Mood Adjustment & Dementia-NCLEX 3000
The son of a client with Alzheimer's disease reports feeling guilty because, at times, he wishes his father would die. What would be the most appropriate response?
"Being responsible for your father's care must be difficult."
A client with a diagnosis of major depression is prescribed clonazepam (Klonopin) for agitation in addition to an antidepressant. Client teaching would include which statement?
"Clonazepam is a minor depressant and may aggravate symptoms of depression."
A geriatric client with Alzheimer's disease has been living with his grown child's family for the last 6 months. He wanders at night and needs help with activities of daily living. Which statement by his child suggests that the family is successfully adjusting to this living arrangement?
"Dad has presented many challenges. We have alarms on all the outside doors now. Respite care gives us a break."
Which statement should be included when teaching clients about monoamine oxidase (MAO) inhibitors?
"Don't take prescribed or over-the-counter medications without consulting the physician."
A client is admitted to the hospital with severe depression after her husband left her. The nurse suspects that the client is at risk for suicide. Which question would be appropriate and helpful for the nurse to ask to evaluate suicide risk?
"How do you think you would kill yourself?"
The daughter of a client diagnosed with Alzheimer's disease tells a nurse, "My mother is incompetent. You'll need to contact me or my sister if any decision must be made about my mother's care." Which response by the nurse is best?
"I must respect your mother's rights until she is legally deemed incompetent."
The nurse is talking with a client who recently attempted suicide. The client asks her not to tell anyone about their conversation. How should the nurse respond?
"I'll need to share information with the rest of your health care team if it's important to your care."
A client, age 42, with antisocial personality disorder brags to the nurse about his counseling abilities. He also says he is starting a relationship with a 15-year-old girl who was recently admitted to the psychiatric unit. When the nurse expresses concern about this, he accuses the nurse of being hostile and threatens to get the nurse in trouble for interfering. Which response by the nurse would be most appropriate?
"If you continue to spend time with her, you will be restricted from the activities area."
During the client-teaching session, which instruction should the nurse give to a client receiving the selective serotonin reuptake inhibitor paroxetine (Paxil)?
"Include high-fiber foods in your diet."
How should a nurse respond to a psychiatric client who complains of constipation after taking a new medication?
"Increasing your fluid and fiber intake will help relieve the constipating effects of your medications."
A 20-year-old client who is receiving sertraline (Zoloft) 50 mg once a day for depression complains that she feels no better after taking three doses of the drug. Which response by the nurse is best?
"Sertraline typically takes at least 2 weeks to become effective."
A depressed client tells the nurse, "I want to die. Life just isn't worth living." Which response by the nurse would be most appropriate?
"This must be a very difficult time for you."
On admission to the psychiatric unit, a client with major depression reports that a family member is physically abusive and requests that the nurse not release any personal information to anyone. When the allegedly abusive family member calls the unit and demands information about the client's treatment, what is the nurse's best response?
"To protect clients' confidentiality, I can't give any information, including whether your relative is receiving treatment here."
A client with Alzheimer's disease says, "I'm so afraid. Where am I? Where is my family?" How should the nurse respond?
"You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is 1 hour from now."
One day after being admitted with bipolar disorder, a client becomes verbally aggressive during a group therapy session. Which response by the nurse would be therapeutic?
"You're disturbing the other clients. I'll walk with you around the patio to help you release some of your energy."
(SELECT ALL THAT APPLY) A client is prescribed sertraline (Zoloft), a selective serotonin reuptake inhibitor. Which adverse effects would the nurse include in the medication teaching plan?
(1) Agitation, (3) Sleep disturbance, (5) Dry mouth
(SELECT ALL THAT APPLY) The nurse is collecting data on a client to determine whether he is suffering from dementia or depression. Which findings indicate dementia?
(1) The progression of symptoms is slow., (4) The family can't identify when the symptoms first appeared., (5) The client's basic personality has changed., (6) The client has great difficulty paying attention to others.
The nurse is caring for a client diagnosed with antisocial personality disorder. The client has a history of fighting, cruelty to animals, and stealing. Which trait would the nurse be likely to uncover during data collection?
A low tolerance for frustration
The nurse is caring for a client with delirium. Which of the following is most important for the nurse to provide the client?
A safe environment
After taking an overdose of phenobarbital (Barbita), a client is admitted to the emergency department. Which drug should the nurse anticipate the physician will prescribe to reverse the effects of this drug?
Activated charcoal
A client with gradually occurring global impairments of cognitive functioning, memory, and personality is most likely to have:
Alzheimer's-type dementia.
Which characteristic is most common among suicidal clients?
Ambivalence
An adolescent who is depressed and whose parents report as having difficulty in school is brought to the community mental health center to be evaluated. Which additional problem would the nurse expect the client to have?
Behavioral difficulties
When monitoring a client receiving amitriptyline (Elavil) therapy, the nurse should be alert for which potentially life-threatening adverse effect?
Cardiac arrhythmias
Which foods are contraindicated for a client taking tranylcypromine (Parnate)?
Chicken livers, Chianti wine, and beer
An hour after an elderly client eats, he complains that he hasn't been fed. How should the nurse document this finding?
Client displays impaired short-term memory.
A 54-year-old female was found unconscious on the floor of her bathroom with self-inflicted wrist lacerations. An ambulance was called and the client was taken to the emergency department. When she was stable, the client was transferred to the inpatient psychiatric unit for observation and treatment with antidepressants. Now that the client is feeling better, which nursing intervention is the first priority?
Continue suicide precautions.
A client is brought to the emergency department after ingesting a handful of unknown pills. Which action is the priority when collecting data on a suicidal client?
Determining whether the client's physical condition is life-threatening
A nurse is caring for a 65-year-old client with depression who was recently prescribed amitriptyline (Elavil) 25 mg daily at bedtime. The nurse should instruct the client to report which adverse reaction to the drug?
Dizziness when rising from a lying position
The physician orders electroconvulsive therapy (ECT) for a severely depressed client who fails to respond to drug therapy. When teaching the client and family about this treatment, the nurse should include which point?
ECT will induce a seizure.
The nurse is collecting data on a client who has just been admitted to the emergency department. Which data would suggest an overdose of an antianxiety agent?
Emotional lability, euphoria, and impaired memory
A mother of three small children is admitted to the psychiatric unit with severe depression. She tells a nurse that she has no reason to live and would "be better off dead." Which intervention by the nurse would best support the client at this time?
Encourage the client to express her feelings.
A 76-year-old client is admitted to a long-term care facility with Alzheimer's-type dementia. The client has been wearing the same dirty clothes for several days. The nurse contacts the family and asks them to bring in clean clothing. Which intervention would best prevent further regression in the client's personal hygiene?
Encouraging the client to perform as much self-care as possible
The nurse is caring for a client in the manic phase of bipolar disorder who's ready for discharge from the psychiatric unit. As the nurse begins to terminate the nurse-client relationship, which client response is most appropriate?
Expressing feelings of anxiety
A client with major depression frequently is irritable, abrasive, and uncooperative and refuses to participate in group activities. When working with this client, the nurse should use which approach?
Firmness
A professional artist is admitted to the psychiatric unit for treatment of bipolar disorder. During the last 2 weeks, the client has created 154 paintings, slept only 2 to 3 hours every 2 days, and lost 18 lb (8.2 kg). Based on Maslow's hierarchy of needs, what should the nurse provide this client with first?
Help with reestablishing a normal sleep pattern
Which nursing action is most appropriate when trying to diffuse a client's impending violent behavior?
Helping the client identify and express feelings of anxiety and anger
The nurse is monitoring a client receiving tranylcypromine sulfate (Parnate). Which serious adverse reaction can occur with high dosages of this monoamine oxidase (MAO) inhibitor?
Hypertensive crisis
A 22-year-old client is diagnosed with dependent personality disorder. Which behavior is most likely to be evidence of ineffective individual coping?
Inability to make choices and decisions without advice
A client is prescribed lithium (Eskalith) to treat bipolar disorder. Which point should the nurse include when developing a teaching plan for this client?
Increase fluid intake to 2.5 to 3 L daily.
A client is presented with the treatment option of electroconvulsive therapy (ECT) . After discussing the treatment with the staff, the client requests that a family member come in to help him decide whether or not to undergo this treatment. Which document must the client sign before undergoing ECT?
Informed consent
An extremely agitated client is brought to the psychiatric unit by her husband. He reports that she has been hospitalized several times for treatment of bipolar disorder and has spent thousands of dollars in the past week. The psychiatrist admits her to the unit for treatment of exacerbation of the manic phase of bipolar disorder. Which approach by the nurse would best promote a therapeutic relationship with this client?
Maintaining a firm but nonthreatening manner
A client who was attempting to carry out a suicide plan is admitted to the unit. Which nursing intervention is the highest priority for this client?
Making sure that a health care team member stays with the client
For which adverse reaction should the nurse monitor a client during the initial phase of lithium carbonate (Lithonate) therapy?
Nausea and vomiting
During the manic phase of bipolar disorder, the client dresses flamboyantly, acts provocatively, and has seriously impaired judgment. What is the nurse's priority when planning this client's care?
Observe the client's behavior closely in the milieu.
A client chronically complains of being unappreciated and misunderstood by others. She is argumentative and sullen. She always blames others for her failure to complete work assignments. She expresses feelings of envy toward people she perceives as more fortunate. She voices exaggerated complaints of personal misfortune. The client most likely suffers from which personality disorder?
Passive-aggressive personality
A client with bipolar disorder is being treated with lithium for the first time. The nurse should observe the client for which early adverse effect of lithium?
Polyuria
The nurse is caring for a client in an acute manic state. What is an effective nursing action for this client?
Reducing his stimulation
The nurse is caring for a client who has been diagnosed with hypochondriasis. The client attributes his cough to tuberculosis. A chest X-ray and skin test are negative for tuberculosis. The client begins to complain about the sudden onset of chest pain. How should the nurse react initially?
Report the complaint of chest pain to the physician.
An emergency department nurse is assessing a 28-year-old client who complains of back pain, migraine headache, and feelings of generalized fatigue. The client's medical record indicates that she has had multiple emergency department visits with the same complaints since her abusive husband left her. Based on these findings, the client most likely has with which disorder?
Somatization disorder
A client experiences major depression after a stroke. The physician prescribes venlafaxine (Effexor) extended-release capsules by mouth, once daily. The client has difficulty swallowing pills since his stroke. How should the nurse intervene?
Sprinkle the contents of the capsule over applesauce and administer it to the client.
What herbal preparation for depression, widely used in Europe, is now being used by many clients in the United States?
St. John's wort
Which drug should the nurse expect to administer to a client with Alzheimer's disease?
Tacrine (Cognex)
A client is a Vietnam War veteran with a diagnosis of posttraumatic stress disorder (PTSD). He has a history of nightmares, depression, hopelessness, and alcohol abuse. Which option offers the client the most lasting relief of his symptoms?
The opportunity to verbalize memories of trauma to a sympathetic listener
Dextroamphetamine (Dexedrine) has been ordered for a client diagnosed with narcolepsy. The nurse understands that this medication acts as:
a CNS stimulant.
A depressed client in the psychiatric unit hasn't been getting adequate rest and sleep. To encourage restful sleep at night, the nurse should:
gently but firmly set limits on time spent in bed during the day.
The nurse is caring for a client with manic depression. The plan of care for a client in a manic state would include:
listening attentively with a neutral attitude and avoiding power struggles.
The nurse is caring for a client who's suicidal. When accompanying the client to the bathroom, the nurse should:
observe him.
A client is in the manic phase of bipolar disorder. To help the client effectively maintain adequate nutrition, the nurse should plan to:
offer finger foods and sandwiches.
A client, age 20, is being treated for depression. During a conversation with the nurse, she states that her father raped her when she was 7 years old. She says she has nightmares about the experience and sometimes relives it. She also reveals that she fears older men. The client may be exhibiting signs of:
posttraumatic stress disorder (PTSD), delayed onset.
A client is newly diagnosed with Alzheimer's disease. When planning the client's care, the nurse should focus on:
providing a safe, structured environment.
A client is in the first stage of Alzheimer's disease. The nurse should plan to focus this client's care on:
providing emotional support and individual counseling.
A client diagnosed with depression tells the nurse that she won't allow herself to cry, "because it upsets the whole family when I cry." This is an example of:
rationalization.
A client with depression doesn't respond to drug therapy. At a team conference, staff members recommend electroconvulsive therapy (ECT). The nurse knows that most people respond negatively to the thought of an electric current passing through the brain. Therefore, when discussing ECT with the client, the nurse should:
refer to the procedure as a "treatment" instead of "shock therapy."
A client in the manic phase of bipolar disorder arrives at the outpatient psychiatric clinic. To help the client manage a manic episode, the nurse should suggest that she:
reorganize a kitchen cabinet.
The major goal of therapy in crisis intervention is to:
resolve the immediate problem.
An adolescent becomes increasingly withdrawn, is irritable with family members, and has been getting lower grades in school. After giving away a stereo and some favorite clothes, the adolescent is brought to the community mental health agency for evaluation. This adolescent is at risk for:
suicide
A client in the second stage of Alzheimer's disease appears to be in pain. Which question by the nurse would best elicit information about the pain?
"Do you hurt?" (pause) "Do you hurt?"
During the admission data collection, a client reports that she frequently has nightmares and memories of a rape that occurred 3 years ago. She feels depressed and asks the nurse, "Do you think I will ever get better? I don't know what is wrong with me." The nurse's most supportive response would be:
"It sounds like you have some unresolved pain about the trauma. Take time here to talk and allow yourself to heal."
A client who lost her spouse suddenly 30 years ago tells a nurse during an interview, "My husband's shoes are at the side of the bed where he left them." The client's daughter informs the nurse that her mother constantly speaks about her deceased husband. Which statement by the daughter shows an understanding of maladaptive grief?
"My mother is in a prolonged phase of the grief process."
A man found wandering in a local park is unable to state who or where he is or where he lives. He is brought to the emergency department, where his identification is eventually discovered. The client's wife states that he was diagnosed with Alzheimer's disease 3 years ago and has had increasing memory loss. She tells the nurse she is worried about how she'll continue to care for him. Which response by the nurse would be most helpful?
"What aspect of caring for your husband is causing you the greatest concern?"
The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client?
"You'll be expected to attend group therapy each day."
(SELECT ALL THAT APPLY) The nurse is caring for a client who talks freely about feeling depressed. During an interaction, the nurse heard the client state, ""Things will never change."" What other indications of hopelessness would the nurse look for?
(1) Bouts of anger, (2) Periods of irritability, (4) Feelings of worthlessness
(SELECT AL THAT APPLY) A client has been diagnosed with an adjustment disorder of mixed anxiety and depression. Which nursing diagnoses are associated with a client who has an adjustment disorder?
(2) Impaired social interaction, (3) Self-esteem disturbance
(SELECT ALL THAT APPLY) The nurse interviews the family of a client who is hospitalized with severe depression and suicidal ideation. Which family assessment information is essential to formulating an effective plan of care?
(4) Communication patterns, (5) expectations, (6) Current family stressors.
A client is admitted to the hospital in the manic phase of bipolar disorder. Which foods are most appropriate for this client?
A cheese sandwich, carrot sticks, grapes, and cookies
The nurse is caring for a client who has been diagnosed with delirium. Which of the following is characteristic of delirium?
Acute onset and lasts hours to a number of days
Which nursing intervention would be appropriate if a client were to develop orthostatic hypotension while taking amitriptyline (Elavil)?
Advising the client to sit up for 1 minute before getting out of bed
A home health nurse visits a 55-year-old client with a history of physical abuse, poverty, and unemployment. The client tells the nurse that she constantly feels sad and has no energy. How should the nurse first intervene?
Arrange a referral for mental health services.
The nurse is assigned to a client who, after a medication teaching session with the nurse, began receiving amitriptyline (Elavil) 1 week ago to treat depression. The client now refuses to take the medication, stating that it has caused blurred vision, dry mouth, and constipation but hasn't improved the mood. Which nursing diagnosis is most appropriate for this client?
Deficient knowledge related to inadequate understanding of teaching
Discharge instructions for clients receiving tricyclic antidepressants include which of following information?
Don't consume alcohol.
A client diagnosed with major depression has started taking amitriptyline (Elavil), a tricyclic antidepressant. What is an adverse effect of this drug?
Dry mouth
An elderly client admitted to the psychiatric unit for periods of confusion and outbursts of anger, shouts, "Get out of my house! Don't come any closer!" when a nurse enters his room. Which intervention by the nurse is best in this situation?
Encourage the family to remain with the client until bedtime.
After a third arrest for abusing a neighbor's cat, a client is admitted to the psychiatric unit for treatment of antisocial personality disorder. The client has a history of conduct disorder. Which action is most appropriate for the nurse assigned to this client?
Examining personal feelings toward the client
A client with dependent personality disorder reports abdominal pain to the nurse. How should the nurse proceed?
Explore the symptom in a matter-of-fact way.
The nurse is caring for a client with hypochondriasis. Which behavior would the nurse be most likely to encounter?
Expression of fear of colorectal cancer following 3 days of constipation
The nurse is assigned to care for a client with dependent personality disorder. Which intervention should the nurse expect in this client's plan of care to promote independence?
Helping the client identify preferences, such as choosing which clothing item to wear
The nurse must administer activated charcoal before administering certain other drugs to a client who's taken an overdose. Which drug is rendered inactive when administered along with activated charcoal?
Ipecac syrup
A 26-year-old male reports losing his sight in both eyes. He's diagnosed as having a conversion disorder and is admitted to the psychiatric unit. Which nursing intervention would be appropriate for this client?
Not focusing on his blindness
A client comes to the emergency department after being attacked and sexually assaulted. What is the most accurate nursing diagnosis for this client?
Rape-trauma syndrome
A client with Alzheimer's disease has a nursing diagnosis of Risk for injury related to memory loss, wandering, and disorientation. Which nursing intervention should appear in this client's plan of care to prevent injury?
Remove hazards from the environment.
The nurse is preparing a teaching plan for an elderly client with depression who will continue on a prescription for venlafaxine (Effexor) after discharge. Because of age-related cognitive changes the nurse should use which approach to client teaching?
Repeat new information frequently.
After an upsetting divorce, a client threatens to commit suicide with a handgun and is involuntarily admitted to the psychiatric unit with major depression. Which nursing diagnosis takes highest priority for this client?
Risk for self-directed violence related to plans to commit suicide by handgun
A client has a diagnosis of borderline personality disorder. She has attached herself to one nurse and refuses to speak with other staff members. She tells the nurse that the other nurses are mean, withhold her medication, and mistreat her. The staff is discussing this problem at their weekly conference. Which intervention would be most appropriate for the nursing staff to implement?
Rotate the nurses who are assigned to the client.
The nurse is assigned to care for a recently admitted client who has attempted suicide. What should the nurse do?
Search the client's belongings and room carefully for items that could be used to attempt suicide.
A client in the manic phase of bipolar disorder constantly belittles other clients and demands special favors from the nurses. Which nursing intervention would be appropriate for this client?
Set limits with consequences for belittling or demanding behavior.
A 40-year-old executive who was unexpectedly laid off from work 2 days ago complains of fatigue and an inability to cope. He admits drinking excessively over the last 48 hours. This behavior is an example of which condition?
Situational crisis
A client begins experiencing physical symptoms believed to be caused by psychological distress. This client is most likely experiencing which disorder?
Somatization
A client has received treatment for depression for 3 weeks. Which behavior suggests that the client is recovering from depression?
The client talks about the difficulties of returning to college after discharge.
Which statement about pain disorder is accurate?
The pain is real to the client, even though there may not be an organic etiology for the pain.
Which classification of drugs is the most potentially fatal if the client takes an overdose?
Tricyclic antidepressants
The nurse is teaching a new group of mental health aides. The nurse should teach the aides that setting limits is most important for:
a manic client.
A client with major depression must take tranylcypromine sulfate (Parnate), a monoamine oxidase (MAO) inhibitor. During medication teaching, the nurse should instruct the client to avoid consuming:
aged cheese.
Family members of a client with bipolar disorder tell the nurse that they are concerned that the client is becoming manic. The nurse knows that the manic phase is marked by:
flight of ideas and inflated self-esteem.
A client with Alzheimer's disease mumbles incoherently and rambles in a confused manner. To help redirect the client's attention, the nurse should encourage the client to:
fold towels and pillowcases.
Nursing preparations for a client undergoing electroconvulsive therapy (ECT) resemble those used for:
general anesthesia.
The nurse is caring for a client, a Vietnam War veteran, who exhibits signs and symptoms of posttraumatic stress disorder (PTSD). Signs and symptoms of PTSD typically include:
hyperalertness
In a client who's predisposed to bipolar disorder, a bipolar episode might be triggered by:
hypothyroidism.
A client with slight memory impairment and poor concentration is diagnosed with primary degenerative dementia of the Alzheimer's type. Early signs of this dementia include subtle personality changes and withdrawal from social interactions. To evaluate for progression to the middle stage of Alzheimer's disease, the nurse should observe the client for:
impaired communication.
The physician prescribes lithium carbonate (Eskalith) for a client who has just been diagnosed with bipolar disorder. Now the nurse is teaching the client about signs and symptoms of lithium toxicity, which include:
lethargy, vomiting, and diarrhea.
A man brings his wife to the facility. He reports that since the death of their 7-month-old daughter 8 weeks ago, his wife has been neglecting her housework and family, has lost 20 lb (9.1 kg) from not eating, and hasn't left the house. She is admitted to the psychiatric unit with a diagnosis of depression. The nurse helps the client settle in. While observing her unpack, the nurse expects her to exhibit:
slow movements.
A client is receiving treatment for severe depression. When evaluating the client for suicidal ideation, the nurse checks for:
suicidal thoughts or plans.
A teenager was driving a car that slipped off an icy road, killing two of his friends. He repeatedly tells the nurse that he should be dead instead of his friends. The client's behavior is an example of:
survivor's guilt.
When preparing a client for electroconvulsive therapy (ECT), the nurse should make sure that:
the client has undergone a thorough medical evaluation.
A client with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that:
this medication may initially cause tiredness, which should become less bothersome over time.
When caring for an adolescent client diagnosed with depression, the nurse should remember that depression manifests differently in adolescents and adults. In an adolescent, signs and symptoms of depression are likely to include:
truancy, a change of friends, social withdrawal, and oppositional behavior.
