Mood Disorders, Bi-polar, Depression, and Personality Disorders Nursing Review

List at least 3 NURSING DIAGNOSES for patients with bipolar disorder: 1. 2. 3.

- Risk for other-directed violence - Risk for injury - Imbalanced nutrition: less than body requirements - Ineffective coping - Noncompliance - Ineffective role performance - Self-care deficit - Chronic low self-esteem - Disturbed sleep pattern may include other diagnoses r/t bipolar disorder

A client is admitted to a psychiatric hospital after a month of unusual behavior that has included eating and sleeping very little, talking and singing constantly, and going on frequent shopping sprees. In the hospital, the client is demanding, bossy, and sarcastic. Which disorder does the nurse associate with these behaviors? 1. Bipolar disorder, manic phase 2. Antisocial personality disorder 3. Obsessive-compulsive disorder 4. Chronic undifferentiated schizophrenia

1. Bipolar disorder, manic phase This kind of hyperactive behavior is typical of the manic flight into reality associated with mood disorders. The behaviors are more indicative of a mood disorder than a personality disorder. Ritualistic, not manic, behavior is indicative of obsessive-compulsive disorder. A flat affect and apathy are more indicative of a schizophrenic disorder.

When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. Which is the most appropriate maintenance goal? 1. Suppressing feelings of anxiety 2. Identifying anxiety-producing situations 3. Continued contact with a crisis counselor 4. Eliminating all anxiety from daily situations

2. Identifying anxiety-producing situations Recognize what triggers anxiety and cope with anxiety as it happens or avoid specific situations.

The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number (1, 2, 3, 4) the diagnoses in order of the appropriate priority: a. disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night b. risk for injury related to manic hyperactivity c. impaired social interaction evidenced by manipulation of others d. imbalanced nutrition: less than body requirements evidenced by loss of weight and poor skin turgor

3 - a. disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night 1 - b. risk for injury related to manic hyperactivity 4 - c. impaired social interaction evidenced by manipulation of others 2 - d. imbalanced nutrition: less than body requirements evidenced by loss of weight and poor skin turgor Use maslows to guide prioritization.

Bethany's daughter, an only child who is visiting from out of town, offers additional information about Bethany's behaviors. She tells the nurse that her mother's clothes fit loosely, and weight loss is evident. Currently alcohol use is suspected, and a breathalyzer test is positive for alcohol use. Bethany denies current suicidal ideation, but the nurse recognizes that the client has risk factors based on the SAD PERSONS scale. Based on the SAD PERSONS scale, how many points does Bethany have?

6: no spouse, lacks social support, loss of rational thinking, alcohol use, depressed mood, age older than 45 years

List the characteristics of a manic episode:

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy. 3 or more of the following symptoms: - inflated self-esteem or grandiosity - decreased need for sleep - more talkative than usual or pressure to keep talking - flight of ideas or subjective experience that thoughts are racing - distractability as reported or observed - increase in goal-directed activity or psychomotor agitation - excessive involvement in activities that have a high potential for painful consequences - buying sprees, sexual indiscretions, or risk-taking behaviors

On the fifth day postpartum, a woman calls her healthcare provider and reports pronounced fatigue, sadness and tearfulness. She states, "I feel so overwhelmed, I don't know what to do!" Which of the following questions is most appropriate for the healthcare provider to ask? A. "Do you ever think about harming yourself or your baby?" B. "How much sleep do you get in a twenty-four hour period?" C. "Is there a friend or relative that come and help you care for your baby?" D. "Do you blame yourself for not being able to cope with motherhood?"

A. "Do you ever think about harming yourself or your baby?" Feelings of fatigue, sadness, and tearfulness can be common symptoms experienced in the postpartum period. The healthcare provider will want to ask questions that will help distinguish postpartum blues from postpartum depression. Whereas patients who are diagnosed with postpartum depression may experience thoughts of harming themselves or the infant, this is not a finding in postpartum blues.

A patient diagnosed with depression is prescribed a monoamine oxidase inhibitor (MAOI). When teaching the patient about the medication, which statement made by the patient indicates the need for additional teaching? A. "I'm glad that I can have pepperoni on my pizza." B. "I can still eat out at restaurants as long as I'm careful." C. "I will miss putting soy sauce on my noodles." D. "I'm glad I can still eat hamburgers and french fries."

A. "I'm glad that I can have pepperoni on my pizza." Patients taking MAOIs need to adhere to numerous dietary restrictions. The patient will need to avoid consuming foods which are high in tyramine. Processed meats such a pepperoni are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor (MAOI) can result in a hypertensive crisis.

Using cognitive-behavioral therapy, which treatment would be appropriate for a client with depression? A. Challenging negative thinking B. Encouraging analysis of dreams C. Prescribing antidepressant medications D. Using ultraviolet light therapy

A. Challenging negative thinking Cognitive-behavioral therapy includes identifying and challenging a client's negative cognitions. The belief is that these negative thoughts influence the feelings and behaviors in depression.

A patient diagnosed with depression is prescribed fluoxetine (Prozac). Which of the following would the healthcare provider most likely observe if the patient experiences an adverse effect of this medication? A. Decreased libido B. Weight loss C. Bradycardia D. Urinary Retention

A. Decreased libido Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Fluoxetine increases the synaptic concentration of serotonin the central nervous system, but may have effects on other nervous system functions. Although the mechanism has not been completely elucidated, sexual dysfunction is one of the most common adverse effects of SSRIs in both men and women.

The healthcare provider is caring for a patient who has undergone electroconvulsive therapy (ECT). The patient should be carefully assessed for which of the following common adverse effects of this treatment? A. Headache and memory loss B. Aggression and violent behavior C. Palpitations and cardiac arrest D. Dizziness and blurred vision

A. Headache and memory loss ECT induces a seizure, which can cause transient increases in blood pressure, pulse, and intracranial pressure. ECT causes numerous alterations in the central nervous system. The most common adverse effects a patient may experience after ECT include headache, confusion, and memory loss.

When the nurse prepares Bethany for ECT, what should be expected?

A. Preparation is similar to a brief surgical procedure

The healthcare provider is counseling a patient who is diagnosed with depression. Which of the following statements made by a patient should the healthcare provider recognize as a sign of transference? A. "I'm glad I lost my job because now I don't have to commute." B. "It's amazing how much you remind me of my favorite teacher." C. "I may not be good looking, but I get really good grades." D. "I drink so I can deal with the difficult situation at work."

B. "It's amazing how much you remind me of my favorite teacher." Transference is an unconscious response that may create a therapeutic impasse in the patient-healthcare provider relationship. Rationalization occurs when the patient attempts to create an acceptable explanation for unacceptable behavior. Transference occurs when a patient directs feelings and attributes from a person or situation in the past on to a person or situation in the present.

During a counseling session with a patient diagnosed with depression, the patient states, "I know my husband doesn't love me anymore." Which response by the healthcare provider demonstrates therapeutic communication? A. "You really should try not to dwell on something that probably isn't true." B. "What happened to make you think your husband doesn't love you anymore?" C. "Let's talk about what you did to cause him to stop loving you." D. "Try not to think about it too much because it will make you depression worse."

B. "What happened to make you think your husband doesn't love you anymore?" Therapeutic communication in this situation would consist of asking a question to explore the patient's perceptions and valuing the patient's feelings.

A patient is diagnosed with mild depression. Which of the following describe a physiological alteration often associated with this diagnosis? Select all that apply: A. Difficulty concentrating B. Anorexia C. Hypersomnia D. Amenorrhea E. Insomnia

B. Anorexia C. Hypersomnia E. Insomnia Anorexia, hypersomnia, insomnia are examples of physical alterations associated with mild depression. Amenorrhea is a physiological alteration associated with severe depression. Difficulty concentrating is a cognitive alteration.

Nurse Rica is teaching a client and her family about the causes of depression. Which of the following causative factors should the nurse emphasize as the most significant? A. Brain structure abnormalities B. Chemical imbalance C. Social environment D. Recessive gene transmission

B. Chemical imbalance Chemical imbalance of neurotransmitters in the brain is the most significant factor in depression. However, the exact cause has not been established, so other factors may also be involved. Although genetic transmission certainly may be a factor, no definite pattern of transmission has been identified. A person's social environment, including lack of support systems, may also increase the risk of depression.

A patient diagnosed with bipolar disorder is experiencing the manic phase of the disorder. Which neurotransmitter alterations will the healthcare provider identify as contributing to mania? Select all that apply: A. Decreased acetylcholine B. Decreased gamma-aminobutyric acid (GABA) C. Decreased dopamine D. Increased serotonin E. Increased norepinephrine F. Increased glutamate

B. Decreased gamma-aminobutyric acid (GABA) E. Increased norepinephrine F. Increased glutamate Recall the functions of the various neurotransmitters of the central nervous system. Mania is characterized by an expansive and elevated mood. There is an excess of excitatory neurotransmitters in mania. Mania is characterized by an excess of excitatory neurotransmitters such as glutamate and norepinephrine, and a deficiency of the inhibitory neurotransmitter GABA.

Which mood disorder is characterized by the client feeling depressed most of the day for a 2-year period? A. Cyclothymia B. Dysthymia C. Melancholic depressive disorder D. Seasonal affective disorder

B. Dysthymia is characterized by at least a 2-year history of depression, occurring most of the day for more days than not. Cyclothymia is characterized by at least 2 years of several periods of hypomanic symptoms. Melancholic depressive disorder is characterized by either anhedonia in relation to all activities or lack of mood reactivity to usually pleasurable stimuli. Seasonal affective disorder is characterized by depressed feelings in fall and winter, associated with loss of sunlight.

The nurse must teach Bethany about possible adverse effects from the ECT treatments. Which information should be included in the teaching Plan?

B. Headaches, nausea, and muscle aches may occur after the treatment

A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? A. Allow the clients to apply the democratic process when developing unit rules. B. Maintain consistency of care by open communication to avoid staff manipulation. C. Allow the client spokesman to verbalize concerns during a unit staff meeting. D. Maintain unit order by the application of autocratic leadership.

B. Maintain consistency of care by open communication to avoid staff manipulation. Clients diagnosed with borderline personality disorder can exhibit negative patterns of interaction such as clinging and distancing, splitting, manipulation, and self-destructive behaviors.

The healthcare provider is teaching a group of students about suicide assessment and prevention. Which of the following will be included in the teaching? Select all that apply: A. If a patient is unsuccessful in a suicide attempt, another attempt is unlikely. B. When medication improves a patient's mood, they may attempt suicide. C. It's important not to ask a patient whether they are having suicidal thoughts. D. A patient who talks about suicide may be signaling others for help. E. There are often no warning signs before a patient commits suicide.

B. When medication improves a patient's mood, they may attempt suicide. D. A patient who talks about suicide may be signaling others for help. When assessing suicide risk the healthcare provider will ask if the patient is having suicidal thoughts. Talking about suicide does not increase suicide risk. Often a patient contemplating suicide will give verbal or nonverbal signals about their intention to harm themselves, but in rare cases a suicide can occur without warning. The strongest single factor predictive of suicide is a history of attempted suicide. The risk of suicide may actually increase, especially during the initial phase of treatment, and more often in children, adolescents, and young adults. Patients should be observed closely for changes in behavior or mood that may indicate suicidality.

A patient diagnosed with bipolar disorder is prescribed lithium carbonate (Lithobid). When teaching the patient about the medication, which of these statements is a priority for the healthcare provider include? A. "You should avoid consuming dairy products when you are taking this medication." B. "You should follow this low calorie, low sodium diet to prevent weight gain." C. "Drink lots of fluids, especially if you are active during hot weather." D. "Call our office immediately if you experience any unusual bruising or bleeding."

C. "Drink lots of fluids, especially if you are active during hot weather." Lithium is an inorganic ion similar to other ions such as potassium and sodium. If sodium levels are low, the kidneys will retain lithium, which could result in toxicity. Lithium increases urine output and antagonizes the effects of antidiuretic hormone. In order to avoid dehydration, patients should be instructed to drink 10 to 12 glasses of water each day. Additional fluids will be needed during strenuous activity, in hot weather, or if the patient experiences fluid loss through vomiting or diarrhea.

A patient diagnosed with major depressive disorder is admitted for inpatient care. Which of the following is the primary goal during the admission assessment? A. Establishing desired outcomes for the patient B. Administering antidepressant medications C. Collecting and organizing patient data D. Reviewing the policies for patient conduct

C. Collecting and organizing patient data The healthcare provider is in the initial stage of planning care for the patient. Goals and outcomes are based on patient problems that have been identified. The primary goal during the admission assessment is to collect and organize objective and subjective data so patient problems and needs can be identified.

A patient is admitted to an inpatient psychiatric unit because of a plan to commit suicide by taking an overdose of medication. When administering medications to this patient, which of these interventions is the priority? A. Monitor the patient's vital signs before administration of medications B. Teach the patient how to recognize adverse effects of the medications C. Ensure that the patient is not "cheeking" the medications D. Monitor the patient for signs of anorexia, nausea, and xerostomia

C. Ensure that the patient is not "cheeking" the medications The priority intervention is designed to increase patient safety. A patient who has suicidal ideation, especially by overdosing on medications, should be monitored for "cheeking." Cheeking occurs when a patient hides the medication in the mouth, and hoards it so it can be used for the suicide attempt.

Ron is admitted in an acute psychiatric unit. He suddenly tells the nurse about his plans for suicide. The nurse's priority is to: A. allow the client time alone for reflection. B. encourage the client to use problem solving. C. follow agency protocol for suicide precautions. D. stimulate the client's interest in activities

C. follow agency protocol for suicide precautions. The nurse must act to safeguard the client from danger, including self-harm implementing the specific agency protocol for suicidal precautions would best protect the client. A client with suicidal intent should not be left alone. One-to-one observations are generally part of suicide precautions. The nurse's priority is to protect the client by initiating suicide precautions.

You are assessing James who is diagnosed with bipolar disorder. As the nurse, you would expect to find a history of: A. a depressive episode followed by prolonged sadness. B. a series of depressive episodes that recur periodically. C. symptoms of mania that may or may not be followed by depression. D. symptoms of mania that include delusional thoughts

C. symptoms of mania that may or may not be followed by depression. The definition of bipolar disorder is a mood disturbance in which the symptoms of mania have occurred at least one time. Depression may or may not occur as a separate episode in bipolar disorder.

Which medication used to treat bipolar 1 disorder recommends genetic testing for patients of Asian ancestry before beginning therapy? a. carbamazepine b. olanzapine c. aripiprazole d. lurasidone

Carbamazepine (Tegretol): anticonvulsant and mood stabilizer. Indicated for acute manic or mixed episodes associated with bipolar 1 disorder. Action: decreases synaptic transmission in the CNS by affecting sodium channels in neurons. Ther. Effs: prevents seizures, relief of pain in trigeminal neuralgia, and decreased mania. Common Adv. Eff: ataxia, drowsiness Assess for: mental status and mood changes for increased risk of suicidal tendencies; s/s of life threatening adverse effects Labs: CBC; platelet count; serum iron; genetic testing for HLA-B*1502 allele in pt's of Asian ancestry prior to beginning therapy; liver function tests; kidney function tests. Serum blood levels should be routinely monitored, therapeutic levels range from 4-12 mcg/mL.

Which atypical antipsychotics are approved for long-term use to prevent the recurrence of mood episodes in clients with bipolar disease? Select all that apply: a. Olanzapine b. Quetiapine c. Ziprasidone d. Risperidone e. Aripiprazole

Correct answers: a. olanzapine c. ziprasidone e. aripiprazole Olanzapine, ziprasidone, and aripiprazole are atypical antipsychotics approved for long-term use to prevent recurrence of mood episodes. Quetiapine and risperidone are atypical antipsychotics approved for use in bipolar disease but are not approved for long-term use to prevent the recurrence of mood episodes.

What signs and symptoms should the nurse expect to assess if a client taking a MAO antidepressant ingests foods containing tyramine?

D. Headaches and palpitations

Clara is under evaluation for imminent suicide risk, which information given by her would be most significant? A. At least a 2-year history of feeling depressed more days than not B. Divorced from spouse 6 months ago C. Feeling loss of energy and appetite D. Reference to suicide as best solution to identified problems

D. Reference to suicide as best solution to identified problems An individual who talks about suicide as a solution to a problem is at high risk. This client's suicidal threats need to be taken seriously because he does not see any other variable solutions to problems in living. All of the factors included in the other options would increase the client's risk for depression; however, actual statements about suicidal intent are red flags indicating imminent danger.

n individual with depression has a deficiency in which neurotransmitters, based on the biogenic amine theory? A. Dopamine and thyroxin B. GABA and acetylcholine C. Cortisone and epinephrine D. Serotonin and norepinephrine

D. Serotonin and norepinephrine The biogenic amine theory of depression describes deficiencies in the neurotransmitters serotonin and norepinephrine. Antidepressants medications increase the levels of these neurotransmitters and therefore help to relieve depressive symptoms.

When assessing a patient with severe depression, which of the following would the healthcare provider identify as a cognitive alteration? A. Low self-esteem B. Anxiety C. Powerlessness D. Somatic Delusions

D. Somatic Delusions Patients diagnosed with depression may experience cognitive, affective, behavioral, or physiological alterations. Cognition relates to processes such as judgment, evaluation, and reasoning. A somatic delusion, the false belief that the patient has some physical defect or disease (e.g. the patient might think he/she has an internal parasite), is a cognitive alteration associated with depression. The other choices are affective alterations.

When Bethany awakens from the treatment , the nurse should be prepared to perform which nursing action?

D. Take vital signs and assess orientation

The community nurse is speaking to a group of new mothers as part of a primary prevention program. Which self-measures would be most helpful as a strategy to decrease the occurrence of mood disorders? A. Keeping busy, so as not to confront problem areas B. Medication with antidepressants C. Use of crisis intervention services D. Verbalizing rather than internalizing feelings

D. Verbalizing rather than internalizing feelings Individuals who develop mood disorders often have difficulty expressing feelings, especially feelings of anger toward significant others. Internalizing those feelings can contribute to loss of self-esteem and guilt, and therefore negative cognitions and depression. Recognizing problems and using problem-solving methods will contribute to mental health.

True or False The recovery model of treatment for bipolar disorder is a binary system in which the physician believes that the patient is either capable of full recovery or lacked hope for recovery even with treatment.

FALSE! Some clinicians choose a course of therapy based on a model of recovery, somewhat like that which has been used for many years with problems of addiction. The basic premise of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care and to enable a person with a mental health problem to live a meaningful life in a community of choice while striving to achieve his or her full potential.

True or False Secondary depression occurs when a patient with chronic depression becomes suddenly and acutely more depressed.

False Secondary depression occurs in response to other physiological disorders.

True or False The categories for personality disorders are: paranoid, co-dependant, hypersocial, and multiple personalities.

False The DSM-5 identifies 10 individual personality disorders: antisocial, avoidant, borderline, histrionic, dependent, narcissistic, obsessive-compulsive, paranoid, schizoid, and schizotypal.

True or False Bipolar Disorders are treated solely with antipsychotic pharmacology.

False Treatment of bipolar disorders includes individual therapy, group and family therapy, cognitive therapy, electroconvulsive therapy, and psychopharmacology. For the majority of clients, the most effective treatment appears to be a combination of psychotropic medication and psychosocial therapy.

True or False Bipolar Disorder is caused exclusively by biochemical imbalances and genetics.

False: the cause of bipolar disorder is likely multifactorial. Genetic influences have been strongly implicated in the development of bipolar disorder. Various other physiological factors, such as biochemical and electrolyte alterations, as well as cerebral structural changes, have been implicated. Side effects of certain medications may also induce symptoms of mania. No single theory can explain the etiology of bipolar disorder, and it is likely that the illness is caused by a combination of factors.

Which food would be considered safe?

Most fruits

True or False Depression is a condition that only affect adults. Children are not depressed, they are going through a stage or phase of unhappy feelings.

The disorder occurs at all developmental levels, including childhood, adolescence, senescence, and during the puerperium.

True or False Bipolar disorder is manifested by mood swings from profound depression to extreme elation and euphoria.

True Bipolar disorder is manifested by mood swings from profound depression to extreme elation and euphoria. The symptoms of bipolar disorder may occur in children and adolescents as well as in adults.

True or False Depression is one of the oldest recognized psychiatric illnesses that is still prevalent today. It is so common that it has been referred to as the "common cold of psychiatric disorders."

True Depression is a common condition. It can be acute, situational, or chronic. The cause of depressive disorders is not entirely known. A number of factors, including genetics, biochemical influences, and psychosocial experiences, likely enter into the development of the disorder. Symptoms of depression occur along a continuum according to the degree of severity from transient to severe.

A new mother is admitted to the acute psychiatric unit with severe postpartum depression. She is tearful and states, "I don't know why this happened to me! I was so excited for my baby to come, but now I don't know!" Which of the following responses by the nurse is MOST therapeutic? a. "Having a new baby is stressful, and the tiredness and different hormone levels don't help. It happens to many new mothers." b. "What happened once you brought the baby home? Did you feel nervous?" c. "Maybe you weren't ready for a child after all." d. "Has your husband been helping you with the housework at all?"

a. "Having a new baby is stressful, and the tiredness and different hormone levels don't help. It happens to many new mothers." Postpartum depression is often hormonally-based and also has to do with support systems. Blaming the husband is not appropriate, nor is blaming the patient.

The nurse completes a physical assessment. Bethany begins and cry says she came to the hospital because "things just aren't right." Bethany describes her mood as very sad. She rarely goes out or invites friends over to visit. She admits that she feels like strangers are saying bad things about her. Sometimes she hears a mans voice that is a little bit scary. What questions should the nurse ask as a priority nursing assessment? a. "what is the voice saying to you?" b. "how long have you been hearing the voice?" c. "have you ever been hospitalized for depression?" d. "where do you see these strangers?"

a. "what is the voice saying to you?"

The physician orders lithium carbonate 600 mg tid for a client newly diagnosed with Bipolar I Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. What is the therapeutic range for acute mania? a. 1.0 to 1.5 mEq/L b. 10 to 15 mEq/L c. 0.5 to 1.0 mEq/L d. 5 to 10 mEq/L

a. 1.0 to 1.5 mEq/L

Which of the following assessment findings is seen in a client diagnosed with borderline personality disorder? a. Abrasions in various healing stages b. Intermittent episodes of hypertension c. Alternating tachycardia and bradycardia d. Mild state of euphoria with disorientation

a. Abrasions in various healing stages Clients with borderline personality disorder tend to self-mutilate and have abrasions in various stages of healing.

Mr. Jones, 24 year old male, is hospitalized following a suicide attempt. His history reveals a previous diagnosis of schizoid personality disorder. Which of the following behaviors would be atypical (not normal) of a client with this disorder? a. Actions designed to please the nurse b. Limited expressions of feelings and emotions c. Odd ideas and mannerisms d. Reluctance to join group activities

a. Actions designed to please the nurse A client with schizoid personality disorder is typically detached, aloof, and socially isolated. He has no interest in seeking the approval of others and would not behave in ways to please the nurse. The behaviors included in the remaining options are characteristic of someone with schizoid personality disorder.

n planning care for a client with borderline personality disorder, a nurse must be aware that this client is prone to develop which of the following conditions? a. Binge eating b. Memory loss c. Cult membership d. Delusional thinking

a. Binge eating Clients with borderline personality disorder are likely to develop dysfunctional coping and act out in self-destructive ways such as binge eating.

A client denying suicidal ideations comes into the emergency department complaining about insomnia, irritability, anorexia, and depressed mood. Which intervention would the nurse implement first? a. Complete a thorough physical assessment including lab tests. b. Remove all hazardous materials from the environment. c. Place the client on a one-to-one observation. d. Request a psychiatric consultation.

a. Complete a thorough physical assessment including lab tests. Numerous physical conditions can contribute to symptoms of insomnia, including irritability, anorexia, and depressed mood. It is important for the nurse to rule out these physical problems before assuming that the symptoms are psychological in nature. The nurse can do this by completing a thorough physical assessment including lab tests. Because the client has denied suicidal ideations, it would be unnecessary at this time to remove all hazardous materials from the environment, or place the client on a one-to-one observation.

The community nurse is following up on Mrs. Jenner who was hospitalized at due to depressive disorder, not otherwise specified, following the death of her spouse. In reviewing the client's chart, the nurse notes that Mrs. Jenner has an Axis II diagnosis of dependent personality disorder. Which behavior would the nurse anticipate in this client? a. Difficulty making decisions, lack of self-confidence b. Grandiose thinking, attention-seeking behaviors c. Odd mannerisms, speech, and behaviors d. Unstable moods and impulsive behaviors

a. Difficulty making decisions, lack of self-confidence The client with a dependent personality disorder typically demonstrates anxious and fearful behavior and is reluctant to make decisions. Lack of self-confidence is reflective of chronic low self-esteem.

When teaching a client about their antidepressant medication, fluoxetine (Prozac), which of the following points would the nurse include? Select all that apply: a. Do not abruptly discontinue use of this drug, as withdrawal symptoms may present. b. Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect. c. Don't take this medication along with the migraine drugs known as "triptans." d. Go to the lab each week to have your blood drawn for therapeutic level of this drug. e. Don't eat chocolate while taking this medication.

a. Do not abruptly discontinue use of this drug, as withdrawal symptoms may present. b. Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect. c. Don't take this medication along with the migraine drugs known as "triptans."

Angela has a history of conflict-filled relationships. Despite an expressed desire for friends, she acts in ways that tend to alienate people. Which nursing intervention would be important for Angela? a. Establish a therapeutic relationship in which the nurse uses role-modeling and role-playing for appropriate behaviors. b. Help the client to select friends who are kind and extra caring. c. Point out that the client acts in ways that alienate others. d. Recognize that this client is unlikely to change and therefore intervention is inappropriate.

a. Establish a therapeutic relationship in which the nurse uses role-modeling and role-playing for appropriate behaviors. A therapeutic relationship shows acceptance, and using role modeling and role-playing can help the client to learn appropriate behaviors. This client is not likely to accept direct criticism of her behavior; such individuals do not perceive a problem with their own behavior.

A client with borderline personality disorder is admitted to the unit after slashing his wrist. Which of the following goals is most important after promoting safety? a. Establish a therapeutic relationship with the client b. Identify whether splitting is present in the client's thoughts c. Talk about the client's acting out and self-destructive tendencies d. Encourage the client to understand why he blames others

a. Establish a therapeutic relationship with the client After promoting safety, the nurse establishes a rapport with the client to facilitate appropriate expression of feelings. At this time, the client isn't ready to address unhealthy behavior. A therapeutic relationship must be established before the nurse can effectively work with the client on self-destructive tendencies and the issues of splitting.

A client is found to have a borderline personality disorder. What is a realistic initial intervention for this client? a. Establishing clear boundaries b. Exploring job possibilities with the nurse c. Initiating a discussion of feelings of being victimized d. Spending 1 hour twice a day discussing problems with the nurse

a. Establishing clear boundaries Individuals with borderline personality disorder are impulsive and have difficulty identifying and respecting boundaries in relation to others.

A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior. A common anti-anxiety medication used for this type of client would be: a. Fluvoxamine (Luvox) b. Benztropine (Cogentin) c. Amantadine (Symmetrel) d. Diphenhydramine (Benadryl)

a. Fluvoxamine (Luvox) a selective serotonin reuptake inhibitor (SSRI) antidepressant. This medicine affects chemicals in the brain that may be unbalanced in people with obsessive-compulsive symptoms.

A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this assessment data? a. Histrionic personality disorder b. Compulsive personality disorder c. Schizotypal personality disorder d. Manic personality disorder

a. Histrionic personality disorder The nurse should associate histrionic personality disorder with this assessment data. Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing, attention seeking, overly gregarious, and seductive. They often use manipulation and exhibitionism as a means of gaining attention.

Jack is a new client on the psychiatric unit with a diagnosis of Antisocial Personality Disorder. Which of the following characteristics would you expect to assess in Jack? a. Lack of guilt for wrongdoing b. Insight into his own behavior c. Ability to learn from past experiences d. Compliance with authority

a. Lack of guilt for wrongdoing

A nurse notices other clients on the unit avoiding a client diagnosed with antisocial personality disorder. When discussing appropriate behavior in group therapy, which of the following comments is expected about this client by his peers? a. Lack of honesty b. Belief in superstitions c. Show of temper tantrums d. Constant need for attention

a. Lack of honesty Clients with antisocial personality disorder tend to engage in acts of dishonesty.

Which of the following nursing interventions has priority for a client with borderline personality disorder? a. Maintain consistent and realistic limits b. Give instructions for meeting basic self-care needs c. Engage in daytime activities to stimulate wakefulness d. Have the client attend group therapy on a daily basis

a. Maintain consistent and realistic limits Clients with borderline who are needy, dependent, and manipulative will benefit greatly from maintaining consistent and realistic limits. They don't tend to have difficulty meeting their self-care needs. They enjoy attending group therapy because they often attempt to use the opportunity to become the center of attention. They don't tend to have sleeping difficulties.

A client with major depression that includes psychotic features tells the nurse, "All of my relatives have been killed because I've been sinful and need to be punished." What is the primary focus of nursing interventions? a. Protecting the client against any suicidal impulses b. Supporting the client's interest in the outside world c. Helping the client manage the concern for family members d. Reassuring the client that past behaviors are not being punished

a. Protecting the client against any suicidal impulses Suicidal impulses take priority, and the client must be stopped from acting on them while treatment is in progress; the client's safety is the focus of nursing interventions.

A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to feeling sad and hopeless, the nurse would assess for? a. Psychomotor retardation or agitation b. Guilt, indecisiveness, poor self-concept c. Meticulous attention to grooming and hygiene d. Anxiety, unconscious anger, and hostility

a. Psychomotor retardation or agitation Somatic or physiologic symptoms of depression include: fatigue, psychomotor retardation or psychomotor agitation, chronic generalized or local pain, sleep disturbances, disturbances in appetite, gastrointestinal complaints and impaired libido.

A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has priority? a. Risk for injury b. Ineffective coping c. Impaired social interaction d. Ineffective therapeutic regimen management

a. Risk for injury Each of the nursing diagnoses listed is appropriate for a patient having a manic episode, however the priority lies with the patient's physiologic safety. Hyperactivity & poor judgment place the patient at risk for injury.

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? a. Risk for suicide R/T hopelessness b. Anxiety: severe R/T hyperactivity c. Imbalanced nutrition: less than body requirements R/T refusal to eat d. Dysfunctional grieving R/T loss of employment

a. Risk for suicide R/T hopelessness The nurse should always prioritize client safety. This client is at risk for suicide because of his or her recent suicide attempt.

A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be "bad." The nurse understands this defense is known as: a. Splitting b. Ambivalence c. Passive aggression d. Reaction formation

a. Splitting Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others.

A patient diagnosed with bipolar disorder is dressed in a red leotard & brightly colored scarves. The patient says, "I'll punch you, munch you, crunch you" while twirling & shadowboxing. Then the patient says gaily, "Do you like my scarves? Here, they are my gift to you." How should the nurse document the patients mood? a. Labile and euphoric b. Irritable and belligerent c. Highly suspicious and arrogant d. Excessively happy and confident

a. The patient has demonstrated angry behavior & pleasant, happy behavior within seconds of each other. Excessive happiness indicates euphoria. Mood swings are often rapid & seemingly without understandable reason in patients who are manic. These swings are documented as labile. Irritability, belligerence, excessive happiness & confidence are not entirely correct terms for the patient's mood. A high level of suspicion is not evident.

As the nurse initially communicates with Bethany, which communication technique is important? a. acknowledge the client's courage in seeking help, then offer to sit quietly with the client b. calmly reassure the client that everything will be fine c. explain that antidepressants are the best treatment options d. offer options for treatment that will support her needs

a. acknowledge the client's courage in seeking help, then offer to sit quietly with the client

A client is unwilling to go to the grocery store because his e-girlfriend works there and he feels that she will laugh at him if she sees him. Because of this hypersensitivity to a reaction from her, the client remains homebound. The home care nurse develops a plan of care that addresses which personality disorder? a. avoidant b. borderline c. schizotypal d. obsessive-compulsive

a. avoidant The avoidant personality disorder is characterized by social withdrawal and extreme sensitivity to potential rejection. The person retreats to social isolation.

A client with depression had just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" Which of the following is the correct response by the nurse? a. blue cheese, red wine, raisins b. black beans, garlic, pears c. pork, shellfish, egg yolks d. milk, peanuts, tomatoes

a. blue cheese, red wine, raisins

Bethany is assessed by a nurse, a social worker, and the HCP. Based on their assessments, hospitalization is recommended for psychotic depression. Which behavior is inconsistent with depression? a. hearing a man's voice b. poor concentration c. poor grooming and hygiene d. slow motor activity

a. hearing a man's voice

When Bethany awakens in the morning, she sits for periods of time at the edge of her bed. She does not initiate combing her hair, getting dressed, or going to breakfast. Which nursing intervention is important? a. help the client with daily activities b. bring the client's meal to her room c. give two choices of clothes to wear d. respond to the client nonverbally

a. help the client with daily activities

A thyroid profile is important for several reasons/ What role do thyroid levels play in depression?

a. hypothyroidism can lead to feeling sluggish and depressed.

What is the goal of cognitive therapy with depressed clients? a. identify and change dysfunctional patterns of thinking b. resolve the symptoms and initiate or restore adaptive family functioning c. alter the neurotransmitters that are creating the depressed mood d. provide feedback from peers who are having similar experiences

a. identify and change dysfunctional patterns of thinking

The nursing diagnosis that would be most appropriate for a 22-year old client who uses ritualistic behavior would be: a. ineffective coping b. impaired adjustment c. personal identity disturbance d. sensory/perception alterations

a. ineffective coping Ineffective coping is the impairment of a person's adaptive behaviors and problem-solving abilities in meeting life's demands; ritualistic behavior fits under this category as a defining characteristic.

Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder? a. overly self-centered and exploitative of others b. suspicious and mistrustful of others c. rule conscious and disapproving of change d. anxious and socially isolated

a. overly self-centered and exploitative of others

Since the client has decrease energy, which intervention is best? a. plan a scheduled rest period b. allow for short, frequent naps c. minimize caffeine in the morning d. excuse the client from exercise

a. plan a scheduled rest period

A visitor brings Bethany cans of her favorite soda. After ensuring the client is not on caffeine or sugar restrictions, what should the nurse do? a. pour the soft drink into a paper cup b. stay with Bethany when she is drinking it c. explain to the visitor that this is not allowed d. ask Bethany to return the cans to the visitor

a. pour the soft drink into a paper cup

The nurse observes a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Behaviors are escalating. Based on these observations, which is the nurse's IMMEDIATE PRIORITY of care? a. provide safety for the client and other clients on the unit b. provide the clients on the unit with a sense of safety and comfort c. assist the staff in caring for the client in a controlled environment d. contact the client's HCP e. offer the client a less stimulating area in which to calm down and gain control

a. provide safety for the client and other clients on the unit The immediate priority is the safety of the client and other clients. This is the only option that addresses the safety needs of the client as well as those of the other clients.

Kim, a client diagnosed with Borderline Personality Disorder, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except: a. refusal to stay in room alone, stating, "It's so lonely." b. asking Nurse Jones for cigarettes after 30 minutes, knowing the assigned nurse has explained she must wait 1 hour. c. stating to Nurse Jones, "I really like having you for my nurse. You're the best one around here." d. cutting arms with razor blade after discussing dismissal plans with physician.

a. refusal to stay in room alone, stating, "It's so lonely."

The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse INITIALLY implement? a. setting limits on the client's behavior b. asking the client to leave the group session c. asking another nurse to walk with the client out of the group session d. telling the client that they will not be able to come to future group sessions

a. setting limits on the client's behavior Manic clients may be talkative and can dominate group meetings or therapy session by their excessive talking. If this occurs, the nurse can initially set limits on the client's behavior. - follow through on the limits and boundaries set. be consistent.

When Bethany wants to change clothes and get ready for sleep at night, what should the staff do? a. stay with Bethany as she gets ready b. allow only 3 minutes for bethany to dress c. only allow Bethany to change in the bathroom d. allow Bethany to change in the unit bathroom

a. stay with Bethany as she gets ready

The client also begins an atypical antipsychotic, risperidone (Risperdal) because she reports hearing a "scary Voice" upon admission. although the client remains very withdrawn and non communicative, the nurse must explain the purpose of dispersal. Which explanation is best? a. this medication will help you think more clearly b. several medications can help you sleep better c. this will control impulsive feelings you may experience d. it will enhance the effectiveness of the antidepressant

a. this medication will help you think more clearly

The nurse understands that SSRIs are now more widely prescribed that tricyclics for antidepressant therapy. What is the rationale? a. tricyclics are more lethal in an overdose b. SSRIs are less likely to be abused c. tricyclics are less potent than SSRIs d. SSRIs are more effective

a. tricyclics are more lethal in an overdose

A patient with a history of schizophrenia is admitted to the acute psychiatric care unit. He mutters to himself as the nurse attempts to take a history and yells, "I don't want to answer any more questions! There are too many voices in this room!" Which of the following assessment questions should the nurse ask NEXT? a. "Do you feel as though you want to harm yourself or anyone else?" b. "Are the voices telling you to do things?" c. "Who else is talking in this room? It's just you and me." d. "I don't hear any other voices."

b. "Are the voices telling you to do things?" We need to assess for command hallucinations to determine if this patient is at increased risk for harming himself or others.

An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client? a. "Do you like exercise?" b. "Come with me. I will go with you to group therapy." c. "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" d. "Why do you stay in your room all the time?"

b. "Come with me. I will go with you to group therapy."

During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the most appropriate nursing statement to address this behavior? a. "You are very disrespectful. You need to learn to control yourself." b. "I understand that you are angry, but this behavior will not be tolerated." c. "What behaviors could you modify to improve this situation?" d. "What anti-personality-disorder medications have helped you in the past?"

b. "I understand that you are angry, but this behavior will not be tolerated." The appropriate nursing statement is to reflect the client's feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism.

Which of the following statements is expected from a client with borderline personality disorder with a history of dysfunctional relationships? a. "I won't get involved in another relationship." b. "I'm determined to look for the perfect partner." c. "I've decided to use better communication skills." d. "I'm going to be an equal partner in a relationship."

b. "I'm determined to look for the perfect partner." This characteristic is a result of the dichotomous manner in which these clients view the world. They go from relationship to relationship without taking responsibility for their behavior. It's unlikely that an unsuccessful relationship will cause clients to make a change. They tend to be demanding and impulsive in relationships.

The HCP orders sertraline (zoloft) 50 mg PO bid for Maggie, a 68 year old woman with MAjor Depressive Disorder. After 3 days of taking the medication, Maggie says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? a. "Cheer up, Maggie. You have so much to be happy about." b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." c. "I'll report that to the HCP for you. Maybe he will order something different." d. "Try not to dwell on your symptoms, Maggie. Why don't you join the others down in the dayroom?"

b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms."

A patient with postpartum depression is scheduled for discharge today. Which of the following statements by the patient would indicate the postpartum depression has RESOLVED? a. "I feel great, so much better!" b. "That scary fog that was clouding my head has disappeared. I feel much more supported and able to care for my baby." c. "I feel a little stressed, but I might be able to care for my baby safely." d. "I've missed my baby so much."

b. "That scary fog that was clouding my head has disappeared. I feel much more supported and able to care for my baby." Patients often describe postpartum depression as a kind of "crazy thinking" or "fog" that resolves into clearer thinking. Support is needed when this patient goes home to prevent stress.

The symptoms of mania may be observed on a continuum of how many phases? a. 2 manic and depressive b. 3 hypomania, acute mania, delirious mania c. 4 depression, hypomania, acute mania, psychosis d. none, mania either occurs or it does not

b. 3 hypomania, acute mania, delirious mania Symptoms of mania may be observed on a continuum of three phases, each identified by the degree of severity: phase I, hypomania; phase II, acute mania; and phase III, delirious mania.

A client with a borderline personality disorder is admitted to the mental health unit. What should the nurse do to maintain a therapeutic relationship with the client? a. Provide an unstructured environment to promote self-expression. b. Be firm, consistent, and understanding and focus on specific target behaviors. c. Use an authoritarian approach, because this type of client needs to learn to conform to the rules of society. d. Record but ignore marked shifts in mood, suicidal threats, and temper displays, because these last only a few hours

b. Be firm, consistent, and understanding and focus on specific target behaviors. Consistency, limit-setting, and supportive confrontation are essential nursing interventions designed to provide a secure, therapeutic environment for clients with borderline personality disorder. To be therapeutic, the environment needs structure, and the staff must help the client set short-term goals for behavioral changes.

The nurse takes the client vital signs and her BP is 141/108. Progress notes show that this is the 3rd incidence of high BP. Which consideration by the nurse is accurate? a. fluoxetine has a side effect of hypertension b. the client's diet consists of high sodium foods, could be contributing to high BP c. depression is a common cause of hypertension d. high BP while hospitalized for mental health is normal, and the BP will resolve once the client is discharged

b. Bethany's diet, which consists of primarily high sodium foods, could be contributing to her high blood pressure

A depressed, withdrawn client exhibits sadness through nonverbal behavior. What should the nurse plan to help the client to do? a. Increase structured physical activity. b. Cope with painful feelings by sharing them. c. Decide which unit activities the client can perform. d. Improve the ability to communicate with significant others.

b. Cope with painful feelings by sharing them. Sharing painful feelings reduces the isolation and sense of uniqueness that these feelings can cause; sharing of these feelings usually decreases depression.

n a day treatment program, a manic client is creating considerable chaos, behaving in a dominating and manipulative way. Which nursing intervention is most appropriate? a. Allow the peer group to intervene. b. Describe acceptable behavior and set realistic limits with the client. c. Recommend that the client be hospitalized for treatment. d. Tell the client that his behavior is inappropriate.

b. Describe acceptable behavior and set realistic limits with the client. In this situation, it would be appropriate for the nurse to suggest alternative behaviors in place of unacceptable ones to help the client gain self-control. The peer group is not responsible for monitoring the client's behavior. The client's behavior does not warrant hospitalization. Option D is inappropriate because the client is told only what is unacceptable and is not given any alternatives.

A person with antisocial personality disorder has difficulty relating to others because of never having learned to: a. Count on others b. Empathize with others c. Be dependent on others d. Communicate with others socially

b. Empathize with others The lack of superego control allows the ego and the id to control the behavior. Self-motivation and self-satisfaction are of paramount concern. Empathy is ability to understand and share the feelings of another.

What should the nurse consider when caring for clients who are at risk for suicide? a. A client who fails in a suicide attempt will probably not try again b. Formal suicide plans increase the likelihood that a client will attempt suicide c. It is best not to talk to clients about suicide, because it may give them the idea d. Clients who talk about suicide are not planning it; they are using the threat to gain attention

b. Formal suicide plans increase the likelihood that a client will attempt suicide. A formal plan demonstrates determination, concentration, and effort, with conclusions already thought out. Failure to successfully complete the suicidal act can add to feelings of worthlessness and stimulate further acts. Verbalizing feelings may help reduce the client's need to act out. Many clients verbalize their suicidal thoughts as they are working on their decision and plan of action; a suicide attempt is not necessarily just to receive attention.

A nurse is caring for a female client during the manic phase of bipolar disorder. What should the nurse do to help the client with personal hygiene? a. Suggest that she wear hospital clothing. b. Guide her to dress appropriately in her own clothing. c. Allow her to apply makeup in whatever manner she chooses. d. Keep makeup away from her because she will apply it too freely

b. Guide her to dress appropriately in her own clothing. Having clients who are experiencing the manic phase of bipolar disorder wear personal clothing helps keep them more in touch with reality. The client may need direction to dress appropriately. Suggesting that she wear hospital clothing does not help the client learn new ways to cope with problem situations.

The client with antisocial personality disorder: a. Suffers from a great deal of anxiety b. Is generally unable to postpone gratification c. Rapidly learns by experience and punishment d. Has a great sense of responsibility toward others

b. Is generally unable to postpone gratification Individuals with this disorder tend to be self-centered and impulsive. They lack judgment and self-control and do not profit from their mistakes.

A client in a psychiatric hospital with the diagnosis of major depression is tearful and refuses to eat dinner after a visit with a friend. What is the most therapeutic nursing action? a. Allowing the client to skip the meal b. Offering an opportunity to discuss the visit c. Reinforcing the importance of adequate nutrition d. Providing the client with adequate quiet thinking time

b. Offering an opportunity to discuss the visit Offering to discuss the visit shows support and provides the client with an opportunity to discuss feelings. Allowing the client to skip dinner does not address the client's depression. Teaching is inappropriate when a client is emotionally distressed. Providing quiet thinking time will limit further communication and may imply rejection.

A client with a diagnosis of narcissistic personality disorder has been given a day pass from the psychiatric hospital. The client is due to return at 6pm. At 5pm the client telephones the nurse in charge of the unit and says "6 o'clock is too early. I feel like coming back at 7:30." The nurse would be most therapeutic by telling the client to: a. Return immediately, to demonstrate control b. Return on time or restrictions will be imposed c. Come back at 6:45, as a compromise to set limits d. Come back as soon as possible or the police will be sent

b. Return on time or restrictions will be imposed set limits, point out reality, and place responsibility for behavior on the client.

Bethany signs the treatment form and is admitted to the mental health unit. During the first days of hospitalization, she begins antidepressant therapy with fluoxetine (Prozac), 10 mg. In what classification of drugs is the antideoressant fluoxetine (Prozac)? a. tricyclic b. SSRI c. nonbenzodiazepine d. atypical

b. SSRI

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights & a 12-pound weight loss over the past 2 weeks. Which should be this clients priority nursing diagnosis? a. Knowledge deficit R/T bipolar disorder AEB concern about symptoms b. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss c. Risk for suicide R/T powerlessness AEB insomnia & anorexia d. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

b. The nurse should identify that the priority nursing diagnosis for this client is altered nutrition: less than body requirements R/T hyperactivity AEB weight loss. Because of the clients rapid weight loss, the nurse should prioritize interventions to ensure proper nutrition & physical health.

Which of the following behavioral patterns is characteristic of individuals with schizotypal personality disorder? a. belittling themselves and their abilities b. a lifelong pattern of social withdrawal c. suspiciousness and mistrust of others d. overreacting inappropriately to minor stimuli

b. a lifelong pattern of social withdrawal

"Splitting" by the client with BPD denotes which of the following? a. evidence of precocious development b. a primitive defense mechanism in which the client sees objects as all good or all bad c. a brief psychotic episode in which the client loses contact with reality d. two distinct personalities within the borderline client

b. a primitive defense mechanism in which the client sees objects as all good or all bad Splitting is a term used in psychiatry to describe the inability to hold opposing thoughts, feelings, or beliefs. Some might say that a person who splits sees the world in terms of black or white, all or nothing. It's a distorted way of thinking in which the positive or negative attributes of a person or event are neither weighed nor cohesive.

You are caring for a client diagnosed with paranoid personality disorder who is experiencing disturbed thought processes. In formulating a nursing plan of care, which BEST intervention should you include? a. increase socialization of the client with peers b. avoid using a whisper voice in front of the client c. begin to educate the client about social supports in the community d. have the client sign a release of information to appropriate parties for assessment purposes

b. avoid using a whisper voice in front of the client The plan of care must address the problem of disturbed thought processes in a client with paranoid personality disorder. The client is distrustful and suspicious of others. Establish rapport and trust with the client. whispering will harbor distrust and be counterproductive.

A patient develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily & begin olanzapine (Zyprexa). The addition of olanzapine to the medication regimen will: a. minimize the side effects of lithium b. bring hyperactivity under rapid control c. enhance the antimanic actions of lithium d. provide long-term control of hyperactivity

b. bring hyperactivity under rapid control Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because this takes several days to accomplish, a drug with rapid onset is necessary to reduce the hyperactivity initially.

Back to Linda... Linda, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after bring brought to the ED by her sister-in-law. Linda yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of which of the following? a. delusion of grandeur b. delusion of persecution c. delusion of reference d. delusion of control or influence

b. delusion of persecution

Milieu therapy is a good choice for clients with antisocial personality disorder because it: a. provides a system of punishment and rewards for behavior modification b. emulates a social community in which the client may learn to live harmoniously with others c. provides mostly one-to-one interaction between the client and therapist d. provides a structured setting in which the clients have very little input into the planning of their care

b. emulates a social community in which the client may learn to live harmoniously with others

The nurse is reviewing the clients admission lab work on the 3rd day of hospitalization. Thyroid profile, urinalysis, chemistry panel, pregnancy test, urine drug screen, and VDRL (RPR). The nurse understands that a VDRL is routinely done on admission for which reason? a. routine screenings for STDs are necessary b. it is a screening test for syphilis c. abnormal thyroid levels require treatment d. is positive, isolation is necessary

b. it is a screening test for syphilis

In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? select all that apply: a. don't eat chocolate while taking this medication b. keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect c. don't take this medication with the migraine drugs "triptans" d. do to the lab each week to have your blood drawn for therapeutic levels of this drug e. this drug causes a high degree of sedation, so take it just before bedtime

b. keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect c. don't take this medication with the migraine drugs "triptans" Fluoxetine (Prozac) is an SSRI antidepressant.

Linda, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Linda had a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that Linda quit taking her medication a few months ago, thinking she didn't need it anymore. Linda is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Linda eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Linda is admitted to the psychiatric unit. What is the priority diagnosis for Linda? a. imbalanced nutrition: less than required r/t not eating b. risk for injury r/t hyperactivity c. disturbed sleep pattern r/t agitation d. ineffective coping r/t denial of depression

b. risk for injury r/t hyperactivity

One morning, the nurse is doing rounds and finds Bethany sitting at the edge of the bed with a sheet around her neck. After removing the sheet, what is the next nursing action? a. ask Bethany "are you feeling suicidal?" b. stay with Bethany c. take the client to a secluded room d. document the incident in the chart

b. stay with Bethany

You are working with a client who is diagnosed with borderline personality disorder. She is defensive and emotionally labile and often becomes suddenly and explosively angry. When interacting with her, you as nurse would: a. point out how angry the client is becoming, and confront the behavior. b. take a calm, quiet, and non confrontational approach, and avoid arguing with the client. c. firmly tell the client to calm down and to avoid becoming explosive or restraints will be used. d. Use gentle touch and a caring approach to calm the client.

b. take a calm, quiet, and non confrontational approach, and avoid arguing with the client. The best way to respond to the client with angry behavior is a calm, non confrontational, non argumentative approach. This will avoid further escalating the client's behavior.

A nurse is educating a client about his lithium therapy. She is explaining s/s of lithium toxicity. Which of the following would she instruct the client to be on the alert for? a. fever, sore throat, malaise b. tinnitus, severe diarrhea, ataxia c. occipital headache, palpitations, chest pain d. skin rash, marked rise in BP, bradycardia

b. tinnitus, severe diarrhea, ataxia

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be MOST APPROPRIATE for this client? a. chess b. writing c. ping pong d. basketball

b. writing Solitary activities that require a short attention span with mild physical exertion are the most appropriate activities for a client who is exhibiting aggressive behavior. Minimize stimuli and provide constructive release for tension. The remaining options involve others to participate, which is a risk for safety r/t aggressive social behavior.

A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern? a. "I don't believe this is true." b. "The guards are not out to kill you." c. "Do you feel afraid that people are trying to hurt you?" d. "What makes you think the guards were sent to hurt you?"

c. "Do you feel afraid that people are trying to hurt you?" It is most therapeutic to empathize with the client's experience. Focus on the emotions related to the delusion.

The nurse cares for a patient on the psychiatric unit who has been diagnosed with depression. Which of the following statements, if made by the patient to the nurse, would require IMMEDIATE intervention? a. "I believe I am feeling better." b. "I feel sad today." c. "I know that yesterday I felt sad, but today I feel great!" d. "Sometimes I think that I will never get better."

c. "I know that yesterday I felt sad, but today I feel great!" This sudden turn-around and complete 180 degree reversal may indicate suicidal thoughts and intentions and should be further assessed.

Which of the following statements is typical for a client diagnosed with a paranoid personality disorder? a. "I understand you're the one to blame." b. "I must be seen first; it's not negotiable." c. "I see nothing humorous in this situation." d. "I wish someone would select the outfit for me."

c. "I see nothing humorous in this situation." Clients with paranoid personality disorder tend to be extremely serious and lack a sense of humor.

A client diagnosed with antisocial personality disorder comes to a nurses' station at 11:00 p.m. requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing reply is most appropriate? a. "Go ahead and use the phone. I know this pending divorce is stressful." b. "You know better than to break the rules. I'm surprised at you." c. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow." d. "The decision to divorce should not be considered until you have had a good night's sleep."

c. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow." Because of the probability of manipulative behavior in this client population, it is imperative to maintain consistent application of rules.

A depressed client is prescribed citalopram hydrobromide. Six days later the client tearfully says to the nurse, "I'm taking an antidepressant, but it's not working. I'm hopeless." What is the best response by the nurse? a. "You feel hopeless." b. "It's easy to get discouraged." c. "It takes 2 or 3 weeks before it begins to relieve depression." d. "Give it a little more time; it works more slowly in some people."

c. "It takes 2 or 3 weeks before it begins to relieve depression." Informing the client about the expected response to the medication is factual information that may decrease the client's sense of hopelessness. Although empathic responses may be helpful, at this time the client needs information and reassurance based on fact. Citalopram hydrobromide does not work more slowly in some people.

A client with antisocial personality disorder was admitted in a unit at the local hospital. The newly admitted client stole money from an elderly patient on the unit. Which of the following is the most appropriate for the nurse to say to this client? a. "Why did you take the money?" b. "Let's talk about how you felt when you took the money." c. "The consequences of stealing are loss of privileges." d. "This client is defenseless against you."

c. "The consequences of stealing are loss of privileges." The most appropriate response is to reinforce the consequences of behavior that disregard the rights of others. Option A is incorrect because this client is likely to rationalize and excuse the behavior. Option B is also incorrect because the nurse should not encourage the client to provide excuses or explanations of behaviors that are clearly against the rules. A client with antisocial personality disorder is unlikely to have compassion for others and typically lacks respect for the rights of others.

A client whose husband dies 6 months ago is diagnosed with Major Depressive Disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? a. "Yes, he should have stopped smoking." b. "I can understand how you must feel." c. "Those feelings are a normal part of the grief response." d. "Just think about the good times that you had together."

c. "Those feelings are a normal part of the grief response."

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? a. "Why do you think we're observing you?" b. "What makes you think we're observing you?" c. "We're concerned that you might try to harm yourself." d. "We're following your primary healthcare provider's instructions, so there must be a reason."

c. "We're concerned that you might try to harm yourself." This answer is honest and helps establish trust. Also, it may help the client realize that the staff members care.

A client with antisocial personality is trying to convince a nurse that he deserves special privileges and that an exception to the rules should be made for him. Which of the following responses is the most appropriate? a. "I believe we need to sit down and talk about this." b. "Don't you know better than to try to bend the rules?" c. "What you're asking me to do is unacceptable." d. "Why don't you bring this request to the community meeting?"

c. "What you're asking me to do is unacceptable." These clients often try to manipulate the nurse to get special privileges or make exceptions to the rules on their behalf. By informing the client directly when actions are inappropriate, the nurse helps the client learn to control unacceptable behaviors by setting limits.

A client scheduled to begin electroconvulsive therapy (ECT) to treat severe depression that has not responded to any of the antidepressant medications tells the nurse, "I'm scared that I'll lose my memory forever after the treatment." What is the most therapeutic response by the nurse? a. "Your memory loss may be permanent, but usually it's just temporary." b. "You won't experience a permanent memory loss, so there's no need to be frightened." c. "You'll experience a temporary loss of memory, and feeling frightened about it is expected." d. "Your memory loss will be temporary, and it will help block out many of your painful past experiences."

c. "You'll experience a temporary loss of memory, and feeling frightened about it is expected." Giving the client simple facts and assuring the client that being frightened is expected may help ease the client's fears. Memory loss affects recently learned information such as the ECT experience; the response that it may be permanent may unnecessarily worry the client. Although it is a true statement that memory loss is not permanent and there is no need to worry, this response negates the client's feelings. ECT does not selectively block out painful experiences.

A nurse discusses job possibilities with a client with schizoid personality disorder. Which suggestion by the nurse would be helpful? a. "You can work in a family restaurant part-time on the weekend and holidays." b. "Maybe your friend could get you that customer service job where you work only on the weekends." c. "Your idea of applying for the position of filing and organizing records is worth pursuing." d. "Being an introvert limits the employment opportunities you can pursue."

c. "Your idea of applying for the position of filing and organizing records is worth pursuing." Clients with schizoid personality disorder prefer solitary activities, such as filing, to working with others.

The nurse is teaching a client who is receiving a monoamine oxidase inhibitor about dietary restrictions. The nurse plans to caution the client to avoid which foods? a. Pork, spinach, and fresh oysters b. Milk, grapes, and meat tenderizers c. Cheese, beer, and products with chocolate d. Leafy green vegetables, fresh apples, and ice cream

c. Cheese, beer, and products with chocolate Cheese, beer, and products with chocolate are high in tyramine, which in the presence of a monoamine oxidase inhibitor can cause an excessive epinephrine-type response that can result in a hypertensive crisis. There is no relationship between monoamine oxidase inhibitors and pork, spinach, oysters, milk, grapes, meat tenderizers, leafy green vegetables, apples, or ice cream.

Which of the following conditions is likely to coexist in clients with a diagnosis of borderline personality disorder? a. Avoidance b. Delirium c. Depression d. Disorientation

c. Depression Chronic feelings of emptiness and sadness predispose a client to depression. About 40% of the clients with borderline struggle with depression.

A patient diagnosed with bipolar disorder is hyperactive & manic after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate? a. Stop that! No one did anything to provoke an attack by you. b. If you do that one more time, you will be secluded immediately. c. Do not hit anyone. If you are unable to control yourself, we will help you. d. You know we will not let you hit anyone. Why do you continue this behavior?

c. Do not hit anyone. If you are unable to control yourself, we will help you. When the patient is unable to control her behavior & violates or threatens to violate the rights of others, limits must be set in an effort to de-escalate the situation. Limits should be set in simple, concrete terms.

Ralph is admitted to the hospital with the diagnosis of bipolar disorder, single manic episode. Which of the following behaviors would the nurse expect to assess? a. Apathy, poor insight, and poverty of ideas b. Anxiety, somatic complaints, and insomnia c. Elation, hyperactivity, and impaired judgment d. Social isolation, delusional thinking, and clang associations

c. Elation, hyperactivity, and impaired judgment A client with bipolar disorder, manic episode, would demonstrate flight of ideas and hyperactivity as part of the increased psychomotor activity. The mood is one of elation and the feeling is that one is invincible; therefore, judgment may be quite impaired.

The nursing staff is discussing the best way to develop a relationship with a new client who has antisocial personality disorder. What characteristic of clients with antisocial personality should the nurses consider when planning care? a. Engages in many rituals b. Independence of others c. Exhibits lack of empathy for others d. Possesses limited communication skills

c. Exhibits lack of empathy for others Self-motivation and self-satisfaction are of paramount concern to people with antisocial personality disorder, and they have little or no concern for others. Clients with obsessive-compulsive disorder, not antisocial personality disorder, engage in rituals. Individuals with antisocial personality disorder are extremely dependent on others; they count on others to extricate them from their problems. They are usually charming on the surface and can easily con people into doing what they want.

Which of the following interventions is important for a client with paranoid personality disorder taking olanzapine (Zyprexa)? a. Explain effects of serotonin syndrome b. Teach the client to watch for extrapyramidal adverse reactions c. Explain that the drug is less effective if the client smokes d. Discuss the need to report paradoxical effects such as euphoria.

c. Explain that the drug is less effective if the client smokes Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes. Note: the client should be made aware of adverse effects such as tardive dyskinesia.

A client has just been admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply. a. Increased libido b. Feels best early in the morning and worse as the day progresses c. Feelings of sadness and hopelessness d. Slumped posture e. Anorexia

c. Feelings of sadness and hopelessness d. Slumped posture e. Anorexia

The nurse should be aware of common side effects of SSRI antidepressants such as Prozac. Which side effects commonly occur in clients who are taking SSRI antidepressants? a. anticholenergic effects b. extrapyramidal side effects c. GI disturbances d. neuroleptic malignant effects

c. Gastrointestinal disturbances

A person is directing traffic on a busy street while shouting & making obscene gestures at passing cars. The person has not slept or eaten for 3 days. What features of mania are evident? a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficit and sad mood

c. Hyperactivity (directing traffic - a goal-oriented activity) & poor judgment (putting self in a dangerous position) are characteristic of manic episodes.

Which of the following types of behavior is expected from a client diagnosed with a paranoid personality disorder? a. Eccentric b. Exploitative c. Hypersensitive d. Seductive

c. Hypersensitive People with paranoid personality disorders are hypersensitive to perceived threats. Schizotypal personalities appear eccentric and engage in activities others find perplexing. Clients with narcissistic personality disorder are interpersonally exploitative to enhance themselves or indulge in their own desires. A client with histrionic personality disorder can be extremely seductive when in search of stimulation and approval.

The nurse is working with the family of a client with a personality disorder. Which of the following should the nurse encourage the family members to work on? a. Avoiding direct expressions of problems with family b. Changing Mary Ann's problem behaviors c. Improving self-functioning d. Supporting Mary Ann's defenses

c. Improving self-functioning Family members typically benefit from working on ways to improve self-functioning. This facilitates ownership of problems among individuals involved in ongoing relationship difficulties.

A client in the mental health clinic who has been seeing a therapist for more than 6 months begins to talk and act like a therapist who is analyzing coworkers. What defense mechanism does the nurse identify? a. Undoing b. Projection c. Introjection d. Intellectualization

c. Introjection Introjection is treating something outside the self as if it is actually inside the self; it is unconsciously incorporating the wishes, values, and attitudes of another as if they were one's own. Undoing is taking some action to counteract or make up for a wrongdoing. Projection is attributing to another person or group one's own unacceptable attitudes or characteristics. Intellectualization is using logical explanations without feelings or an affective component.

In evaluating the progress of Jack, a client diagnosed with antisocial personality disorder, which of the following behaviors would be considered the most significant indication of positive change? a. Jack got angry only once in group this week b. Jack was able to wait a whole hour for a cigarette without verbally abusing the staff c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight d. Jack stated that he would no longer start any more fights

c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight

A client scheduled for electro-convulsive therapy asks the nurse how the therapy helps relieve her depression. The nurse's response is based on an understanding that ECT: a. Increases the perception of external stimuli b. Decreases levels of cortisol from the adrenal cortex c. Produces a seizure that temporarily alters brain chemicals d. Eliminates the neurotransmitter acetylcholine

c. Produces a seizure that temporarily alters brain chemicals Electroconvulsive therapy produces a tonic-clonic seizure that temporarily increases brain chemicals, serotonin, dopamine, and norepinephrine. Other options are not true statements; therefore, they are incorrect.

Which of the following characteristics or situations is indicated when a client with borderline personality disorder has a crisis? a. Antisocial behavior b. Suspicious behavior c. Relationship problems d. Auditory hallucinations

c. Relationship problems Relationship problems can precipitate a crisis because they bring up issues of abandonment. Clients with borderline personality disorder aren't usually suspicious; they're more likely to be depressed or highly anxious.

When caring for a client with a diagnosis of schizotypal personality disorder, the nurse should: a. Set limits on manipulative behavior b. Encourage participation in group therapy c. Respect the client's needs for social isolation d. Understand that seductive behavior is expected

c. Respect the client's needs for social isolation These clients are withdrawn, aloof, and socially distant; allowing distance and providing support may encourage the eventual development of a therapeutic alliance. Group therapy would increase this client's anxiety; cognitive or behavioral therapy would be more appropriate.

Which of the following therapeutic communication skills is MOST likely to encourage a depressed client to vent feelings? a. Reality orientation b. Direct confrontation c. Silence, active listening d. Projective identification

c. Silence, active listening Use of therapeutic communication skills such as silence and active listening encourages verbalization of feelings.

An adult client with a borderline personality disorder become nauseated and vomits immediately after drinking after drinking 2 ounces of shampoo as a suicide gesture. The most appropriate initial response by the nurse would be to: a. Promptly notify the attending physician b. Immediately initiate suicide precautions c. Sit quietly with the client until nausea and vomiting subsides d. Assess the client's vital signs and administer syrup of ipecac

c. Sit quietly with the client until nausea and vomiting subsides This intervention demonstrates the nurse's caring presence which is vital for this client. (a) Although the treatment team does need to know about the event, notification is not the immediate concern. (b) This is premature and it reinforces the client's predisposition to manipulative behavior. (d) This medication is inappropriate in this situation; vomiting would be expected after the ingestion of shampoo

What is a therapeutic nursing action in the care of a depressed client? a. Playing a game of chess with the client b. Allowing the client to make personal decisions c. Sitting down next to the client at frequent intervals d. Providing the client with frequent periods of time for reflection

c. Sitting down next to the client at frequent intervals Be Present. 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.

What is most important for a nurse to do when initially helping clients resolve a crisis situation? a. Encourage socialization. b. Meet dependency needs. c. Support coping behaviors. d. Involve them in a therapy group.

c. Support coping behaviors. In a crisis situation, the individual frequently just needs support to regroup and re-establish the ability to cope.

A child with bipolar disorder also has attention-deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? a. No medication would be given for either condition b. Medication would be given for both conditions simultaneously c. The bipolar condition would be stabilized first before medication for the ADHD would be given d. The ADHD would be treated before consideration of the bipolar disorder

c. The bipolar condition would be stabilized first before medication for the ADHD would be given

Which of the following characteristics is expected for a client with paranoid personality disorder who receives bad news? a. The client is overly dramatic after hearing the facts b. The client focuses on self to not become over-anxious c. The client responds from a rational, objective point of view d. The client doesn't spend time thinking about the information.

c. The client responds from a rational, objective point of view Clients with paranoid personality disorder are affectively restricted, appear unemotional, and appear rational and objective.

Which statement about an individual with personality disorder is true? a. Psychotic behavior is common during acute episodes. b. Prognosis for recovery is good with therapeutic intervention c. The individual typically remains in the mainstream of society, although he has problems in social and occupational roles. d. The individual usually seeks treatment willingly for symptoms that are personally distressful.

c. The individual typically remains in the mainstream of society, although he has problems in social and occupational roles. An individual with a personality disorder usually is not hospitalized unless a coexisting Axis I psychiatric disorder is present. Generally, these individuals make marginal adjustments and remain in society, although they typically experience relationship and occupational problems related to their inflexible behaviors. Personality disorders are chronic, lifelong patterns of behavior; acute episodes do not occur. Psychotic behavior is usually not common, although it can occur in either schizotypal personality disorder or borderline personality disorder. Because these disorders are enduring and evasive and the individual is inflexible, prognosis for recovery is unfavorable. Generally, the individual does not seek treatment because he does not perceive problems with his own behavior. Distress can occur based on other people's reaction to the individual's behavior.

A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? a. Provide objective evidence, that violence is unwarranted. b. Initially restrain the client to maintain safety. c. Use clear, calm statements and a confident physical stance. d. Empathize with the client's paranoid perceptions.

c. Use clear, calm statements and a confident physical stance. PMAB - A calm attitude avoids escalating the aggressive behavior and provides the client with a feeling of safety and security. It may also be beneficial to have sufficient staff on hand to present a show of strength.

A nurse is caring for a client with antisocial personality disorder. What client characteristic should the nurse consider when formulating a plan of care? a. Suffers from extreme anxiety b. Rapidly learns by experience if punished c. Usually is unable to postpone gratification d. Has a great sense of responsibility toward others

c. Usually is unable to postpone gratification Individuals with antisocial personality disorder tend to be self-centered and impulsive. They lack judgment and self-control and are unable to postpone gratification. Generally they do not suffer from anxiety. These individuals believe that the rules do not apply to them, and they do not profit from their mistakes. These people are too self-centered to have a sense of responsibility to anyone.

A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit-and-run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. The nurse plans care based on which condition that should be the focus of the consult? a. psychosis b. repression c. conversion disorder d. dissociative disorder

c. conversion disorder A conversion disorder is the alteration or loss of a physical function that cannot be explained by any known pathophysiological mechanism. It is thought to be an expression of a psychological need or conflict.

DEFINE: mydriasis a. excessive sweating b. uncontrollable salivation or drooling c. dilation of the pupil d. intoxication caused by a prescription medication

c. dilation of the pupil Dilated pupils, which may occur normally or in response to a trauma, illness, or drugs. Examples include a dark room, sleep, fear, or medication side effects.

A manic client begins to make sexual advances toward visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens the nurse with physical violence. Which intervention should the nurse implement? a. place the client in seclusion for 30 minutes b. tell the client that the behavior is inappropriate c. escort the client to their room, with the assistance of other staff d. tell the client that their telephone privileges are revoked for 24 hours

c. escort the client to their room, with the assistance of other staff The client is at risk for injury to self and others and should be escorted out of the dayroom.

When the client receives fluoxetine (prozac), the nurse must explain the purpose and when to expect therapeutic effectiveness. when should the client begin to feel less depressed? a. 2-4 months b. 2-4 days c. 2-4 weeks d. 24 hours after taking the initial dose

c. generally within 2 to 4 weeks

What is the major action of SSRI antidepressants? a. enhance GABA b. potentiate serotonin and norepinephrine c. increase availability of serotonin d. stimulate the release of serotonin

c. increase availability of serotonin

Linda, age 68, is diagnosed with Bipolar I Disorder, current episode manic. She is extremely hyperactive and has lost weight. What is one way to promote adequate nutritional intake for the client? a. sit with her during meals to ensure that she eats everything on her tray. b. have her sister-in-law bring all her food from home because she knowns what Linda likes. c. provide high-calorie, nutritious finger foods and snacks that Linda can eat "on the run." d. tell Linda that she will be on room restriction until she starts gaining weight.

c. provide high-calorie, nutritious finger foods and snacks that Linda can eat "on the run."

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. tell the client she cannot wear this outfit while she is in the hospital b. do nothing, and allow her to learn from the responses of her peers c. quietly walk with her back to her room and help her change into something more appropriate d. explain to her that if she wears this outfit, she must remain in her room

c. quietly walk with her back to her room and help her change into something more appropriate

Maggie, age 68, is a widow of 6 months. Since her husband died, her sister reports that Maggie has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery. She told her sister that she "didn't have anything more to live for." She has been hospitalized with a diagnosis of Major Depressive Disorder. Which of the following is the PRIORITY nursing diagnosis for Maggie? a. imbalanced nutrition: less than body requirements b. complicated grieving c. risk for suicide d. social isolation

c. risk for suicide

The nurse is caring for a client admitted to the mental health unit who is diagnosed with catatonic stupor. The client is lying on the bed in the fetal position. Which is the most appropriate nursing intervention? a. ask direct questions to encourage talking b. leave the client alone so as to minimize external stimuli c. sit beside the client in silence with occasional open-ended questions d. take the client into the dayroom with other clients so that they can help watch them

c. sit beside the client in silence with occasional open-ended questions Clients who are withdrawn may be immobile and mute and may require consistent, repeated approaches. Communication with withdrawn clients requires much patience from the nurse. Interventions include the establishment of interpersonal contact. Between silence and occasional open-ended questions, pause to provide opportunities for the client to respond.

nurse progress notes: decreased social interaction, rarely talks, needs assistance to her room and appears confused. Slept only 30 minutes in the past 24 hours. Hx says she slept an average of 2 hours in the past week. Eating 50% of meals. According to this data, what is the priority nursing problem? a. disturbbed thought processes b. impaired social interaction c. sleep disturbance d. nutrition imbalance

c. sleep disturbance

Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? Select all that apply: A. Olanzepine (Zyprexa) B. Paroxetine (Paxil) C. Carbamazepine (Tegretol) D. Gabapentin (Neurontin) E. Tranylcypromine (Parnate)

correct answers: A. Olanzepine (Zyprexa) C. Carbamazepine (Tegretol) D. Gabapentin (Neurontin)

A client diagnosed with BPD often attempts to manipulate the staff to fulfill their own desires. Which of the following would be an example of manipulative behavior by the borderline client? Select all that apply: a. Asking Nurse Jones for cigarettes after 30 minutes, knowing the client's assigned nurse has explained they must wait 1 hour. b. Stating to Nurse Jones, "I really like having you for my nurse. You're the best one around here." c. Cutting arms with a razor blade after discussing discharge plans with the provider d. Refusing to stay in their room alone, stating, "It's so lonely."

correct answers: a. Asking Nurse Jones for cigarettes after 30 minutes, knowing the client's assigned nurse has explained they must wait 1 hour. b. Stating to Nurse Jones, "I really like having you for my nurse. You're the best one around here." c. Cutting arms with a razor blade after discussing discharge plans with the provider

A 20-year old college student has been brought to the psychiatric hospital by her parents. Her admitting diagnosis is borderline personality disorder. When talking with the parents, which information would the nurse expect to be included in the client's history? Select all that apply: a. Impulsiveness b. Lability of mood c. Ritualistic behavior d. Psychomotor retardation e. Self-destructive behavior

correct answers: a. Impulsiveness b. Lability of mood e. Self-destructive behavior

Sally is admitted to the hospital with Major Depressive Disorder and repeatedly makes negative statements about herself. Which of the following interventions is identified as an approach that promotes positive self-esteem in the patient? Select all that apply: a. Teach assertive communication skills b. Make observations to Sally when she completes a goal or task c. Instruct Sally that you will not talk with her unless she stops talking negatively about herself d. Offer to spend time with Sally using a nonjudgmental, accepting approach

correct answers: a. Teach assertive communication skills b. Make observations to Sally when she completes a goal or task d. Offer to spend time with Sally using a nonjudgmental, accepting approach

A client has just been admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply: a. slumped posture b. delusional thinking c. feelings of despair d. feels best early in the morning and worse as the day progresses e. anorexia

correct answers: a. slumped posture b. delusional thinking c. feelings of despair e. anorexia

The nurse asks Bethany to sign consent for treatment. If the client refuses treatment, which behaviors justify short-term involuntary treatment? Select all that apply: a. unable to meet basic self-care needs b. experiences auditory hallucinations c. lives alone and lacks social support d. prior hospitalization for depression e. states she has a plan to harm herself

correct answers: a. unable to meet basic self-care needs e. states she has a plan to harm herself

Although lithium has historically been the medication of choice for mania, other agents have been recently discovered to be effective. Which of the following medications are used in the treatment of bipolar disorder? Select all that apply: a. Olanzepine (Zyprexa) b. Oxycodone (OxyContin) c. Tranylcypromine (Parnate) d. Gabapentin (Neurontin) e. Carbamazepine (Tegretol)

correct answers: a. Olanzepine (Zyprexa) d. Gabapentin (Neurontin) e. Carbamazepine (Tegretol)

A patient is prescribed amitriptyline for the management of depression. When assessing the patient for adverse effects, which of the following questions should the healthcare provider ask? Select All That Apply: A. "Have you noticed that your mouth gets dry since you started taking this medication?" B. "Have you noticed any palpitations or irregular heartbeats?" C. "Is the regularity of your bowel movements changed since taking this medication?" D. "Have you experienced any unusual tingling feelings in your extremities?" E. "Do you ever get dizzy when you get up after you've been laying down for awhile?" F. "Have you noticed any visual changes such as blurring of your vision?"

correct answers: A, B, C, E, F Amitriptyline is a tricyclic antidepressant. Amitriptyline exerts its effects by increasing synaptic concentrations of serotonin and norepinephrine in the central nervous system, but it affects other parts of the body as well. Amitriptyline also blocks muscarinic cholinergic receptors and alpha-1 adrenergic receptors in blood vessels. By blocking alpha-1 adrenergic receptors in blood vessels, amitriptyline can cause orthostatic hypotension. By blocking muscarinic cholinergic receptors, amitriptyline can cause numerous anticholinergic effects such as constipation, urinary retention, blurred vision, and decreased vagal influence on the heart.

Emergency medical personnel bring a patient to the emergency department. The patient reports overdosing on sertraline (Paxil) in a suicide attempt. Which of these would the healthcare provider identify as consistent with serotonin syndrome? Select all that apply: A. Hypothermia B. Tachycardia C. Agitation D. Facial grimacing E. Gastrointestinal distress F. Muscle rigidity

correct answers: B, C, E, F Serotonin is a neurotransmitter that has numerous roles throughout the body. Serotonin syndrome is caused by overstimulation of serotonin receptors in the central and peripheral nervous systems. Clinical features of serotonin syndrome include agitation, diaphoresis, tachycardia, hypertension, hyperthermia, gastrointestinal distress, and hyperreflexia.

Treatment of depression includes which of the following modalities? Select all that apply: a. individual therapy b. group and family therapy c. cognitive therapy d. lobotomy e. light therapy f. psychopharmacology g. seclusion therapy

correct answers: a, b, c, e, f Treatment of depression includes individual therapy, group and family therapy, cognitive therapy, electroconvulsive therapy, light therapy, transcranial magnetic stimulation, and psychopharmacology.

The nurse is assessing a client who enters a walk-in mental health clinic. Which statements support an existent crisis situation? Select all that apply. a. "I feel so overwhelmed. I don't know what to do." b. "I feel very tense and irritable. I can't concentrate." c. "I have these vague feelings of uneasiness that come and go." d. "This has been building up slowly. I don't know what's causing it." e. "Nothing I have tried has helped the situation. It keeps getting worse."

correct answers: a, b, e Feelings of being overwhelmed are symptomatic of crisis. A crisis causes an increased level of anxiety that leads to adaptations of emotional distress and cognitive impairment. Crises occur when usual methods of coping are no longer effective. Crises are acute situations, not situations that come and go; they are associated with feelings of being overwhelmed, not vague feelings of uneasiness, and are precipitated by specific identifiable events.

You assess Mrs. Bennedict who has borderline personality disorder. Which of the following behaviors are common to this diagnosis? Select all that apply: a. Intense fear of being alone b. Evidence of self-mutilating attempts c. Evidence of suspiciousness and mistrust of others d. Indifferent attitude toward approval of criticism e. Unstable moods with impulsive behaviors f. Presence of odd mannerisms, speech, and behaviors

correct answers: a, b, e These are all common characteristics of an individual with borderline personality disorder. Suspiciousness and mistrust of others (option C) is characteristic of paranoid personality disorder. Option D and F are characteristic of someone with schizoid personality disorder, who is generally aloof in relationships and has unusual speech and mannerisms.

Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply: a. communicate expected behaviors to the client b. ensure that the client knows that they are not in charge of the unit c. assist the client in identifying ways of setting limits on personal behaviors d. follow through about the consequences of behavior in a nonpunitive manner e. enforce rules by informing the client that they will not be allowed to attend group therapy sessions f. have the client state the consequences for behaving in ways that are viewed as unacceptable

correct answers: a, c, d, f Interventions for a client exhibiting manipulative behavior should include setting clean, consistent, and enforceable limits on unacceptable behavior. Be clear with the client regarding the consequences of exceeding the limits set.

When a client with personality disorder begins demonstrating manipulative behavior, which of the following nursing actions are most appropriate? Select all that apply. a. Ask the client to think about the consequences of behavior. b. Allow the client time to perform specific rituals. c. Develop a consistent team approach to handle the client's behaviors. d. Help the client to express anxiety verbally rather than with specific symptoms. e. Provide immediate feedback concerning the client's specific behaviors. f. Set limits in a clear, direct manner.

correct answers: a, c, e, f These interventions allow the nurse to immediately confront the client's manipulative behavior and provide consistent structure (through limit-setting and team approach). Option B is appropriate for the client with obsessive-compulsive behavior; option D, for someone with somatization problem.

A nurse is planning care for a client diagnosed with bipolar disorder: current manic episode. In which order should the nurse prioritize the client outcomes? Client Outcomes: a. Maintains nutritional status b. Interacts appropriately with peers c. Remains free from injury d. Sleeps 6 to 8 hours a night

correct order: c, a, d, b safety, nutritional/fluid/electrolyte balance, sleep/rest needs, interpersonal relationships and appropriate behavior choices. Use Maslow's to address the hierarchy of needs.

A patient with antisocial personality disorder enters the private meeting room of a nursing unit as a nurse is meeting with a different patient. Which of the following statements by the nurse is BEST? a. "You may sit with us as long as you are quiet." b. "I'm sorry, but HIPPA says that you can't be here. Do you mind leaving?" c. "I need you to leave us alone." d. "Please leave and I will speak with you when I am done."

d. "Please leave and I will speak with you when I am done." For any patient with a personality disorder, it is best to be polite yet firm. Do not phrase it as a question or say "do you mind?"

The nurse is preparing a client with a history of command hallucinations for discharge by providing instruction on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? a. "The medications will help my anxious feelings." b. "I'll go to support groups and talk about what I am feeling." c. "I need to get enough sleep and eat well to help prevent anxious feelings." d. "When I have command hallucinations, I will call a friend or family member and ask them what I should do."

d. "When I have command hallucinations, I will call a friend or family member and ask them what I should do." The risk for impulsive and aggressive behavior may increase if a client is receiving command hallucinations to harm self or others. The nurse, HCP, or health care counselor should be contacted if the client is experiencing a hallucination, not a friend or family member. Assess whether the client has intentions to hurt self or others. Talking about auditory hallucinations can interfere with subvocal muscular activity associated with a hallucination.

During a period of hyperactivity a client on the psychiatric unit demands to be allowed to go downtown to shop. The client does not currently have privileges. How should the nurse respond? a. "You can't leave the unit, because you're too sick." b. "You'll have to ask your primary healthcare provider for permission to go." c. "You'll have to wait, because no staff member is available to go with you." d. "You don't have privileges to leave, but we can look through this new catalog."

d. "You don't have privileges to leave, but we can look through this new catalog." Clients who are hyperactive are easily diverted. It is best to use distraction rather than precipitate a confrontation. Telling the client that leaving will not be allowed ignores the client's wishes and offers no alternative behavior. Telling the client that the primary healthcare provider will have to be called shifts responsibility to the primary healthcare provider; the nurse should know that a shopping trip is unrealistic at this time.

A depressed client whose spouse recently died attends an inpatient group therapy session in which the nurse is a co-leader. When another client talks about being divorced and the resulting feelings of abandonment, the nurse notices that tears are running down the depressed client's face. What should the nurse do to support this client? a. Ask group members to return to discuss this client's feelings. b. Have another client stay and spend time talking with the client. c. Observe the client's behavior carefully during the next several hours. d. Accompany the client to his or her room and encourage a discussion of his or her feelings.

d. Accompany the client to his or her room and encourage a discussion of his or her feelings. Helping a client cope with unresolved grief involves assisting the client in expressing thoughts and feelings about the lost object or person as a necessary part of grief work.

The nurse knows that there are other risk factors for high blood pressure, which risk factor does Bethany have? a. depression b. decreased energy c. female d. African-American

d. African-American

A highly agitated client paces the unit & states, I could buy & sell this place. The clients mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this clients behavior? a. Rates mood 8/10. Exhibiting looseness of association. Euphoric. b. Mood euthymic. Exhibiting magical thinking. Restless. c. Mood labile. Exhibiting delusions of reference. Hyperactive. d. Agitated & pacing. Exhibiting grandiosity. Mood labile.

d. Agitated & pacing. Exhibiting grandiosity. Mood labile. The nurse should document that this clients behavior is Agitated & pacing. Exhibiting grandiosity. Mood labile. The client is exhibiting mood swings from euphoria to irritability. Grandiosity refers to the attitude that ones abilities are better than everyone else's.

A hospitalized client, diagnosed with a BPD, consistently breaks the unit's rules. This behavior should be confronted because it will help the client: a. Control anger b. Reduce anxiety c. Set realistic goals d. Become more self-aware

d. Become more self-aware

After several days of constant observation, the nurse reassesses the need to maintain safety precautions. What is the best predictor of client safety? a. Bethany reports feeling less depressed and sleeping better b. staff documentation that Bethany's mood is less depressed c. there are no items in Bethany's room to cause self-harm d. Bethany agrees to talk to the staff if she has thoughts of self-harm

d. Bethany agrees to talk to the staff if she has thoughts of self-harm

A nurse identifies the establishment of trust as a major nursing goal for a depressed client. How can this goal best be accomplished? a. By spending a day with the client b. By asking the client at least one question daily c. By waiting for the client to initiate the conversation d. By visiting frequently for short periods with the client each day

d. By visiting frequently for short periods with the client each day Frequent short visits with the client each day demonstrate to the client that the nurse feels that the client is worth spending time with and helps restore and build trust. Spending a day with the client may be impossible on a regular basis unless the client is potentially suicidal. Asking the client at least one question a day will do little to establish communication between the nurse and the client and may be seen as threatening. The depressed client may never speak to the nurse and, left alone, will withdraw even further.

A nurse is assisting with the administration of electroconvulsive therapy (ECT) to a severely depressed client. What side effect of the therapy should the nurse anticipate? a. Loss of appetite b. Postural hypotension c. Total memory loss d. Confusion immediately after the treatment

d. Confusion immediately after the treatment The electrical energy passing through the cerebral cortex during ECT results in a temporary state of confusion after treatment. Loss of appetite, postural hypotension, and total memory loss are not usual or expected side effects. Memory loss is usually restored after a few months of treatment.

Bethany is placed on constant observation for safety precautions, so the nurse must assign a staff member to remain with her at all times. Which staff member is best to assign to Bethany? a. RN b. a male UAP c. medication nurse d. a female UAP

d. Female unlicensed assistive personnel

A client with schizotypal personality disorder is sitting in a puddle of urine. She's playing in it, smiling, and softly singing a child's song. Which action would be best? a. Admonish the client for not using the bathroom b. Firmly tell the client that her behavior is unacceptable c. Ask the client if she's ready to get cleaned up now d. Help the client to the shower, and change the bedclothes.

d. Help the client to the shower, and change the bedclothes. A client with schizotypal personality disorder can experience high levels of anxiety and regress to childlike behaviors. This client may require help needing self-care needs. The client may not respond to the other options or those options may generate more anxiety.

Which statement about psychotherapeutic drugs in elderly clients requires correction? a. Tricyclic antidepressants may increase anxiety in elderly clients. b. Normal dosage of lithium may result in lithium toxicity in elderly clients. c. Elderly clients on antipsychotic drugs are susceptible to orthostatic hypotension. d. Low serum levels of the drug are reported in elderly clients on psychotherapeutic drugs

d. Low serum levels of the drug are reported in elderly clients on psychotherapeutic drugs High serum levels are recorded in elderly clients on psychotherapeutic drugs. Instead of decreasing the anxiety, tricyclic antidepressant drugs may increase the anxiety in older adults. Normal dosage of lithium may result in lithium toxicity in elderly clients, thus necessitating the need to administer low doses of the drug. Orthostatic hypotension, anticholinergic adverse effects, sedation, and extrapyramidal symptoms are more common in elderly clients taking psychotherapeutic drugs.

Mrs. B is diagnosed with borderline personality disorder has a nursing diagnosis of Risk for self-directed violence, which is related to the client's self mutilation behavior (burning arms with cigarettes). Which client behavior would indicate a positive outcome of intervention? a. Mrs. B denies feelings of wanting to harm anyone. b. Mrs. B expresses feelings of anger towards others. c. Mrs. B requests cigarettes at appropriate times. d. Mrs. B tells the nurse about wanting to burn herself

d. Mrs. B tells the nurse about wanting to burn herself The fact that Mrs. B directly tells the nurse about wanting to self-mutilate, rather than acting on these feelings, is evidence of her responding to nursing intervention

A nurse notices that a client is mistrustful and shows hostile behavior. Which of the following types of personality disorder is associated with these characteristics? a. Antisocial b. Avoidant c. Borderline d. Paranoid

d. Paranoid Paranoid individuals have a need to constantly scan the environment for signs of betrayal, deception, and ridicule, appearing mistrustful and hostile. They expect to be tricked or deceived by others.

A nurse takes into consideration that the key factor in accurately assessing how a client will cope with body image changes is what? a. Suddenness of the change b. Obviousness of the change c. Extent of the change d. Perception of the change

d. Perception of the change It is not the reality of the change, but the client's feeling about the change, that is most important in determining a client's ability to cope. Although the suddenness, obviousness, and extent of the body change are relevant, they are not as significant as the client's perception of the change.

According to Margaret Mahler, predisposition to borderline personality disorder occurs when developmental tasks go unfulfilled in which of the following phases? a. Autistic phase, during which the child's needs for security and comfort go unfulfilled b. Symbiotic phase, during which the child fails to bond with the mother c. Differentiation phase, during which the child fails to recognize a separateness between self and mother d. Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence

d. Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence The period of rapprochement spans the ages of approximately fifteen to twenty-four months and is characterized behaviorally by an active approach back to the caregiver. Children begin to realize the limits of their omnipotence and have a new awareness of their separateness and the separateness of the caregiver.

The nurse is working with clients who have personality disorders. Which of the following techniques would the nurse use to deal with her own feelings that interfere with therapeutic performance? a. Active listening techniques b. Challenging the client's assertions c. Forming social relations d. Seeking peer or supervisor direction

d. Seeking peer or supervisor direction The nurse is likely to have strong reactions to clients with personality disorders, especially those who display intense emotions and manipulative behaviors. Seeking the direction of peers and supervisors can help clarify issues and determine the best nursing responses to difficult behaviors.

When working with the nurse during the orientation phase of the relationship, a client with a borderline personality disorder would probably have the most difficulty in: a. Controlling anxiety b. Terminating the session on time c. Accepting the psychiatric diagnosis d. Setting mutual goals for the relationship

d. Setting mutual goals for the relationship Clients with borderline personality disorders frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals.

Carol is a nurse who was floated to the psychiatric unit to cover for a staff nurse who called out sick. She encounters a patient who is diagnosed with BPD, and the patient states "Thank goodness they sent you to the unit. No one else here has taken the time to listen to my concerns." This may be an example of which symptom common in BPD? a. Impulsivity b. Self-harming behaviors c. Dissociation d. Splitting

d. Splitting

A nurse identifies that a client seems to be depressed after a thymectomy for treatment of myasthenia gravis. Which nursing action is most appropriate at this point? a. Recognize that depression often occurs after surgery b. Ask the primary healthcare provider to arrange for a psychologic consultation c. Reassure the client that things will feel better after the discharge date has been set d. Talk with the client about the prognosis and emphasize activities the client is still able to perform

d. Talk with the client about the prognosis and emphasize activities the client is still able to perform Honest discussion with emphasis on functional and psychologic abilities helps promote adjustment. Postoperative depression is not a characteristic feature of thymectomy. Asking the client's practitioner to arrange for a psychologic consultation is too soon; it may eventually be necessary if the client has difficulty adjusting to the chronicity of this condition.

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) & olanzapine (Zyprexa). The clients spouse questions the Zyprexa order. Which is the appropriate nursing response? a. Zyprexa in combination with Eskalith cures manic symptoms. b. Zyprexa prevents extrapyramidal side effects. c. Zyprexa increases the effectiveness of the immune system. d. Zyprexa calms hyperactivity until the Eskalith takes effect.

d. The nurse should explain to the clients spouse that olanzapine can calm hyperactivity until the lithium carbonate takes effect. Lithium carbonate may take 1 to 3 weeks to begin to decrease hyperactivity. Monotherapy with the traditional mood stabilizers like lithium carbonate, or atypical antipsychotics like olanzapine, has been determined to be the first-line treatment for bipolar I disorder.

Which of the following situations on a psychiatric unit are an example of a trusting patient-nurse relationship? a. The nurse gives the patient his daily medications right on schedule. b. The nurse offers to contact the doctor if the patient has a headache. c. The nurse enforces rules strictly on the unit. d. The patient tells the nurse that he feels suicidal.

d. The patient tells the nurse that he feels suicidal. The trusting relationship between the patient and nurse means that the patient feels he can express his feelings in a safe environment.

The nurse cares for a client diagnosed with bipolar disorder on the psychiatric unit. Which of the following, if noted by the nurse, is an unexpected outcome for this patient? a. The patient refrains from inappropriate behavior on the unit. b. The patient is able to sit and eat a meal for a period of five minutes at a time. c. The patient sleeps four hours per night and complains of insomnia. d. The patient's migraine headaches disappear.

d. The patient's migraine headaches disappear. Migraine headaches that disappear are good for the patient, yet have nothing to do with bipolar disorder and is therefore an unexpected outcome. Approach each answer as if it were a True or False question. IF the answer is true, then it's not the answer to select. If the answer is false, it meets the criteria for a negative-answer question asking for an "unexpected" outcome, one that is not true for the disorder in the scenario.

Which drugs are considered typical antipsychotics? Select all that apply: a. Asenapine b. Lurasidone c. Aripiprazole d. Thioridazine e. Chlorpromazine

d. Thioridazine e. Chlorpromazine First-generation antipsychotic drugs are also known as typical/conventional antipsychotics. Thioridazine and chlorpromazine are typical antipsychotics. Asenapine, lurasidone, and aripiprazole are atypical antipsychotics, also known as second-generation antipsychotics.

Education for the client who is taking MAOIs should include which of the following? a. Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity. b. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks. c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment. d. Tyramine-restricted diet, prohibitive concurrent use of over the counter medications without physician notification.

d. Tyramine-restricted diet, prohibitive concurrent use of over the counter medications without physician notification.

What characteristic uniquely associated with psychophysiologic disorders differentiates them from somatoform disorders? a. Emotional cause b. Feeling of illness c. Restriction of activities d. Underlying pathophysiology

d. Underlying pathophysiology The psychophysiologic response (e.g., hyperfunction or hypofunction) produces actual tissue change. Somatoform disorders are unrelated to organic changes. There is an emotional component in both instances. There is a feeling of illness in both instances. There may be a restriction of activities in both instances.

A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? a. encourage quiet reading and writing for the first few days b. identification of physical activities that will provide exercise c. no socializing activities, until the client asks to participate in milieu d. a structured program of activities in which the client can participate

d. a structured program of activities in which the client can participate A client with depression often is withdrawn while experiencing difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness and poor self esteem. The plan of care needs to provide successful experiences in a stimulating yet structured environment.

Which of the following is the most common comorbid condition in children with bipolar disorder? a. schizophrenia b. substancedisorder c. oppositional defiant disorder d. attention deficit/hyperactivity disorder

d. attention deficit/hyperactivity disorder ADHD

The nurse cares for a client diagnosed with conversion reaction. The nurse identifies the client is utilizing which of the following defense mechanisms? a. introjection b. displacement c. identification d. repression

d. repression The patient is repressing their stressful thoughts and converting them into a physical symptom (conversion reaction).

Kim has a diagnosis of Borderline Personality Disorder. She often exhibits alternating clinging and distancing behaviors. Which of the following is the most appropriate nursing intervention with this type of behavior? a. encourage Kim to establish trust in one staff person, with whom all therapeutic interaction should take place. b. secure a verbal contract from Kim that she will discontinue these behaviors. c. withdraw attention if these behaviors continue d. rotate staff members who work with Kim so that she will learn to relate to more than one person

d. rotate staff members who work with Kim so that she will learn to relate to more than one person

A nurse is educating a client about their lithium therapy. The nurse is explaining signs and symptoms of lithium toxicity. Which of the following symptoms of toxicity would the nurse instruct the client to report immediately? a. Occipital headache, palpitations, jaw pain b. Fever, sore throat, malaise c. Skin rash, rise in blood pressure, bruising d. Tremors, severe diarrhea, ataxia

d. tremors, severe diarrhea, ataxia

Since Bethany is eating 50% of her meals, which priority nursing intervention should be included on the treatment plan? a. assess appetite daily b. include double portions of food during meals c. consult the unit dietician d. weigh weekly and document

d. weigh weekly and document

The nurse reports the high blood pressure to the HCP and hydrochlorothiazide (Hydro-chlor) is prescribed for 25 mg daily. The dietician is consulted about the client's meal plan. Which dietary instruction should the nurse provide the client taking Hydro-chlor?

decrease sodium and increase potassium

Which specific nursing consideration is most important?

maintain a low tyramine or tyramine-free for 10-14 days

Bethany King is a 52-year-old, Black, widowed female who is accompanied to the Emergency Department (ED) by her daughter. The client's grooming and hygiene are fair, but her overall appearance is disheveled. Bethany's motor activity is slow, she rarely makes eye contact, and her responses to questions are slow and barely audible. When asked what she prefers to be called, she replies, "I don't care."

scenario details for reference only - no answer required.