(N125) mood and affect

A client with the diagnosis of bipolar disorder, depressive episode, has been hospitalized on a psychiatric unit for 1 week. What is the most appropriate activity for this client? 1.Completing a jigsaw puzzle alone 2. Playing cards with several other clients 3. Talking with the nurse several times during the day 4. Engaging in a game of table tennis with another client

3. Rationale: Involving the client in a one-on-one conversation provides individualized, low-anxiety-producing attention and gives the message that the client is important, which supports self-esteem. Completing a jigsaw puzzle alone may require too much concentration for a depressed client. Playing a game of cards with several other clients may require too much concentration for a depressed client; also, it involves competition, which is not therapeutic at this time. A depressed client does not have the energy to engage in a game of table tennis; also, this is a competitive game, which is not therapeutic at this time.

A male client is brought to the psychiatric emergency department with severe depression with bouts of crying on and off throughout the day. He is unable to sleep at night. He feels hopeless and discouraged. The client's wife states that he lost his job several months ago and has been unable to find another one. The priority nursing intervention at this time is assessing the client for what? 1. Feelings of failure 2. Marital difficulties 3. Past episodes of depression 4. Plans of committing suicide

4 Rationale: The existence of a suicide plan is a major criterion in the assessment of a client's determination to make an attempt. Although assessing the client for feelings of failure, marital difficulties, or past episodes of depression may be important in planning future therapeutic approaches, it does not explore the potential for suicide, the priority at this time.

A nurse is counseling a client who is taking lithium carbonate. What is the priority nursing assessment when a client is taking this medication? 1. Daily weights 2. Psychomotor activity 3. Red blood cell counts 4. Blood level of the drug

4 Rationale: The therapeutic level of lithium carbonate is very close to the toxic level. Therefore it is vital that blood levels of the drug be checked twice a week during the acute phase and bimonthly once the client is on a maintenance dosage. Lithium does cause some weight gain, but daily weights are not necessary. Although psychomotor activity assessment should be done, it is not the priority. Lithium does not affect red blood cells.

One morning a client tells the nurse, "My legs are turning to rubber because I have an incurable disease called schizophrenia." What is this statement an example of? 1. Hallucinations 2. Paranoid thinking 3. Depersonalization 4. Autistic verbalization

The state in which the client feels unreal or believes that parts of the body are distorted is known as depersonalization or loss of personal identity. This is not an example of a hallucination; a hallucination is a sensory experience for which there is no external stimulus. The client's statement does not indicate any feelings that others are out to do harm, are responsible for what is happening, or are in control of the situation. The statement is not an example of autistic verbalization.

Depersonalization

When the client feels unreal or believes that parts of the body are distorted

When are restraints used?

they are used only when the client's behavior escalates to the point that it becomes a threat to the client or others.

Electroconvulsive therapy (ECT) is a mode of treatment that is used primarily to treat which mental disorder? 1. Clinical depression 2. Substance abuse disorders 3. Antisocial personality disorder 4. Psychosis occurring in schizophrenia

1 Rationale: ECT is used to treat clinical depression in clients who do not respond well to a trial of psychotropic medications or who are so severely depressed that immediate intervention is needed. ECT is not used as a primary treatment for clients with substance abuse disorders, antisocial personality disorder, or schizophrenic psychosis.

One day while shaving, a male client with the diagnosis of bipolar disorder tells the nurse, "I've hidden a razor blade, and tonight I'm going to kill myself." What is the best reply by the nurse? 1. "You're going to kill yourself?" 2. "Things really can't be that bad." 3. "Are you sure you really mean that?" 4. "Killing yourself is not going to solve your problems."

1 Rationale: The response "You're going to kill yourself?" focuses on the client's statement and does not challenge or deny it. It provides the client with an opportunity to verbalize further. The response "Things really can't be that bad" negates the client's feelings and interprets the situation for the client. The response "Are you sure you really mean that?" demeans the client and denies the client's feelings. The response "Killing yourself is not going to solve your problems" denies the client's feelings.

A client on the psychiatric unit is noisy, loud, and disruptive. The nurse informs the client, "Unless you're quiet, you'll be isolated and put in restraints, if necessary." How can this interaction be described in relation to the law? 1. The information given to the client is actually assault. 2. The client's behavior is to be expected and should be ignored. 3. Clients who are hyperactive need to be restrained for their own protection. 4. Clients who are disruptive and hyperactive cannot be expected to understand instructions.

1 Rationale: A threat is considered a type of assault (legally, an intentional tort). The client's behavior may be expected, but it should be dealt with directly; behavior should never be ignored. Restraints are unnecessary for this client; they are used only when the client's behavior escalates to the point that it becomes a threat to the client or others. Disruptive, hyperactive clients may respond to calm limit-setting.

A severely depressed male client responds to therapy and with the help of the staff begins to set some daily objectives. Which behavior most indicates improvement in this client? 1. Staying clear of people who make him anxious 2. Talking with at least one person on the unit daily 3. Sitting alone several hours a day to think about personal concerns 4. Demonstrating to the staff that he can do what they want him to do

2 Rationale: Initiation of interactions demonstrates that the depressed person is attempting to change behavior patterns. Avoiding people is a reinforcement of the depressed lifestyle. Solitary activities are nonthreatening but do not deal with the problem of impaired relationships. Clients who attempt to modify behavior to please others make only superficial changes.

A 56-year-old man is admitted to the inpatient unit after family members report that he seems to be experiencing auditory hallucinations. The man has a history of schizophrenia and has had several previous admissions. Which statement indicates to the nurse that the client is experiencing auditory hallucinations? 1. "Get these horrible snakes out of my room!" 2. "I am not the devil! Stop calling me those names!" 3. "The food on this plate has poison in it, so take it away—I won't eat it." 4. "I did see an alien spaceship last night outside in my yard, and I've felt worse ever since."

2 Rationale: The client is responding to messages that he is hearing, which are auditory hallucinations. The responses regarding the snakes and the spaceship are examples of visual hallucinations because they describe what the client sees. The accusation of poisoning is the statement of a client who is suspicious and paranoid but not hallucinating.

The nurse is caring for a client who is confused and delirious. What is the most therapeutic intervention when the nurse is interacting with this client? 1. Reassuring the client that the client will get better 2. Directing the client's daily activities on the unit 3. Helping the client clarify the client's experience and gain insight into personal behavior 4. Providing the client with solutions to past and current problems that have been experienced

2 Rationale: The client needs to have activities decided and directed until delirium and confusion clear. Reassuring the client that the client will get better is false reassurance. Clients who are delirious are unable to develop insight into their behavior. Providing the client with solutions to past and current problems experienced is not therapeutic and does not help the client develop insight.

A client demonstrating manic behavior is elated and sarcastic. The client is constantly cursing and using foul language and has the other clients on the unit terrified. What should the nurse do initially? 1. Demand that the client stop the behavior immediately. 2. Tell the client firmly that the behavior is unacceptable. 3. Ask the client to identify what is precipitating the behavior. 4. Increase the client's medication or get a prescription for another drug.

2. Rationale: A firm voice is most effective; the statement tells the client that the behavior, not the client, is upsetting to others. Demanding that the client stop the current behavior is a useless action; the client is out of control and needs external control. The client does not know what is precipitating the behavior, and asking the client will be frustrating. The dosage of the client's medication should be increased or a prescription for another drug should be obtained if the client does not respond to firm limit-setting, but this may only be done by the healthcare provider.

A client who has been diagnosed with a bipolar disorder has been admitted to the psychiatric unit. The nurse recognizes that providing adequate nutrition during the manic phase may be a challenge. Why would adequate nutritional intake be a challenge? 1. The client is too depressed to eat. 2. The client lacks the energy to eat. 3. The client is too busy keeping active to eat. 4. The client is on a restricted diet limiting cheese and other favorite foods.

3 Rationale: The client is too busy keeping active during the manic part of a bipolar disorder. This stage is characterized by elation, activity, restlessness, and increased energy. Although the client may be using more calories than usual during this period, food is not a priority, and the client will not spend the time to eat. Finger foods and high-calorie snacks are suggested. The client is not too depressed to eat during the manic phase; rather there is a feeling of euphoria or grandeur. The client in the manic phase has too much energy rather than the lack of energy that accompanies depression. The restricted diet limiting cheese is associated with the parnate diet.

When caring for clients who are demonstrating manic behavior, the nurse must constantly reassess these clients' physical needs. What characteristic about these clients makes this particularly important? 1. Will withdraw to their rooms if left alone 2. Have difficulty making their needs known 3. May gain too much weight from overeating 4. May become exhausted from excessive activity

4 Rationale: The elated client expends a great deal of energy; dehydration, oxygen deficit, cardiac problems, and death may occur. The elated person does not withdraw from reality but continues to run headfirst into reality. The elated client has little difficulty verbalizing needs. The elated client usually does not take time to eat while expending a great deal of energy, so weight loss is the problem.

A nurse identifies the establishment of trust as a major nursing goal for a depressed client. How can this goal best be accomplished? 1. By spending a day with the client 2. By asking the client at least one question daily 3. By waiting for the client to initiate the conversation 4. By visiting frequently for short periods with the client each day

4 Rationale: 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 client with a diagnosis of dementia of the Alzheimer type has been taking donepezil 10 mg/day for 3 months. The client's partner calls the clinic and reports that the client has increasing restlessness and agitation accompanied by nausea. What does the nurse advise the partner to do? 1. Give the medication with food. 2. Administer the medication to the partner at bedtime. 3. Omit one dose today and start with a lower dose tomorrow. 4. Bring the partner to the clinic for testing and a physical examination.

4 Rationale: Many people with dementia experience physical problems such as urinary tract infections but cannot adequately verbalize what is happening. They may just become more restless and agitated. Because the client has been taking this dose for 3 months, the problems are probably not being caused by the medication. The client should be brought in for an evaluation. Taking the medication with meals is recommended to decrease gastrointestinal side effects, but this client is experiencing more than gastrointestinal effects. Donepezil (Aricept) can cause insomnia. The client is already restless and agitated. Taking the medication at bedtime will not help. The nurse should not advise a modification of the dosage without consulting the healthcare provider.