MOOD & AFFECT EAQs
On the day after admission a suicidal client asks a nurse, "Why am I being watched around the clock, and why can't I walk around the whole unit?" Which reply is most appropriate? 1 - "Why do you think we're observing you?" 2 - "What makes you think we're observing you?" 3 - "We're concerned that you might try to harm yourself." 4 - "We're following your primary healthcare provider's instructions, so there must be a reason."
3 - "We're concerned that you might try to harm yourself." Explanation: The statement "We're concerned that you might try to harm yourself" is honest and helps establish trust. Also, it may help the client realize that the staff members care. "Why do you think we're observing you?" will put the client on the defensive. "What makes you think we're observing you?" is an inappropriate response when the answer is so obvious. The response "We're following your primary healthcare provider's instructions, so there must be a reason" is evasive.
What is a therapeutic nursing action in the care of a depressed client? 1 - Playing a game of chess with the client 2 - Allowing the client to make personal decisions 3 - Sitting down next to the client at frequent intervals 4 - Providing the client with frequent periods of time for reflection
Sitting down next to the client at frequent intervals. Explanation: Sitting down next to the client at frequent intervals gives the client the nonverbal message that someone cares and views the client as being worthy of attention and concern. The concentration required for chess is too much for the client at this time. The client is incapable of making decisions at this time. Depressed clients often have too much thinking time.
After a child's visit to a healthcare provider, the parent tells the nurse, "I'm so upset! The doctor prescribed an antidepressant!" What is the best response by the nurse? 1 - "Tell me more about what's bothering you." 2 - "Weren't you told why your child needs an antidepressant?" 3 - "You need to speak with the healthcare provider about your concerns." 4 - "Are you sure it's an antidepressant and not a drug for attention deficit disorder?"
1 - "Tell me more about what's bothering you." Explanation: "Tell me more about what's bothering you" provides an opportunity to explore the parent's feelings. It is the nurse's responsibility, not the healthcare provider's, to assess the parent's concerns before planning further interventions. "Weren't you told why your child needs an antidepressant?" is a confrontational response that may put the parent on the defensive. "Are you sure it's an antidepressant and not a drug for attention deficit disorder?" is a judgmental, nontherapeutic response that may worsen the parent's concerns.
A nurse enters a depressed client's room on the evening of admission and observes the client sitting in a chair crying. What is the most therapeutic response by the nurse? 1 - "You're crying. Let's talk about it." 2 - "Let me get a cup of coffee; then we can talk." 3 - "Visitors will be here soon; you'd better get ready." 4 - "You'll feel better soon. Come to the sitting room with me."
1 - "You're crying. Let's talk about it." Explanation: Noting that the client is crying and suggesting that the nurse and client talk about it addresses the behavior observed, and the offer by the nurse to spend time to help the client implies that the client is worthy. With "Let me get a cup of coffee; then we can talk" the nurse offers to help but places the client second by stating the desire to get coffee first. The nurse denies the client's feelings by focusing on getting ready for visitors. Assuring the client that the client will feel better soon and asking the client to come to the sitting room constitutes false reassurance. The nurse first recognizes the client's feelings and then moves away from discussing them.
A client is found to have a borderline personality disorder. What is a realistic initial intervention for this client? 1 - Establishing clear boundaries 2 - Exploring job possibilities with the nurse 3 - Initiating a discussion of feelings of being victimized 4 - Spending 1 hour twice a day discussing problems with the nurse
1 - Establishing clear boundaries Explanation: Individuals with borderline personality disorder are impulsive and have difficulty identifying and respecting boundaries in relation to others. Exploration of this topic in a meaningful manner can be done only after an ongoing relationship has been established. Feeling victimized is a frequent theme among clients with this disorder; however, they rarely have the insight to initiate discussion of these feelings and usually show resistance when the topic is broached. An individual with a borderline personality disorder may not be able to spend this length of time having a meaningful discussion with the nurse; usually they are too impulsive to engage in consistent work until a therapeutic relationship has been established.
A 24-year-old woman states that she no longer enjoys any of the activities that she once found fun and pleasurable, such as socializing, sports, and hobbies. What term should the nurse use to describe this condition? 1 - Anergia 2 - Anhedonia 3 - Grandiosity 4 - Learned helplessness
2 - Anhedonia Explanation: Anhedonia is the inability to experience pleasure in events or activities that once were enjoyable. Anergia is lethargy and a decreased level of energy. Grandiosity is a symptom seen during manic episodes in which an individual displays an inflated self-esteem. Learned helplessness is a theory proposing that depression occurs when an individual believes that he or she has no control over life situations. This results in the individual's giving up and becoming passive and dependent.
After assessing a client, the nurse suspects that the client has shift-work sleep disorder (SWSD). Which medication would be prescribed to the client? 1 - Caffeine 2 - Modafinil 3 - Atomoxetine 4 - Methylphenidate
2 - Modafinil Explanation: Modafinil is a unique nonamphetamine stimulant used to treat shift-work sleep disorder (SWSD). This drug promotes wakefulness in clients suffering from excessive sleepiness associated with SWSD. Caffeine is a central nervous stimulant used to promote wakefulness, but this drug is not as effective in the treatment of SWSD. Atomoxetine is a nonstimulant used to treat attention deficit hyperactivity disorder (ADHD). Methylphenidate is considered the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD).
A nurse is caring for a hyperactive, manic client who exhibits flight of ideas and is not eating. What may be the reason why the client is not eating? 1 -Feeling undeserving of the food 2 -Too busy to take the time to eat 3 -Wishes to avoid others in the dining room 4 - Believes that there is no need for food at this time
2 -Too busy to take the time to eat Explanation: Hyperactive clients frequently will not take the time to eat because they are overinvolved with everything in their environment. Feeling undeserving of the food is characteristic of a depressive episode. The client is unable to sit long enough with the other clients to eat a meal; this is not conscious avoidance. The client probably gives no thought to food because of overinvolvement with the activities in the environment.
The primary healthcare provider prescribes "bathroom privileges only" for a client with pulmonary edema. The client becomes irritable and asks the nurse whether it is really necessary to stay in bed so much. What would be the best reply by the nurse? 1 - "Why do you want to be out of bed?" 2 - "Bed rest plays a role in most therapy." 3 - "Rest helps your body direct energy toward healing." 4 - "Would you like me to ask your primary healthcare provider to change the prescription?"
3 - "Rest helps your body direct energy toward healing." Explanation: A client's knowledge about the treatment program enhances compliance and reduces stress. The response "Why do you want to be out of bed?" does not answer the client's question and might produce frustration. The response "Bed rest plays a role in most therapy" does answer the client's question, but does not explain specifically why. The response "Would you like me to ask your primary healthcare provider to change the prescription?" does not support the treatment regimen; the client needs education.
A client is experiencing feelings of sadness and is having difficulty concentrating and sleeping. What are additional common signs and symptoms of depression that the nurse should expect when performing an assessment of this client? 1 -Rigidity and a narrowing of perception 2 - Alternating episodes of fatigue and high energy 3 - Diminished pleasure in activities and alteration in appetite 4 - Excessive socialization and interest in activities of daily living
3 - Diminished pleasure in activities and alteration in appetite Explanation: Depression is characterized by feelings of hopelessness, helplessness, and despair, leaving little room for any pleasure; alteration in appetite (either decreased or increased) is common in depressed clients. Although there is a narrowing of perception, rigidity is uncommon with depression. Fatigue is continually present and does not alternate with a high energy level. There is a loss of interest in socialization and little participation in activities of daily living.
The husband of a young mother who has attempted suicide asks whether he may bring their 26-month-old daughter to visit his wife. What is the best response by the nurse? 1 -"Probably so, but you'd better check with her primary healthcare provider first." 2 -"Of course! Children of all ages are welcome to visit relatives." 3 - "It could be very upsetting for your child to see her mother so depressed." 4 - "Tell me what your wife said when you offered to bring your child for a visit."
4 - "Tell me what your wife said when you offered to bring your child for a visit." Explanation: The nurse should determine whether the spouse has discussed the child visiting with the client before commenting further. The responses "Probably so, but you'd better check with her primary healthcare provider first" and "Of course! Children of all ages are welcome to visit relatives" assume that the client has consented to the visit; this assumption may be incorrect. The response "It may be very upsetting for your child to see her mother so depressed" makes an assumption that requires more data and discussion to validate.
When talking with the nurse, a client with a mood disorder says, "I feel rotten. I feel useless. I can't think straight. I feel overwhelmed by everything. I don't know if I can go on." What should the nurse document when describing this encounter? 1 - Client stated, "I can't think straight," and is not able to cope with current problems. 2 - Client appeared to be very depressed for most of the morning and has little interest in self or the environment. 3 - Client expressed suicidal thoughts about not being able to go on and exhibits diminished ability to think clearly. 4 - Client stated, "I feel rotten. I feel useless. I can't think straight. I feel overwhelmed by everything. I don't know if I can go on."
4 - Client stated, "I feel rotten. I feel useless. I can't think straight. I feel overwhelmed by everything. I don't know if I can go on." Explanation: Directly quoting the client, with no added value judgments, is an objective documentation of what happened. Writing down part of what the client said ("I can't think straight") and then concluding that the client can't cope reflects a subjective judgment and an interpretation of what the client actually said. Noting that the client appeared very depressed for most of the morning and showed little interest in self or the environment is a subjective judgment and an interpretation of what the client actually said. Documenting that the client expressed suicidal thoughts about not being able to go on and has a decreased ability to think clearly is a subjective judgment and an interpretation of what the client actually said.