Mood, Adjustment, and Dementia Disorders

A client taking disulfiram during alcohol rehabilitation therapy reports to the nurse that they have a mild cold and plan to use a cough medicine. Which statement made by the client indicates understanding of the nurse's teaching? "Small doses of cough syrup might make me crave alcohol." "I realize that taking cough syrup with this medication might cause me to be depressed." "I may experience vomiting and an upset stomach if I take cough medicine while taking this medicine." "As long as the physician is aware, its okay."

"I may experience vomiting and an upset stomach if I take cough medicine while taking this medicine." Disulfiram provokes a violent reaction in the presence of alcohol; the client may not realize that cough medicine may contain an alcohol base. This medication combination won't cause depression. Because the cold is minor, there's no need for the client to talk with his physician.

The nurse understands that the client with severe dementia and motor apraxia may still be able to perform which action? Use confabulation when telling a story. Find misplaced car keys. Brush the teeth when handed a toothbrush. Balance a checkbook accurately.

Brush the teeth when handed a toothbrush. Highly conditioned motor skills, such as brushing teeth, may be retained by the client who has dementia and motor apraxia. Balancing a checkbook involves calculations, a complex skill that is lost with severe dementia. Confabulation is fabrication of details to fill a memory gap. This is more common when the client is aware of a memory problem, not when dementia is severe. Finding keys is a memory factor, not a motor function.

The nurse is working on a psychiatric unit with new admissions with suicidal ideation. What characteristic is being described by a client who states, "I want to live, but maybe the answer is to die"? frustration ambivalence remorse psychosis

ambivalence One of the characteristics most commonly shared by suicidal persons is ambivalence, an internal struggle between self-preserving and self-destructive forces. These doubts are expressed when a person threatens or attempts suicide and then tries to get help to save their life. When the possible consequences of suicide are discussed, such persons commonly describe life-related outcomes such as relief from an unhappy situation. Many people consider suicide an alternative to present circumstances, but they may not have considered the implications of no longer being alive. A psychotic person may or may not have suicidal tendencies. Remorse and anger may be associated with depression but aren't universally present in suicidal persons. Frustration isn't specifically associated with suicidal ideation.

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 the client's hygiene needs and ensure that these needs are met. assess for and maintain adequate nutrition and hydration. involve the family in the client's care as much as possible. assess for level of depression and continue antidepressant medication.

assess for and maintain adequate nutrition and hydration. Food and fluid intake may be compromised in a client who is severely depressed. The nurse must ensure that the client is adequately hydrated and is receiving proper nutrition. Although the client's psychological needs are important, physiological needs are the priority in this case. Assessing the client's depression level, continuing the client's ordered medication, and maintaining the client's hygiene needs are lower priorities at this time. The nurse should be aware that family involvement may not be indicated in this client's care.

Which behaviors from a client with dementia would prompt nursing intervention? pulling at clothes trying to exit locked doors yelling at others attempting to hit others

attempting to hit others Attempting to hit others would need to be corrected immediately. Yelling and attempting to exit doors would need to be addressed; however, safety is the primary concern. Clients with dementia can be redirected and should be addressed calmly.

The health care provider (HCP) prescribes a serum lithium level tomorrow for a client with bipolar disorder, manic phase, who has been receiving lithium 300 mg PO three times daily for the past 5 days. At what time should the nurse plan to have the blood specimen obtained? after lunch before bedtime before breakfast during the afternoon

before breakfast Because lithium reaches peak blood levels in 1 to 3 hours, blood specimens for serum lithium concentration determinations are usually drawn before the first dose of lithium in the morning (which is usually 8 to 12 hours after the previous dose) or before breakfast. Stat lithium levels can be drawn at any time, usually when toxicity is suspected.

An elderly client's lithium level is 1.4 mEq/L. The client complains of diarrhea, tremors, and nausea. The nurse should: administer another lithium dose. reassure the client that these are normal adverse effects. hold the lithium and notify the physician. discontinue the lithium.

hold the lithium and notify the physician. The client exhibits symptoms of lithium toxicity. Therefore, the lithium should be held and the physician notified immediately. These aren't normal adverse effects, and administering another dose would increase the toxic effects. A nurse can't discontinue a medication without a physician's order.

A nurse is caring for an elderly client in a long-term care facility. This client has a history of attempted suicide. The nurse observes the client giving away personal belongings and has heard the client express feelings of hopelessness to other residents. Which intervention should the nurse perform first? setting aside time to listen to the client removing items that the client could use in a suicide attempt referring the client to a mental health professional communicating a nonjudgmental attitude

removing items that the client could use in a suicide attempt The nurse's first responsibility is to protect the client from self-harm. Listening and being nonjudgmental are important elements of the nurse's communication with the client but aren't immediate priorities. After the client's safety has been established, the client would benefit from a referral to a mental health professional.

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: a manic episode. depression. alcoholism. situational crisis.

situational crisis. A situational crisis results from a specific event in the life of a person who is overwhelmed by the situation and reacts emotionally. Fatigue, insomnia, and inability to make decisions are common signs and symptoms. The situational crisis may precipitate behavior that causes a crisis (alcohol or drug abuse). There isn't enough information to label this client an alcoholic. A manic episode is characterized by euphoria and labile affect. Symptoms of depression are usually present for 2 or more weeks.

The client diagnosed with severe major depression has been taking escitalopram 10 mg daily for the past 2 weeks. Which parameter should the nurse monitor most closely at this time? sleep energy level suicidal ideation appetite

suicidal ideation After about 2 weeks of medication therapy, the nurse should expect improvements in sleep, appetite, and energy though mood may not have improved significantly yet. The increased energy related to better sleep and food intake gives the client the ability to act on thoughts to harm self (suicide) since the depressed mood has not completely lifted.

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." "Have you considered putting together a living trust that states your desires?" "An advance directive will allow others to make decisions about your care." "You need to discuss this issue with your family; they will help you decide what to do."

"An advance directive will help to make sure that your wishes are carried out." The client's Alzheimer's is in an early stage and his question indicates awareness of his situation. Providing information about how an advance directive can be used to carry out the client's wishes may help relieve some anxiety. Telling the client that an advance directive will allow others to make care decisions and asking if the client has considered establishing a living trust provide inaccurate information and don't address the real need for assurance. A health care power of attorney, not an advance directive, gives others power to make decisions about a client's medical care. A living trust, which concerns property ownership, wouldn't address the client's concerns. Discussing the client's needs with family is important, but this suggestion doesn't address the client's concerns or respond to the request for the nurse's professional advice.

The friend of a client with depression and suicidal ideation asks the nurse, "How should I act around her?" Which response by the nurse is best? "Try to cheer her up." "Avoid asking how she's feeling." "Control your expressions." "Be caring and genuine."

"Be caring and genuine." The best response would be for the nurse to advise the visitor to be caring and genuine to the client as a friend normally would. Family and friends are commonly afraid or at a loss about how to act or what to say to someone with a mental illness or to someone who may voice thoughts of self-harm. The statement, "Try to cheer her up," is inappropriate because the client may feel overwhelmed and thus become more despondent when she cannot meet or match the cheerful demeanor. The statement, "Control your expressions," is inappropriate because the client is not helped when interactions are not natural and genuine. The statement, "Avoid asking how she's feeling," is inappropriate because it conveys a lack of interest in and concern for the client.

A client in the second stage of Alzheimer's disease appears to be in pain. Which question by the nurse would best elicit information about the pain? "Can you describe your pain?" "Where is your pain located?" "Where do you hurt?" "Do you hurt?" (pause) "Do you hurt?"

"Do you hurt?" (pause) "Do you hurt?" When speaking to a client with Alzheimer's disease, the nurse should use close-ended questions (those that the client can answer with "yes" or "no") whenever possible, and avoid questions that require the client to make choices. Also, repeating the question aids comprehension. Asking "Where do you hurt?," "Can you describe your pain?," or "Where is your pain located?" would require the client to make choices.

A client with dementia who prefers to stay in his room has been brought to the dayroom. After 10 minutes, the client becomes agitated and retreats to his room again. The nurse decides to assess the conditions in the dayroom. Which is most likely the 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. There are three staff members and one health care provider (HCP) in the nurse's station working on charting. A housekeeping staff member is washing off the countertops in the kitchen, which is on the far side of the dayroom. There is only one other client in the dayroom; the rest are in a group session in another room.

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. The tape and television are competing, even conflicting, stimuli. Crime events portrayed on television could be misperceived as a real threat to the client. A low number of clients and the presence of a few staff members quietly working are less intense stimuli for the client and not likely to be disturbing.

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? gastritis bradycardia exhaustion vertigo

exhaustion The client in the manic phase experiences insomnia, as evidenced by his sleeping only for about 4 hours a night for the past 5 days. The client experiencing an acute manic episode is not capable of judging the need for sleep. Therefore, the nurse should assess the amount of rest the client is receiving daily to prevent exhaustion. The development of vertigo, gastritis, or bradycardia typically does not result from acute mania.

The nurse is educating a client who insists that the newly prescribed imipramine is not working for the client's feelings of depression. When evaluating the client's statement, which question is most important to ask first? "Do you feel worse since taking the medication?" "What is the dosage of medication that you are prescribed?" "What time of day are you taking the medication?" "How long have you been taking the medication?"

"How long have you been taking the medication?" Clients are often hopeful of positive results when a new medication is prescribed. It is frustrating to the client when symptom relief does not occur in a time frame which the client feels is acceptable. Understanding that symptom relief takes time, the nurse's next question is to ask how long they have been taking the medication. The nurse is correct to realize that one disadvantage of cyclic antidepressants is the lag time between initiation of drug therapy and relief of depressive symptoms. Nursing instruction includes maintaining the medication for at least a month before medication adjustments are made. Confirming the other questions is appropriate.

A client with major depression and suicidal ideation is suddenly calmer and more energetic. Which conclusion should the nurse reach? The client is improving. The client is overstimulated. The client is imminently suicidal. The client's medication dosage is too high.

The client is imminently suicidal. When a client with major depression and suicidal ideation displays a sudden elevation in mood, seems calmer, has more energy, and is more peaceful, the nurse should judge these behaviors as an indication that a suicide attempt is imminent. These symptoms may indicate relief from ambivalent thoughts about suicide and that the client has an immediate plan for killing himself.

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 hypertension weight loss muscle spasms

dry mouth Tricyclic antidepressants can have anticholinergic adverse effects, with dry mouth being the most common. Hypotension would be expected, rather than hypertension. Weight gain — not loss — is typical when taking this medication. Muscle spasms aren't an adverse effect of tricyclic antidepressants.

A client with Alzheimer's disease mumbles incoherently and rambles in a confused manner. To help redirect the client's attention, the nurse should encourage the client to: participate in a game of charades. perform an aerobic exercise. play cards with another client. fold towels and pillowcases.

fold towels and pillowcases. Folding towels and pillowcases is a simple activity that redirects the client's attention. Also, because this activity is familiar, the client is likely to perform it successfully. Cards, charades, and aerobic exercise are too complicated for a confused client.

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 ready to be discharged from treatment. may be experiencing increased energy and is at increased risk for suicide. is experiencing a split personality. is responding appropriately to the antipsychotic.

may be experiencing increased energy and is at increased risk for suicide. As antidepressants take effect, an individual suffering from depression may begin to feel energetic enough to mobilize a suicide plan. Amitriptyline is an antidepressant, not an antipsychotic. The client shouldn't be discharged until the risk of suicide has diminished. The client's elevated mood is a response to the antidepressant, not an indication of a split personality.

Which response is most helpful for a client who is euphoric, intrusive, and interrupts other clients engaged in conversations to the point where they get up and leave or walk away? "You should remember to use your manners." "When you interrupt others, they leave the area." "You're being rude and uncaring." "You know better than to interrupt someone."

"When you interrupt others, they leave the area." Saying, "When you interrupt others, they leave the area," is most helpful because it serves to increase the client's awareness of others' perceptions of the behavior by giving specific feedback about the behavior. The other statements are punitive and authoritative, possibly threatening to the client, and likely to increase defensiveness, decrease self-worth, and increase feelings of guilt.

A nurse meets frequently with a depressed client. The client stays mostly in his room and speaks only when addressed, answering briefly and abruptly while keeping his eyes on the floor. Initially, the nurse should focus on the client's ability to do which function? Express himself verbally. Relate to other clients. Function independently. Make decisions.

Express himself verbally. When working with a client who is withdrawn and speaks little, answers briefly, and looks at the floor, the nurse should focus on interacting with the client to decrease withdrawal and establish a nurse-client relationship.Decision making is a higher-order cognitive function and will be difficult for the client at this time.Relating to others is an important therapeutic goal; however, a short-term goal such as appropriate verbal expression with the nurse is the first step.Functioning independently is not an initial goal with this client, who is barely interacting with the nurse.

A healthcare 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? The extended-release tablet can be crushed if necessary for ease of swallowing. Follow-up blood tests are necessary while on this medication. Tachycardia and upset stomach are common side effects. Consumption of a moderate amount of alcohol is safe if the medication is taken in the morning.

Follow-up blood tests are necessary while on this medication. Valproic acid can cause hepatotoxicity, so regular liver function tests are needed. Other side effects include nausea and drowsiness. Extended-release tablets should not be split or crushed; doing so changes their absorption. Alcohol should never be mixed with this medication. There will be medication in the client's body at all times. Nausea and tachycardia are not common side effects of valproic acid.

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? Involve the client in usual at-home activities. Provide for a schedule of activities outside the home. Encourage the client to sleep as much as possible. Discourage visitors while the client is at home.

Involve the client in usual at-home activities. It is best to involve the client in usual at-home activities as much as the client can tolerate them. Discouraging visitors may not be in the client's best interest because visits with supportive significant others will help reinforce supportive relationships, which are important to the client's self-worth and self-esteem. Providing for a schedule of activities outside the home may be overwhelming for the client initially. Involving the client in planning for outside activities would be appropriate. Encouraging the client to sleep as much as possible is nontherapeutic and promotes withdrawal from others.

The client has been taking the monoamine oxidase inhibitor (MAOI) phenelzine, 10 mg twice a day. The healthcare provider prescribes a selective serotonin reuptake inhibitor (SSRI), paroxetine 20 mg to be given every morning. What action should the nurse take? Ask the health care provider to prescribe benztropine for adverse effects. Question the dosage prescribed. Question the health care provider about the prescription. Give the medication as prescribed.

Question the health care provider about the prescription. The nurse should question the health care provider about the prescription because the client who has been taking an MAOI such as phenelzine must wait 14 days after stopping the MAOI before starting an SSRI such as paroxetine. Serotonin syndrome, a potentially lethal consequence, can occur when combining an MAOI and an SSRI. Serotonin syndrome is characterized by hyperreflexia, hyperthermia, myoclonus, and other symptoms similar to neuroleptic malignant syndrome. Giving the medication as prescribed can result in serious adverse consequences, as described previously. The dosage is accurate. Benztropine is not given with an SSRI; it is an antiparkinsonian agent usually prescribed for the adverse effects of antipsychotic medication.

What is a realistic short-term goal to be accomplished in 2 to 3 days for a client with delirium? Explain the experience of having delirium. Regain orientation to time and place. Establish normal bowel and bladder function. Resume a normal sleep-wake cycle.

Regain orientation to time and place. In approximately 2 to 3 days, the client should be able to regain orientation and thus become oriented to time and place. Being able to explain the experience of having delirium is something that the client is expected to achieve later in the course of the illness, but ultimately before discharge. Resuming a normal sleep-wake cycle and establishing normal bowel and bladder function probably will take longer, depending on how long it takes to resolve the underlying condition.

A nurse is completing a health history on a psychiatric client brought to the emergency department. The client states that they are a relative of the president of the United States and has very important business to attend to that involves national security. What is the nurse's best intervention? Respect the client's point of view while refocusing on issues based in the immediate reality. Ask the client questions about the business involving national security. Wait to complete the health history until the client's family arrives. Explain to the client that they are experiencing delusions.

Respect the client's point of view while refocusing on issues based in the immediate reality. A delusion of grandeur is a false belief that one is highly important or famous. Appropriate interventions for caring for a person with delusions in a community or hospital setting include: Validate any part of the delusion that is real. Do not maintain that what the person is thinking is wrong. Respect their point of view regardless of whether you agree. Do not expect that rational thinking will have an effect on the person's delusions and do not debate the delusion. Encourage the client to talk about things that are based in the immediate reality and encourage participation in reality-based physical activities where possible.

A client with Alzheimer's disease has random violent outbursts, wanders, and is incontinent. The client can no longer identify people who were once familiar and is unable to identify common objects. What is the priority nursing diagnosis? Self-care deficits Impaired communication skills Altered patterns of elimination Risk for injury

Risk for injury Risk for injury to self and others should maintain the highest priority in care planning. In this case, the client's wandering, memory loss, and aggression pose hazards for accidents, falls, and injuries. Self-care, impaired communication, and alteration in elimination are issues with Alzheimer's disease, but would not be the highest priority at this time.

A client and her partner come to the clinic stating they have been unable to have sexual intercourse. The female client states she has pain and her "vagina is too tight." The client was raped at age 15 years of age. Which nursing problem is most appropriate for this client? Sexual dysfunction related to sexual trauma Dysfunctional grieving related to loss of self- esteem because of lack of sexual intimacy Vaginismus related to vaginal constriction Risk for trauma related to fear of vaginal penetration

Sexual dysfunction related to sexual trauma Sexual dysfunction is the problem that is the most appropriate. Dysfunctional grieving because of lack of intimacy is not correct as the couple may have emotional intimacy. The trauma occurred when the female client was 15 years of age thus is not an acute problem. Vaginismus is a medical diagnosis.

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 nurse won't say anything to the parents, but that the client must tell the physician. Tell the adolescent that the law requires the nurse to report the sexual contact because of the age difference. Tell the adolescent that any information shared is privileged and confidential. Tell the adolescent that the nurse will consult the unit's charge nurse and be back to talk later.

Tell the adolescent that the law requires the nurse to report the sexual contact because of the age difference. Although what a client says is considered privileged communication, there are exceptions when there's a risk of danger to the client or to another person. In this case, the adolescent is having sex with an adult, which is considered statutory rape even if the sex is consensual. The nurse must report this information to the proper authorities. It's inappropriate to tell the adolescent that the nurse will speak only with the physician because the law requires the nurse to report this situation to the authorities. Although consulting with the charge nurse might be useful, doing so doesn't relieve the nurse of the duty to report the situation.

A client experienced the loss of home and beloved family dog in flood waters 4 months ago. The client states that since the loss, the client finds it hard to "feel anything." The client says they can't concentrate on simple tasks, thinks about the flood incessantly, and fears losing control. The client reports becoming extremely anxious whenever the flood is mentioned and must leave the room if people talk about it. The admitting nurse suspects the client has post-traumatic stress disorder (PTSD). Which nursing goal would be most appropriate for this client? The client will avoid disturbing thoughts or feelings associated with the trauma. The client will demonstrate progress in dealing with the grief of losing their home and dog. The client will acclimate to the psychiatric unit. The client will be able to sleep 8 hours per night.

The client will demonstrate progress in dealing with the grief of losing their home and dog. Survivors of trauma, disasters, and events outside of the usual ranges of human experiences may experience PTSD. The client is displaying dysfunctional grieving, which is common in PTSD. The priority for the nurse is to help the client gain adaptive coping strategies. Although sleep loss is an issue with PTSD, assisting the client with the grief would have the most impact on the client's behavior. Acclimation to the unit should not be an issue to the client with PTSD. The client will have difficulty avoiding thoughts of the trauma due to the persistent nature of PTSD.

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? watching television reading the newspaper cleaning the dayroom tables leading a group activity

cleaning the dayroom tables The client with mania is very active and needs to have this energy channeled in a constructive task such as cleaning or tidying the dayroom. Because the client is distracted easily and can concentrate only for short periods, the successful completion of a helpful task would give the nurse the opportunity to thank the client for the help, thereby enhancing the client's self-esteem. Leading a group activity is too stimulating for the client. Participating in this type of activity also may cause the client to be disruptive. Watching television or reading the newspaper would be inappropriate for the client who cannot sit for a period of time.

The nurse is assessing a client who has been admitted to the acute care facility. The client experiences an acute onset of altered level of consciousness and recent memory loss. What does the nurse anticipate the client will be evaluated for? delirium tertiary syphilis depression dementia

delirium Delirium presents as an acute process by which the client exhibits an alteration in level of consciousness, disorientation, and recent memory loss. It may be difficult to differentiate between dementia, delirium, and depression, as many of the clinical manifestations overlap. Dementia, tertiary syphilis, and depression are chronic states and do not manifest acutely.

The parent of a soldier who was killed 2 days ago is admitted after a serious suicide attempt. The client is medically stable and is no longer suicidal. During a talk with the nurse, the parent says, "Terrorism and war are holding me and the whole world hostage. It is so unfair. I would rather be dead than live alone in constant fear." Which nursing interventions are important in the next few days? Select all that apply. recommending an antiwar advocacy group identifying community groups for relatives of military personnel discussing effective ways to express justifiable anger teaching stress management and relaxation techniques strategizing about ways to increase a personal sense of security

identifying community groups for relatives of military personnel discussing effective ways to express justifiable anger teaching stress management and relaxation techniques strategizing about ways to increase a personal sense of security Dealing with anger, stress, and anxiety; identifying resources and support groups; and increasing a sense of safety and security are appropriate interventions at this time. However, recommending an antiwar advocacy group may or may not be appropriate, even much later in the client's recovery.

A nurse is performing an assessment on a client with depression. Which finding should the nurse anticipate? Select all that apply. tangentially of ideas and speech negative and pessimistic feelings difficulty concentrating and making decisions moods vary between depression, anger, and elation psycho-motor retardation and agitation

negative and pessimistic feelings psycho-motor retardation and agitation difficulty concentrating and making decisions Major depression is a mood disorder that affects one's physical, psychological and social needs or well-being. Thus, symptoms from this disorder affect all those areas. According to the DSM-V, 5 of the 9 criteria need to be present in a 2 week period for a person to be diagnosed with the illness. Of the symptoms above, the common signs of depression are the following: difficulty concentrating and making decisions, psycho-motor retardation and agitation, and negative and pessimistic feelings. Variable moods and tangentially of ideas and speech are seen in bipolar mania.

A client chronically complains of being unappreciated and misunderstood by others, is argumentative and sullen, and always blames others for the client's failure to complete work assignments. The client expresses feelings of envy toward people the client perceives as more fortunate. The client voices exaggerated complaints of personal misfortune. The client most likely suffers from which personality disorder? obsessive-compulsive disorder avoidant personality disorder dependent personality passive-aggressive personality

passive-aggressive personality The client with passive-aggressive personality disorder displays a pervasive pattern of negative attitudes, chronic complaints, and passive resistance to demands for adequate social and occupational performance. The client with a dependent personality is unable to make everyday decisions and allows others to make important decisions for the client. In addition, the client with a dependent personality commonly volunteers to do things that are unpleasant so that others will like the client. The avoidant personality displays a pervasive pattern of social discomfort, fear of negative evaluation, and timidity. The client with obsessive-compulsive disorder displays a pervasive pattern of perfectionism and inflexibility.

A nurse is assessing a client who has just been admitted to the emergency department. Which signs suggest an overdose of an antianxiety agent? combativeness, sweating, and confusion suspiciousness, dilated pupils, and increased blood pressure slurred speech, dyspnea, and impaired coordination agitation, hyperactivity, and grandiose ideation

slurred speech, dyspnea, and impaired coordination Signs of antianxiety agent overdose include slurred speech, dyspnea, and impaired circulation. Phencyclidine (PCP) overdose can cause combativeness, sweating, and confusion. Amphetamine overdose can result in agitation, hyperactivity, and grandiose ideation. Hallucinogen overdose can produce suspiciousness, dilated pupils, and increased blood pressure.

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? appropriate self-disclosure to support a trusting relationship challenging the client so that they begin to look not at the embarrassment for being admitted but at the realities of the client's feelings and actions supporting suicide precautions and safety measures for the client on the unit allowing the client time for self-reflection and insight development

supporting suicide precautions and safety measures for the client on the unit Although all the other aspects of forming a helping relationship and successful therapy on the unit are important, the priority nursing approach is supporting safety and suicide precautions. Supporting the client's involvement in group therapy will be more important later on in the treatment, as will challenging and appropriate self-disclosure.

The husband of a client who was diagnosed 6 years ago with Alzheimer's disease approaches the nurse and says, "I'm so excited that my wife is starting to use donepezil for her illness." What should the nurse tell the husband? effectiveness in the terminal phase of the illness is scientifically proven. the medication is effective mostly in the early stages of the illness. the client will attain a functional level equal to that of 6 years ago. the adverse effects of the drug are numerous.

the medication is effective mostly in the early stages of the illness. When compared with other similar medications, donepezil has fewer adverse effects. Donepezil is effective primarily in the early stages of the disease. The drug helps to slow the progression of the disease if started in the early stages. After the client has been diagnosed for 6 years, improvement to the level seen 6 years ago is highly unlikely. Data are not available to support the drug's effectiveness for clients in the terminal phase of the disease.

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 as which area of the mental status examination? thought content mood and affect psychomotor behavior attitude toward the nurse

thought content The client's statement, "I am the Queen of England. Bow before me," is an example of a grandiose delusion and refers to thought content of the mental status examination. Examples of psychomotor behavior to be documented would include excited, typically exaggerated and repetitive physical movements, and excessive talking and gesturing. Mood is a subjective state, and affect is an observable expression of emotion. Mood is what a client tells you she is feeling, and affect is what you see the client feeling. For example, the client may state that she feels sad or happy in reference to mood. Affect refers to the display of physical emotion, commonly described as "appropriate" or "flat." Attitude toward the nurse refers to the client's behavior in the presence of the nurse during the mental status examination (pleasant and cooperative, irritable, and guarded).

A client has been treated for major depression and is taking antidepressants. He asks the nurse, "How long do I have to take these pills?" How should the nurse respond to the client's question? "Once you're feeling better, the medication can be discontinued." "You'll need to take the medication for at least 3 months." "Antidepressants are prescribed for 6 to 12 months before considering discontinuation." "The medication can be discontinued when you don't have suicidal thoughts."

"Antidepressants are prescribed for 6 to 12 months before considering discontinuation." With major depression, antidepressants are prescribed for 6 to 12 months before the client is evaluated for discontinuation. Discontinuation of the medication prematurely may cause a relapse. An adequate duration for maintenance treatment is a minimum of 6 months; it is often longer depending on the stage of the illness and the specific client's characteristics. This regimen must be explained to clients as they often want to stop the medication when they feel better.

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? "It is better that you drink beer than wine with this medication." "Beer contains tyramine which must be avoided when on this medication." "Beer contains wheat which must be avoided when taking this medication." "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." A client taking a monoamine oxidase inhibitor antidepressant such as tranylcypromine should not consume foods containing tyramine. Such foods include beer, ale, Chianti wine, chicken livers, aged game meats, broad beans, aged cheeses, sour cream, avocados, yogurt, pickled herring, yeast extract, chocolate, excessive caffeine, vanilla, and soy sauce.

The unlicensed assistive personnel (UAP) approaches the nurse and states, "The client doesn't know what caused him to be so depressed. He must not want to tell me because he doesn't 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 isn't caused by an outside stressor or problem. The client can't tell you why he's depressed because he really doesn't know." "Endogenous depression can be caused by various stressors. Perhaps the client isn't willing to tell you at this time." "Endogenous depression usually derives from past childhood conflicts. It really isn't important for the client to remember what happened years ago." "Endogenous depression comes from within the person. It's a reaction to a loss. You need to give the client more time to identify the cause or loss."

"Endogenous depression is biochemical and isn't caused by an outside stressor or problem. The client can't tell you why he's depressed because he really doesn't know." The cause of endogenous depression is believed to be biochemical and not a reaction to a loss. It is caused by an imbalance or decreased availability of norepinephrine, serotonin, and possibly dopamine, so the client cannot identify a specific outside cause or a loss.Reactive depression is a reaction to a loss or a stressor.It is wrong to consider that lack of trust or slow thinking are reasons why the client will not identify the cause of his depression.Problems and stressors from past childhood conflicts may be present; however, the client can discuss them with the staff when he is willing or able.

The nurse is taking a client's mental health history and assessment. The client with depression has been diagnosed with anergia. The nurse teaches a client how to increase the levels of the neurotransmitter serotonin. Which statement made by the nurse educator is best? "Eat a high-protein, low-fat diet." "Exercise daily for at least 30 minutes." "Try group therapy." "Add more individual counseling to your program."

"Exercise daily for at least 30 minutes." Clients with anxiety and depression may have anergia (little mental or physical energy). Exercise has a greater impact on serotonin than counseling and there are no significant data on the correlation of increased serotonin levels and group therapy. Similarly, there are no data on the correlation of increased levels of serotonin eating a high-protein, low-fat diet.

An adolescent client comes to the community crisis clinic. The client has multiple superficial cuts on their bilateral wrists. The client is crying uncontrollably and states that a close friend has left recently and the client doesn't want to live without the friend. What would be the most therapeutic initial nursing response? "Let's set some boundaries on your behavior, and let's find ways to deal with your stress." "There are plenty of friends out there. Don't worry, at your age you will find another friend quickly." "Many friends change their minds about relationships. This is really quite normal." "I can see that you are feeling anxious. I will stay with you until you feel better."

"I can see that you are feeling anxious. I will stay with you until you feel better." The priority is to provide for a safe environment and to use anxiety reduction techniques to calm the client. The nurse exhibits empathy, calmness, and support in the crisis, unlike the authoritarian setting of boundaries at the outset. The other responses are incorrect because suggesting the client will find another friend provides false reassurance, and asserting that many friends change their minds in relationships is dismissive of the client's experience.

A client taking mirtazapine is disheartened about a 20-lb (9 kg) weight gain over the past 3 months. The client tells the nurse, "I stopped taking my mirtazapine 15 days ago. I don't want to get depressed again, but I feel awful about my weight." Which response by the nurse is most appropriate? "Your depression is much better now, so your medication is helping you." "Look at all the positive things that have happened to you since you started mirtazapine." "I hear how difficult this is for you and will help you approach your health care provider about it." "Focusing on diet and exercise alone should control your weight."

"I hear how difficult this is for you and will help you approach your health care provider about it." The nurse should express concern for the client and offer to help the client speak with the HCP, which will lend support to the client's concerns. The client who has stopped the medication must be taken seriously because medication noncompliance could result in a recurrence of symptoms of depression. Telling the client to focus on diet and exercise ignores the client's feelings and subtly implies the weight gain is the client's fault. Pointing out that the medication has helped and that positive things have happened since the depression lifted may be true, but it does not address the client's current feelings or needs.

The client with mania is irritable and insulting to an unlicensed assistive personnel (UAP). The UAP states, "I cannot believe this client is so rude. Should he not be overly happy?" Which response by the nurse should help the UAP understand the client's behavior? "We must reprimand the client for doing that because there is no reason to behave like that." "I know it is difficult, but being irritable is a sign of the client's mania." "It is our responsibility to listen even though we might not like what the client is saying." "I will go and speak to the client about this behavior and make sure he understands that he needs to control what he is saying."

"I know it is difficult, but being irritable is a sign of the client's mania." The nurse should help the unlicensed assistive personnel (UAP) understand the client's behavior by stating that the irritable mood is a symptom of mania. Not all clients with mania are euphoric or have an expansive mood. Saying, "It is our responsibility to listen even though we might not like what he is saying" does not help the UAP understand the client with mania. Reprimanding the client for the behavior and asking to control the behavior are inappropriate actions and show poor nursing judgment and a lack of understanding of the manic client.

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? "You sound hopeless about the future since your divorce." "I know you took an overdose of barbiturates. Are you thinking of suicide now?" "It seems as if your self-esteem has been affected by all your losses." "Helplessness is common after losing a job. Are you having trouble making decisions?"

"I know you took an overdose of barbiturates. Are you thinking of suicide now?" The highest priority is assessing for suicide risk. When the client is safe, then the self-esteem, helplessness, and hopelessness issues can be addressed.

During family teaching, the daughter of a client with dementia mentions to the nurse that her mother distorts things. The nurse understands that the daughter needs further teaching about dementia when she makes which statement? "I tell her reality, such as, 'That noise is the wind in the trees.'" "I tell her she's wrong, and then I tell her what's right." "I turn off the radio when we're in another room." "I understand the misperceptions are part of the disease."

"I tell her she's wrong, and then I tell her what's right." Telling the client that she is wrong and then telling her what is right is argumentative and challenging. Arguing with or challenging distortions is least effective because it increases defensiveness. Telling the client about reality indicates awareness of the issues and is appropriate. Acknowledging that misperceptions are part of the disease indicates an understanding of the disease and an awareness of the issues. Turning off the radio helps to limit environmental stimuli and indicates an awareness of the issues.

The nurse accompanies the physician when a client is told that they have colon cancer and will require surgery. When the physician informs the client of the diagnosis, the client states, "There is no way that this is true, I am not even sick!" Which is the nurse's best response? "Maybe it's not as bad as you think it will be." "I understand how difficult this must be to accept." "You will come to accept this diagnosis and work through it." "Other people have done very well with this surgery."

"I understand how difficult this must be to accept." Denial is exhibited by disbelief regarding a loss or potential loss. It is a protective mechanism that allows the client to eventually accept the loss. The nurse should be supportive and demonstrate empathy. Using platitudes and clichéd statements are not supportive.

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." "Don't say that; your dad would want you to keep going." "Are you currently using drugs or alcohol?" "I think you are just tired and need some sleep."

"I will stay here with you." The client's statement, "I just feel like I can't do anything," indicates that the client is feeling helplessness. It is most therapeutic to tell the client that the nurse will stay with them. Often adolescents do withdraw into themselves during grief, and drug and alcohol use should be assessed, but not in response to that statement. Giving advice to get sleep is a nontherapeutic reaction to the client's statement, and stating that the client's father would want the client to keep going is also a nontherapeutic statement by using the father to disapprove of the client's statement.

The 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, a nurse working on this unit." "I can't go out to dinner with you." "I don't want to go out to dinner." "It doesn't matter how I look; the answer is no."

"I'm Chris, a nurse working on this unit." The nurse should state her first name and purpose on the unit to clarify her identity and to counteract other beliefs the client may have. Stating that the nurse does not want to or cannot go out to dinner is not therapeutic because it fails to clarify the client's misperceptions or erroneous beliefs, as is the statement "It doesn't matter how I look; the answer is no."

After a few minutes of conversation, a client who is depressed wearily asks the nurse, "Why pick me to talk to? Go talk to someone else." Which reply by the nurse is best? "You have a lot of potential, and I'd like to help you." "I'm assigned to care for you today, if you'll let me." "I'm interested in you and want to help you." "I'll talk to someone else later."

"I'm interested in you and want to help you." The nurse tells the client that the nurse is interested in her to increase the client's sense of importance, worth, and self-esteem. Also, stating that the nurse wants to help conveys to the client that she is worthwhile and important. Telling the client that the nurse is assigned to care for her is impersonal and implies that the client is being uncooperative. Telling the client that the nurse is there because the client has potential for improvement will not help the client with low self-esteem because most people develop a sense of self-worth through accomplishment. Simply saying that the client has a lot of potential will not convince her that she is worthwhile. Telling the client that the nurse will talk to someone else later is not client focused and does not address the client's question or concern.

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? "I promise I won't tell anyone about the information you share with me today." "I promise I won't tell anyone about the information you share with me today unless you give me permission to do so." "If information is important to your care, I'll need to share it with the rest of your health care team." "Please don't tell me anything that you wouldn't want others on your health care team to know."

"If information is important to your care, I'll need to share it with the rest of your health care team." The nurse must tell the client that information will be shared if it affects the client's safety or care. The nurse shouldn't promise to withhold information, because the nurse may have to break that promise if the information must be shared with others. The nurse shouldn't promise to ask permission before disclosing information to others. The nurse also shouldn't encourage the client to withhold information. Doing so violates the nurse's responsibility to develop a therapeutic relationship with the client. The nurse — not the client — should judge what specific information must be shared with others on the health care team.

The wife of a 67-year-old client who has been taking imipramine for 3 days asks the nurse why her husband is not better. The nurse should tell the wife: "It can take 6 weeks to see if the medication will help your husband." "Your husband may need an increase in dosage." "It takes 2 to 4 weeks before the full therapeutic effects are experienced." "A different antidepressant may be necessary."

"It takes 2 to 4 weeks before the full therapeutic effects are experienced." Imipramine, a tricyclic antidepressant, typically requires 2 to 4 weeks of therapy before the full therapeutic effects are experienced.Because the client has been taking the drug for only 3 days, it is too soon to determine if the current dosage of imipramine is effective.It is also too soon to consider taking another antidepressant.

A nurse is administering venlafaxine capsules to a client diagnosed with depression. What education will the nurse provide to the client about venlafaxine? "If you experience side effects, stop taking the medication immediately." "It's best to take the medication with food at the same time each day." "If you have trouble swallowing the capsule, it can be opened and put in food." "You should notice an improved mood after taking the medication for two weeks."

"It's best to take the medication with food at the same time each day." Venlafaxine is prescribed to treat depressive disorders and should be taken with food at the same time each day. The capsule should not be broken. The medication takes 6 to 8 weeks to get the full benefit of the medication. Clients taking the medication should be weaned off, not stop it suddenly.

After the nurse teaches a client with bipolar disorder about lithium therapy, which client statement indicates the need for additional teaching? "I need to take my medicine at the same time each day." "It's okay to double my next dose of lithium if I forget a dose." "I should drink about 8 to 10 8-oz (240 to 300 mL) glasses of water each day." "It's important to keep using a regular amount of salt in my diet."

"It's okay to double my next dose of lithium if I forget a dose." The therapeutic and toxic range of lithium is very narrow. If the client forgets to take a scheduled dose of lithium, the client needs to wait until the next scheduled time to take it because taking twice the amount of lithium can cause lithium toxicity. The client needs to maintain a regular diet and regular salt intake. Lithium and sodium are eliminated from the body through the kidneys. An increase in salt intake leads to decreased plasma lithium levels because lithium is excreted more rapidly. A decrease in salt intake leads to increased plasma lithium levels. The client needs to drink 8 to 10 8-oz (240 to 300 mL) glasses of water daily to maintain fluid balance and decrease thirst. Decreased water intake can lead to an increase in the lithium level and consequently a risk of toxicity. Lithium must be taken on a regular basis at the same time each day to ensure maximum therapeutic effect.

A nurse on the geropsychiatric unit receives a call from the son of a recently discharged client. He reports that his father just got a prescription for memantine to take "on top of his donepezil." The son then asks, "Why does he have to take extra medicines?" What should the nurse should tell the son? "Memantine and donepezil are commonly used together to slow the progression of dementia." "Maybe the donepezil alone is not improving his dementia fast enough or well enough." "Memantine is more effective than donepezil. Your father will be tapered off the donepezil." "Donepezil has a short half-life, and memantine has a long half-life. They work well together."

"Memantine and donepezil are commonly used together to slow the progression of dementia." Memantine and donepezil are commonly given together. Neither medicine will improve dementia, but they may slow the progression. Neither medicine is more effective than the other; they act differently in the brain. Both medicines have a half-life of 60 or more hours.

Which statement by a client taking trazodone as prescribed by the health care provider indicates to the nurse that further teaching about the medication is needed? "I'll continue to take my medication after a light snack." "Taking trazodone at night will help me to sleep." "My depression will be gone in about 5 to 7 days." "I won't drink alcohol while taking trazodone."

"My depression will be gone in about 5 to 7 days." Symptom relief can occur during the first week of therapy, with optimal effects possible within 2 weeks. For some clients, 2 to 4 weeks is needed for optimal effects. The client's statement that the depression will be gone in 5 to 7 days indicates to the nurse that clarification and further teaching is needed. Trazodone should be taken after a meal or light snack to enhance its absorption. Trazodone can cause drowsiness, and therefore the major portion of the drug should be taken at bedtime. The depressant effects of central nervous system depressants and alcohol may be potentiated by this drug.

The nurse is explaining to a client and the client's family about what to expect immediately after electroconvulsive therapy (ECT) treatments. Which statement would indicate to the nurse that the teaching was effective? "I may experience muscle soreness and tenderness after the treatment." "My family member will likely experience some confusion and disorientation after the treatment." "My family member will have almost immediate positive results from the treatment and will feel much improved after the first ECT." "I will be heavily sedated after the treatment and may sleep for several hours."

"My family member will likely experience some confusion and disorientation after the treatment." Clients typically experience some confusion and disorientation after treatment, but this generally recovers quite quickly. Clients are not heavily sedated after treatment. Muscle soreness is rare. Clients do not have immediate benefits after treatment; the typical course of treatment is 6 to 10 treatments.

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." "I can take my medicine whenever I feel anxious." "It's safe to have a glass of wine while taking this medicine." "It's okay to double my dose if I need to."

"My medicine isn't for the everyday stress of life." The statement, "My medicine isn't for the everyday stress of life," indicates an accurate understanding of the nurse's teaching about the use of lorazepam. Antianxiety agents like the benzodiazepines are used to treat anxiety that is unmanageable by other means and beyond the client's ability to cope. For the drug to be effective, it must be taken as prescribed. Lorazepam can cause physical and psychological dependence. Tolerance can occur, and doubling the dose of lorazepam may increase the risk of tolerance. Lorazepam is a central nervous system depressant. When it is taken in combination with alcohol, the depressant effect increases, posing a danger to the client.

A nurse should intervene when a depressed client makes which statement? "I've gained some weight." "Nobody cares about me." "I have trouble falling asleep." "Television doesn't interest me anymore."

"Nobody cares about me." The client's statement "Nobody cares about me" may indicate the presence of suicidal ideation. Major themes associated with suicide are loneliness, abandonment, psychic pain, loss, helplessness, and hopelessness. The nurse should ask the client directly about suicidal thoughts and plans. Sleep disturbances are a sign that the depression still exists, but they do not indicate suicidal ideation. Thus, the statement regarding difficulty falling asleep does not require immediate intervention by the nurse. Change in appetite and decreased interest in usual activities are common symptoms of depressed mood.

Which statement made by an adolescent who has just begun taking an antidepressant would indicate the need for further teaching? "A week ago when I started my antidepressant, I didn't care about eating, but now I want to eat a bit more." "Now that I've had a week of my antidepressant, it's a little easier to get up in the morning." "After a week of taking my antidepressant, I can sleep a little better—6 hours or so each night." "Now that I've been taking my antidepressant for a week, I'm going to feel better about myself."

"Now that I've been taking my antidepressant for a week, I'm going to feel better about myself." In the first week or so of taking an antidepressant, the vegetative symptoms of depression (poor sleep, appetite, and energy level) improve. However, it takes 3 to 4 weeks for improvement in self-concept/self-esteem to take place.

A client is admitted to the hospital for a recent suicide attempt. While on the unit, the client has been taking antidepressants as prescribed, attending group therapy, and engaging with other clients and staff. The client states, "I have lots of things to do when I get home, and I don't really need to be in the hospital anymore." Which response by the nurse would be most appropriate? "Tell me how you feel about killing yourself." "How can we be sure you will not harm yourself?" "Are you willing to follow your safety plan after you leave?" "How would you rate your mood on a scale of 1 to 10?"

"Tell me how you feel about killing yourself." Asking about suicidal ideation in an open-ended manner is correct because the client may have more energy and capacity to act on suicidal thoughts. The client remains at risk. It is necessary to assess the client's continued risk for suicide before discharge is considered. A client and nurse may have created a client specific safety plan with a list of coping strategies and sources for support, but the client may have decided on a specific suicide plan and should not be discharged until suicidal thoughts are managed appropriately. Although rating mood is relevant, it does not assess for the presence of suicidal thoughts. Asking about how the staff can be assured of the client's safety is not therapeutic because it indicates a lack of trust and damages the rapport between client and nurse.

A client is a 25-year-old pregnant mother of two children under the age of 6. She is a very protective mother and will not allow her children play outdoors for fear of tick bites. She tells the nurse that she feels "worn out" from cleaning the house from top to bottom every day. She asks the nurse how she can stop worrying so much. What is the most appropriate response from the nurse? "Have you sprayed your backyard for ticks or other pests?" "Why do you worry about the children getting tick bites?" "Have you considered spraying your children with an insect repellent?" "Tell me your concerns about the children playing in your backyard."

"Tell me your concerns about the children playing in your backyard." Asking the client to express her concerns assists the client to identify thoughts that are improbable or distorted. This is the beginning of the process of restructuring her cognitive thoughts and reducing anxiety. Offering advice such as spraying the children or yard with insecticides would be incorrect because these responses offers advice and do not allow the client to express her feelings. Asking, "Why do you worry about the children getting tick bites?" is incorrect because it challenges the client to defend her irrational fears and does not help her develop insight.

A client has just been admitted with acute delirium of unknown etiology. The client's daughter states that she is worried about her mom because she has never been this sick before. Which would be the most helpful statement to make to the daughter? "We can help you learn how to take care of her after she's discharged." "It helps if you avoid arguing when she talks about seeing people who aren't there." "The health care provider will prescribe tests to find out what's causing her condition." "Please don't worry. We'll take good care of your mother."

"The health care provider will prescribe tests to find out what's causing her condition." It is important for the daughter to know that there is an underlying cause for what her mother is experiencing and that it is treatable. Telling her not to worry is a useless cliché and does nothing to inform the daughter. Talking about care after discharge implies that the delirium is irreversible. Delirium is a reversible condition. Although not arguing with hallucinations is valid, this response ignores the daughter's concern.

A client is admitted to the psychiatric unit with a diagnosis of unipolar depression. The client has not responded to antidepressant drugs, so the health care provider prescribes electroconvulsive therapy (ECT). What education will the nurse provide about the procedure to the client and family? "Your family member should notice a change in mood the same day as treatment." "The number of ECT treatments are based on your family member's response to the therapy." "ECT requires the use of anesthesia, which means at least 2 days admission to the hospital." "The ECT will work faster than medications to treat your family member's depression."

"The number of ECT treatments are based on your family member's response to the therapy." The number of ECT treatments are based on the client's responses to the therapy. ECT is used when medication therapy has not worked. Anesthesia is used during ECT, but the treatment can be done on an outpatient basis. After ECT, clients may have memory loss but not immediate mood improvement. No similarity between the action of ECT and that of antidepressant medication has been proven.

A client with bipolar disorder has been experiencing more frequent mood swings. The client's serum lithium level is 1.3 mEq/dL. Which statement by the nurse would assist the client's understanding of bipolar disorder? "You need to have an increase in your medication because your blood levels are not therapeutic." "Your body develops a tolerance to the medication after a few months, and you need a higher dose to control the mood swings." "The part of your brain that controls emotion becomes supersensitive to stress over time and it releases extra neurotransmitters, causing more rapid mood swings." "The shorter days in fall and winter mean you're not getting enough sunlight to produce melatonin, which affects your mood and circadian rhythm."

"The part of your brain that controls emotion becomes supersensitive to stress over time and it releases extra neurotransmitters, causing more rapid mood swings." A defective feedback mechanism in the limbic system (known as kindling) can occur, causing excessive release of neurotransmitters and increased transmission of impulses. Serum levels are within therapeutic range and a higher dose may lead to lithium toxicity (normal range is 0.5 to 1.5 mEq/dL). There is no tolerance effect with lithium. Lack of sleep, not excessive sleep, can trigger a manic episode. Similarly, sunlight stimulates melatonin production in the spring and summer months and can cause hypomania, so the answer relating to the fall season is incorrect.

A nursing student and a charge nurse of a psychiatric unit are discussing the outcomes of clients with depression. Which if stated by the student, indicates that the student understands depression outcomes? "When an individual has depression, they will experience the problem all of their life." "There are patterns with this illness. If a person has one depressive episode, they have a 60% chance of experiencing another." "All people are at risk of depression. Nine out of 10 people will have depression in their lives." "Depression is situational. As long as the cause does not happen again, the depression should never happen again."

"There are patterns with this illness. If a person has one depressive episode, they have a 60% chance of experiencing another." If a person has a depressive episode, there is a 60% chance of a second episode. Factors related to depression include gender, age, socioeconomic status, race, and marital status, but are not necessarily situational. A major depressive disorder can be recurrent and could be chronic, but does not have to be a lifelong issue. Depression can occur in up to 25% of women and up to 12% of men.

A client is taking lithium carbonate. The client asks for explanations of why regular blood tests are needed. The nurse explains that it is to detect lithium toxicity. Which statement, if made by the client, indicates to the nurse that the teaching about lithium toxicity has been effective? "I should get my blood checked if I don't feel well." "This blood test tells the doctor if the medication is effective." "There may be too much medication in my bloodstream." "Blood tests will prevent common side effects of taking the medication."

"There may be too much medication in my bloodstream." Lithium has a very narrow range between the therapeutic range and the toxic level. Toxicity describes the systemic effects of the medication when there is an excess of medication in the bloodstream. The level at which the medication is most effective (therapeutic level) is the desired state of having the correct amount of medication in the bloodstream. Having a lithium level drawn will not prevent common side effects. The client should still get blood level drawn even if they feel well and are not having side effects. A therapeutic level is more likely to have positive effects on bipolar disorder. The level is individualized for each client, and effectiveness should be determined by penetrance of symptoms.

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? "I can understand what is going on with you." "Can you tell me what you are thinking right now?" "Are you are feeling like others have abandoned you?" "This must be a difficult time for you."

"This must be a difficult time for you." "This must be a difficult time for you" is an empathetic response. The response signifies that the nurse understands the ideas and the feelings that are present in the client. Stating, "I can understand what is going on with you" blocks effective communication; the nurse is minimizing the client's feelings. This statement indicates that the nurse is unable to empathize with the client. Asking if they feel abandoned names the feelings for the client and does not convey empathy. Asking what the client is thinking right now is not an empathetic response but it is a therapeutic technique called exploring.

The client with a cognitive disorder tells the nurse, "Everyone is after me. They want to kill me." How should the nurse respond? "You're frightened. This is a hospital and these people are staff members. You're safe here." "Tell me who do you mean when you say 'everyone' wants to kills you." "Don't worry, we'll protect you. No one can come here to harm you." "Why do you think someone wants to kill you?"

"You're frightened. This is a hospital and these people are staff members. You're safe here." The nurse does not argue with the client having delusions. The nurse addresses the client's underlying feelings and presents reality to promote the client's trust, comfort, and sense of reality. Asking why someone wants to kill the client challenges and further distances the client from reality. Asking what the client means by "everyone" does not help the client address reality. Indicating that staff will protect the client from others who intend harm validates the client's delusion, does not address the client's feelings, and may further confuse the client.

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? "Things will get better." "You're wearing a new shirt today." "I like the shoes you wore yesterday." "Everybody feels down once in a while."

"You're wearing a new shirt today." Pointing out facts of the present day draws the client into reality. By offering inane platitudes such as "everybody feels down once in a while," or "things will get better" minimize the client's feelings and may increase the feelings of worthlessness. Informing the client that the nurse liked something the client wore yesterday could make the client feel the nurse did not like other things he/she wore and requires the client to remember what that item was—often difficult with severe depression.

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? "You're scaring everyone in the group. Leave the room immediately." "Your behavior is disturbing to other clients. I'll walk with you to help you release some energy." "You're behaving in an unacceptable manner, and you need to control yourself." "If you continue to talk like that, no one will want to be around you."

"Your behavior is disturbing to other clients. I'll walk with you to help you release some energy." This response shows that the nurse finds the client's behavior unacceptable, yet still regards the client as worthy of help. Also, the nurse is recommending an appropriate alternative to the client's inappropriate behavior. The other options critique the client's behavior and offer no appropriate alternative.

A client is brought to the emergency department (ED) after ingesting an unknown quantity of antidepressant medication and sleeping pills. A family member tells the nurse that the client has recently experienced several significant losses. The client is stabilized in the ED and transferred to a psychiatric unit. What is the nurse's best response when the client sobs uncontrollably and refuses to come to breakfast? "Your feelings are real. I'll bring your breakfast and sit with you if you want." "I know you are feeling sad now, but it will get better with time." "I will bring you some medication to help settle your anxiety." "Come join the others. It will be good to get into the routine of the unit."

"Your feelings are real. I'll bring your breakfast and sit with you if you want." Acknowledging the client's feelings is validating and builds rapport. The offer to bring breakfast and sit with the client is the most therapeutic response since the client is adjusting to the unit and requires considerable assessment. Encouraging someone who is in a poor emotional state to join others is not productive to the client or the milieu. Acknowledging the client's sadness is part of validating feelings; however, this response names the feelings for the client and provides platitudes that are not therapeutic. Finally, offering anti-anxiety medication simply because someone is tearful is not an acceptable intervention, and closes down what is a potentially a helpful opportunity for ventilation, validation, assessment, and intervention.

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 asleep during the treatment and will not be in pain." "The health care provider will make sure your mother does not suffer needlessly." "Your mother will be able talk to us and tell us if she is in pain." "Your mother will be given something for pain before the treatment."

"Your mother will be asleep during the treatment and will not be in pain." The nurse should explain that ECT is a safe treatment and that the client is given an ultrashort-acting anesthetic to induce sleep before ECT and a muscle relaxant to prevent musculoskeletal complications during the convulsion, which typically lasts 30 to 60 seconds to be therapeutic. Atropine is given before ECT to inhibit salivation and respiratory tract secretions and thereby minimize the risk of aspiration. Medication for pain is not necessary and is not given before or during the treatment. Some clients experience a headache after the treatment and may request and be given an analgesic such as acetaminophen. Telling the daughter that the HCP will ensure that the client does not suffer needlessly would not provide accurate information about ECT. This statement also implies that the client will have pain during the treatment, which is untrue.

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. Repeat the lithium level. Hold the lithium carbonate. Notify the healthcare provider.

Administer the lithium carbonate. To treat acute mania, the client's serum lithium level should be between 0.6 and 1.2 mEq/L (mmol/L). The serum lithium level shouldn't exceed 2 mEq/L (mmol/L). The nurse must monitor the client continuously for signs and symptoms of lithium toxicity, such as diarrhea, vomiting, drowsiness, muscular weakness, ataxia, stupor, and lethargy. The nurse must also keep in mind that even a normal lithium level can become toxic. Notifying the healthcare provider of the normal level with a client in mania is not appropriate. There are no signs and symptoms of toxicity, so the medication should not be held. There is no reason to repeat the level.

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? Leave her alone to promote recovery of her faculties and composure. Give her a tour of the unit to acquaint her with the new environment in which she will live. Allow her sufficient extra time in which to gain an understanding of what is happening to her. Medicate her to ensure her calm cooperation during the admission procedure.

Allow her sufficient extra time in which to gain an understanding of what is happening to her. When admitting an elderly client, especially one who is confused and disoriented, it is best to give the client extra time in which to gain an understanding of what is happening to her. This will help her to get her bearings and adjust to a new environment.Leaving the client alone will not help her confusion and disorientation and will increase her fear and anxiety.Medication would not be appropriate until the cause of the client's confusion and disorientation is determined. Overmedicating elderly clients is sometimes a cause of their confusion.A tour of the unit will not be helpful for the client who is confused and disoriented.

An adolescent client with depression and a suicide attempt is admitted to an inpatient unit. The nurse notes that the client describes a recent breakup of a dating relationship with an emotionless tone and a flat facial expression. What will the nurse do next? Listen for clues suggesting the client has suicidal ideation. Encourage the client to express emotions. Reassure the client that life will get better. Ask the client if there is a plan in place for suicide.

Ask the client if there is a plan in place for suicide. The priority for this client is the risk for suicide, and the nurse needs to seek more information about a plan. Listening and waiting for expression of suicidal ideation delay important safety measures. The client has turned anger inward and may not be able to express emotions, so the nurse must be alert for another suicide attempt. The nurse should avoid using platitudes like "life will get better."

The nurse cares for a client who is breathing rapidly, pacing back and forth across the room, has lips tightly closed, and with arms crossed tightly across his chest. What action should the nurse do first? Ask the client why he or she is so anxious. Administer PRN buspirone. Assist client to a safe, calm environment. Place the client in an isolation room.

Assist client to a safe, calm environment. The nurse should first ensure the safety of the severely anxious client in a safe, quiet, environment. The nurse should not leave the client alone. Asking the client "why" is not therapeutic. Buspirone is a maintenance medication that will not help relieve anxiety immediately.

A preadolescent client diagnosed with oppositional defiant disorder is verbally lashing out at other clients and threatening violence. What intervention should the nurse include when planning the care for a child? Take away privileges on the unit. Seclude the client when they threaten violence. Act as a mediator between the client and the other clients to reduce tension. Assist the client to find ways to deal with their anger.

Assist the client to find ways to deal with their anger. Assisting the client in dealing with feelings is a behavior modification technique that is quite effective for children and adolescents with defiance and oppositional behaviors. By assisting the client to find ways to deal with anger, the nurse sets limits on the child's behavior and emphasizes appropriate behavior. Taking away privileges and secluding the client misses the opportunity to help the client learn ways to manage their anger. It is not the role of the nurse to go between this client and the other clients and mediate issues.

The mobile crisis unit of a large city receives an emergency call from an adolescent who states, "My life is worthless. I do not want to live anymore." The mobile crisis unit is on its way to the home. The nurse's best first response would be which of the following? Provide reassurance that life is not that bad. Attempt to calm and support the client. Do not tell the client that the police will accompany the crisis team. Ask the client if they ever felt like this before.

Attempt to calm and support the client. The priority of need is to calm the client and to offer support and safety. Providing for reassurance that life is not that bad is offering a sense of false assurance. Asking the client if they felt like this before is premature to building a trusting relationship and ensuring safety. Not telling the client that the police will accompany the crisis team will increase the client's level of stress.

The nurse is caring for a client who is prescribed phenelzine for depression that has not responded to other medications. When reviewing the dietary restrictions associated with this medication, the client reports that most of the client's favorite foods are now going to be restricted. Which collaborative action would best meet the needs of the client? Identify the primary meal preparer in the family and review a meal plan with that person to decrease client stress. Review the diet restrictions with the client and make a schedule of when the preferred foods can be eaten. Collaborate with the dietitian to counsel the client on additional foods or preparation methods that are acceptable with the medication. Report the client's noncompliance to the health care provider so the medication can be adjusted to a previous prescription.

Collaborate with the dietitian to counsel the client on additional foods or preparation methods that are acceptable with the medication. Nurses rely on the expertise of other disciplines to assist in meeting client needs. Collaborating with the dietician to identify foods agreeable to the client provides client-centered care for the therapeutic plan. "Scheduling" the intake of restricted foods puts the client at risk for adverse reactions. Bypassing the client in making meal plans undermines trust and may create problems between the client and meal preparer. The client has not responded to other medications, so returning to a previous medication class will not improve the depression experienced by the client.

The client with bipolar disorder is approaching discharge after being hospitalized with her first episode of acute mania. The client's husband asks the nurse what he can do to help her. What recommendation for the husband should the nurse anticipate including in the teaching plan? Help the client to be free from worry and anxiety. Remind the client to control her symptoms. Communicate openly and offer support. Relieve the client of all responsibilities.

Communicate openly and offer support. The nurse should encourage the husband to support and communicate openly with his wife to maintain effective family-client interactions. During any illness, open communication and support helps the relationship between husband and wife. It is unrealistic for any individual to be free from anxiety or worry and impossible for the husband to be able to control what his wife may think or feel. Relieving the client of all responsibilities is unrealistic and not helpful. The client needs to resume activities as soon as she can manage them. Reminding his wife to control her symptoms is not appropriate and indicates that the husband needs further teaching about this condition.

The nurse notices that a client diagnosed with major depression and social phobia must get up and move to another area when someone sits next to her. Which action by the nurse is appropriate? Have nursing staff follow the client as moves away. Question the client about her avoidance of others. Ignore the client's behavior. Convey awareness of the client's anxiety about being around others.

Convey awareness of the client's anxiety about being around others. The nurse conveys empathy and awareness of the client's need to reduce anxiety by showing acceptance and understanding to the client, thereby promoting trust. Ignoring the behavior, questioning the client about her avoidance of others, or telling other clients to follow her when she moves are not therapeutic or appropriate.

A nurse should include which discharge instruction for clients receiving tricyclic antidepressants? Discontinue this medication if dry mouth and blurred vision occur. Don't consume alcohol while using this medication. It's safe to continue taking this medication during pregnancy. Restrict fluid and sodium intake while using this medication.

Don't consume alcohol while using this medication. Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants. Fluid and sodium intake must be monitored during lithium treatment, not during treatment with tricyclic antidepressants. Safe use of tricyclic antidepressants during pregnancy and breast-feeding hasn't been established.

During a home visit to an older adult with mild dementia, the client's daughter reports that she has one major problem with her mother. She says, "She sleeps most of the day and is up most of the night. I can't get a decent night's sleep anymore." Which suggestions should the nurse make to the daughter? Select all that apply. Establish a set routine for rising, hygiene, meals, short rest periods, and bedtime. Promote relaxation before bedtime with a warm bath or relaxing music. Ask the client's health care provider for a strong sleep medicine. Have the daughter encourage the use of caffeinated beverages during the day to keep her mother awake. Engage the client in simple, brief exercises or a short walk when she gets drowsy during the day.

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 she gets drowsy during the day. Promote relaxation before bedtime with a warm bath or relaxing music. A set routine and brief exercises help decrease daytime sleeping. Decreasing caffeine and fluids and promoting relaxation at bedtime promote nighttime sleeping. A strong sleep medicine for an older adult client is contraindicated due to changes in metabolism, increased adverse effects, and the risk of falls. Using caffeinated beverages may stimulate metabolism but can also have long-lasting adverse effects and may prevent sleep at bedtime.

A client with acute mania exhibits euphoria, pressured speech, and flight of ideas. The client has been talking to the nurse nonstop for 5 minutes and lunch has arrived on the unit. What should the nurse do next? Excuse oneself while telling the client to come to the dining room for lunch. Walk away, and approach the client in a few minutes before the food gets cold. Do not interrupt the client, but wait for him to finish talking. Tell the client he needs to stop talking because it is time to eat lunch.

Excuse oneself while telling the client to come to the dining room for lunch. The nurse would request to be excused, showing respect and regard for the client, while telling the client to come to the dining room for lunch. Acutely manic clients need clear, concise comments and directions. Telling the client that he needs to stop talking because it is lunchtime is disrespectful and does not give the client directions for what he needs to do. Using the familiar skill of waiting without interrupting until the person pauses would not be effective with the very talkative, manic client. Walking away and approaching the client after a few minutes before the food gets cold is not helpful because the client would probably continue talking.

A client with erectile disorder is taking sildenafil. What instructions should the nurse give the client? Take the medication 8 hours before having intercourse. Expect an erection that may last up to 4 hours. Take up to three tablets within 24 hours. Use nitroglycerine if chest pains occur during intercourse.

Expect an erection that may last up to 4 hours. An expected outcome of taking sildenafil is an erection that can last up to 4 hr. The nurse instructs the client to take the medication 1 hour before having intercourse as an erection will occur within 1 hour, and to take only take one tablet in 24 hours. The nurse advises the client to avoid taking the drug if he takes nitrate therapy, such as nitroglycerine, to avoid unsafe decreases in blood pressure.

A client is admitted to a psychiatric unit after a suicide attempt. The client is withdrawn, has poor hygiene, and appears underweight. What is the priority for a nurse in keeping a therapeutic milieu for this client? Encourage the client to participate in group therapy sessions. Validate a client's worth and respect for life. Manage the client's spiritual needs. Give the client structure and support until the client is able to function.

Give the client structure and support until the client is able to function. The nurse's priority for a client who has just entered the milieu of the psychiatric unit is to provide a client with safety and security. As the client progresses and displays less destructive behavior, the nurse will encourage the client to participate in group therapy. Validation is part of the actions of a nurse to establish the therapeutic milieu. The nurse will begin validation by giving the client respect and showing the client worth through the nurse's actions. Management of the client's spiritual needs is continuous within the therapeutic milieu; however, the client's physical environment and physical needs are the priority.

The wife of a client with bipolar disorder, manic phase, states to the nurse, "He's acting so crazy. What did he do to get this way?" The nurse bases the response on which understanding of this disorder? It is caused by underlying psychological difficulties. It is caused by disturbed family dynamics in the client's early life. It is the result of a genetic inheritance from someone in the family. It is the result of an imbalance of chemicals in the brain.

It is the result of an imbalance of chemicals in the brain. Bipolar disorder is a biochemical disorder caused by an imbalance of neurotransmitters in the brain. Manic episodes seem to be related to excessive levels of norepinephrine, serotonin, and dopamine. Psychopharmacologic therapy aims to restore the balance of neurotransmitters. In the past, it was thought that bipolar disorder may have been caused by early psychodynamics or disturbed families, but the current view emphasizes the role of biology. Bipolar disorder could be genetic or inherited from someone in the family, but it is best for the client and family to understand the disease concept related to neurotransmitter imbalance. This understanding also helps them to refrain from placing blame on anyone. Siblings and close relatives have a higher incidence of bipolar disorder and mood disorders in general when compared with the general population.

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. Assess the client's nutritional status. Help the client organize his room. Instruct the family regarding the disease progression. Provide a safe environment. Schedule physical therapy sessions twice a day.

Provide a safe environment. Instruct the family regarding the disease progression. Assess the client's nutritional status. Help the client organize his room. Preventing injury is an important goal of care for a client with Alzheimer's disease and can be achieved by providing a safe, structured environment, helping the client organize their surroundings, and assessing nutritional level, given that many Alzheimer clients are malnourished. Other care goals include establishing effective communication to help the client and their family adjust to the client's altered cognitive abilities, offering emotional support, teaching the client and their family about the disease, and encouraging the client to exercise to help maintain mobility. Alzheimer's disease cannot be reversed. Cognitive losses cannot be prevented because Alzheimer's disease is an insidious, degenerative dementia that eventually causes disorientation; severe deterioration of memory, language, and motor ability; emotional lability; and physical and intellectual disability.

A client with depression is exhibiting a brighter affect, ability to attend to hygiene and grooming tasks, and is beginning participation in group activities. The nurse asks the client to identify three of her strengths. After much hesitation and thinking, the client can state she is usually a nice person, a good cook, and a hard worker. What should the nurse do next? Educate the client about the importance of medication. Reinforce the client for identifying and sharing her strengths. Ask the client to identify an additional three strengths. Volunteer the client to lead the cooking group later in the day.

Reinforce the client for identifying and sharing her strengths. After the client identifies and shares her strengths, the nurse reinforces the client for her ability to evaluate herself in a positive manner. Doing so promotes self-esteem and offers hope for improvement. Asking the client to identify three additional strengths or volunteering the client to lead the cooking group could be too overwhelming for the client at this time and may increase her anxiety and feelings of worthlessness. Although educating the client about the importance of medication is important, doing so at another time would be more appropriate.

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? Teach the client relaxation exercises to perform before bedtime. Refer the client to the concurrent disorders program at the clinic. Share the information at the next interdisciplinary treatment conference. Report the client's beer consumption to the health care provider (HCP).

Report the client's beer consumption to the health care provider (HCP). The nurse should report the client's beer consumption to the HCP. Duloxetine should not be administered to a client with renal or hepatic insufficiency because the medication can elevate liver enzymes and, together with substantial alcohol use, can cause liver injury. Referring the client to the concurrent diagnosis program, sharing information at the next interdisciplinary treatment conference, and teaching the client relaxation exercises are helpful interventions for the nurse to implement. However, reporting the findings to the HCP is most important.

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 room carefully for items that could be used to attempt suicide. Express trust that the client won't attempt self-harm while in the facility. Respect the client's privacy by not searching the client's belongings. Remind all staff members to check on the client frequently.

Search the client's belongings and room carefully for items that could be used to attempt suicide. Because a client who has attempted suicide could try again, the nurse should search the client's belongings and room to remove any items that could be used in another suicide attempt. Expressing trust that the client won't self-harm may increase the client's feelings of guilt and pain if the client can't live up to that trust. The nurse should search the client's belongings because the need to maintain a safe environment supersedes the client's right to privacy. Although frequent checks by staff members are helpful, they aren't enough. The client may attempt suicide between checks.

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? Offer a variety of stimulating activities to distract from the client from belittling others or making demands of them. Offer the client an antianxiety drug when belittling or demanding behavior occurs. Set limits with consequences for belittling or demanding behavior. Ask other clients and staff members to ignore the client's behavior.

Set limits with consequences for belittling or demanding behavior. To protect others from a client who exhibits belittling and demanding behaviors, the nurse may need to set limits with consequences for noncompliance. Asking others to ignore the client is likely to increase the belittling and demanding behaviors. Offering the client an antianxiety drug or stimulating activities provides no incentive to change the problematic behaviors.

A client in the manic phase of bipolar disorder constantly belittles other clients and is demanding special favors from the nurses. Which intervention by the nurse would be most appropriate for this client? Provide the client with an anti-anxiety agent whenever their belittling or demanding behavior occurs. Set limits with specific and consistent consequences for belittling or demanding behavior. Offer the client a variety of stimulating activities to distract them from other clients and from making demands on the nurses. Ask other clients and staff members to ignore the client's behavior.

Set limits with specific and consistent consequences for belittling or demanding behavior. The nurse will need to set limits and consequences for belittling and being demanding of others because this is inappropriate behavior. Requiring that others ignore the client is likely to increase those behaviors. Offering the client stimulating activities would be counterproductive and providing the client with anti-anxiety medication, while useful at times, does not address the impact of the client's behaviors or provide motivation for the client to adjust their behaviors.

A client admitted to the psychiatric hospital with somatic symptom disorder is to be discharged tomorrow. The client starts screaming, "Nobody believes that I have real physical illnesses. I'll prove to you that I can't be discharged until my physical problems are treated." Which of the following actions should the nurse take? Select all that apply. Document the client's behaviors and verbalizations in the chart. Talk about fears and feelings with the client. Restate that the discharge will take place the next day. Place the client on suicide and self-mutilation precautions as a nursing measure. Call the psychiatrist to report the client's behavior and statements. Tell the client to calm down or the nurse will not talk.

Talk about fears and feelings with the client. Place the client on suicide and self-mutilation precautions as a nursing measure. Document the client's behaviors and verbalizations in the chart. Call the psychiatrist to report the client's behavior and statements. Talking about fears and feelings is a typical intervention for clients with somatic symptom disorder. Although the client's threat is vague, self-mutilation, suicide, or both are possibilities, so monitoring for them is important. Documenting in the chart and calling the psychiatrist are essential for client care and safety. Saying that the nurse will not talk to the client and discharge will happen anyway is likely to increase the client's anger and anxiety and is punitive.

A client was hospitalized for 1 week with major depression with suicidal ideation. He is taking venlafaxine 75 mg 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 wouldn't do anything to hurt myself." The nurse should make which judgment about the client? The presence of suicidal ideation warrants a telephone call to the client's health care provider. The client is decompensating and in need of being readmitted to the hospital. The depression is improving, and the suicidal ideation is lessening. The client needs an adjustment or increase in his dose of antidepressant.

The depression is improving, and the suicidal ideation is lessening. The client's statements about being in control of his behavior and his plans to return to work indicate an improvement in depression and that suicidal ideation, although present, is decreasing.Nothing in his comments or behavior indicates he is decompensating.There is no evidence to support an increase or adjustment in the dose of venlafaxine or a call to the healthcare provider.Typically, the cognitive components of depression are the last symptoms eliminated. For the client to be experiencing some suicidal ideation in the second week of psychopharmacologic treatment is not unusual.

The nurse is caring for a client with an irritable mood, grandiose thinking, impulsive hyperactive behaviors, and little sleep. What is the nurse's best initial approach? Use a calm, firm approach, offering clear directions. Administer mood stabilizer medications as prescribed. Confine the client to a quiet setting away from others. Ensure the client knows staff are in charge on the unit.

Use a calm, firm approach, offering clear directions. In planning care for the client with mania, the nurse needs to provide for safety and the client's physiological needs in the initial phase of treatment. The nurse does this with therapeutic communication. A calm and firm approach with the client begins the relationship in a positive manner. It aides in the formation of trust. Once the nurse-client relationship has begun, the nurse can set limits, calm the milieu (not confine), and administer medications while using therapeutic communication. The nurse does not begin by asserting authority over the client.

A nurse is prioritizing care for four new admissions to the inpatient psychiatric unit. Which client should the nurse assess first? a client who periodically burns self with cigarettes when feeling anxious. a significantly depressed client with decreased energy who was isolated in the bedroom. a client with new-onset confusion and disorientation. a client who is anxious and is washing hands excessively.

a client with new-onset confusion and disorientation. New-onset confusion may be a sign of delirium, which is commonly caused by medications and systemic infection. This client may need urgent medical evaluation. The other clients all need to be assessed, but they aren't the highest priority.

A student nurse has observed the behavior of a client who was admitted to an inpatient psychiatric unit. The client attempts to get the student's attention during the shift and during lunch tries to regain the nurse's attention by shouting, "You're just like my mother. You pay attention to everyone else but me!" Which of the following would indicate to the nursing instructor that the student correctly identified the client's behavior? evidence that the nursing staff is failing to meet the client's needs a demonstration of resistance to therapy a demonstration of transference evidence of family abuse

a demonstration of transference The unconscious transfer of qualities originally associated with another relationship to a nurse or therapist is referred to as transference. Quite often these qualities are those of a parent, family member, or authority figure, and may provoke responses that are not appropriate to the new situation to which they are ascribed. Resistance is also unconscious, but has to do with the discomfort over the possible change that may result from therapy. Defense mechanisms and transference are expected aspects of therapy and arise in the client themselves, not because the nurse is failing to meet client needs or as a result of previous family abuse.

A client with major depression is taking tranylcypromine sulfate, a monoamine oxidase (MAO) inhibitor. The nurse understands that additional teaching is needed when the client reports eating which food? whole grain bread free-range poultry aged cheese fresh fish

aged cheese When taking an MAO inhibitor, the client should avoid consuming high-tyramine foods, such as aged cheese, because the interaction may cause a life-threatening hypertensive crisis. Therefore, a client who reports eating aged cheese requires additional teaching. The client may safely consume low-tyramine foods, such as poultry, whole grain bread, and fresh fish.

The health care provider prescribes risperidone for a client with Alzheimer's disease. The nurse anticipates administering this medication to help decrease which behavior? concomitant depression agitation and aggression sleep disturbances confusion and withdrawal

agitation and aggression Antipsychotics are most effective with agitation and aggression. Antipsychotics have little effect on sleep disturbances, concomitant depression, or confusion and withdrawal.

Which foods are contraindicated for a client taking tranylcypromine? oranges and vodka whole grain cereals and bagels chicken, rice, and apples chicken livers, Chianti wine, and beer

chicken livers, Chianti wine, and beer A client taking a monoamine oxidase inhibitor antidepressant such as tranylcypromine shouldn't eat foods containing tyramine. Such foods include chicken livers, Chianti wine, beer, ale, aged game meats, broad beans, aged cheeses, sour cream, avocados, yogurt, pickled herring, yeast extract, chocolate, excessive caffeine, vanilla, and soy sauce. The client also must refrain from taking cold and hay fever preparations that contain vasoconstrictive agents.

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? ineffective coping related to personal vulnerability anxiety related to unconscious conflict noncompliance (treatment regimen) related to treatment resistance deficient knowledge (treatment regimen) related to inadequate understanding of teaching

deficient knowledge (treatment regimen) related to inadequate understanding of teaching The nurse should understand that this client doesn't have the information necessary to make an informed decision about using the medication. The therapeutic effects of amitriptyline aren't seen for 2 to 3 weeks after starting therapy, and the client may develop a tolerance to the adverse effects of the medication if the client continues taking it. Therefore, deficient knowledge related to inadequate understanding of teaching is the most appropriate nursing diagnosis. The nurse also should assume that the client wants to feel better; a nursing diagnosis of noncompliance related to treatment resistance would imply that the client is deliberately choosing to be ill. No data support a nursing diagnosis of anxiety related to unconscious conflict or ineffective coping related to personal vulnerability.

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 problem-focused coping style increased decisiveness disturbance in his sleep patterns

disturbance in his sleep patterns Depression can be a mixture of affective responses (feelings of worthlessness, hopelessness, sadness), behavioral responses (appetite changes, withdrawal, sleep disturbances, lethargy), and cognitive responses (decreased ability to concentrate, indecisiveness, suicidal ideation). Increased decisiveness, problem-solving ability, and increased social interactions are reflective of adaptive coping.

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 encouraging attendance at group cognitive-behavioral therapy on the unit exploring the client's feelings of grief and loss encouraging the client to express their feelings of isolation

ensuring that the client is not permitted to use anything that would be potentially dangerous Although grief, loss, and isolation are impacting the client's depressed state, the priority intervention is to prevent the client from self harm. All of the interventions listed are appropriate, but ensuring safety from potential danger is the priority.

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 offering the client a less-stimulating area in which to calm down isolating the agitated client and offering sedation to calm the behavior removing the other clients from the area until this client settles down

ensuring the safety of this client and other clients on the unit Ensuring the safety of this client and other clients on the unit is the nurse's immediate priority. Moving the agitated client to a less-stimulating environment, isolating the client, or sedating the client address the client's needs but don't address those of the other clients. Removing other clients from the area until the agitated client calms down addresses the safety of the other clients without addressing the needs of the agitated client.

A nurse is caring for a client in the manic phase of bipolar disorder who's ready for discharge from the psychiatric unit. As the nurse begins to terminate the nurse-client relationship, which client response is appropriate? withdrawing from the nurse in silence displaying anger, shouting, and banging the table rationalizing the termination, saying that "everything comes to an end" expressing feelings of anxiety

expressing feelings of anxiety Anxiety is a normal reaction to the termination of the nurse-client relationship. The nurse should help the client explore the feelings about the end of the therapeutic relationship. Although anger about the termination may be a healthy response, banging the table, shouting, and other forms of acting out aren't appropriate behavior. Withdrawal isn't a healthy response to the termination of a relationship. By rationalizing the termination, the client avoids expressing feelings and emotions.

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: decreased self-esteem and increased physical restlessness. obsession with following rules and maintaining order. flight of ideas and inflated self-esteem. increased sleep and greater distractibility.

flight of ideas and inflated self-esteem. The manic phase of bipolar disorder is characterized by recurrent episodes of a persistently euphoric and expansive or irritable mood. This phase is diagnosed if the client experiences four of the following signs and symptoms for at least 1 week: flight of ideas; inflated self-esteem; unusual talkativeness; increased social, occupational, or sexual activity; physical restlessness; a decreased need for sleep; increased distractibility; and excessive involvement in activities with a high potential for painful but unrecognized consequences. Obsession with following rules and maintaining order characterizes obsessive-compulsive disorder.

A depressed client in the psychiatric unit hasn't been getting adequate rest and sleep. To encourage restful sleep at night, the nurse should: encourage environmental stimulation during the evening. talk with the client for a long time at night to reduce anxiety. encourage the client to take an antianxiety agent as needed at bedtime. gently but firmly set limits on how much time the client spends in bed during the day.

gently but firmly set limits on how much time the client spends in bed during the day. Setting limits on how much time the client may spend in bed and what time the client must get up in the morning lets the client know what is expected while conveying genuine concern. Talking with the client for a long time at night would interfere with sleep and give the client attention for not sleeping. Encouraging environmental stimulation in the evening would discourage rest and sleep at night. While most antianxiety agents have sedating adverse effects, they aren't intended for use as sleep-inducing agents.

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? hypokalemia hiatal hernia hypernatremia hepatic disease

hepatic disease Conditions requiring cautious use of amitriptyline include pregnancy, breast-feeding, suicidal tendencies, cardiovascular disease, and impaired hepatic function. Hiatal hernia, hypernatremia, and hypokalemia don't affect amitriptyline therapy.

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? bizarre, colorful, inappropriate dress insulting, provocative behavior directed at staff grandiose thinking and poor concentration hyperactivity, ignoring eating and sleeping

hyperactivity, ignoring eating and sleeping Safety needs are always the first priority in care planning. A client who has not eaten or slept for several days and has been extremely hyperactive may be at risk of exhaustion and malnutrition, and the implications of those states. Although thought disorder, expansive mood, and dress are important assessment information, priority interventions must center on the basic needs.

A nurse is caring for a veteran, who exhibits signs and symptoms of posttraumatic stress disorder (PTSD). Signs and symptoms of posttraumatic stress disorder include: memory loss of a traumatic event and somatic distress. feelings of hostility and violent behavior. sudden behavioral changes and anorexia. hyperalertness and sleep disturbances.

hyperalertness and sleep disturbances. Signs and symptoms of PTSD include hyperalertness, sleep disturbances, exaggerated startle response, survivor's guilt, and memory impairment. The client may relive the traumatic event through dreams and recollections. Hostility, violent behavior, and anorexia aren't typical signs or symptoms of PTSD.

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

hypertensive crisis The most serious adverse reaction associated with high doses of MAO inhibitors is hypertensive crisis, which can lead to death. Although not a crisis, orthostatic hypotension is also common and may lead to syncope with high doses. Muscle spasticity (not flaccidity) is associated with MAO inhibitor therapy. Hypoglycemia isn't an adverse reaction of MAO inhibitors.

The client with depression has been hospitalized for 3 days on the psychiatric unit. This is the second hospitalization during the past year. The healthcare provider prescribes tranylcypromine sulfate because the client did not respond positively to a tricyclic antidepressant. If the client's diet includes foods containing tyramine, the nurse should teach the client about which possible reaction? generalized tonic-clonic seizure heart block respiratory arrest hypertensive crisis

hypertensive crisis Tranylcypromine sulfate is a monoamine oxidase (MAO) inhibitor. A client taking this drug in combination with foods or beverages rich in tyramine can have a hypertensive crisis. Tyramine, a precursor to norepinephrine, is usually deactivated in the GI tract, but MAO inhibitors block the deactivation. Tyramine is then absorbed systemically, causing a sudden release of large amounts of norepinephrine.Heart block, respiratory arrest, and generalized tonic-clonic seizures are not adverse effects of tranylcypromine sulfate.

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? exploitation hypervigilance indecisiveness passive resistance

hypervigilance The client with a paranoid personality disorder is suspicious of others. The client is extremely sensitive and may misinterpret cues from other clients in the group. Clients with schizotypal personality disorder often have difficulty making decisions. Clients with antisocial personality disorder are socially irresponsible and will exploit and manipulate others. Clients with passive-aggressive personality disorder feel cheated and unappreciated. They use passive resistance to meet the expectations of others.

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? providing for uninterrupted sleep bringing familiar objects from home for the room keeping lights dimmed during daylight hours posting a calendar in the room

keeping lights dimmed during daylight hours Clients with dementia are at risk for sudden decreases in their mental status when placed in unfamiliar settings. Keeping clients in a darkened room during the day simulates night and can disrupt the client's sleep wake cycle which exacerbates confusion. Providing for uninterrupted sleep helps maintain cognition. Bringing familiar objects from home makes the environment more comfortable and less strange. Clocks and calendars help keep the clients oriented to time.

A 3-year-old is seen in the well child clinic. The parent is concerned that the child may be autistic. Which assessment data would indicate a concern to the nurse? Select all that apply. withdrawing into a private world inability to stay on task lack of communication abilities inability to develop social skills inability to separate from mother

lack of communication abilities withdrawing into a private world inability to develop social skills Children with autism spectrum disorder (ASD) fail to develop interpersonal skills. The child with ASD withdraws into a private world and is not able to develop social skills and communication abilities. Inability to separate is a behavior found in children with separation anxiety. Inattention is associated with children who are diagnosed with Attention Deficit Disorder (ADD).

A client in the manic phase of bipolar disorder is admitted to the facility. Which agents are appropriate for this client? bupropion and lithium lithium and valproic acid risperidone and clozapine haloperidol and fluphenazine

lithium and valproic acid Lithium and valproic acid are the drugs of choice for treatment of bipolar disorder. Bupropion is an antidepressant, not an antimanic. Haloperidol, fluphenazine, clozapine, and risperidone are antipsychotic agents. Antipsychotics may be used if the client's agitation increases; however, they aren't mood stabilizing agents.

A physician orders lithium carbonate for a client who's in the manic phase of bipolar disorder. During lithium therapy, the nurse should watch for which adverse reactions? nausea, diarrhea, tremor, and lethargy weakness, tremor, and urine retention constipation, lethargy, and ataxia anxiety, restlessness, and sleep disturbance

nausea, diarrhea, tremor, and lethargy The most common adverse effects of lithium are nausea, diarrhea, tremor, and lethargy. Lithium doesn't cause urine retention, anxiety, restlessness, sleep disturbance, or constipation.

A client reports losing sight in both eyes. The client is diagnosed as having a functional neurologic symptom disorder and is admitted to the psychiatric unit. Which nursing intervention is most appropriate for this client? telling the client that the blindness isn't real providing self-care for the client not focusing on the client's blindness teaching the client exercises to strengthen the eyes

not focusing on the client's blindness Focusing on the client's blindness can positively reinforce the blindness and further promote the use of maladaptive behaviors to obtain secondary gains. The client should be encouraged to participate in self care as much as possible to avoid fostering dependency. To promote self-esteem, provide positive reinforcement for what the client can do. Blindness and other physical symptoms in a functional neurologic symptom disorder aren't under the client's control and are real to the client. Eye exercises won't resolve the client's blindness because no organic pathology is causing the symptoms.

A client is brought to the crisis intervention center by the partner, who states that the client has recently become increasingly listless and less involved with the family. The partner reports that the client sleeps poorly, eats little, and can barely perform basic self-care. The partner also reveals that 3 months ago the client was in a car accident in which the client's best friend was killed. After the physician diagnoses acute depression, the nurse should anticipate administering: imipramine, 500 mg daily. paroxetine, 20 mg by mouth (P.O.) every morning. amitriptyline hydrochloride, 20 mg P.O. daily. doxepin, 500 mg daily.

paroxetine, 20 mg by mouth (P.O.) every morning. Paroxetine, amitriptyline, doxepin, and imipramine are all antidepressants that may be ordered for this client. However, paroxetine, 20 mg P.O. every morning, is the only correct dosage. Amitriptyline is usually started at 75 to 150 mg P.O. daily in divided doses. Doxepin is started at 25 to 50 mg daily and may be titrated upward to a maximum daily dose of 300 mg. Imipramine is started at 50 to 75 mg daily and, if tolerated, titrated upward to a maximum daily dose of 300 mg.

When caring for the client diagnosed with delirium, the nurse should investigate which condition as the most important? heart failure impaired hearing cancer of any kind prescription drug intoxication

prescription drug intoxication Polypharmacy is much more common in the older adult. Drug interactions increase the incidence of intoxication from prescribed medications, especially with combinations of analgesics, digoxin, diuretics, and anticholinergics. With drug intoxication, the onset of the delirium typically is quick. Although cancer, impaired hearing, and heart failure could lead to delirium in the older adult, the onset would be more gradual.

In the community room, a nurse observes a client who suffers from depression. The client paces swiftly around the room, swings both arms, and rubs both hands together. What term should the nurse use to describe these behaviors to members of the health care team? tardive dyskinesia mania psychomotor agitation compulsions

psychomotor agitation Psychomotor agitation is defined by constant motion, such as pacing, wringing hands, biting nails, and other types of energetic body movements. Tardive dyskinesia occurs with long-term use of antipsychotic agents. It's characterized by irregular, repetitive, involuntary movements of the mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, and rapid blinking. Compulsions are ritualistic actions that the client feels compelled to perform. A client with mania has inflated self-esteem, and displays an abnormal and persistently elevated, expansive, and irritable mood.

A client comes to the emergency department after being attacked and sexually assaulted. What is the most accurate nursing diagnosis for this client? hopelessness anxiety rape-trauma syndrome fear

rape-trauma syndrome The nursing diagnosis rape-trauma syndrome refers to the acute and long-term phases experienced by the victim of sexual assault. Specific nursing interventions can be planned on the basis of this diagnosis. A rape victim may also experience fear, anxiety, and hopelessness; however, these aren't the most accurate nursing diagnoses for this client.

"I won't allow myself to cry," a client diagnosed with depression tells a nurse, "because my crying upsets the whole family." This is an example of: insight. repression. rationalization. manipulation.

rationalization. Rationalization is a defense mechanism used to justify actions or feelings with seemingly reasonable explanations. Insight is comprehension of one's own behavior, commonly followed by an attempt to change it. Repression is involuntary exclusion from awareness of painful and conflicting thoughts or feelings. Based on the information provided, the client doesn't seem to be manipulating others

A client diagnosed with a cognitive disorder is showing signs of confusion, short-term memory loss, and a short attention span. Which therapy group would be best suited for this client? insight oriented reality orientation problem solving medication management

reality orientation Because the client has confusion, short-term memory loss, and a short attention span, a reality-orientation group is recommended to help the client maintain an optimal level of functioning, decrease isolation, and increase self-esteem. Focus is on the "here and now" and provides reality testing, structure, and social support.A client with a cognitive disorder is unlikely to benefit from an insight-oriented group, where the focus is on role relationships.Short-term memory loss and confusion interfere with the ability to learn about medication management and the ability to describe and solve problems.

A nurse is caring for a client in an acute manic state. What is the most effective nursing action that can be taken on behalf of this client? assisting the client with self-care reducing stimuli for the client assigning the client to group activities helping the client express feelings

reducing stimuli for the client Reducing stimuli helps to reduce hyperactivity during a manic state. Group activities would provide too much stimulation. Trying to assist the client with self-care could cause increased agitation. When in a manic state, clients aren't able to express their inner feelings in a productive, introspective manner. The focus of treatment for a client in the manic state is behavior control.

A client in the manic phase of bipolar disorder arrives at the outpatient psychiatric clinic. To help the client manage a manic episode, the nurse should suggest that the client: go shopping with a friend. reorganize a kitchen cabinet. read a book in a quiet room. play a game with a few friends.

reorganize a kitchen cabinet. Reorganizing a kitchen cabinet or painting a picture in a quiet environment are suitable outlets for this client's excess energy. Doing so transfers inappropriate aggressive drives into a constructive activity, which helps the client control manic behavior. Going shopping is much too tempting an activity for this client, who can't control behavior and is likely to overspend. During the manic phase, a client with bipolar disorder lacks the concentration needed to read a book. Playing a competitive game may be overly stimulating and could make the client more agitated.

A client who is very depressed exhibits psychomotor deficits, a flat affect, and apathy. The nurse observes the client to be in need of grooming and hygiene. Which nursing action is most appropriate? stating to the client that it is time for him to take a shower explaining the importance of hygiene to the client waiting until the client's family can participate in the client's care asking the client if he is ready to shower

stating to the client that it is time for him to take a shower The client with depression is preoccupied, has decreased energy, and cannot make decisions, even simple ones. Therefore, the nurse presents the situation, "It's time for a shower," and assists the client with personal hygiene to preserve his dignity and self-esteem. Explaining the importance of good hygiene to the client is inappropriate because the client may know the benefits of hygiene but is too fatigued and preoccupied to pay attention to self-care. Asking the client if he is ready for a shower is not helpful because the client with depression commonly cannot make even simple decisions. This action also reinforces the client's feeling about not caring about showering. Waiting for the family to visit to help with the client's hygiene is inappropriate and irresponsible on the part of the nurse. The nurse is responsible for making basic decisions for the client until the client can make decisions for himself.