Mood Disorder SCC Nursing 4th Quarter Psych

Which statement by a client taking valproic acid for bipolar disorder indicates that further teaching about this medication is necessary? a) "I can take the pills with food." b) "I need to call my health care provider if I start bruising easily." c) "I need to take the pills at the same time each day." d) "I can chew the pills if necessary."

"I can chew the pills if necessary."

To treat acute mania in a client with bipolar disorder, the physician orders lithium. During lithium carbonate therapy for acute mania, this client's serum lithium level should be maintained within which range? a) 1 to 1.4 mEq/L b) 10 to 15 mEq/L c) 0.8 to 1.2 mEq/L d) 0.2 to 1.6 mEq/L

1 to 1.4 mEq/L

Which foods are contraindicated for a client taking tranylcypromine? a) Chicken livers, Chianti wine, and beer b) Oranges and vodka c) Chicken, rice, and apples d) Whole grain cereals and bagels

Chicken livers, Chianti wine, and beer

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? a) Question the client about her avoidance of others. b) Convey awareness of the client's anxiety about being around others. c) Ignore the client's behavior. d) Have nursing staff follow the client as moves away.

Convey awareness of the client's anxiety about being around others.

A depressed client on a psychiatric unit asks the nurse to call the hospital lawyer to discuss writing out a will. What is the nurse's priority intervention? a) Call a lawyer as requested by the client. b) Inform the physician first, and place the client on suicide watch. c) Discuss thoughts and explore intent for suicide with the client. d) Offer the client medication for anxiety.

Discuss thoughts and explore intent for suicide with the client.

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

Don't consume alcohol while using this medication.

A newly admitted client is extremely hostile toward a staff member without apparent reason. According to Freudian theory, the nurse would suspect that the client is exhibiting which phenomena? a) Transference b) Splitting c) Intellectualization d) Triangulation

Transference

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

may be experiencing increased energy and is at increased risk for suicide.

A client with major depression states, "Life is not worth living anymore. Nothing matters." Which response by the nurse is best? a) "Why do you think that way?" b) "Things will get better, you know." c) "You should not feel that way." d) "Are you thinking about killing yourself?"

"Are you thinking about killing yourself?"

A client taking paroxetine 40 mg PO every morning tells the nurse that her mouth "feels like cotton." Which statement by the client necessitates further assessment by the nurse? a) "I am sucking on sugarless candy." b) "I am using sugarless gum." c) "I am drinking 12 glasses of water every day." d) "I am sucking on ice chips."

"I am drinking 12 glasses of water every day."

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 do not want to get depressed again, but I feel awful about my weight." Which response by the nurse is most appropriate? a) "Look at all the positive things that have happened to you since you started mirtazapine." b) "Your depression is much better now, so your medication is helping you." c) "I hear how difficult this is for you and will help you approach your health care provider about it." d) "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."

A female client with acute mania brings six suitcases and three shopping bags of personal belongings on admission to the unit. When informed that some of the suitcases and bags need to be returned home with her husband because of a lack of storage space, the client begins to use profanity against the nurse. Which response by the nurse is most therapeutic? a) "We do not want to put you in seclusion yet." b) "Swearing and profanity are unacceptable here." c) "You are acting inappropriately." d) "I will not tolerate your talking to me like that."

"Swearing and profanity are unacceptable here."

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) There are three staff members and one health care provider (HCP) in the nurse's station working on charting. b) 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. c) A housekeeping staff member is washing off the countertops in the kitchen, which is on the far side of the dayroom. d) 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.

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

Regain orientation to time and place.

A nurse is assigned to care for a recently admitted client who has attempted suicide. What should the nurse do? a) Respect the client's privacy by not searching his belongings. b) Search the client's belongings and his room carefully for items that could be used to attempt suicide. c) Remind all staff members to check on the client frequently. d) Express trust that the client won't harm himself while in the facility.

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

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

Set limits with consequences for belittling or demanding behavior.

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? a) Sexual Dysfunction related to sexual trauma b) Dysfunctional Grieving related to loss of self- esteem because of lack of sexual intimacy c) Risk for Trauma related to fear of vaginal penetration d) Vaginismus related to vaginal constriction

Sexual Dysfunction related to sexual trauma

An Alzheimer's client has difficulty following instructions but listens intently when he hears the voice of a nurse, who is his primary caregiver. The physician orders an electrocardiogram (ECG) to ascertain cardiac status. The client becomes agitated when the ECG technician enters the room. What is the nurse's best course of action? a) Ask the client to try to understand what's going to happen. b) Sit next to the client and provide verbal support until he calms down. c) Assure the client that he's safe and explain the purpose of the procedure in simple terms. d) Offer the client a sedative and attempt to obtain the ECG when the client is calmer.

Sit next to the client and provide verbal support until he calms down.

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? a) gastritis b) vertigo c) exhaustion d) bradycardia

exhaustion

The nurse assesses a client who has Alzheimer's disease. Her hair is dirty; her clothing is soiled and has an odor of urine. The nurse should: a) instruct the client to bathe and put on clean clothing. b) ask the daughter to bathe her mother c) ask the client when was the last time she bathed and changed her clothes. d) help the client with her bath, allowing her to do as much for herself as she is able.

help the client with her bath, allowing her to do as much for herself as she is able.

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

hold the lithium and notify the physician.

While assessing a client diagnosed with dementia, the nurse notes that her husband is concerned about what he should do when she uses vulgar language with him. The nurse should: a) tell her that she is very rude. b) tell her to stop swearing immediately. c) ignore the vulgarity and distract her. d) say nothing and leave the room.

ignore the vulgarity and distract her.

A client with early dementia exhibits disturbances in mental awareness and orientation to reality. The nurse should expect to assess a loss of ability in which other area? a) balance b) judgment c) endurance d) speech

judgment

The nurse answers a call on a telephone hotline from a man who was at the crisis center once in the past when he made a suicide threat. The client says, "Do not try to help me anymore. This is it. I have had enough and I have a gun in front of me now." Then he hangs up the telephone. Which call should the nurse make first? a) neighbor, to request he go to the client's home immediately b) client's wife at work, to suggest she hurry home c) police, to request their intervention d) client, to make an attempt to calm him

police, to request their intervention

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? a) thought content b) psychomotor behavior c) mood and affect d) attitude toward the nurse

thought content

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? a) "I tell her reality, such as, 'That noise is the wind in the trees.'" b) "I tell her she is wrong, and then I tell her what is right." c) "I turn off the radio when we are in another room." d) "I understand the misperceptions are part of the disease."

"I tell her she is wrong, and then I tell her what is right."

The nurse meets with the client and his wife to discuss depression and the client's medication. Which comment by the wife would indicate that the nurse's teaching about disease process and medications has been effective? a) "His depression is almost cured." b) "It is important for him to take his medication so that the depression will not return or get worse." c) "He is intelligent and will not need to depend on a pill much longer." d) "It is important to watch for physical dependency on sertraline."

"It is important for him to take his medication so that the depression will not return or get worse."

A client's wife states, "I do not think lithium is helping my husband. He has been taking it for 2 days now, and he is still so hyper and thinks we are rich." Which response by the nurse would be most accurate? a) "Your husband may need to have his dosage increased." b) "Because his symptoms are very acute, more time is needed." c) "It takes 1 to 2 weeks for the drug to build up in the blood to be effective." d) "I will be sure to pass on your concern about your husband to your health care provider."

"It takes 1 to 2 weeks for the drug to build up in the blood to be effective."

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: a) "It takes 2 to 4 weeks before the full therapeutic effects are experienced." b) "A different antidepressant may be necessary." c) "It can take 6 weeks to see if the medication will help your husband." d) "Your husband may need an increase in dosage."

"It takes 2 to 4 weeks before the full therapeutic effects are experienced."

A nurse should intervene when a depressed client makes which statement? a) "Nobody cares about me." b) "I have trouble falling asleep." c) "I have gained a little weight." d) "Television does not interest me anymore."

"Nobody cares about me."

The son of a client with Alzheimer's disease excitedly tells the nurse, "Mom was singing one of her favorite old songs. I think she is getting her memory back!" What response by the nurse is most appropriate? a) "I am so happy to hear that. Maybe she is getting better." b) "She still has long-term memory, but her short-term memory will not return." c) "I am glad she can sing even if she cannot talk to you." d) "Do not get your hopes up. This is only a temporary improvement."

"She still has long-term memory, but her short-term memory will not return."

A man found wandering in a local park is unable to state who or where he is or where he lives. He is brought to the emergency department, where his identification is eventually discovered. The client's wife states that he was diagnosed with Alzheimer's disease 3 years earlier and has experienced increasing memory loss. She tells a nurse she is worried about how she'll continue to care for him. Which response by the nurse is most helpful? a) "What aspect of caring for your husband is causing you the greatest concern?" b) "Do you have any children or friends who could give you a break from his care every now and then?" c) "You may benefit from a support group called Mates of Alzheimer's Disease Clients." d) "Because of the nature of your husband's disease, you should start looking into nursing homes for him."

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

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

Allow her sufficient extra time in which to gain an understanding of what is happening to her.

When caring for the client diagnosed with delirium, which condition is the most important for the nurse to investigate? a) impaired hearing b) heart failure c) cancer of any kind d) prescription drug intoxication

prescription drug intoxication

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? a) energy level b) sleep c) appetite d) suicidal ideation

suicidal ideation