supervision needed by the client. 3. Willingness to transport the client to medical and psychiatric services. 4. Interest in engaging the cognitively disordered family member in reminiscence and games. 5. Willingness to install door alarms and make other safety changes. 6. Understanding the client's abilities and limitations. 1, 2, 3, 5, 6. It is important for a caregiver to have support for herself as well as be able to provide adequate safety, supervision, and medical care to the client. The caregiver must also have realistic expectations of the client, given his abilities and limitations. Reminiscing and engaging the client in games is desirable but not crucial to care. The son of an elderly client who has cognitive impairments approaches the nurse and says, "I'm so upset. The physician says I have 4 days to decide on where my dad is going to live." The nurse responds to the son's concerns, gives him a list of types of living arrangements, and discusses the needs, abilities, and limitations of the client. The nurse should intervene further if the son makes which comment? 1. "Boy, I have a lot to think about before I see the social worker tomorrow." 2. "I think I can handle most of Dad's needs with the help of some home health care." 3. "I'm so afraid of making the wrong decision, but I can move him later if I need to." 4. "I want the social worker to make this decision so Dad won't blame me." 4. Expecting the social worker to make the decision indicates that the son is avoiding participating in decisions about his father. The other responses convey that the son understands the importance of a careful decision, the availability of resources, and the ability to make new plans if needed. Transfer data for a client brought by ambulance to the hospital's psychiatric unit from a nursing home indicate that the client has become increasingly confused and disoriented. The client's behavior is found to be the result of cerebral arteriosclerosis. Which of the following behaviors of the nursing staff should positively influence the client's behavior? Select all that apply. 1. Limiting the client's choices. 2. Accepting the client as he is. 3. Allowing the client to do as he wishes. 4. Acting nonchalantly. 5. Explaining to the client what he needs to do step-by-step. 1, 2, 5. Confused clients need fewer choices, acceptance as a person, and step-by-step directions. Allowing the client to do as he wishes can lead to substandard care and the risk of harm. Acting nonchalantly conveys a lack of caring. The nurse observes a client in a group who is reminiscing about his past. Which effect should the nurse expect reminiscing to have on the client's functioning in the hospital? 1. Increase the client's confusion and disorientation. 2. Cause the client to become sad. 3. Decrease the client's feelings of isolation and loneliness. 4. Keep the client from participating in therapeutic activities. 3. Reminiscing can help reduce depression in an elderly client and lessens feelings of isolation and loneliness. Reminiscing encourages a focus on positive memories and accomplishments as well as shared memories with other clients. An increase in confusion and disorientation is most likely the result of other cognitive and situational factors, such as loss of short-term memory, not reminiscing. The client will not likely become sad because reminiscing helps the client connect with positive memories. Keeping the client from participating in therapeutic activities is less likely with reminiscing. A 69-year-old client is admitted and diagnosed with delirium. Later in the day, he tries to get out of the locked unit. He yells, "Unlock this door. I've got to go see my doctor. I just can't miss my monthly Friday appointment." Which of the following responses by the nurse is most appropriate? 1. "Please come away from the door. I'll show you your room." 2. "It's Tuesday and you are in the hospital. I'm Anne, a nurse." 3. "The door is locked to keep you from getting lost." 4. "I want you to come eat your lunch before you go the doctor." 2. Loss of orientation, especially for time and place, is common in delirium. The nurse should orient the client by telling him the time, date, place, and who the client is with. Taking the client to his room and telling him why the door is locked does not address his disorientation. Telling the client to eat before going to the doctor reinforces his disorientation. When assisting a new nurse plan a psychoeducational group for family members about depression, which topic would the nurse suggest omitting? drug classifications education about depression support and self-help groups managing the depressed client at home During the discharge planning teaching process, a client who has been prescribed tranylocypromine (An MAOI drug) states that he enjoys a beer or two in the evenings. Which of the following is the nurse's most appropriate response? "You can only drink one beer every now and then when on this medication." "Beer contains tyramine, which must be avoided when on this medication." (x) "It is better that you drink beer than wine with this medication." "Beer contains wheat, which must be avoided when taking this medication." When assisting a new nurse plan a psychoeducational group for family members about depression, which topic would the nurse suggest omitting? managing the depressed client at home drug classifications (x) support and self-help groups education about depression 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 he still feels depressed. At this time, what is the nurse's best response? "Imipramine may not be the most effective medication for you. You should call your physician for further evaluation." "Don't abruptly stop taking the medication. If you do, you may experience serious adverse effects." "Because imipramine must build to a therapeutic level, it may take 2 to 3 weeks to reduce depression." (x) "The physician may need to increase the dosage for you to get the medication's maximum benefit." A client in the manic phase of bipolar disorder constantly belittles other clients and demands special favors from the nurses. Which nursing intervention is most appropriate for this client? Set limits with consequences for belittling or demanding behavior. (x) Offer the client a variety of stimulating activities to distract him from belittling others or making demands of them. Ask other clients and staff members to ignore the client's behavior. Offer the client an antianxiety drug when belittling or demanding behavior occurs. A nurse notices that a client admitted for treatment of major depression is pacing, agitated, and becoming verbally aggressive toward other clients. What is the immediate care priority? Offering the client a less-stimulating area in which to calm down Isolating the agitated client and offering sedation to calm his behavior Ensuring the safety of this client and other clients on the unit (x) Removing the other clients from the area until this client settles down A client with early dementia exhibits disturbances in mental awareness and orientation to reality. The nurse should expect to assess a loss of ability in which other area? speech judgment (x) balance endurance 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? Refer the client to the concurrent disorders program at the clinic. Report the client's beer consumption to the health care provider (HCP). (x) Teach the client relaxation exercises to perform before bedtime. Share the information at the next interdisciplinary treatment conference. A client with severe depression and weight loss has not eaten since admission to the hospital 2 days ago. Which approach should the nurse include when developing the plan of care to ensure that the client eats? serving the client her meal trays in her room sitting with the client and spoon-feeding if required (x) calling the family to bring the client food from home explaining the importance of nutrition in recovery A client diagnosed with major depression spends most of the day lying in bed with the sheet pulled over his head. Which approach by the nurse is most therapeutic? Wait for the client to begin the conversation. Initiate contact with the client frequently. (x) Sit outside the client's room. Question the client until he responds. 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. (x) Which foods are contraindicated for a client taking tranylcypromine? Whole grain cereals and bagels Chicken livers, Chianti wine, and beer Oranges and vodka Chicken, rice, and apples In a predischarge program to educate clients with bipolar disorder and their family members, the nurse emphasizes which symptom is the most significant indicator for the onset of relapse? a sense of pleasure and motivation for new endeavors decreased need for sleep and racing thoughts self-concern about increase in energy leaving a good job to start a new business

LvL 1 to 2