PP RNSG 1538 Mood and Affect Mastery Quiz

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

"It is okay to double my next dose of lithium if I forget a dose."

After the nurse teaches a client with bipolar disorder about lithium therapy, which client statement indicates the need for additional teaching?

Expansive and grandiose

On admission to the psychiatric unit, a client is dressed in a red leotard and an exercise bra and has an assortment of chains and brightly colored scarves on her head, waist, wrists, and ankles. The client shakes the nurse's hand and says cheerfully, "We need to become better acquainted. I have the world's greatest intellect, and you are probably an intellectual midget." How can the nurse document the client's mood in her assessment?

A client with borderline personality disorder who has acted on suicidal ideation, and has cut herself

Which client would require one-on-one contact with a staff member?

depression.

A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with:

Respect the client's need for personal space and avoid physical contact with the client.

A client was admitted with a diagnosis of schizophrenia and exhibiting behaviors of hostility, paranoia and isolation. The student nurse discussed with the nurse what the most therapeutic approach to take with the client would be. Which of the following would indicate to the nurse that the student understands the best approach?

allow privacy, but check on the client frequently.

A client with a history of post-traumatic stress is found in his room panting and breathing heavily while shouting out some strange words. The nurse reviews the nursing assessment and understands that the client is practicing a form of relaxation called power breathing. The best action for the nurse to take is to:

Excuse oneself while telling the client to come to the dining room for lunch.

A client with acute mania exhibits euphoria, pressured speech, and flight of ideas. The client has been talking to the nurse nonstop for 5 minutes and lunch has arrived on the unit. What should the nurse do next?

"Telling sexual jokes and touching others is not permitted here."

A nurse observes a male client who is hyperactive and intrusive sitting very close to a female client with his arm around her shoulders. The nurse hears the male client tell a sexually explicit joke. The nurse approaches the client and asks him to walk down the hallway. Which statement by the nurse should benefit the client?

Ask the client whether she has any thoughts of hurting herself or her baby.

The nurse phones a client after 8 weeks postpartum to conduct a postpartum depression screen. The client states that she isn't enjoying the baby. She resents the baby due to the attention he receives from her husband. She has been unable to sleep and is overwhelmed with caring for her baby. What is the most appropriate immediate action from the nurse?

sleeps through the night, eats 80% of her meals, and is out of bed.

A nurse is caring for a client with severe depression. The client reports changes in appetite and sleep pattern and has lost her job because of the effects of her depression. The client has two young children at home and states, "I just wish things could be like they were. I feel so helpless that I can't even get out of bed in the morning." The physician has ordered electroconvulsive therapy (ECT) for the client in addition to her current antidepressant medications. A nurse evaluates the ECT therapy as effective when the client:

Engaging the client in reality-based conversations

A nurse is caring for a client with schizoaffective disorder. The client is currently experiencing auditory hallucinations. Which of the following nursing actions would take first priority for this client?

Making observations

During therapy, a client on the mental health unit is restless and is starting to make sarcastic remarks to others in the therapy session. The nurse responds by saying, "you look angry." Which of the following communication techniques is the nurse using?

Ensuring that the client is not permitted to use anything that would be potentially dangerous

A client hospitalized for depression remains extremely depressed and expresses increasing suicidal ideation to her primary nurse. What should be the nurse's priority intervention?

emotional lability

A client receiving dialysis directs profanities at the nurse and then abruptly hangs his head and pleads, "Please forgive me. Something just came over me. Why do I say those things?" The nurse interprets this as which finding?

"You feel like a failure; would you like to talk more about the way you feel?"

A client states the following to the nurse: "I am a failure, and I wish I had died." Which of the following statements by the nurse demonstrates a therapeutic response?

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

A client taking paroxetine 40 mg PO every morning tells the nurse that her mouth "feels like cotton." Which statement by the client necessitates further assessment by the nurse?

Discuss thoughts and explore intent for suicide with the client.

A depressed client on a psychiatric unit asks the nurse to call the hospital lawyer to discuss writing out a will. What is the nurse's priority intervention?

Notify the wife that she may be in danger.

A nurse on the crisis team in the emergency department is caring for a client who is angry and is experiencing delusional episodes. The client says to the nurse, "I'm going to kill my wife and chop her up to get rid of her." What is the nurse's priority action in this situation?

alcohol

While a client is taking alprazolam, which food should the nurse instruct the client to avoid?

Risk for suicide related to depressed mood

An adolescent client, diagnosed with depression and a suicide attempt, is admitted to an inpatient adolescent psychiatric unit. The nurse documents that "the client describes a recent breakup of a dating relationship with an emotionless tone and a flat facial expression." Which nursing diagnosis would be a priority in the client's plan of care?

There will be simultaneous treatment of the addiction and depression.

A client diagnosed with major depression and substance dependence is being admitted to the concurrent disorder treatment unit. In explaining the focus of this program, the nurse should tell what information to the client?

The client's sudden improvement calls for close observation by the staff.

A client was admitted to the inpatient unit 3 days ago with a flat affect, psychomotor retardation, anorexia, hopelessness, and suicidal ideation. The health care provider (HCP) prescribed 75 mg of venlafaxine extended release to be given every morning. The client interacted minimally with the staff and spent most of the day in his room. As the nurse enters the unit at the beginning of the evening shift, the client is smiling and cheerful and appears to be relaxed. What should the nurse interpret as the most likely cause of the client's behavior?

A preoccupation with death

A nurse is assessing a severely depressed adolescent. Which finding indicates a risk of suicide?

Disturbed thought processes

At shift change, the oncoming staff nurse is unable to locate a client with bipolar disorder on an unlocked medical-surgical health unit. The nurse reports the client missing. Two hours later, the police, who found the client swimming in the local creek in a hospital gown, return the client to the hospital. The client states he was "being baptized by Mother Nature, who loves and worships me." What is the nurse's priority nursing diagnosis?

"Beer contains tyramine, which must be avoided when on this medication."

During the discharge planning teaching process, a client who has been prescribed tranylocypromine states that he enjoys a beer or two in the evenings. Which of the following is the nurse's most appropriate response?

clean tables

The client with mania is skipping up and down the hallway, nearly running into other clients. The nurse should include which activity in the client's plan of care?

an exaggerated sense of well-being

The nurse assesses for euphoria in a client with multiple sclerosis, looking for what characteristic clinical manifestation?

"I believe that my sadness affects my work and feelings."

The nurse has been teaching a client about depression. Which statement indicates insight into the client's diagnosis?

Orient the client to the surroundings.

The nurse is caring for a client immediately after receiving electroconvulsive therapy for the treatment of severe depression. What is a priority intervention for this client?

Closely monitor the client's eating and sleeping habits.

The nurse is caring for a client with bipolar disorder who was recently admitted to an inpatient unit and is experiencing a manic episode. What is a priority nursing intervention for this client?

most likely related to low thyroid hormone levels and will improve with treatment.

When discussing recent onset of feelings of sadness and depression in a client with hypothyroidism who has just started to take thyroid hormone replacement, the nurse should inform the client that these feelings are:

Use a caring approach to maintain close observation of the client

The nurse is developing a plan of care for a hospitalized client who is at risk for suicide. What is the most important intervention for the nurse to include?

empathetic

The nurse is teaching a group of unlicensed assistive personnel (UAP) about providing care to clients with depression. Which approach by one of the UAPs indicates an understanding of the most effective approach to a depressed client?

Obtain an order for the client to have a white blood cell count drawn.

The nurse is working in a community mental health clinic. A client who is diagnosed with schizophrenia is taking clozapine and reports of a sore throat. What is the most appropriate action for the nurse to take?

Ensuring relevance to, and quickly refocusing upon, the client's experience

The nurse is working with a client with depression in a mental health clinic. During the interaction, the nurse uses the technique of self-disclosure. In order for this technique to be therapeutic, which of the following steps must be a priority for the nurse?


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