Mood, Adjustment, and Dementia Disorders

A client with a diagnosis of major depression is prescribed clonazepam for agitation in addition to an antidepressant. Client teaching would include which statement?

"Clonazepam is a minor depressant and may aggravate symptoms of depression."

A geriatric client with Alzheimer's disease has been living with his grown child's family for the last 6 months. He wanders at night and needs help with activities of daily living. Which statement by his child suggests that the family is successfully adjusting to this living arrangement?

"Dad has presented many challenges. We have alarms on all the outside doors now. Respite care gives us a break."

The daughter of a client diagnosed with Alzheimer's disease tells a nurse, "My mother is incompetent. You'll need to contact me or my sister if any decision must be made about my mother's care." Which response by the nurse is best?

"I must respect your mother's rights until she is legally deemed incompetent."

A nurse is observing the effectiveness of an assertiveness group attended by a client with dependent personality disorder. Which client statement indicates the group had therapeutic value?

"I want to talk about something that's bothering me."

A nurse is preparing to talk with a client who recently attempted suicide. Before engaging in the conversation, which statement by the nurse would be most appropriate?

"I'll need to share information with the rest of your health care team if it's important to your care."

A client with dependent personality disorder is working to increase self-esteem. Which statement by the client shows that the education was successful?

"I'm not just going to look at the negative things about myself."

While shopping, a nurse meets a neighbor who asks about a friend receiving treatment at the nurse's clinic. What is the nurse's most appropriate response?

"I'm sorry, I can't disclose client information."

A nurse is talking with a client who recently attempted suicide. The client asks the nurse not to tell anyone about their conversation. How should the nurse respond?

"If information is important to your care, I'll need to share it with the rest of your health care team."

A client who has been taking imipramine, 125 mg P.O. daily, for 1 week wants to stop taking the medication because the client still feels depressed. Which response by the nurse would be most appropriate at this time?

"Imipramine must build up to a therapeutic level; it may take 3 to 4 weeks to reduce depression."

A client avoids leaving home to shop for groceries and states to the nurse, "I feel crazy from the fear even when I know it is unrealistic." What is the best response by the nurse?

"It is better if you gradually face your fear with professional coaching."

During the admission data collection, a client reports that she frequently has nightmares and memories of a rape that occurred 3 years ago. She feels depressed and asks the nurse, "Do you think I will ever get better? I don't know what is wrong with me." The nurse's most supportive response would be:

"It sounds like you have some unresolved pain about the trauma. Take time here to talk and allow yourself to heal."

The nurse is discussing the incidence of obsessive-compulsive disorder (OCD) with a client. Which statement made by the client demonstrates an understanding of the education?

"OCD is as common as diabetes and asthma."

A client is diagnosed with an extremely severe form of obsessive-compulsive disorder (OCD) and wants to know whether the scheduled gamma knife procedure will alleviate symptoms. What is the best response by the nurse?

"The procedure has been helpful to about 60 percent of treatment-resistant OCD patients."

On admission to the psychiatric unit, a client with major depression reports that a family member is physically abusive and requests that the nurse not release any personal information to anyone. When the allegedly abusive family member calls the unit and demands information about the client's treatment, what is the nurse's best response?

"To protect clients' confidentiality, I can't give any information, including whether your relative is receiving treatment here."

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 ago and has had increasing memory loss. She tells the nurse she is worried about how she'll continue to care for him. Which response by the nurse would be most helpful?

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

A client who is a lawyer is admitted to a psychiatric unit for assessment. The client is angry about not being allowed to go off the unit. The client yells at the nurse, "I have rights and you must let me go outside. You are not allowed to keep me hostage here." Which would be the most therapeutic response by the nurse?

"You are correct; you do have rights. Let's sit and discuss them."

A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis?

Bipolar illness

A client with self-inflected wrist lacerations was stabilized in the emergency department and then transferred to the inpatient psychiatric unit for observation and treatment with antidepressants. After initiating antidepressant therapy, the client is now exhibiting an increase in energy levels. What nursing intervention is most appropriate?

Continue suicide precautions.

A client who retired six weeks ago, has been diagnosed with an adjustment disorder with mixed anxiety and depression. What can the nurse reinforce to help the client adapt well to the stress? Select all that apply.

Do something that gives you a sense of accomplishment. Find a support group geared toward your situation. Live a healthy lifestyle including a healthy diet and regular physical activity.

A 76-year-old client is admitted to a long-term care facility with Alzheimer's-type dementia. The client has been wearing the same dirty clothes for several days. The nurse contacts the family and asks them to bring in clean clothing. Which intervention would best prevent further regression in the client's personal hygiene?

Encouraging the client to perform as much self-care as possible

The nurse is caring for a client with illness anxiety disorder. Which behavior would the nurse be most likely to encounter?

Expression of fear of colorectal cancer following 3 days of constipation

A client with major depression frequently is 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 caring for a client diagnosed with depression. Which short-term goal should the nurse focus on for a client who makes statements about not deserving things?

Identify distorted thoughts.

A client has been diagnosed with borderline personality disorder (BPD) and will be treated with cognitive behavior therapy (CBT). How will the nurse best reinforce the education regarding this form of therapy?

Inform the client that it will help determine self-perception and relationships with others.

The nurse is caring for a client diagnosed with borderline personality disorder. The nurse tells the client that they will be meeting for 1 hour every week on Monday at 1 p.m. Which statement best describes the rationale for setting limits for a client with borderline personality disorder?

It helps the client clarify limits.

For which adverse reaction should the nurse monitor a client during the initial phase of lithium carbonate therapy?

Nausea and vomiting

A client comes to the emergency department after being attacked and sexually assaulted. What is the most accurate nursing diagnosis for this client?

Rape-trauma syndrome

After an upsetting divorce, a client threatens to commit suicide with a handgun and is involuntarily admitted to the psychiatric unit with major depression. Which nursing diagnosis takes highest priority for this client?

Risk for self-directed violence related to plans to commit suicide by handgun

A client who wanders is admitted to a restraint-free facility. Which nursing interventions can be implemented to avoid restraint use? Select all that apply.

Schedule diversional activities. Take the client on daily walks. Place the client in a room close to the nurses' station

A nurse is assigned to care for a client recently admitted to the psychiatric facility who has attempted suicide. When collecting data from the client, which action would be most appropriate at this time?

Search the client's belongings carefully for items that could be used to attempt suicide.

A 40-year-old executive who was unexpectedly laid off from work 2 days ago reports fatigue and an inability to cope. He admits drinking excessively over the last 48 hours. This behavior is an example of which condition?

Situational crisis

The nurse is gathering data from a client suspected of early dementia. Which finding shows impairment in abstract thinking and reasoning?

The client can't find similarities and differences between related words or objects.

A client with a history of major depression established a psychiatric advance directive that was deemed legally valid. The directive specified that the client did not want electroconvulsive therapy (ECT) at any time. The client is legally competent and has expressed a renewed interest in trying ECT. The nurse should anticipate what event?

The client may revoke or amend the terms of the advance directive.

A nurse is caring for a client diagnosed with borderline personality disorder. Which action by a client indicates adequate learning about personal behavior?

The client talks about intense anger.

A client with paranoid personality disorder responds aggressively to something another client said during a psychoeducational group session. Which rationale explains the likely underlying cause of the client's response to the interaction?

The client took the statement as a personal criticism.

Which long-term goal is appropriate for a client with paranoid personality disorder who is trying to improve peer relationships?

The client will become involved in activities that foster social relationships.

A client admitted to the inpatient psychiatric unit changes clothes eight or nine times a day, wears heavy eye makeup, is intrusive with other clients, and makes inappropriate sexual advances toward staff members. Which client goal would be most appropriate?

The client will refrain from hugging other clients and change clothing only twice per day.

The nurse is assisting with a plan of care for a client in the behavioral health unit with antisocial personality disorder. What goal would be appropriate for this client?

The family must stop reinforcing inappropriate negative behavior.

A Mini-Mental State Examination has been scheduled for a client who has been experiencing episodes of memory impairment. What information can be provided to the client and family about this test? Select all that apply.

The level of a client's education can impact overall scoring. Lower scores are associated with dementia. The test is used to measure cognitive impairment.

Dextroamphetamine has been ordered for a client diagnosed with narcolepsy. The nurse understands that this medication acts as:

a central nervous system (CNS) stimulant.

A nurse places an object in the hand of a client with Alzheimer's disease (AD) and asks the client to identify the object. Which term represents the client's inability to name the object?

agnosia

The nurse observes a child with autism banging his or her head against the floor repetitively. Which nursing action is the priority?

apply a helmet on the child

The nurse is assisting with the development of a treatment plan for a client with a specific phobia. Which intervention should the nurse prepare the client for?

behavioral therapy

Which intervention can the nurse discuss with the parents of a child with attention deficit hyperactivity disorder (ADHD) to help their child to achieve daily tasks?

break up the task into smaller steps

The nurse is caring for a client with a cognitive disorder. Which characteristic does the nurse observe that correlates with a cognitive disorder?

deficit in memory

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 major depression begins to improve and participates in treatment programs on the unit. Which client behavior would best indicate to the team that the client is ready for discharge?

discusses plans to return home and continue outpatient treatment

The nurse is obtaining data when the postpartum client comes for follow-up visits at 2, 4, and 6 weeks. When would be the best time for the client to have postpartum depression screenings?

during each of the three visits using the Edinburgh Postnatal Depression Scale

Which short-term goal is appropriate for a client with an antisocial personality disorder who acts out when distressed?

educating the client about expressing feelings in a nondestructive manner

A client with major depression hasn't responded to antidepressants. Which intervention should the nurse prepare the client for?

electroconvulsive therapy (ECT)

A client exhibits signs of dementia. Which condition, that can cause a dementia similar to Alzheimer's disease (AD), is reversible?

electrolyte imbalance

A client with a diagnosis of borderline personality disorder is admitted to the unit after slashing their wrist. When assisting with the planning of care, which goal is most appropriate for this client?

establish a therapeutic relationship with the client

A nurse is speaking with a client diagnosed with an antisocial personality disorder. Which behavior by the client alerts a nurse to the need for reinforcement of education related to interaction skills?

failure to follow social norms

Family members of a client with bipolar disorder tell the 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.

Which communication guideline should the nurse use when talking with a client experiencing mania?

focus and redirect the conversation as necessary

A depressed client in the psychiatric unit hasn't been getting adequate rest and sleep. To encourage restful sleep at night, the nurse should:

gently but firmly set limits on time spent in bed during the day.

A client with antisocial personality is admitted to a psychiatric facility. Which nursing interventions would be most effective for handling this client's inappropriate behavior? Select all that apply.

identifying limits establishing consequences for violations

A nurse determines that a client with antisocial personality disorder is beginning to practice several socially acceptable behaviors in the group setting. Which behavior observed by the nurse would indicate this is taking place?

improved self-esteem

A client is diagnosed with dependent personality disorder. When gather data from the client, which behavior would the nurse suspect as being most likely indicative of ineffective coping?

inability to make choices and decisions without advice

The nurse is caring for a client in the behavioral health unit that is diagnosed with bipolar disorder. The client is laughing and talking rapidly and then 30 minutes later, sitting on the floor not talking. How would the nurse document this behavior?

labile

A nurse is providing care to a client diagnosed with bipolar disorder, currently experiencing mania. When reviewing the plan of care for the client, which intervention would the nurse most likely implement at this time?

listening attentively with a neutral attitude, avoiding situations involving increased stimulation

A nurse on the psychiatric unit is caring for a client with antisocial personality disorder. Which behavior is the nurse most likely to observe?

manipulation, shallowness, and the need for immediate gratification

The nurse is assisting with the admission of a client with an amnestic disorder. Which evaluation would the nurse anticipate preparing to help identify the cause of the disorder?

metabolic and endocrine tests

A nurse observes that a client is mistrustful and shows hostile behavior. Which type of personality disorder is associated with these characteristics?

paranoid

A client diagnosed with bipolar disorder is receiving a maintenance dosage of lithium carbonate. The client is reported by a family member to be hyperactive and hyperverbal. Which intervention is appropriate?

prepare the client for lithium blood levels

A nurse is caring for a client diagnosed with late stage Alzheimer's disease (AD). What nursing intervention is priority?

providing supervision

A nurse is obtaining data from a client diagnosed with major depression and observes that the client is unable to perform activities of daily living (ADL) independently. The nurse would assume which role?

self-care deficit

A nurse is reinforcing education for the parents of a teenage client about the warning signs of potential adolescent suicide. Which signs should the nurse include?

statements such as not being around much longer

A client with bipolar disorder has abruptly stopped taking prescribed medication. Which behavior would indicate the client is experiencing a manic episode?

thoughtless spending

A client is admitted to the hospital in the manic phase of bipolar disorder. Which foods are most appropriate for this client?

A cheese sandwich, carrot sticks, grapes, and cookies

The nurse is caring for a client who has been diagnosed with delirium. Which of the following is characteristic of delirium?

Acute onset and lasts hours to a number of days

A client with gradually occurring global impairments of cognitive functioning, memory, and personality is most likely to have:

Alzheimer's-type dementia.