NURS 132 - EXAM 2 - SHERPATH

Which nursing diagnosis is most applicable to a patient experiencing an acute exacerbation of schizophrenia with predominantly negative symptoms? a. Disturbed sensory perception related to auditory hallucinations b. Impaired verbal communication related to associative looseness c. Risk for other-directed violence related to inability to control hostile impulses d. Social isolation related to withdrawal and reduced communication with others

Chapter 12

Which symptom seen in a patient with schizophrenia can be categorized as a positive symptom? a. Delusions b. Dysphoria c. Loss of motivation d. Impaired judgment

Chapter 12 a. Delusions Rationale The behavioral traits not normally found in healthy patients are called positive symptoms of schizophrenia. They include delusions, hallucinations, bizarre behavior, and paranoia. The behaviors that the patient lacks compared with healthy people are negative symptoms, such as loss of motivation and alogia (poverty of thought or inability to speak). Impaired judgment and illogical thinking are the cognitive symptoms associated with schizophrenia. Dysphoria and suicidal intentions are affective symptoms of schizophrenia. Affective symptoms involve emotions and their expression. pp. 197, 201, Table 12.2

The most common course of schizophrenia is an initial episode followed by a. Complete recovery b. Continuous deterioration c. Recurrent acute exacerbations d. Recurrent acute exacerbations and deterioration

Chapter 12 d. Recurrent acute exacerbations and deterioration Rationale Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs. p. 196

Which nursing diagnosis is most applicable to a patient experiencing an acute exacerbation of schizophrenia with predominantly negative symptoms? a. Disturbed sensory perception related to auditory hallucinations b. Impaired verbal communication related to associative looseness c. Risk for other-directed violence related to inability to control hostile impulses d. Social isolation related to withdrawal and reduced communication with others

Chapter 12 d. Social isolation related to withdrawal and reduced communication with others Rationale Negative symptoms include social isolation, anergia, lack of motivation, blunted affect, and inattention to personal hygiene. Associative looseness, auditory hallucinations, and hostile impulses represent positive symptoms. p. 201, Table 12.2

What information concerning electroconvulsive therapy (ECT) treatment and its effectiveness for patients diagnosed with bipolar disorder is true? Select all that apply. a. It is appropriate for all cases of manic behavior. b. It is promising for patients with a history of rapid cycling. c. Treatment is appropriate for pregnant patients experiencing mania. d. Treatment is contraindicated for patients during depressive episodes. e. Treatment shows little effectiveness for patients experiencing paranoid tendencies.

Chapter 13 b. It is promising for patients with a history of rapid cycling. c. Treatment is appropriate for pregnant patients experiencing mania. Rationale ECT is used to subdue severe manic behavior, especially in patients with treatment-resistant mania and patients with rapid cycling. Depressive episodes, particularly those with severe, catatonic, or treatment-resistant depression, are an indication for this treatment and may be helpful for mania during pregnancy. ECT is effective for patients with bipolar disorder who have rapid cycling, and for those with paranoid-destructive features. p. 236

Which nursing diagnosis would be least useful for a depressed patient who shows psychomotor retardation? a. Constipation b. Death anxiety c. Activity intolerance d. Self-care deficit: bathing or hygiene

Chapter 14 b. Death anxiety Rationale A patient with psychomotor retardation has vegetative signs of depression and often is constipated, too tired to engage in activities, and lacks the energy to attend to personal hygiene. Depressed patients usually do not have death anxiety. They are more likely to welcome the idea of dying. p. 252

Subsyndromal depression primarily occurs in which population? a. Adults b. Elderly c. Children d. Teenagers

Chapter 14 b. Elderly Rationale Subsyndromal depression is most prevalent in older adults. It occurs when the patient experiences some, but not all, of the symptoms that are seen in a major depressive episode. Children, adolescents, and adults are less susceptible to subsyndromal depression. p. 246

A patient with late-luteal-phase dysphoric disorder is prescribed fluoxetine. What information should the nurse give the patient? a. To stop the medication immediately if the side effects are severe b. To consult their primary healthcare provider if there is loss of libido c. To take acetaminophen if there is fever d. The drug may cause dry mouth and blurred vision

Chapter 14 b. To consult their primary healthcare provider if there is loss of libido Rationale Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), which is a class of drug known for having low side effects. The nurse should advise the patient to consult the primary healthcare provider about any side effects, such as loss of libido or sexual dysfunction. Stopping the drug abruptly may cause serotonin withdrawal, so the patient should be advised not to stop the drug without first consulting the healthcare provider. Acetaminophen or any other over-the-counter drugs should not be taken without consulting the primary healthcare provider, as it can lead to drug interactions. SSRIs are known to have low occurrence of side effects, and they do not cause dry mouth or low vision as some older antidepressants do. p. 261, Box 14.4

Which individual has the highest risk for major depression? a. 8-year-old girl b. 16-year old boy c. 60-year-old man d. 35-year-old woman

Chapter 14 d. 35-year-old woman Rationale Females and the 25- to 44-year-old age-group have the highest incidences of depression. p. 246, Box 14.1

What is the best question for the nurse to ask when attempting to assess for the presence of depression in an elderly patient? a. Are you having crying spells every day? b. What is your family history related to depressive illnesses? c. Would you say you are currently having a major depressive episode? d. How do you compare your activities and health now to six months ago?

Chapter 14 d. How do you compare your activities and health now to six months ago? Rationale Elderly patients may not acknowledge depression directly. Changes in somatic and interpersonal activities often give clearer evidence of depression. pp. 252-253

An adult attempted suicide after termination from employment. This patient was hospitalized and has taken antidepressant medication for 2 weeks. The nurse observes the patient is now brighter and more sociable. What is the nurse's highest priority intervention? a. Begin discharge planning for the patient. b. Maintain continuous supervision of the patient. c. Consider discontinuation of suicide precautions. d. Refer the patient for cognitive behavioral therapy.

Chapter 25 b. Maintain continuous supervision of the patient. Rationale A change from sad or depressed to happy and peaceful may be a red flag. Often a decision to commit suicide gives a feeling of relief and calm. The nurse should continue 24-hour supervision of this patient. Discharge plans, discontinuation of suicide precautions, and referring the patient for cognitive behavior therapy may apply but are not the priority action.

The nurse is assessing a patient who attempted suicide once. Which method used by the patient in the previous suicide attempt would put the patient at higher risk? a. Slashing the wrists b. Staging a car crash c.Inhaling natural gas d. Ingesting sleeping pills

Chapter 25 b. Staging a car crash Rationale A method can be considered high or low risk based on the lethality, that is, how quickly a person can die using that particular method. Therefore, staging a car crash would put the patient at higher risk. Ingesting pills, inhaling natural gas, and slashing one's wrists are considered low-risk methods. If the patient uses these methods to commit suicide, there may be time to rescue the patient from dying. p. 479

The nurse is providing suicide awareness and prevention training for members of the community. What does the nurse include when teaching about nonverbal behavioral clues to watch out for in a person who may be suicidal? a. Giving away possessions b. Going to the doctor more frequently c. Finding excuses to not leave the house d. Looking through old, sentimental belongings

a. Giving away possessions Rationale Giving away possessions, as well as writing letters and organizing financial affairs, is an example of nonverbal behaviors of a person who might be suicidal. Going to the doctor more frequently, finding excuses to not leave the house, and looking through sentimental belongings are not always associated with suicide.

When caring for a child with posttraumatic stress disorder, which intervention should the nurse include in the patient plan of care? a. Provide changeable environment. b. Help patient learn positive avoidance. c. Reduce stimulation of traumatic memories. d. Promote arousal to build tolerance to stress.

c. Reduce stimulation of traumatic memories. Rationale When caring for a patient with posttraumatic stress disorder, it is important to reduce stimulations that may remind the patient of the traumatic event. The patient should be taught relaxation therapies to alleviate arousal. The patient may tend to avoid any mention of the traumatic event. However, the patient should be helped to overcome avoidance to promote desensitization to the emotions related to the event. It is important to provide a safe and predictable environment rather than a changeable one to make the child comfortable. p. 300

A nurse is devising a treatment plan for a patient who is in the first phase of schizophrenia. Which of these actions by the patient supports the assumption that the patient is in the first phase of schizophrenia? Select all that apply. a. The patient takes the medication properly. b. The patient has good interactions with others. c. The patient hears the voice of a late grandfather. d. The patient repeats the words uttered by the nurse. e. The patient reports that the primary health care provider tried to kill him.

c. The patient hears the voice of a late grandfather. d. The patient repeats the words uttered by the nurse. e. The patient reports that the primary health care provider tried to kill him. Rationale Schizophrenia is characterized by three phases. The first phase is the acute phase. In this phase, the patient has positive schizophrenia symptoms such as hallucinations, echolalia, and paranoia. The patient may hear unusual voices and repeat what others have said. The patient also may have irrational fears and may believe that the primary health care provider had tried to kill him. In the second phase of schizophrenia, the patient starts taking medication and shows improvement. In this phase, the patient also develops an ability to interact with others. pp. 201-204

A child reared in a minority culture is at greatest risk for: a. Bullying b. Homicidal thoughts c. Eating- and sleep-related disorders d. Traumatic experiences in early childhood

d. Traumatic experiences in early childhood Rationale Poverty, parental substance abuse, and exposure to violence have received increasing attention and place minority children at greater risk for trauma and stress. p. 299

Which body system is most at risk for decompensation during the acute phase of a severe manic episode? a. Renal b. Cardiac c. Endocrine d. Pulmonary

Chapter 13 b. Cardiac Rationale A primary consideration for a patient in acute mania is the prevention of exhaustion and death from cardiac collapse. In this instance, a careful cardiac assessment takes priority over renal, endocrine, and pulmonary systems. p. 230

Which behavior would be most characteristic of a patient during a manic episode? a. Watching others intently and talking little b. Going rapidly from one activity to another c. Taking frequent rest periods and naps during the day d. Being unwilling to leave home to see other people

Chapter 13 b. Going rapidly from one activity to another Rationale: Hyperactivity and distractibility are basic to manic episodes.

A patient is diagnosed with major depressive disorder. Which assessment findings are categorized as vegetative symptoms? Select all that apply. a. Anorexia b. Insomnia c. Joint pain d. Headache e. Constipation

Chapter 14 a. Anorexia b. Insomnia e. Constipation Rationale Vegetative signs of depression include changes in bowel movements and eating habits, sleep disturbances, and disinterest in sex. Pain is not usually classified as a vegetative symptom. p. 252

Which statement regarding bipolar I is true? Select all that apply. a. The median age for onset is 18 years. b. The disorder tends to begin with a depressive episode. c. The disorder is more common among women than men. d. Severe postpartum depression increases the risk for developing the disorder. e. The episodes tend to increase in number and severity during the course of the illness.

a. The median age for onset is 18 years. b. The disorder tends to begin with a depressive episode. d. Severe postpartum depression increases the risk for developing the disorder. e. The episodes tend to increase in number and severity during the course of the illness. Rationale The median age of onset for bipolar I is 18 years. Bipolar I tends to begin with a depressive episode in both women and men. The episodes tend to increase in number and severity during the course of the illness. Women who experience a severe postpartum psychosis within 2 weeks of giving birth have a four times greater chance of subsequent conversion to bipolar disorder. Bipolar I disorder seems to be somewhat more common among men. p. 225, Table 13.1

In a clinical interview conducted at a community health care center, the nurses observe that a patient with schizophrenia is very sensitive and feels extremely guilty about previous actions. What is the appropriate nursing diagnosis? a. The patient is a victim of child abuse. b. The patient has risk for self-directed violence. c. The patient has impaired verbal communication. d. The patient is showing positive symptoms of schizophrenia.

b. The patient has risk for self-directed violence. Rationale: The patient with schizophrenia shows negative symptoms such as self-blaming, guilt, and becoming sensitive. It indicates that the patient is at risk for self-directed violence and can do self-harm. Impaired verbal communication is characterized by dissociative ideas. Positive symptoms of schizophrenia include hallucination and associative looseness. Feeling guilty and being sensitive are negative symptoms of schizophrenia. Schizophrenia is not associated with a history of child abuse. pp. 201, 207, Table 12.2, Table 12.3

The nurse is teaching a patient and the patient's family about lithium therapy. Which instructions will the nurse include? Select all that apply. a. "Restrict the sodium in your diet." b. "Take lithium on an empty stomach." c. "Take lithium with meals to avoid an upset stomach." d. "Lithium is a mood stabilizer that helps prevent relapse." e. "Maintain a consistent fluid intake of 1,500-3,000 mL/day." f. "You should stop taking lithium if you have excessive diarrhea, vomiting, or sweating."

c. "Take lithium with meals to avoid an upset stomach." d. "Lithium is a mood stabilizer that helps prevent relapse." e. "Maintain a consistent fluid intake of 1,500-3,000 mL/day." f. "You should stop taking lithium if you have excessive diarrhea, vomiting, or sweating." Rationale Lithium is a Food and Drug Administration-approved drug to treat acute mania and maintenance treatment. The patient should be taught the purpose of lithium as a mood stabilizer and significance in preventing relapse. Patients receiving lithium therapy should be taught the importance of maintaining a consistent fluid intake of 1,500 to 3,000 mL per day to avoid toxicity. The patient should take lithium with meals to avoid an upset stomach. The patient should be taught to stop taking lithium and notify prescriber if diarrhea, vomiting, or excessive sweating occur as these symptoms can lead to dehydration and lithium toxicity. Taking lithium on an empty stomach should be avoided due to possible gastrointestinal upset. Sodium in the diet should be consistent, not restricted.

A patient with schizophrenia is prescribed clozapine. Which physiological conditions of the patient should the nurse monitor? Select all that apply. a. Liver function b. Kidney function c. Total red blood cell count d. Total white blood cell count e. Total water intake and output

Chapter 12 a. Liver function d. Total white blood cell count Rationale Agranulocytosis is the most common symptom of clozapine. It is characterized by a reduced white blood cell count (less than 3000/mm 3) and liver impairment. Hence, the nurse should frequently monitor the liver function and total white blood cell count. Clozapine does not have an effect on the kidneys; therefore the total water intake and output and kidney function do not need to be monitored. Clozapine reduces white blood cell count but does not affect red blood cell count; therefore, it is not required to monitor red blood cell count. pp. 214, 216, Table 12.6

A patient who has been receiving antipsychotic medication for 6 weeks tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the patient reports flulike symptoms, including a fever and a very sore throat, the nurse should a. Consider recommending a change of antipsychotic medication b. Arrange for the patient to have blood drawn for a white blood cell count c. Suggest that the patient take something for his or her fever and get extra rest d. Advise the health care provider that the patient should be admitted to the hospital

Chapter 12 b. Arrange for the patient to have blood drawn for a white blood cell count Rationale Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms. Agranulocytosis with infection could be life threatening, so recommending rest does not address the underlying problem. The patient may not need to be admitted to the hospital but should have blood drawn to guide the next step. A nurse would not recommend a change of medication. The medication has been effective and might not need to be changed. p. 216, Table 12.6

The nurse documents that a patient is demonstrating a negative symptom of schizophrenia when observing the patient doing what? a. Refusing to eat anything that is not tasted by the staff first b. Having difficulty focusing on any task for more than a few minutes c. Communicating using a pattern of speech identified as "word salad" d. Reporting hearing voices telling the patient that the world will end soon

Chapter 12 b. Having difficulty focusing on any task for more than a few minutes Rationale Attention impairment is considered a negative symptom because it represents a diminution or loss of normal brain function. Paranoia, hallucinations, and distorted speech are considered positive symptoms because they are an exaggeration or distortion of normal brain function. p. 201, Table 12.2

An adult with a 6-year history of schizophrenia begins a community rehabilitation program. Select the most appropriate initial outcome for this patient. The patient will a. Lead the morning exercise group b. Participate actively in scheduled programming c. Apply for employment in a local sheltered workshop d. Report that no auditory hallucinations have occurred

Chapter 12 b. Participate actively in scheduled programming Rationale Participation in scheduled activities of the program should occur first. After the patient is accustomed to the program, he or she might lead a group or apply for employment. Hallucinations commonly continue to occur in patients diagnosed with schizophrenia. pp. 203, 210, Box 12.5

A patient with schizophrenia was prescribed perphenazine. During the follow-up visit after 12 weeks on the medication, the nurse suggests that the patient go on bed rest and follow a diet rich in proteins and carbohydrates. Which is the most appropriate reason for the nurse to give this suggestion? a. The patient has the symptoms of agranulocytosis. b. The patient has the symptoms of cholestatic jaundice. c. The patient has the symptoms of postural hypotension. d. The patient has the symptoms of autonomic dysfunction.

Chapter 12 b. The patient has the symptoms of cholestatic jaundice. Rationale Schizophrenic patients taking perphenazine, a first-generation antipsychotic drug, may have toxic effects as a result of long-term therapy. The nurse should identify the signs and symptoms of the toxic effects, like cholestatic jaundice, which is due to collection of bile juice in the gallbladder. The patient should be instructed to go on bed rest and consume a diet rich in proteins and carbohydrates. Postural hypotension is characterized by a drop in blood pressure with a change in position. It cannot be managed by a protein-rich diet. Agranulocytosis is characterized by dangerously low levels of white blood cells; this condition is not related to bed rest and diet changes. Autonomic nervous system controls involuntary actions of the body. An autonomic dysfunction is not treated by bed rest and diet changes. p. 212, Table 12.5

A patient with undifferentiated schizophrenia lives in a community care home and takes olanzapine daily with supervision. During the patient's monthly outpatient visits with a psychiatric nurse, which assessment parameter takes priority? a. Height b. Weight c. Pupillary response to light d. Integrity of mucous membranes

Chapter 12 b. Weight Rationale An important part of the nurse's role in the community is monitoring the patient's response to medications, compliance, and potential side or adverse effects. Key side effects of sexual dysfunction and weight gain are particularly important to monitor for persons taking antipsychotic medications. Olanzapine is an atypical antipsychotic drug that can cause significant weight gain, which results in diabetes for many patients. Neither height, mucous membrane integrity, nor pupil response takes priority over weight. p. 202, Box 12.2

The nurse is performing an assessment of geriatric patients in a community health care center. The nurse reports that one of the patients has schizophrenia. Which statement made by the patient while interacting with the nurse supports the nurse's assessment? a. "Every morning I enjoy the humming of birds; it relaxes me." b. "Every day my friends wait for me in front of my gate for our morning walk." c. "Every day birds sing songs for me and spread flowers on the path where I walk." d. "Everyone feels as if I am a burden to them; I would like to put an end to their problem."

Chapter 12 c. "Every day birds sing songs for me and spread flowers on the path where I walk." Rationale Patients with schizophrenia have delusions of self-importance and state false events related to them, like birds singing songs for them and spreading flowers on their path. The statement that every morning the patient enjoys the humming of birds indicates that the patient has no impaired perception and is able to connect with reality. The statement that every morning the patient's friends wait for him or her is normal. The statement that everyone feels the patient is a burden indicates that the patient feels worthless and has suicidal intentions. It does not indicate schizophrenic symptoms. p. 198, Table 12.1

A patient diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be a. "The voices are wrong about the hospital food. It is not contaminated." b. "You are safe here in the hospital; nothing bad will happen to you." c. "I understand that the voices are very real to you, but I do not hear them." d. "Other people are eating the food, and nothing is happening to them."

Chapter 12 c. "I understand that the voices are very real to you, but I do not hear them." Rationale This reply acknowledges the patient's reality but offers the nurse's perception that he or she is not experiencing the same thing. p. 209, Box 12.4

Which statement is accurate regarding the relationship between depression and schizophrenia? a. Suicide attempts usually occur early in the course of schizophrenia. b. Antipsychotic medications alleviate symptoms of depression for patients diagnosed with schizophrenia. c. Regular assessments should occur for both depression and suicide risk in patients diagnosed with schizophrenia. d. Nicotine use in patients diagnosed with schizophrenia stimulates neurotransmitters, resulting in a decreased incidence of depression and suicide.

Chapter 12 c. Regular assessments should occur for both depression and suicide risk in patients diagnosed with schizophrenia. Rationale Almost half of people with schizophrenia will attempt suicide; therefore, assessments for depression and suicide should occur throughout the patient's life. Both depression and suicide attempts can occur at any point in the illness. Antipsychotic medications do not alleviate symptoms of depression for patients diagnosed with schizophrenia. Nicotine use is higher in patients diagnosed with schizophrenia; nicotine stimulates some neurotransmitters, but this does not result in a decreased incidence of depression. p. 193

A patient diagnosed with schizophrenia reports voices stating the patient is a horrible human being. The nurse can correctly assume that the hallucination a. May signal seizure onset b. Is a retained memory fragment c. Derives from neuronal impulse misfiring d. Is a projection of the patient's own feelings

Chapter 12 d. Is a projection of the patient's own feelings Rationale One theory about derogatory hallucinations is that the content is a projection of the individual's feelings about him- or herself. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal period. pp. 198-199

Which statement is true regarding schizophrenia, treatment, and outcomes? a. If treated quickly following diagnosis, schizophrenia can be cured. b. Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations. c. If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms. d. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability.

Chapter 12 d. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. Rationale Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. Untrue statements about schizophrenia are that it can be cured if treated quickly, it can be managed by receiving treatment only at the time of acute exacerbations, and if patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms. p. 196

Which drug would a nurse anticipate being given with chlorpromazine to reduce extrapyramidal side effects? a. Lamivudine b. Valacyclovir c. Montelukast d. Trihexyphenidyl

Chapter 12 d. Trihexyphenidyl Rationale Chlorpromazine is a first-generation antipsychotic drug. It can cause extrapyramidal side effects, like akathisia, tremor, impaired gait, and so on, as a result of the blockage of dopamine receptors. These side effects can be treated by administering antiparkinson drugs like trihexyphenidyl. Trihexyphenidyl is an antimuscarinic class of drug. Montelukast is a leukotriene receptor antagonist used to treat asthma. Lamivudine is a nucleoside reverse transcriptase used to treat HIV/AIDS; it cannot be used to reduce the extrapyramidal side effects of chlorpromazine. Valacyclovir is an antiviral drug used to treat viral infections. p. 211

Which patient statement supports the diagnosis of mania? Select all that apply. Select all that apply a. "I really don't need much sleep; two hours a night is enough." b. "I really enjoy cooking and eating all sorts of expensive foods." c. "My mother says this outfit is way too sexy but I like it and wear it all the time." d. "I've telephoned everyone I know and talked for hours; my husband will be mad." e. "My family is really upset with me but it's just because they're jealous of all I do."

Chapter 13 a. "I really don't need much sleep; two hours a night is enough." c. "My mother says this outfit is way too sexy but I like it and wear it all the time." d. "I've telephoned everyone I know and talked for hours; my husband will be mad." e. "My family is really upset with me but it's just because they're jealous of all I do." Rationale When in full-blown mania, a person constantly goes from one activity, place, or project to another with little or no regard for sleep or food. Inactivity is impossible, even for the shortest period of time. Flowery and lengthy letters are written, and excessive phone calls are made. The behaviors often alienate family, friends, employers, health care providers, and others. Modes of dress often reflect the person's grandiose yet tenuous grasp of reality. Dress may be described as outlandish, bizarre, colorful, and noticeably inappropriate. The statement regarding cooking and eating is not supportive of manic behavior. pp. 223-224

A patient is prescribed 300 mg lithium carbonate twice a day. The patient shows symptoms of exhaustion. Which category of drug would help to prevent exhaustion in the patient? a. Benzodiazepines b. Monoamine oxidase inhibitors c. Selective serotonin reuptake inhibitors d. Serotonin-norepinephrine reuptake inhibitors

Chapter 13 a. Benzodiazepines Rationale Patients with mania have a risk of exhaustion, coronary collapse, and death with lithium carbonate, as lithium reaches its therapeutic level in the blood after 7 to 14 days of treatment. Benzodiazepines can be used to prevent coronary collapse in patients. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors are antidepressants. Antidepressants must not be prescribed to the patients with mania because they enhance the symptoms of mania. p. 233

A male patient admitted with acute mania tells the staff and the other patients that he is on a secret mission given to him by the President of the United States to monitor citizens for terrorist activity. He states, "I am the only one he trusts, because I am the best!" For documentation purposes what is this behavior referred to as? a. Grandiosity b. Rapid cycling c. Flight of ideas d. Unpredictability

Chapter 13 a. Grandiosity Rationale Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although patients with mania are unpredictable, the scenario does not describe unpredictability. Rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes. p. 229

With a serum lithium level of 0.8 mEq/L, which assessment data would be expected? Select all that apply. a. Mild thirst b. Polyuria c. Diarrhea d. Muscle weakness e. Fine hand tremors

Chapter 13 a. Mild thirst b. Polyuria e. Fine hand tremors Rationale Expected side effects for a 0.4 to 1.0 mEq/L serum lithium level (therapeutic level) include a fine hand tremor, polyuria, and mild thirst. Muscle weakness and diarrhea are associated with early toxicity, which can be experienced with a serum lithium level of 1.5 mEq/L. page 234, Table 13.4

What intervention will help minimize staff-splitting by a manic patient? Select all that apply. a. Set reasonable limits on patient behavior. b. Regularly self-reflect for possible countertransference. c. Consistently reenforce consequences for inappropriate behavior. d. Schedule frequent staff meetings to discuss problematic behavior. e. Identify one staff member who will work exclusively with the patient.

Chapter 13 a. Set reasonable limits on patient behavior. b. Regularly self-reflect for possible countertransference. c. Consistently reenforce consequences for inappropriate behavior. d. Schedule frequent staff meetings to discuss problematic behavior. Rationale People with mania have the ability to staff-split using humor, manipulation, power struggles, or demanding behavior to prevent or minimize the staff's ability to set limits on and control dangerous behavior, or divide the staff into the good guys or the bad guys. This divisive tactic may pit one staff member or group against another, undermining a unified and consistent plan of care. Frequent staff meetings to deal with the behaviors of the patient and the nurses' responses to these behaviors can help minimize staff-splitting. Consistency among staff is imperative if the limit-setting is to be carried out effectively. If one is working with a patient experiencing mania, one may feel helplessness, confusion, or even anger. Understanding, acknowledging, and sharing these responses and countertransference reactions will enhance professional ability to care for the patient and perhaps promote personal development as well. Identifying one staff member to consistently work with the patient would eliminate the environment necessary for splitting. p. 237

A manic patient tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." The best approach for the nurse to use would be to say, a. "I don't have sex with patients." b. "It's time to work on your art project." c. "What an offensive thing to suggest!" d. "Let's walk down to the seclusion room."

Chapter 13 b. "It's time to work on your art project." Rationale Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the patient. p. 231, Table 13.3

A nurse caring for a manic patient observes that the patient has persistent gastrointestinal upset. The nurse assumes that the patient is showing advanced signs of lithium toxicity and tests the serum levels of lithium in the patient. What concentration of lithium does the nurse expect to find in the patient's blood serum? a. 0.5 mEq/L b. 1.8 mEq/L c. 2.5 mEq/L d. 3.4 mEq/L

Chapter 13 b. 1.8 mEq/L Rationale Serum levels of more than 1.8 mEq/L can cause advanced signs of toxicity such as gastrointestinal upset, mental confusion, incoordination, and sedation. Serum level of 0.5 mEq/L indicates the therapeutic level of lithium. Serum levels of 2.5 and 3.4 mEq/L indicate severe toxicity. The symptoms of severe toxicity include oliguria, convulsions, severe hypotension, and death. p. 234, Table 13.4

What information regarding lithium carbonate is true? Select all that apply. a. It is effective for patients with a history of rapid cycling. b. It demonstrates effectiveness in the treatment of bipolar I. c. Indefinite maintenance dosing is required for many patients. d. Manic behaviors generally show improvement in 10 to 21 days. e. Associated hypersexual behavior is well managed with the medication.

Chapter 13 b. It demonstrates effectiveness in the treatment of bipolar I. c. Indefinite maintenance dosing is required for many patients. d. Manic behaviors generally show improvement in 10 to 21 days. Rationale Lithium is effective in the treatment of bipolar I acute and recurrent manic and depressive episodes. Lithium inhibits about 80% of acute manic and hypomanic episodes within 10 to 21 days. It can help reduce hypersexuality but to a lesser degree than for other symptomology. Lithium is less effective in those with rapid cycling. Many patients receive lithium for maintenance indefinitely and experience manic and depressive episodes if the drug is discontinued. p. 234drug is discontinued. p. 234

What should the nurse monitor in bipolar disorder patients who have been administered divalproex sodium? Select all that apply. a. Skin rashes b. Liver function c. Platelet count d. Blood pressure e. Pancreatic function

Chapter 13 b. Liver function c. Platelet count Rationale The nurse should monitor platelet count and liver function in the patients who are prescribed divalproex sodium. It may cause thrombocytopenia by decreasing the platelet count, and it may cause liver dysfunction by altering the levels of liver enzymes. Blood pressure need not be monitored in the patients because it does not affect the blood pressure. Skin rashes are not caused by divalproex sodium but can be seen in patients who are prescribed lamotrigine. The drug does not cause impairment of pancreatic function, nor does it affect the levels of insulin and glucagon; thus the pancreatic function need not be monitored. p. 235

A desirable short-term goal for the nursing diagnosis of defensive coping, related to biochemical changes as evidenced by aggressive verbal and physical behaviors, would be a. Sleeping soundly for 12 of the next 24 hours b. Making no attempts at self-harm within 12 hours of admission c. Willingly taking prescribed medication as offered by staff within 24 hours of admission d. Demonstrating psychomotor retardation associated with sedation from prescribed medication within 6 hours of admission

Chapter 13 b. Making no attempts at self-harm within 12 hours of admission Rationale Whenever aggressive verbal or physical behaviors are demonstrated, a desirable goal is cessation of those behaviors. Verbal and physical aggression are most apt to occur when staff are trying to structure the patient's behavior for his or her own safety or the safety of others. p. 230

The nurse has developed a plan for a patient with a severe sleep pattern disturbance to spend 20 minutes in the gym exercising each afternoon. Which intervention should be scheduled upon returning to the unit? a. Rest b. Group therapy c. A protein-based snack d. Unstructured private time

Chapter 14 a. Rest Rationale A depressed patient usually has little energy. After even a short exercise period, the patient may feel exhausted and need rest. p. 256, Table 14.5

The nurse is managing the care of an older adult diagnosed with bipolar disorder who is in a manic phase. The nurse closely monitors the patient for risks to his or her safety. What factor makes this intervention especially appropriate for this patient? a. Such a patient is abused easily by other aggressive patients. b. Mania can result in irresponsible and physically risky behaviors. c. The manic phase will be followed by a phase of severe depression. d. Older adults experience physical conditions that greatly increase the potential for injury.

Chapter 13 b. Mania can result in irresponsible and physically risky behaviors. Rationale Patients in the manic phase of bipolar disorder may have misperceptions about their power and importance and involve themselves in senseless, irresponsible, and risky activities that can result in physical harm. Although it is true that older adults are at risk for injury related to both acute and chronic illness, that depression generally follows mania, and that manic individuals are at risk for injury caused by those who are affected by or who misunderstand the behavior, the primary risk to this patient comes from the manic behavior itself. p. 230, Table 13.2

A nurse is planning a diet chart for a manic patient who is on lithium therapy. Which instruction should be included in the diet chart? a. Reduce sodium intake. b. Take lithium with meals. c. Take lithium before breakfast. d. Avoid taking lithium before going to bed.

Chapter 13 b. Take lithium with meals. Rationale Lithium should be given with meals because lithium causes irritation of the stomach lining. Patients on lithium therapy should ensure they have adequate salt in their diets because lithium decreases sodium reabsorption, leading to a possible deficiency of sodium. Lithium should not be taken on an empty stomach before breakfast because it causes irritation of the stomach lining. Lithium intake should not affect the patient's sleep patterns. p. 235, Box 13.1

The nurse is reviewing the medical records of several patients receiving therapy for manic disorders. Which medication has a rare, potentially life-threatening rash? a. Lithium b. Valproate c. Lamotrigine d. Carbamazepine

Chapter 13 c. Lamotrigine Rationale Lamotrigine is an FDA-approved maintenance drug that patients usually tolerate well; however, a potentially life-threatening dermatologic reaction can occur, though rarely. Patients should be instructed to seek immediate medical attention if a rash develops during therapy. Liver function and platelet counts should be monitored periodically with valproate therapy. Liver enzymes and complete blood counts should be closely monitored in patients receiving carbamazepine. Lithium has many life-threatening side effects including convulsions, oliguria, and death, but life-threatening dermatological conditions are not associated with this therapy. pp. 234-235

Which patient is the best candidate for electroconvulsive therapy (ECT)? a. Patient with mania controlled on lithium therapy b. Patient with schizophrenia refusing medications c. Patient with bipolar depression displaying catatonia d. Patient with an altered level of consciousness (LOC)

Chapter 13 c. Patient with bipolar depression displaying catatonia Rationale ECT is used to subdue severe bipolar disorder, especially in patients with treatment-resistant mania, rapid cycling, or depressive episodes with severe catatonia. Patients with schizophrenia refusing medications may require involuntary treatment such as an assistive medication program or involuntary admission to stabilize symptoms. A patient with altered LOC should have a physical examination to determine the cause. A patient on controlled lithium therapy does not require ECT unless he or she develops catatonia or treatment-resistant symptoms. p. 236

A pregnant patient is diagnosed with bipolar disorder. Which treatment strategy would be included in the treatment plan? a. Lithium therapy b. Antianxiety therapy c. Anticonvulsant therapy d. Electroconvulsive therapy

Chapter 13 d. Electroconvulsive therapy Rationale Electroconvulsive therapy can be used to treat the patient with manic episodes during pregnancy. Lithium, anticonvulsants, and antianxiety drugs have teratogenic effects and can cause congenital malformation in the developing fetus. They cannot be used for pregnant and breastfeeding patients. p. 236

A patient diagnosed with major depressive disorder has vegetative symptoms. Which nursing diagnosis is most applicable to these symptoms? a. Self-care deficit b. Spiritual distress c. Disturbed thought processes d. Risk for self-directed violence

Chapter 14 a. Self-care deficit Rationale Vegetative signs of depression include grooming and hygiene deficiencies; significantly reduced appetite; and changes in sleeping, eating, elimination, and sexual patterns. Spiritual distress, disturbed thought processes, and risk for self-directed violence relate to assessment findings in depression associated with other symptoms, not vegetative signs of depression. p. 252

When preparing a patient for electroconvulsive therapy (ECT), the nurse discusses with the patient that: a. Maintenance treatments are seldom required. b. The initial course of therapy requires 6 to 12 treatments. c. This form of therapy is particularly successful for positive symptoms of schizophrenia. d. The initial therapy involves an ECT treatment repeated once a week for a prescribed time period.

Chapter 14 b. The initial course of therapy requires 6 to 12 treatments. Rationale A usual course is 6 to 12 treatments given two or three times per week. Maintenance ECT usually involves weekly treatments for the first month after remission, with gradual tapering to monthly ECT treatments. ECT is not typically used in the treatment of schizophrenia. p. 264

Which individual has the highest risk for major depression? a. 35-year-old married male who recently lost his job b. 6-year-old child who suffers from frequent ear infections c. 55-year-old single female recently diagnosed with rheumatoid arthritis d. 16-year-old male whose family recently moved from one state to another

Chapter 14 c. 55-year-old single female recently diagnosed with rheumatoid arthritis Rationale The correct response incorporates the most risk factors for depression. Primary risk factors include female gender, being unmarried, low socioeconomic class, early childhood trauma, a negative life event (especially loss and humiliation), family history of depression, ineffective coping ability, postpartum time period, medical illness, absence of social support, and alcohol or substance abuse. p. 246, Box 14.1

The nurse cares for a patient diagnosed with major depressive disorder. Assessment findings include psychosis and repeated threats to murder members of the immediate family. Which treatment modality is most likely for this patient? a. Light therapy b. St. John's wort c. Electroconvulsive therapy d. Cognitive behavioral therapy

Chapter 14 c. Electroconvulsive therapy Rationale The patient described in this scenario demonstrates psychosis and homicidal thinking. While medication is generally the first line of treatment for ease of use, electroconvulsive therapy may be a primary treatment when a patient is suicidal, homicidal, or psychotic. Light therapy is appropriate for a person diagnosed with seasonal affective disorder. Cognitive behavioral therapy is used in the treatment of depression, but is more effective in the maintenance phase. St. John's wort is an over-the-counter herb sometimes used for its antidepressant effects; however, the urgency and acuity of this patient's symptoms necessitate use of an intervention that will produce more immediate effects. pp. 263-264, Figure 14.3

It is likely that a patient diagnosed with seasonal affective disorder will begin to experience fewer symptoms in the a. Fall b. Winter c. Spring d. Summer

Chapter 14 c. Spring Rationale Seasonal affective disorder occurs during the months when sunlight diminishes. Patients may begin to feel effects in the late fall and will be affected throughout the winter. They improve during the spring and feel well during the summer. p. 266

A depressive patient is prescribed monoamine oxidase inhibitors. The nurse gives the diet chart to the patient. Which food does the patient consume according to the diet chart? a. The patient eats lot of cheese. b. The patient eats bananas. c. The patient eats yogurt. d. The patient eats dried fish.

Chapter 14 c. The patient eats yogurt. Rationale The patient eats yogurt as it contains less or no tyramine and is safe. Monoamine oxidase inhibitors (MAOIs) increase the levels of tyramine. So a patient on MAOIs should consume foods which have no or very low levels of tyramine, as an increase in tyramine levels can cause high blood pressure and hypertensive crisis. The patient avoids eating cheese, bananas, and dried fish as they contain high levels of tyramine. p. 262, Table 14.7

A patient was admitted to an intensive care unit after reporting chest pain, an elevated heart rate, and a very high body temperature. The patient's family reported to the nurse that the patient was taking antidepressants. They also reported that the patient started having chest pain after eating avocados and cheese. Which antidepressant medication was the patient likely taking that would have caused this interaction? a. Duloxetine b. Trazodone c. Desipramine d. Isocarboxazid

Chapter 14 d. Isocarboxazid Rationale Some foods, such as cheese, are rich sources of tyramine, which increases the production of serotonin in the body. Patients who are taking isocarboxazid, which is a monoamine oxidase inhibitor (MAOI), should avoid eating foods rich in tyramine because this substance can interact with MAOI drugs and cause adverse effects, such as hypertensive crisis and pyrexia (high body temperature). These reactions are seen within a few hours after consuming the contraindicated foods. The symptoms of hypertensive crisis are chest pain and increased or reduced heart rate. Desipramine is a tricyclic antidepressant and does not cause hypertensive crisis. Trazodone is a serotonin antagonist and reuptake inhibitor (SSRI), and its side effects are sedation and nausea. Hypertensive crisis is not a side effect associated with SSRIs. Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI); its side effects are nausea, headache, and dry mouth. p. 260, Table 14.6

The nurse is caring for a child who is demonstrating posttraumatic stress behaviors related to possibly being sexually abused. Which intervention will the nurse include in the child's plan of care? Select all that apply. a. Introducing and practicing relaxation techniques with the child. b. Assuring the child that everything discussed will be kept confidential. c. Directing the discussion to focus only on the issue of the possible abuse. d. Avoiding the use of sexually oriented terms that could trigger anxiety in the child. e. Providing the child with puppets to facilitate communication about the possible abuse.

Chapter 16 a. Introducing and practicing relaxation techniques with the child. e. Providing the child with puppets to facilitate communication about the possible abuse. Rationale Appropriate interventions to assist a child through the process to resolve a traumatic experience would include helping the child to identify and cope with feelings through the use of art and play to promote expression and teaching relaxation techniques before trauma exploration to restore a sense of control over thoughts and feelings. There is no reason to restrict the use of certain terms unless it is known to trigger anxiety. While the information is confidential, such a statement is not true in situations of abuse. The child should be in control of the discussion; the nurse facilitates but does not limit the discussion. pp. 299, 301, Box 16.1

A young adult diagnosed with dissociative identity disorder was hospitalized with self-inflicted lacerations. When asked about these injuries, the patient responded, "I don't know what happened. I just looked down and they were there." What is the priority nursing intervention for this patient? a. Maintain continuous observation. b. Teach coping skills and stress management strategies. c. Offer alternative activities to provide distraction from current stressors. d. Clean and dress the wounds while maintaining a matter-of-fact manner with the patient.

Chapter 16 a. Maintain continuous observation. Rationale The lacerations indicate violence, directed at self, and therefore pose a risk to the patient's safety. Alternate personalities may pose danger to this patient. Continuous monitoring is the highest priority nursing action. Teaching the patient is important, but safety has a higher priority. This patient needs a simple, safe treatment environment rather than many activities. It is appropriate for the nurse to provide care in a compassionate manner. p. 311, Table 16.2

A patient with dissociative disorder is prescribed paroxetine for treating anxiety. The nurse reports to the primary health care provider that the patient is unable to tolerate paroxetine. Which class of medication does the nurse anticipate in the new prescription to treat the patient's anxiety? a. Tricyclic antidepressants b. Beta adrenergic blockers c. Monoamine oxidase inhibitors d. Centrally acting alpha agonists

Chapter 16 a. Tricyclic antidepressants Rationale Paroxetine is a selective serotonin reuptake inhibitor. Some patients may have intolerance to the medication due to serotonin receptor insensitivity. Tricyclic antidepressants are medications that can be prescribed in such patients, as they act by enhancing the hormones serotonin and norepinephrine. Norepinephrine plays an important role in symptoms related to stress and anxiety. Beta adrenergic blockers are used for hyperarousal and panic. Monoamine oxidase inhibitors are not prescribed in these patients due to major side effects and adverse effects. Centrally acting alpha agonists can be used to treat hyperarousal and intrusive symptoms. pp. 304-305

A patient who has been diagnosed with dissociative identity disorder asks, "What exactly are 'alters'? My health care provider told me I have several of them." Which statement by the patient illustrates that the education provided has been effective? a. "Alters are never aware of each other." b. "Alters are separate personalities that take over during stress." c. "Alters are based in mysticism and religiosity, such as demons." d. "Alters are just like me, but they have no memory of the trauma I went through."

Chapter 16 b. "Alters are separate personalities that take over during stress." Rationale Dissociative identity disorder appears to be associated with at least two dissociative identity states: one is a state or personality that functions on a daily basis and blocks access and responses to traumatic memories, and another state (also referred to as an alter state) is fixated on traumatic memories. Each alter has its own memories, behavior patterns, and characteristics. Transition from one personality to another (switching) occurs during times of stress. The other responses are incorrect, because alters may be aware of the existence of each other to some degree. Alters are not just like the host; they have different behaviors and memories. p. 308

The nurse is caring for a child with posttraumatic stress disorder (PTSD). The parents ask the nurse about psychopharmacologic interventions. What is the best response by the nurse? a. "Medication that cures PTSD has undesirable side effects." b. "Certain medications can be taken to help minimize symptoms of PTSD." c. "Your child could be cured of PTSD with natural supplements rather than drugs." d. "Pharmacologic interventions are the optimal treatment for children with PTSD."

Chapter 16 b. "Certain medications can be taken to help minimize symptoms of PTSD." Rationale There are no FDA-approved medications for children who have PTSD. Rather, certain medications can be prescribed to help manage the symptoms of PSTD, such as anxiety or depression. There are no medications that can cure PTSD, not even with the use of natural supplements or drugs. The optimal treatment for children with PTSD is cognitive behavioral therapy, and this intervention can be used in addition to medication. p. 196

What does the nurse know about risk factors in posttraumatic stress disorder (PTSD) in children? a. There are no specific risk factors; anything can cause PTSD. b. Good social support can help build a child's resilience to PTSD. c. PTSD is a genetic condition, which comes from one or both parents. d. All people are born predisposed to PTSD because of brain chemistry.

Chapter 16 b. Good social support can help build a child's resilience to PTSD. Rationale Environmental factors can cause certain children to be more susceptible to PTSD. Therefore, children with good social support are more resilient when faced with PTSD triggers. There are environmental, biological, and psychological risk factors for PTSD. It is not accurate that all people are born predisposed to PTSD because not everyone has the same neurobiological makeup. PTSD is not a genetic condition, although there may be genetic factors that put children at higher risk of getting PTSD. p. 299

The nurse is caring for a patient with dissociative amnesia disorder. The patient gets extremely aggressive due to anxiety and causes physical harm to him or herself and to others. Which nursing intervention does the nurse follow to reduce anxiety and aggression in the patient? a. The nurse lets the patient make decisions on major issues. b. The nurse frequently observes the patient by visiting the patient's room. c. The nurse reminds the patient about the happy moments of the patient's life. d. The nurse prepares a schedule and instructs the patient to follow it regularly.

Chapter 16 b. The nurse frequently observes the patient by visiting the patient's room. Rationale The nurse frequently observes the patient to provide a protective environment by reducing the stressors. The nurse should not frequently remind the patient of past events, as it can cause severe panic and anxiety in the patient. The nurse should not be demanding or compel the patient to follow a schedule, as it can create anxiety in the patient. The nurse should help the patient in major decision-making, as the patient has reduced cognitive levels and reduced decision-making ability. It helps to lower the patient's stress and prevents the patient from making unwise decisions. p. 311, Table 16.2

If a patient diagnosed with a disorder resulting from trauma is within the window of tolerance, there is: a. Hypervigilance related to the environment. b. Avoidance of stimuli associated with the trauma. c. Evidence of accurate and meaningful self-disclosure. d. Balance between sympathetic and parasympathetic arousal.

Chapter 16 d. Balance between sympathetic and parasympathetic arousal. Rationale Many psychiatric disorders have trauma as a precipitant. Treatment strategies are designed to modulate arousal so that the person is able to stay within a window of tolerance. Window of tolerance means there is balance between sympathetic and parasympathetic arousal. Hypervigilance is associated with dominance by the sympathetic nervous system. Avoidance of stimuli associated with the trauma is a common assessment finding for persons diagnosed with disorders resulting from trauma. Self-disclosure is a psychosocial phenomenon. p. 300

A nurse is taking care of a patient who has attempted suicide. What appropriate intervention should the nurse follow for effective treatment? a. Emotionally connect with the patient's situation. b. Identify the problems experienced by the patient. c. Encourage nonverbal communication in the patient. d. Believe that the patient doesn't plan to commit suicide in the future.

Chapter 25

A novice nurse tells the nurse manager, "I don't want to ask my patients about suicidal ideation because 'It might put ideas in their heads about suicide.'" How will the nurse manager respond? a. "Actually, it's a myth that asking about suicide puts ideas into someone's head." b. "If I were you, I'd ask the health care provider to talk to the patient about that subject." c. "You are right; however, because of professional liability, we have to ask that question." d. "I'm glad you are thinking that way. The patient may not have thought of suicide before, and we don't want to introduce that."

Chapter 25 a. "Actually, it's a myth that asking about suicide puts ideas into someone's head." Rationale Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients usually have been thinking about suicide already; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason to ask patients about suicidal thoughts or plans; it is for patient safety. Asking the health care provider to speak to the patient on that subject does not educate the student nurse regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe. p. 479

A high school student tells the school nurse, "I just failed my chemistry test. I'm going to shoot myself." What is the most critical question for the nurse to ask this student? a. "Do you have access to a gun?" b. "Why do you want to kill yourself?" c. "Have you failed any other subjects?" d. "Did something happen with your parents?"

Chapter 25 a. "Do you have access to a gun?" Rationale The evaluation of a suicide plan is important in determining the degree of suicidal risk. Three main elements that must be considered when evaluating lethality are whether there is a specific plan with details (in this scenario, a self-inflicted gunshot wound), how lethal is the proposed method (guns are high lethality methods of suicide), and whether there is access to the planned method (does the patient have a gun). People who have definite plans for the time, place, and means are at high risk. "Why" questions are probing, nontherapeutic communication techniques. "Have you failed any other subjects?" and "Did something happen with your parents?" are yes/no questions that do not encourage the patient's self-disclosure. p. 479

A patient with diagnoses of borderline personality disorder, depression, and a high risk of suicide is stabilized and is getting discharged. The nurse interacts with this patient. Which response by the patient indicates effective treatment? a. "I promise you I will lead a happy life." b. "Sorry, I don't feel like talking with you." c. "I can help myself; I don't need your assistance." d. "Let me get discharged; I will put an end to everything."

Chapter 25 a. "I promise you I will lead a happy life." Rationale Patients with borderline personality disorder, depression, and suicidal ideation are at risk of suicide and injury to self or others. The treatment outcomes include the patient would remain free from injury, have a will to live, and would refrain from attempting suicide. In the statement that the patient promises to lead a happy life, the patient expresses the will to live. The statement suggests that the treatment is effective. The patient doesn't feel like talking to the nurse indicates that the patient is still depressed and prefers to be isolated. The statement suggests that treatment is not effective. In the statement that the patient does not need the nurse's assistance, the patient is denying the help. It indicates that the patient prefers to be alone and believes that no one would be able to help. The statement that the patient would put an end to everything once discharged is a covert statement. The patient is having suicide ideation, and the treatment is ineffective. p. 480, Table 25.2

A nurse assesses five new patients admitted to a psychiatric unit. Which patients have the highest risk for suicide? Select all that apply. a. 88-year-old Caucasian male b. 65-year-old Caucasian female c. 26-year-old Alaskan Native male d. 36-year-old African American male e. 17-year-old African American female

Chapter 25 a. 88-year-old Caucasian male c. 26-year-old Alaskan Native male e. 17-year-old African American female Rationale Men, particularly white men of advanced age, have a higher risk than women for suicide. Among American Indians/Alaska Natives aged 15 to 34 years, suicide is the second-leading cause of death. Hispanic and Black, non-Hispanic female high-school students in grades 9 to 12 have higher percentages of suicide attempts than White, non-Hispanics. Among females, those in their 40s and 50s have the highest rate of suicide. pp. 476, 478, Box 25.1

A registered nurse was appointed in charge of a psychiatric ward. What appropriate actions does the nurse take to keep patients safe in the ward? Select all that apply. a. Count the kitchen utensils daily b. Lock the utility rooms, kitchen, and office c. Install unbreakable shower rods in the bathroom d. Ensure that the windows remain open in the morning e. Decorate the ward with flowers in beautiful glass vases

Chapter 25 a. Count the kitchen utensils daily b. Lock the utility rooms, kitchen, and office Rationale The nurse should lock the utility rooms, kitchen, and offices and instruct all the staff members to do so. The nurse should count the number of utensils daily to ensure that the patients don't take harmful objects from the kitchen. The ward must be kept free of harmful objects, like glass vases and nails. The nurse should close the windows to prevent the patients from escaping. The bathrooms must be made jump-proof and hanging-proof by installing breakaway showers. p. 484, Box 25.4

A patient tells the nurse that he or she believes his or her situation is intolerable. The nurse assesses that the patient is isolating socially. A nursing diagnosis that should be considered is a. Hopelessness b. Deficient knowledge c. Chronic low self-esteem d. Compromised family coping

Chapter 25 a. Hopelessness Rationale The defining characteristics are present for the nursing diagnosis of hopelessness. p. 480, Table 25.2

The nurse develops a safety plan for a suicidal patient. Which interventions will the nurse include in the plan? Select all that apply. a. Identifying warning signs of a crisis b. Avoiding issues that trigger suicidal ideation c. Telling oneself that negative emotions are not "real" d. Making lists of things that are most important to the patient e. Calling on friends and other people who provide distractions

Chapter 25 a. Identifying warning signs of a crisis d. Making lists of things that are most important to the patient e. Calling on friends and other people who provide distractions Rationale Safety plans for patients who are suicidal include identifying warning signs of a crisis, identifying things that are most important and worth living for, and calling on friends and others for support and to provide distraction. Avoiding issues that trigger suicidal ideation and telling oneself that negative emotions are not "real" are ineffective psychosocial interventions and are not part of the safety plan. Patients who attempted suicide or have suicidal ideation must be encouraged to create and use internal coping strategies with triggers and negative emotions. p. 482

A divorced woman is treated with antidepressants in an inpatient setting. The patient expresses to the nurse, "My depression is gone. I feel very energetic today. Soon everything will be fine." What would be the most appropriate response for the nurse? a. "Yes, I will surely plan for your discharge." b. "Congrats! You seem to have recovered well." c. "Do you have any sort of suicidal ideas or plans?" d. "I am happy to see you recover from depression."

Chapter 25 c. "Do you have any sort of suicidal ideas or plans?" Rationale It is important for the nurse to be aware of verbal and nonverbal hints of suicide by a patient to prevent suicide. When there is a sudden rise in the mood and energy of a depressed patient, the nurse should understand that the patient may have suicidal ideation. These behavioral changes may be the patient's attempt to mask suicidal intent. In such situations, the nurse should ask the patient directly about suicidal ideation. The patient should not be discharged as the patient is not safe. The patient should not be congratulated for recovery from depression because the patient is still not mentally stable. The patient does not seem to have recovered from depression. Therefore the nurse should not express satisfaction with the patient's recovery. p. 479

The nurse is checking on a patient who is under 24-hour observation for suicide risk. The nurse checked the meal tray and found that there was no glass or silverware. The nurse then gave the patient medication and saw the patient swallow it. The nurse also gave the patient instructions about the things to be done the next day. After some time the patient went to sleep and the nurse later found that the patient was in a deep sleep, with hands and legs under the covers. Which observation or measure taken by the nurse needs to be addressed or corrected? a. Observing the patient's hands under the covers b. Observing the patient swallowing his medication c. Absence of any glass or silverware on the meal tray d. Telling the patient about things to be done the next day

Chapter 25 a. Observing the patient's hands under the covers Rationale A patient with suicidal ideation under 24-hour observation should be checked regularly by the attending nurse. The patient may hide any material used for suicide using his or her hands. The nurse should make sure that when the patient is sleeping, the hands are never under the covers. The nurse also needs to observe the patient swallowing each dose of medication and not retaining it in the mouth. The nurse should make sure that there are no glasses or silverware in meal trays with which the patient could injure him- or herself. The nurse should also explain the next day's schedule and document it in a chart to make the patient prepared for the next day's schedule. p. 484, Table 25.3

Which suicide intervention has the greatest impact on a patient's safety? a. One-on-one observation by the staff. b. Educating visitors about potentially dangerous gifts. c. Removal of personal items that might prove harmful. d. Restricting the patient from potentially dangerous areas of the unit.

Chapter 25 a. One-on-one observation by the staff. Rationale One-on-one observation allows for constant supervision, which minimizes the patient's opportunities to cause self-harm. Although educating visitors about potentially dangerous gifts, restricting the patient from potentially dangerous areas of the unit, and removal of personal items that might prove harmful are appropriate, they do not have the impact that one-on-one observation has. p. 484, Table 25.3

One week ago, a patient attempted suicide. When counseling this patient, which comment by the nurse is most therapeutic? a. As you look back on the past week, why do you think you tried to hurt yourself?" b. "I'd like to hear about how you are feeling now and the image you have of yourself." c. "You've made so much progress in one week. Do you think you're ready to go home?" d. "When you begin to have negative feelings, try to focus on something more positive."

Chapter 25 b. "I'd like to hear about how you are feeling now and the image you have of yourself." Rationale The nurse should give frequent opportunities for discussion of feelings through verbal invitation and stated concern. These topics are pertinent to the care of the suicidal patient: suicide prevention, hope instillation, coping enhancement, self-esteem enhancement, family mobilization, and support system enhancement. "Why" questions are probing and nontherapeutic communication techniques. While giving recognition is a therapeutic communication technique, asking a yes or no question about the patient's readiness for discharge does not invite further dialogue. Giving advice is a nontherapeutic technique.

A community nurse is assessing the risk factors for suicide among a group of people. What are the factors that are associated with highrisk of suicide? Select all that apply. a. Pregnancy in women b. Family history of suicide c. History of childhood abuse d. Responsibility to the family e. Religious values and beliefs

Chapter 25 b. Family history of suicide c. History of childhood abuse Rationale It is important for the nurse to be aware of factors associated with a high risk of suicide. A family history of suicide and a history of childhood abuse make an individual highly susceptible to suicide. However, pregnancy, religious values and beliefs, and a sense of responsibility to the family are protective factors. These factors often make a patient rethink the decision to commit suicide. p. 478, Box 25.2

Nurses should assess the lethality of the patient's plan for suicide. What factor would be irrelevant to that assessment? a. Whether the plan has specific details b. How long the patient has been suicidal c. Whether the method is one that causes death quickly d. Whether the patient has the means to implement the plan

Chapter 25 b. How long the patient has been suicidal Rationale Lethality refers to how deadly a plan is. The length of time a patient has been suicidal has nothing to do with the lethality of the plan. Evaluation of specific details, speed of death, and means to implement the plan all contribute to the lethality of a plan. p. 479

A nurse is taking care of a patient who has attempted suicide. What appropriate intervention should the nurse follow for effective treatment? a. Emotionally connect with the patient's situation. b. Identify the problems experienced by the patient. c. Encourage nonverbal communication in the patient. d. Believe that the patient doesn't plan to commit suicide in the future.

Chapter 25 b. Identify the problems experienced by the patient. Rationale The nurse should try to identify the problems experienced by the patient and his or her feelings toward it. It helps to explore alternative ways of helping the patient and decrease hopelessness in the patient. The patient could develop a positive orientation toward the future. The nurse should encourage the patient to interact verbally. When the feelings are conveyed verbally, the actions to show aggression will be reduced, which decreases physical harm. Though the patients deny a suicide idea, they may have a future plan of committing suicide. The nurse should not connect emotionally with the patient's situation as it can distract his or her attention and can lead to counter transference. The nurse should remain neutral to avoid arguments and sympathy with the patient. p. 480

A schizophrenic patient is aggressive and says, "I want to kill myself with a gun." What appropriate action should the nurse take while caring for the patient? a. Instruct the staff to stay away from the patient. b. Instruct the staff to observe the patient 24 hours a day. c. Instruct the staff to let the patient interact with other patients. d. Instruct the staff to chart the patient's whereabouts and record mood every 5 hours.

Chapter 25 b. Instruct the staff to observe the patient 24 hours a day. Rationale The patient is clearly communicating suicidal intentions. The staff should observe the patient 24 hours a day. The nurse should be around the patient and record his or her mood and behavior every 15-30 minutes. One-to-one nursing interaction must be done with the patient 24 hours a day. The patient should not be allowed to mingle with other patients as the patient can harm them. The nurse is supposed to chart the patient's whereabouts and record the mood and behavior every 15-30 minutes, not every 5 hours. p. 484, Table 25.3

A primary health care provider prescribes a tricyclic antidepressant to treat a depressive patient who is being held for psychiatric observation. The nurse observes that the patient is expressing suicidal thoughts and intentions. What should the nurse do while caring for the patient? Select all that apply. a. Hand over the complete course of medication to the patient. b. Suggest that the patient take a larger dose of the medication. c. Check the patient's mouth after providing doses of the medication. d. Give a reduced dose of the prescribed medication to prevent risk of overdose. e. Advise the patient's family to closely monitor the medication if the dose is taken at home.

Chapter 25 c. Check the patient's mouth after providing doses of the medication. e. Advise the patient's family to closely monitor the medication if the dose is taken at home. Rationale A tricyclic antidepressant, such as desipramine, can be prescribed to treat depressed patients but the doses should be carefully monitored in suicidal patients. Overdosing on a tricyclic antidepressant can be fatal due to its potent side effects and many suicidal patients attempt suicide by overdose of pills. The nurse should ensure that the patient swallows the tablet by checking the mouth. This will ensure that patients are not hoarding doses of medication with the intention to overdose later. The patient must be given medication only under the supervision of the nurse or the family to avoid overdose. Suggesting the patient increase the dose is not an acceptable option because dosage can only be changed by the primary health care provider and this is not necessarily an action to prevent suicide. The nurse should not give the complete course of medication at one time to the patient as the patient could abuse the drug. Patients must be given a limited day supply of medication so that they cannot consume all the tablets at a time. The nurse should not reduce the dose unless the primary health care provider prescribes it. p. 482

The nursing diagnosis risk for self-directed violence has been added to the care plan of a suicidal patient. The most appropriate short-term goal would be that while hospitalized, the patient will a. Participate in a self-help group b. Name three personal strengths c. Seek help when feeling self-destructive d. Reclaim any prized possessions that were given away

Chapter 25 c. Seek help when feeling self-destructive Rationale Having the patient cope with self-destructive impulses in a healthy way is the only appropriate short-term goal here. p. 481

Which term is used in the medical record to indicate a patient wishes to be dead and is thinking about methods to use to accomplish death? a. Suicide b. Suicide attempt c. Suicidal ideation d. Completed suicide

Chapter 25 c. Suicidal ideation Rationale Suicidal ideation is the term used to describe thinking about death, wishes to die, and methods of accomplishing death. Suicide is not a formal term used in the medical record. It describes the intentional act of killing oneself by any means. Suicide attempt is the behavior of carrying out acts with the intention of death. Completed suicide is a term used to describe actions committed by an individual that lead to death. p. 475

A nurse interacts with a depressive patient. The patient says, "Can you get me carbon monoxide tomorrow? I want to kill myself." What conclusion should the nurse make from the patient's response? a. The patient has delusions. b. The patient is socially withdrawn. c. The patient is at higher risk of suicide. d. The patient can cause harm to others.

Chapter 25 c. The patient is at higher risk of suicide. Rationale The nurse should appropriately evaluate the suicide plan of the patient. Patients with definite intention and time are at high risk. Based on the method of lethality, patients can be classified as higher risk and lower risk. Carbon monoxide poisoning, using a gun, jumping off a high place, or car crash indicate high risk. Depressive patients normally feel rejected and avoid social gatherings. The statement by the nurse does not indicate that the client is socially withdrawn. Although delusions are not a high risk of suicide, they can result in suicide. The patient does not have manifestations of delusions. The patient is depressed and sad but not aggressive, so there is no harm to others. p. 479

The nurse meets with a 13-year-old adolescent who has depression and whose parents report the patient "has stopped wanting to go to school." Which statement made by the adolescent most makes the nurse believe that the child is at risk for suicide? a. "All my friends use drugs, and I don't want to be around people like that at school." b. "Classrooms make me nervous because they are small, and there are too many kids in one room." c. "I don't like my teachers because they call on me all the time, and I feel nervous and embarrassed." d. "The kids at school either call me names or make up stories about me to get my friends to not like me anymore."

Chapter 25 d. "The kids at school either call me names or make up stories about me to get my friends to not like me anymore." Rationale When the adolescent expresses that classmates bully him or her, the nurse knows this is a risk factor for suicide among youths. Not wanting to use drugs at school, feeling anxious in the classroom, and not liking teachers are not statements that indicate risk for suicide.

Which statement is true concerning the act of suicide? a. More women than men commit suicide. b. Native Americans and Alaskan Natives have low suicide rates. c. Suicide is the second leading cause of death in the United States. d. A patient with schizophrenia is at great risk for attempting suicide.

Chapter 25 d. A patient with schizophrenia is at great risk for attempting suicide.' Rationale Individuals with schizophrenia are 50 times more likely to attempt suicide than the general public. More women attempt suicide, but more men are successful. Suicide is the tenth leading cause of death in the United States. Native Americans and Alaskan Natives have high suicide rates. p. 476

A patient on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." The nurse should a. Leave the patient's room and wait outside in the hall b. Say "I understand" and allow the patient to close the door c. Keep the door open, but step to the side out of the patient's view d. Say "For your safety I can be no more than an arm's length away"

Chapter 25 d. Say "For your safety I can be no more than an arm's length away" Rationale This level of suicide watch does not make adjustments based on patient preference. The explanation quoting the protocol and the reason (the patient's safety) is appropriate. p. 484, Table 25.3

A nurse is caring for a patient with gallbladder cancer. The patient says, "Though my family is very supportive, I feel like a burden on my family." What appropriate diagnosis should the nurse make from the patient's response? a. Social Isolation b. Disabled family coping c. Impaired social interaction d. Situational low self-esteem

Chapter 25 d. Situational low self-esteem Rationale Patients with situational low self-esteem have feelings of worthlessness and being a burden on family and others. Disabled family coping is characterized by ineffective communication with the family and unavailability of the family. Patients with impaired social interaction have few supportive groups and don't interact with others. Intense feeling of isolation, deprivation, and lack of love can be seen in patients with social isolation. p. 480, Table 25.2

Which closed-ended assessment question focuses on identifying a classic comorbid condition of bipolar disorder? Select all that apply. a. Have you ever experienced a panic attack? b. Are you comfortable when you are among strangers? c. Have you ever been arrested by the police for fighting? d. Do you rely on alcohol to help cope with your problems? e. Have you ever been told you have obsessive-compulsive disorder?

a. Have you ever experienced a panic attack? b. Are you comfortable when you are among strangers? c. Have you ever been arrested by the police for fighting? d. Do you rely on alcohol to help cope with your problems? Rationale Within a lifetime, the most commonly co-occurring disorders for all bipolar disorders are panic attacks (62%), alcohol abuse (39%), social phobia (38%), oppositional defiant disorder (37%), specific phobia (35%), and seasonal affective disorder (35%). Obsessive-compulsive disorder generally is not associated with bipolar disorder. p. 225

A patient with depression was prescribed fluvoxamine. On regular examination, the nurse identifies that the patient is having serotonin syndrome. Which symptoms in the patient support the nurse's assumption? Select all that apply. a. Hyperactivity b. Reduced heart rate c. Altered mental states d. Abnormally high fever e. Reduced blood pressure

a. Hyperactivity c. Altered mental states d. Abnormally high fever Rationale Fluvoxamine is a selective serotonin reuptake inhibitor. It can cause potential side effects such as serotonin syndrome due to overactivation of central serotonin receptors. Serotonin syndrome is characterized by hyperactivity, altered mental state, and hyperpyrexia characterized by excessively high fever. It is also characterized by elevated blood pressure and increased heart rate. p. 260, Box 14.3

The nurse is addressing a primary symptom of schizophrenia when a. Arranging for the patient to attend stress management classes b. Reinforcing the patient's ability to interrupt intrusive paranoid thoughts c. Working with the patient to arrive at a budget that allows him or her to live independently d. Supporting the patient in his or her attempts to stop using alcohol to cope with hallucinations

b. Reinforcing the patient's ability to interrupt intrusive paranoid thoughts Rationale Primary symptoms are ones that are directly caused by the mental illness, such as paranoid thoughts. Stress is a secondary symptom of schizophrenia resulting from stressors related to coping with the illness. A need for assistance while living independently is a secondary symptom of schizophrenia resulting from stressors created by the illness. Alcohol abuse is a secondary symptom of schizophrenia resulting from the use of alcohol to manage the stress of the hallucinations (a primary symptom). p. 193

The nurse teaches the parents of an adolescent who was diagnosed with schizophrenia about comorbidity. What does the nurse include in the teaching? a. "Watch your child for signs of substance abuse." b. "Make sure your child does not become dehydrated." c. "With schizophrenia, your child will not experience any depression." d. "Contact the healthcare provider immediately if your child has anxiety."

Chapter 12 a. "Watch your child for signs of substance abuse." Rationale Substance use disorders involving alcohol, marijuana, and nicotine occur in nearly half of the people who are diagnosed with schizophrenia. Substance use is linked to higher rates of treatment nonadherence. Schizophrenia may cause polydipsia, which is a compulsive drinking of excess fluids, not dehydration. Depression frequently co-occurs in individuals with schizophrenia. Anxiety co-occurs with schizophrenia, but it is not necessary to contact the healthcare provider immediately if these symptoms present. p. 193

The causation of schizophrenia currently is understood to be a. A combination of inherited and nongenetic factors b. Deficient amounts of the neurotransmitter dopamine c. Excessive amounts of the neurotransmitter serotonin d. Stress related and ineffective stress management skills

Chapter 12 a. A combination of inherited and nongenetic factors Rationale Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme nongenetic factors (e.g., viral infection, birth injuries, and nutritional factors) that can affect the genes governing the brain or directly injure the brain. Changes in dopamine and serotonin are signs of schizophrenia but not thought to be the cause. Stress and ineffective stress management are risk factors but not thought to cause schizophrenia.

What area of instruction should the nurse include in the education of a family with a member who has been diagnosed with schizophrenia? Select all that apply. a. Medication side effects b. Stress as a psychotic trigger c. Relapse prevention strategies d. Need for family to take over the management of care e. Family's role in achieving positive treatment outcomes

Chapter 12 a. Medication side effects b. Stress as a psychotic trigger c. Relapse prevention strategies e. Family's role in achieving positive treatment outcomes Rationale Education is essential and includes teaching the patient and family about the illness: causes, medications, and side effects, coping strategies, what to expect, and relapse prevention. This knowledge and skill help the patient and family to appreciate the impact of stress and the importance of treatment to a good outcome. The patient who returns to a warm, concerned, and supportive environment is less likely to experience relapse. The patient should always be involved in the management of his or her care to the extent of his or her abilities. p. 210, Box 12.5

The nurse is caring for a patient who presents with disorganized thoughts and reports hearing voices that tell him or her to stay home. As a result, the patient has not shown up for work in several weeks and is at risk of losing employment. How does the nurse document this in the patient's chart? a. Positive symptoms of schizophrenia b. Negative symptoms of schizophrenia c. Cognitive symptoms of schizophrenia d. Affective symptoms of schizophrenia

Chapter 12 a. Positive symptoms of schizophrenia Rationale The patient is presenting with positive symptoms of schizophrenia. This includes the presence of something that should not be present, such as hallucinations, delusions, paranoia, disorganized thoughts, and bizarre behaviors. Negative symptoms are the absence of something that should be present. Examples include the inability to enjoy activities or being uncomfortable in social situations. Cognitive symptoms can include subtle or obvious impairment in memory, thinking, and attention. Affective symptoms involve motions and their expressions. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 197

A patient with schizophrenia prescribed with trihexyphenidyl complains of constipation. What is the most appropriate action by a nurse to help the patient? a. The nurse should give prune juice. b. The nurse should prescribe benztropine. c. The nurse should discontinue administration of the drug. d. The nurse should report to the primary health care provider.

Chapter 12 a. The nurse should give prune juice. Rationale Constipation is a side effect usually caused by anticholinergic drugs like trihexyphenidyl. A nurse can help by advising the patient to take fluids like prune juice and water, as well as eat fiber-rich foods. A nurse should not discontinue administration of the medication because patients with schizophrenia develop extrapyramidal side effects (EPSs) as a result of conventional antipsychotics. Trihexyphenidyl is a centrally acting anticholinergic that reduces EPS. A nurse should report to the primary health care provider, but it is not the primary action to be taken. Benztropine is an anticholinergic drug. It has the same side effects as that of trihexyphenidyl.

The nurse is caring for a patient with schizophrenia who was given an injectable dose of dopamine (D 2) antagonists for the limbic center. Which side effects does the nurse anticipate? Select all that apply. a. Tremors b. Difficulty walking c. Increased energy d. Loosening of reflexes e. Pacing back and forth f. Muscular contraction in the neck

Chapter 12 a. Tremors b. Difficulty walking e. Pacing back and forth f. Muscular contraction in the neck Dopamine antagonists are first-generation antipsychotics that are used less frequently because of their side effects. The medications block D 2 receptors, causing extrapyramidal side effects that include pacing and general restlessness (akathisia); muscular contractions (acute dystonia); gait impairment; and tremors (pseudoparkinsonism). These agents do not loosen reflexes or increase energy, though akathisia can sometimes be confused with increased energy.

Which statement by a person with paranoid schizophrenia mostclearly indicates that the antipsychotic medication is effective? a. "My medicine is working fine. I'm not having any problems." b. "I used to hear scary voices but now I don't hear them anymore." c. "Sometimes it's hard for me to fall asleep, but I usually sleep all night." d. "I think some of the staff members don't like me. They're mean to me."

Chapter 12 b. "I used to hear scary voices but now I don't hear them anymore." Rationale: Auditory hallucinations are a common manifestation of paranoid schizophrenia, so their absence is an indicator of medication effectiveness. "My medicine is working fine. I'm not having any problems" and "Sometimes it's hard for me to fall asleep, but I usually sleep all night" are too vague. "I think some of the staff members don't like me. They're mean to me" indicates paranoid thinking.

Which symptom would NOT be assessed as a positive symptom of schizophrenia? a. Idea of reference b. Affective flattening c. Auditory hallucinations d. Delusion of persecution

Chapter 12 b. Affective flattening Rationale Positive symptoms are those symptoms that should not be present, but are. They include hallucinations, delusions, bizarre behavior, and paranoia and are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated. pp. 197-199, 201, Table 12.2

Which of the following symptoms would alert a health care provider to a possible diagnosis of schizophrenia in a young adult patient? a. Excessive sleeping with disturbing dreams b. Command hallucinations to hurt roommate c. Withdrawal from college because of failing grades d. Chaotic and dysfunctional relationships with family and peers

Chapter 12 b. Command hallucinations to hurt roommate Rationale: People diagnosed with schizophrenia all have at least one psychotic symptom, such as hallucinations, delusional thinking, or disorganized speech. Excessive sleeping, failing grades, and chaotic and dysfunctional relationships do not describe schizophrenia but could be caused by a number of problems.

A patient with schizophrenia who is experiencing symptoms of disorganized thinking would have the greatest difficulty when the nurse a. Uses concrete language b. Gives multistep directions c. Interacts with a neutral attitude d. Provides nutritional supplements

Chapter 12 b. Gives multistep directions Rationale: The thought processes of the patient with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the patient to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times.

Which drug can be used to treat alogia, avolition, and anhedonia in schizophrenic patients? a. Molindone b. Olanzapine c. Thiothixene d. Thioridazine

Chapter 12 b. Olanzapine Olanzapine is a second-generation antipsychotic. It is prescribed to treat both positive symptoms, like hallucination and delusion, and negative symptoms, like alogia, avolition, and anhedonia. Thiothixene is a high-potency first-generation antipsychotic. It is prescribed to treat positive symptoms like hallucination and delusion. Molindone is a medium-potency first-generation antipsychotic. It does not treat alogia, avolition, or anhedonia. Thioridazine is a low-potency first-generation antipsychotic used to treat positive symptoms of schizophrenia. p. 212, Table 12.5

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill patient who has been diagnosed with schizophrenia is early detection of a. Acute dystonia b. Tardive dyskinesia c. Cholestatic jaundice d. Pseudoparkinsonism

Chapter 12 b. Tardive dyskinesia Rationale An AIMS assessment should be performed periodically on patients who are being treated with antipsychotic medication known to cause tardive dyskinesia. p. 213, Figure 12.2

Which side effect of antipsychotic medication is generally nonreversible? a. Dystonic reaction b. Tardive dyskinesia c. Pseudoparkinsonism d. Anticholinergic effects

Chapter 12 b. Tardive dyskinesia Rationale Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects of anticholinergic effects, pseudoparkinsonism, and dystonic reaction often appear early in therapy and can be minimized with treatment.

A nursing intervention designed to help a patient with schizophrenia manage relapse is to a. Schedule the patient to attend group therapy that includes those who have relapsed b. Teach the patient and family about behaviors associated with relapse c. Remind the patient of the need to return for periodic blood draws to minimize the risk for relapse d. Help the patient and family adapt to the stigma of chronic mental illness and periodic relapses

Chapter 12 b. Teach the patient and family about behaviors associated with relapse Rationale By knowing what behaviors signal impending relapse, interventions can be invoked quickly when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted. p. 202, Box 12.2

A nurse is caring for a patient with schizophrenia. The nurse observes that the patient does opposite of any given instruction unintentionally and the patient often runs in the corridor. What is the probable diagnosis by the nurse from such behavior? a. The patient is restless. b. The patient has negativism. c. The patient has hearing problems. d. The patient does not like the nurse.

Chapter 12 b. The patient has negativism. Rationale Schizophrenia is characterized by the symptoms of negativism, in which patients tend toward resistance and to do the opposite of what they are told. These patients also have motor agitation, in which they run or pace rapidly in response to stimuli and show unintended excessive movements. The patient's behavior is unlikely to be due to hearing problem, restlessness, or dislike toward the nurse.

A patient diagnosed with schizophrenia says, "Cheese dog run fast." How should the nurse document this comment? a. Neologism b. Word salad c. Circumstantiality d. Magical thinking

Chapter 12 b. Word salad Rationale: A word salad is a jumble of words that is meaningless to the listener and results from an extreme level of disorganization. A neologism is an invented word. Circumstantiality refers to verbal expression with excessive detail. Magical thinking means believing that one's thoughts or actions can affect others.

A young adult is hospitalized with schizophrenia. The parents are distraught and filled with guilt. What would be an appropriate nursing response? a. "I'll recommend some excellent websites to learn about schizophrenia and other mental illnesses." b. "Look on the bright side. With the right medications and treatment, this disease can be cured." c. "There are many theories about the cause of schizophrenia, but this illness is not your fault." d. "Does anyone in your family have mental illness? Schizophrenia is a genetically transmitted disease."

Chapter 12 c. "There are many theories about the cause of schizophrenia, but this illness is not your fault." Rationale It is important for the nurse to give accurate information without adding to the parent's emotional burden. There are many theories about the etiology of schizophrenia; asking whether anyone in the family has schizophrenia is not a therapeutic statement and may induce guilt. Telling the family to look on the bright side is not realistic and does not respond to their feelings. Recommending websites for research is an incorrect response because the parents are not ready to learn details about mental illness. pp. 194-196

A patient diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as a. Blocking b. A delusion c. A neologism d. Clang association

Chapter 12 c. A neologism Rationale A neologism is a newly coined word that has meaning only for the patient. Clang association is choosing a word with similar sound like "click, clack, clutch." Blocking is related to thoughts and a stop or reduction in thoughts often related to interruptions caused by hallucinations. Delusions are false beliefs. p. 198

A patient diagnosed with schizophrenia is most likely to experience which type of hallucination? a. Visual b. Tactile c. Auditory d. Olfactory

Chapter 12 c. Auditory Rationale: Patients diagnosed with schizophrenia may experience hallucinations arising out of any of the senses; however, auditory hallucinations are experienced by 60% of people with schizophrenia at some time during their lives. Visual hallucinations more commonly are associated with substance abuse and withdrawal. Tactile and olfactory hallucinations are rare.

A nurse assesses a patient diagnosed with schizophrenia who states, "Aliens are trying to inject me with their DNA." The nurse documents the patient's comment and applies which term? a. Anosognosia b. Affective blunting c. Positive symptoms d. Negative symptoms

Chapter 12 c. Positive symptoms Rationale The patient's comment indicates delusional thinking, which is a positive symptomof schizophrenia. Anosognosia refers to an inability to realize an illness exists. Affective blunting relates to the patient's outward expression of emotion. Negative symptoms include social isolation, anergia, lack of motivation, blunted affect, and inattention to personal hygiene. pp. 197-199, 201, Table 12.2

A nurse is caring for a patient with schizophrenia. Upon the nurse's report, the primary health care provider prescribed 25 mg of diphenhydramine hydrochloride to the patient. What had the nurse reported to the primary health care provider about the patient? a. The patient has a peptic ulcer and asthma. b. The patient has mydriasis and photosensitivity. c. The patient has tremors and tardive dyskinesia. d. The patient has excessively dry mucous membranes.

Chapter 12 c. The patient has tremors and tardive dyskinesia. Rationale Patients with schizophrenia are generally prescribed antipsychotic drugs. These drugs cause extrapyramidal side effects, like tremors, and abnormal involuntary movements, like tardive dyskinesia. Diphenhydramine hydrochloride 25 mg by the intramuscular or intravenous route is prescribed to such patients to treat extrapyramidal side effects. Diphenhydramine hydrochloride is contraindicated in patients with peptic ulcer and asthma because it causes stomach distress like nausea, vomiting, and diarrhea. Physostigmine and benzodiazepines are administered to control these symptoms. Photosensitivity and mydriasis are symptoms of anticholinergic toxicity. Dry mucous membranes can be a symptom of anticholinergic toxicity but are not a major concern with the administration of diphenhydramine hydrochloride. p. 211

A patient with schizophrenia reports to the nurse, "At night my business rival came to the hospital to kill me for my property." What is the most appropriate response of the nurse while handling such a patient? a. "Next time when you see him, call me." b. "Oh, really! Let's file a police complaint." c. "No one can come to the hospital in the night." d. "Because of your illness you are having hallucinations. No one can hurt you."

Chapter 12 d. "Because of your illness you are having hallucinations. No one can hurt you." Rationale A patient with schizophrenia often has hallucinations. The nurse should try to persuade the patient to focus on reality by convincing him that these visions are part of the illness. This assurance makes the patient confident and does not support the illness. A nurse also should not neglect the patient's hallucinations because this can make the patient feel rejected and be at risk for withdrawing. It is advisable that the nurse does not encourage the patient's hallucination by saying that the patient should call her the next time he sees the business rival. This can worsen the patient's condition. p. 209, Box 12.3

The nurse is teaching a patient and the patient's family about first- and second-generation antipsychotics for schizophrenia. What will the nurse include in the teaching? a. "Most people who take first-generation antipsychotics report fewer side effects." b. "Second-generation antipsychotics are mostly used for treating negative symptoms of schizophrenia." c. "First-generation antipsychotics are used more frequently than second-generation antipsychotics." d. "Second-generation antipsychotics are usually better than first-generation antipsychotics because they have fewer side effects."

Chapter 12 d. "Second-generation antipsychotics are usually better than first-generation antipsychotics because they have fewer side effects." Rationale Both first- and second-generation antipsychotics are used to treat schizophrenia. Second-generation antipsychotics are used more frequently than and are starting to replace first-generation antipsychotics, because they are more effective with fewer side effects. Second-generation antipsychotics are used to treat positive symptoms of schizophrenia, not negative symptoms. First-generation antipsychotics are used less frequently than second-generation drugs, not more frequently. First-generation antipsychotics cause more negative side effects, not fewer side effects.

The type of altered perception most commonly experienced by patients with schizophrenia is a. Delusions b. Illusions c. Tactile hallucinations d. Auditory hallucinations

Chapter 12 d. Auditory hallucinations Rationale Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of individuals with schizophrenia.

A patient with schizophrenia was changed to clozapine 3 weeks ago. The patient calls the clinic nurse complaining of sore throat, fever, and malaise. Which laboratory test would be most helpful in determining the cause of these findings? a. Urinalysis b. Liver panel c. Serum lithium level d. Complete blood cell count

Chapter 12 d. Complete blood cell count Rationale: Agranulocytosis is the reduction of white blood cells (WBCs) and is a possible adverse effect of antipsychotic drugs, particularly clozapine. Chief complaints are flulike symptoms. A complete blood cell count would show the reduction in WBCs. Serum lithium level, liver panel, and urinalysis are not necessary.

A patient has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be a. Acute symptom stabilization b. Safety and crisis intervention c. Stress and vulnerability assessment d. Social, vocational, and self-care skills

Chapter 12 d. Social, vocational, and self-care skills Rationale During the stable plateau phase of schizophrenia, planning is geared toward the patient and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community. p. 196

A patient diagnosed with bipolar disorder has taken lithium for 1 year with good results. Today, the patient phones the nurse with these complaints. Which complaint should receive the nurse's priorityattention? a. "I've had very bad diarrhea for 3 days." b. "I notice my hand trembling occasionally." c. "In the past 6 months, I have gained 8 pounds." d. "I have been putting a little extra salt on my food."

Chapter 13 a. "I've had very bad diarrhea for 3 days." Rationale Diarrhea makes this patient vulnerable to dehydration, which can result in increased concentration of lithium in the blood. This increased drug concentration can lead to lithium toxicity. Fine tremors and weight gain are expected side effects associated with lithium therapy. The nurse should be sensitive to these concerns, but they are not a priority. Salt is important for patients who take lithium. pp. 234, 235, Box 13.1

Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply. a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." b. "Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder. c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."

Chapter 13 a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."

Which room placement would be best for a patient experiencing a manic episode? a. A single room near the nurses' station b. A single room near the unit activities area c. A shared room with a patient with dementia d. A shared room away from the unit entrance

Chapter 13 a. A single room near the nurses' station Rationale: The room placement that provides a nonstimulating environment is best. Nearness to the nurses' station means close supervision can be provided.

Which behavior is important to include for the patient and the family to recognize possible signs of impending mania? a. Decreased sleep b. Increased appetite c. Decreased social interaction d. Increased attention to body functions

Chapter 13 a. Decreased sleep Rationale Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. Increased appetite, decreased social interaction, and increased attention to bodily functions do not indicate impending mania. p. 237

A patient displays a period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extremely goal-directed activity. What is the term for the patient's behavior? a. Mania b. Hypomania c. Flight of ideas d. Loose associations

Chapter 13 a. Mania Rationale Mania is a period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extremely goal-directed activity or energy. Mania commonly occurs with bipolar I disorder. Flight of ideas is a continuous flow of accelerated speech with abrupt changes from topic to topic. Hypomania refers to a low-level and less-dramatic mania. Loose associations represent the disordered way that a person is processing information and thoughts that are only loosely connected to each other in the person's conversation.

A nurse is assisting a manic patient in dressing and maintaining basic hygiene tasks. Which nursing interventions are appropriate for the patient in a manic state? Select all that apply. a. Provide step-by-step instructions for dressing. b. Allow the patient to wear whatever he or she chooses. c. Provide simple clothes and hygiene tasks to the patient. d. Warn the patient that seclusion can be used to control behavior. e. Provide repeated reminders to finish tasks if necessary.

Chapter 13 a. Provide step-by-step instructions for dressing. c. Provide simple clothes and hygiene tasks to the patient. e. Provide repeated reminders to finish tasks if necessary. Rationale The nurse should supervise the clothes and hygiene of the patient who is in a manic state. The patient should be provided simple clothing and can be instructed in a step-by step manner so that the patient can understand and follow the instructions. The patient may need to be given frequent reminders to maintain hygiene because manic patients can be easily distracted and have poor concentration. Manic patients may choose overly flamboyant or bizarre fashion and should be provided with clothes that help to maintain their dignity while in a manic state. Frequent warning of seclusion to the patient can cause depression and withdrawal of the patient. p. 232, Table 13.3

The priority nursing diagnosis for a hyperactive manic patient during the acute phase is a. Risk for injury b. Ineffective role performance c. Risk for other-directed violence d. Impaired verbal communication

Chapter 13 a. Risk for injury Rationale: Risk for injury is high, related to the patient's hyperactivity and poor judgment.

To plan care for a manic patient the nurse must consider that lithium cannot be started until a. The physical examination and laboratory tests are analyzed b. The initial doses of antipsychotic medication have brought behavior under control c. Seclusion has proven ineffective as a means of controlling assaultive behavior d. Electroconvulsive therapy can be scheduled to coincide with lithium administration

Chapter 13 a. The physical examination and laboratory tests are analyzed Rationale: Lithium should not be given to patients with impaired renal or thyroid function. A thorough physical examination and various laboratory tests are necessary to rule out other organic causes for the behavior and to ensure that the lithium can be excreted normally.

A patient who is treated with lithium carbonate shows no improvement and often gets agitated and depressed. Which drug would the nurse expect the primary health care provider to prescribe to the patient? a. Valproate b. Phenytoin c. Gabapentin d. Phenobarbital

Chapter 13 a. Valproate Rationale Valproate, carbamazepine, and lamotrigine are the three anticonvulsants that can be used in treating bipolar disorders. Anticonvulsants are used when the patient is not responding to lithium therapy. They are also used in dysphoric mania characterized by mixed state, or when the patient often gets agitated and depressed. The other anticonvulsants such as phenobarbital, gabapentin, and phenytoin are not effective in bipolar disorders because they may worsen the patient's condition. pp. 235-236, Table 13.5

When a patient reports that lithium causes an upset stomach, the nurse suggests taking the medication a. With meals b. With an antacid c. 30 minutes before meals d. 2 hours after meals

Chapter 13 a. With meals Rationale Many patients find that taking lithium with or shortly after meals minimizes gastric distress. p. 235, Box 13.1

What is the usual age of onset for cyclothymic disorders? a. Childhood b. Adolescence c. Middle adulthood d. Late adulthood

Chapter 13 b. Adolescence Rationale: Cyclothymic disorders usually begin in adolescence or early adulthood. They typically begin later than childhood but earlier than middle or late adulthood.

The plan of care for a patient who takes lithium should include a. Dietary teaching to restrict daily sodium intake b. Periodic laboratory monitoring of renal and thyroid function c. The requirement for laboratory tests to monitor serum potassium level d. The importance of discontinuing the medication if fine hand tremors occur

Chapter 13 b. Periodic laboratory monitoring of renal and thyroid function Rationale Two major long-term risks of lithium therapy are hypothyroidism and impairment of the kidney's ability to concentrate urine; therefore, a person receiving lithium therapy must have periodic follow-ups to assess thyroid and renal function. Weight gain and fine tremors are common side effects associated with this medication, but the patient should continue taking the medication. Sodium intake for patients who take lithium is not restricted. p. 235, Box 13.1

A nurse prepares the plan of care for a person having a manic episode. Which nursing diagnoses are most likely to apply? Select all that apply. a. Social isolation b. Sleep deprivation c. Disturbed thought processes d. Risk for deficient fluid volume e. Altered nutrition; more than body requirements

Chapter 13 b. Sleep deprivation c. Disturbed thought processes d. Risk for deficient fluid volume Rationale A person experiencing mania sleeps poorly, does not take time to eat or drink, and talks rapidly and insistently with others. Psychosis may be present. Impaired social interaction would be an appropriate diagnosis rather than social isolation. p. 230, Table 13.2

A patient diagnosed with bipolar disorder has taken lamotrigine (Lamictal) for 3 months with good results. Today, the patient phones the nurse with these complaints. Which complaint should receive the nurse's priority attention? a. "Last night I slept for only 7½ hours." b. "I have not had a bowel movement in 2 days." c. "I have a new rash on my chest and abdomen." d. "I bumped into a table yesterday and got a bruise on my elbow."

Chapter 13 c. "I have a new rash on my chest and abdomen." Rationale: Lamotrigine is a first-line treatment for bipolar depression and is approved for acute and maintenance therapy. Lamotrigine generally is tolerated well, but there is one serious but rare dermatological reaction: a potentially life-threatening rash. Patients should be instructed to seek immediate medical attention if a rash appears, although most rashes are likely benign. Sleeping for 7½ hours is healthy. Two days without a bowel movement does not necessarily represent constipation. A bruise is a normal result from a minor trauma.

The patient treated with lithium carbonate repeatedly requests water to drink and has slurred speech. What is the priority nursing action in this case? a. Provide food to the patient. b. Administer mannitol to the patient. c. Check the patient's blood lithium level. d. Report to the primary health care provider.

Chapter 13 c. Check the patient's blood lithium level. Rationale Excessive thirst, slurred speech, and polyuria are early signs of lithium toxicity. The nurse should check the lithium level of the patient frequently. The nurse can report to the primary health care provider but after checking the lithium levels in the blood. Mannitol can be administered to eliminate the drug in case of severe toxicity. Food does not help prevent lithium toxicity. p. 234, Table 13.4

Which symptom related to communication is likely to be present in a patient experiencing mania? a. Mutism b. Poverty of ideas c. Clang associations d. Psychomotor retardation

Chapter 13 c. Clang associations Rationale: Clang associations are the stringing together of words because of their rhyming sounds, without regard to their meaning. This communication style occurs commonly in persons experiencing mania. Mutism, poverty of ideas, and psychomotor retardation are assessment findings usually associated with depression.

Which food should be incorporated in the diet of patients with bipolar disorder that would also help in mood regulation? a. Cereals b. Chocolates c. Cod liver oil d. Milk products

Chapter 13 c. Cod liver oil Rationale Integrative therapy for bipolar disorder may involve the use of foods rich in omega-3 fatty acids because those help with mood regulation and improve attention. Cod liver oil is a rich source of omega-3 fatty acids; hence it can be included in a patient's diet. Milk products can be included, but they do not help in mood regulation but rather as a source of protein. Chocolate must be avoided for patients with bipolar disorder because chocolate contains cocoa, which has caffeine. Caffeine causes central nervous system stimulation and can cause anxiety. Cereals are a source of carbohydrates. They do not contain high amounts of omega-3 fatty acids, so they do not cause mood regulation. p. 236

Which side effects of lithium can be expected at therapeutic levels? a. Nausea and thirst b. Ataxia and hypotension c. Fine hand tremor and polyuria d. Coarse hand tremor and gastrointestinal upset

Chapter 13 c. Fine hand tremor and polyuria Rationale The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some patients. These and other side effects are factors in noncompliance. p. 234, Table 13.4

The nurse cares for a patient in the acute phase of bipolar disorder who has mania. This patient annoys other patients, loudly engages in power struggles with staff, and gives orders to the housekeeping employees about how to clean. Which nursing diagnosis is most applicable? a. Defensive coping b. Ineffective coping c. Impaired social interaction d. Impaired verbal communication

Chapter 13 c. Impaired social interaction Rationale This patient's behavior relates to interactions with others; therefore, impaired social interaction is the most appropriate diagnosis. Poor reality testing, grandiosity, denial of problems, difficulty organizing and attending to information, poor concentration, and inability to meet basic needs are aspects of coping problems. Impaired verbal communication is a diagnosis that applies to pressured speech, clang associations, and flight of ideas. Defensive coping also relates to denial of problems and grandiosity, but incorporates projection of blame to others and rationalization of own failures; therefore, impaired social interaction is a better diagnosis because of the additional behaviors presented in the scenario. p. 230, Table 13.2

A patient with bipolar disorder takes lithium. After playing soccer on a hot summer day, the patient complains of nausea, vomiting, diarrhea, and thirst. The patient's hands begin to tremble and the gait becomes unsteady. What is the priority nursing intervention? Select all that apply. a. Administer an antiemetic medication to the patient. b. Collaborate with the health care provider regarding increasing the daily lithium dose. c. Instruct the patient not to take any more lithium until directed by the health care provider. d. Collaborate with the health care provider about drawing a serum lithium level immediately. e. Complete an abnormal involuntary movement scale (AIMS) evaluation on this patient immediately.

Chapter 13 c. Instruct the patient not to take any more lithium until directed by the health care provider. d. Collaborate with the health care provider about drawing a serum lithium level immediately. Rationale The patient likely became dehydrated by the high activity in the summer heat. Lithium toxicity probably has developed. The lithium must be held, and a serum lithium level needs to be drawn. It is the nurse's responsibility to discuss possible toxicity with the health care provider. p. 235, Box 13.1

A patient with mania reports inability to sleep. What appropriate action does the nurse take to help the patient sleep better? a. Provide a low-protein diet. b. Provide tea or coffee before sleep. c. Instruct the patient to perform slow exercises. d. Help the patient perform intense physical activity.

Chapter 13 c. Instruct the patient to perform slow exercises. Rationale Manic patients suffer from sleep deprivation because of hyperactivity. The nurse directs the energy into productive and calming activities by providing slow exercise, writing, or playing soft music. The manic patient must be given frequent rest periods during a physical activity. Lack of rest can cause exhaustion and death. The patient must be given decaffeinated coffee, cola, and tea, because caffeine can interfere with sleep. Manic patients are usually overactive, so they must be provided high-calorie and high-protein foods. p. 232, Table 13.3

When a patient experiences four or more mood episodes in a 12-month period, the patient is said to be a. Incongruent b. Cyclothymic c. Rapid cycling d. Dyssynchronous

Chapter 13 c. Rapid cycling Rationale Rapid cycling implies four or more mood episodes in a 12-month period, as well as more severe symptomology. p. 236

Which principle should the nurse use when communicating with a patient experiencing an elated mood and euphoria? a. Use abstract concepts. b. Give detailed explanations. c. Use a calm, firm approach. d. Encourage frequent self-disclosure.

Chapter 13 c. Use a calm, firm approach. Rationale: A patient experiencing an elated mood and euphoria is distracted easily and can become irritable. A calm, firm approach sets limits while communicating caring. Consistency of all staff is needed to maintain controls and minimize manipulation by patient. Distractibility reduces the patient's ability to understand abstract concepts or pay attention to detailed explanations. The patient is likely to be hyperverbal, so it is not necessary to encourage the patient to talk.

A patient diagnosed with bipolar disorder was hospitalized 15 days ago and has been receiving lithium. Current assessment findings include increased restlessness, pressured speech, and flight of ideas. The patient sleeps 2 hours per night. What is the nurse's best intervention? a. Continue to monitor the patient's symptoms until the lithium begins to take effect. b. Discourage the patient from attending groups because of the likelihood of disruptive behavior. c. Offer the patient opportunities to practice concentration and ways to increase attention span. d. Consider the need to obtain a lithium level. The patient may not be swallowing the medication.

Chapter 13 d. Consider the need to obtain a lithium level. The patient may not be swallowing the medication. Rationale Lithium must reach therapeutic levels in the blood to be effective, which usually takes 7 to 14 days. In this scenario, the assessment findings indicate continued mania, so the nurse should question whether the patient actually has been taking the medication. Only a serum lithium level can give definitive results. The patient has taken lithium long enough to begin to see therapeutic effects; continuing to monitor the patient's symptoms is an inadequate response by the nurse. The patient needs therapeutic intervention; excluding group therapies denies the patient's right to treatment. This patient will be unable to practice concentration because of continuing flight of ideas. p. 234

The nurse is writing a plan of care for a patient in the manic phase of bipolar I disorder. What is the most important outcome for the patient? a. Decreasing food intake b. Increasing physical activity c. Sleeping for 8 to 10 hours a night d. Maintaining a stable cardiac status

Chapter 13 d. Maintaining a stable cardiac status

Which patients can be safely prescribed lithium therapy to treat bipolar disorder? a. Patients with renal diseases b. Patients with thyroid disorder c. Patients with myasthenia gravis d. Patients with erectile dysfunction

Chapter 13 d. Patients with erectile dysfunction Rationale Patients with erectile dysfunction can be prescribed lithium therapy because lithium does not interfere with sexual function. Lithium therapy must be avoided in patients with myasthenia gravis because it causes ataxia and severe muscle weakness. Lithium causes hypothyroidism by reducing the levels of thyroxine hormone. It should not be prescribed to patients with thyroid disorder. Lithium causes impairment in kidney functioning. It should not be prescribed to patients with renal diseases. p. 235

Which behavior of the nurse is appropriate while caring for a patient experiencing acute mania? a. Judging the values of the patient as incorrect b. Giving long, detailed explanations to the patient c. Using a polite and gentle approach with the patient d. Redirecting the patient's energy into alternate channels

Chapter 13 d. Redirecting the patient's energy into alternate channels Rationale The best way for the nurse to manage a patient in acute mania is to firmly redirect the patient's energy into more constructive channels. This intervention helps the patient to use the elevated energy levels associated with acute mania for useful activities. The nurse should avoid judging the patient's values because this could give the patient an excuse to argue and may exaggerate the mania. In acute mania, the patient has a short attention span and therefore the nurse should give short and precise explanations. The nurse should use a firm and calm approach to handle the patient in acute mania. p. 231, Table 13.3

A manic patient showed progressive improvement with continued lithium therapy. After successful treatment, the patient is discharged from the hospital. What appropriate suggestions should the nurse make to the patient and his or her family during discharge? Select all that apply. a. Water pills or diuretics will help with lithium side effects. b. You can reduce the lithium dose if there is an excessive weight gain. c. Over-the-counter medications are safe if taken as instructed on the box. d. Schedule regular checkups to test the function of your thyroid and kidney. e. Contact the primary health care provider if there is any excessive vomiting.

Chapter 13 d. Schedule regular checkups to test the function of your thyroid and kidney. e. Contact the primary health care provider if there is any excessive vomiting. Rationale Lithium affects thyroid and kidney functioning so the patient should be advised to have regular assessment of functioning after being discharged. Lithium may cause diarrhea, vomiting, or sweating as a result of dehydration, so the patient should be advised to consult the primary health care provider if these symptoms occur. Patients on lithium should be advised not to take over-the-counter medicine without consulting the primary health care provider. Patients should not be advised to reduce the medication if there is a weight gain; dosage should only be adjusted by the health care provider. Lithium causes dehydration in the patients, so water pills or other diuretics should not be taken by the patient. p. 235, Box 13.1

The nurse assesses laboratory results for an adult patient who takes lithium 600 mg twice a day. The patient has taken this dose of lithium for 3 years. Which laboratory value should alert the nurse to confer promptly with the health care provider? a. Hemoglobin 15 g/dL b. Serum sodium 142 mEq/L c. Fasting glucose 99 mg/dL d. Serum creatinine 1.95 mg/dL

Chapter 13 d. Serum creatinine 1.95 mg/dL The serum creatinine in this scenario is elevated, which indicates problems with renal function; the normal value is 0.5 to 1.2 mg/dL. A major long-term risk of lithium therapy is impairment of the kidney's ability to concentrate urine. The hemoglobin, fasting glucose, and serum sodium levels show normal laboratory findings.

When the wife of a manic patient asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that a. No research exists to suggest genetic transmission b. Much depends on the socioeconomic class of the individuals c. Highly creative people tend toward development of the disorder d. The rate of bipolar disorder is higher in relatives of people with bipolar disorder

Chapter 13 d. The rate of bipolar disorder is higher in relatives of people with bipolar disorder

What action should the nurse take on learning that a manic patient's serum lithium level is 1.8 mEq/L? a. Advise the patient to limit fluids for 12 hours. b. Continue to administer medication as prescribed. c. Advise the patient to curtail salt intake for 24 hours. d. Withhold medication and notify the health care provider.

Chapter 13 d. Withhold medication and notify the health care provider. 0.5 - 1.6

Which statements are associated directly with Beck's cognitive triad? Select all that apply. a. "I'm not worth much; I can't do anything right." b. "Things will only get worse; they never get better." c. "I'll never find anyone who loves or values me." d. "I don't think other people are worthless." e. "Good luck happens to good people."

Chapter 14 a. "I'm not worth much; I can't do anything right." b. "Things will only get worse; they never get better." c. "I'll never find anyone who loves or values me." Rationale Three assumptions constitute Beck's cognitive triad: (1) a negative, self-deprecating view of self; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement (or no validation for the self) will continue in the future. Statements such as "I don't think other people are worthless" and "Good luck happens to good people" lack the negative assumptions associated with the cognitive triad. p. 248

A patient who had undergone a hysterectomy has low self-esteem and avoids taking food. Which appropriate method does the nurse choose to reduce anorexia? a. The nurse allows family members to remain with the patient during meals. b. The nurse gives food low in fiber to the patient. c. The nurse gives a large quantity of low-calorie food to the patient. d. The nurse gives tea and coffee frequently to the patient.

Chapter 14 a. The nurse allows family members to remain with the patient during meals. Rationale Low self-esteem and reduced food intake are symptoms of depression. Patients can be encouraged to take food in the presence of their family members as it increases their self-esteem. Taking food rich in fiber helps reduce constipation. Small amounts of high-calorie and high-protein food should be given frequently to meet the patient's nutritional demands. The patient must not be given tea or coffee frequently as they cause insomnia. p. 256, Table 14.5

A nurse caring for a patient with depression instructs the patient to rest after group activity. The nurse provides warm milk to the patient in the morning and at night. What change does the nurse find in the patient after implementation of this these interventions? a. The patient sleeps properly. b. The patient interacts with the nurse. c. The patient maintains good hygiene. d. The patient has an increased appetite.

Chapter 14 a. The patient sleeps properly. Rationale Depressive patients often have insomnia. The nurse should ensure that patients rest adequately after group activity. This helps to reduce fatigue, which can intensify the symptoms of depression. The patient can be given warm milk at night to induce sleep. Encouraging the patient to interact with the nurse or practice good hygiene or improving the patient's appetite may be treatment goals but they are not directly related to the nurse's intervention with warm milk. p. 256, Table 14.5

When the nurse remarks to a depressed patient, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to a. Wait quietly for the patient to reply b. Prompt the patient if the reply is slow c. Repeat the question if the patient does not answer promptly d. Review the patient's medical record to support the patient's response

Chapter 14 a. Wait quietly for the patient to reply Rationale Depressed patients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply. p. 254, Table 14.3

A patient hospitalized for major depression has been taking sertraline for the past week and has verbalized increased energy and improved sleep. What is the highest priority question the nurse should ask? a. "Do you think your depression is less severe?" b. "Are you having any thoughts of harming yourself?" c. "Have you experienced any side effects from this drug?" d. "How has your appetite changed since starting this drug?"

Chapter 14 b. "Are you having any thoughts of harming yourself?" Rationale: The patient is starting to experience increased energy, but suicidal thoughts may still remain. The patient may now have the energy for self-harm. It is important to assess for other side effects, such as appetite changes and depression, but suicide is the highest priority. p. 253

Dysthymia cannot be diagnosed unless it has existed for a. At least one year b. At least two years c. At least six months d. At least three months

Chapter 14 b. At least two years Rationale Dysthymia (persistent depressive disorder) is a chronic condition that by definition has to have existed for longer than two years. p. 243

A nurse counsels a patient diagnosed with depression to begin a mild exercise regime. What is the physiologic basis of the nurse's recommendation? a. Exercise reduces inflammation. b. Exercise stimulates serotonin production. c. Exercise will stabilize the client's sleep pattern. d. Exercise eliminates toxins from the client's body.

Chapter 14 b. Exercise stimulates serotonin production. Rationale Exercise stimulates serotonin production, which will help improve the patient's mood. Exercise has biological, social, and psychological effects on symptoms of depression. Inflammation may be a factor in depression, but exercise is not targeted at this aspect of the disorder. While exercise may contribute to improved sleep, it will not necessarily stabilize the sleep pattern. Exercise improves circulation, but does not necessarily eliminate toxins. p. 266

Which statement about antidepressant medications, in general, can serve as a basis for patient and family teaching? a. They tend to be more effective for men. b. Onset of action is from one to six weeks. c. Recent memory impairment is observed commonly. d. They often cause the patient to have diurnal variation.

Chapter 14 b. Onset of action is from one to six weeks. Rationale People are accustomed to fast results from medication: 30 minutes for aspirin, 24 hours for antibiotics. Information is necessary to prevent discouragement and maintain compliance. p. 258

Which food is safe for a patient taking monoamine oxidase inhibitors (MAOIs)? a. Avocados b. Pineapple c. Chocolate d. Cheddar cheese

Chapter 14 b. Pineapple Rationale Patients taking MAOIs must avoid foods containing tyramine. Most fruits, like pineapple, are safe to eat while taking MAOIs, as they have low levels of tyramine. Avocados, especially overripe ones, are high in tyramine. Almost all dairy products like cheddar cheese contain tyramine. Chocolate is also a food to avoid. p. 262

A nurse tries to communicate with a depressive patient who is mute and avoids interaction. How should the nurse approach the patient? a. The nurse should leave the patient alone. b. The nurse should talk to the patient about the weather. c. The nurse should say "Things will be fine, don't be upset." d. The nurse should ask the patient about their family members.

Chapter 14 b. The nurse should talk to the patient about the weather. Rationale Depressed patients often avoid interacting with others. In such cases, the patient's attention must be drawn toward the surrounding environment. This helps the patient to focus on reality. Leaving the patient unattended may make the patient feel lonely and cause withdrawal. Asking repeated questions to the patient can make the patient feel aggressive and can cause anxiety. Making a remark or statement on the patient's condition can make the patient feel guilty. p. 254, Table 14.3

The nursing diagnosis of imbalanced nutrition—less than body requirements—has been identified for a patient diagnosed with severe depression. The most reliable evaluation of outcomes will be based on the patient's a. Energy level b. Weekly weights c. Observed eating patterns d. Statement of appetite

Chapter 14 b. Weekly weights Rationale The patient's body weight is the most reliable and objective evaluation of success in treating this nursing diagnosis. p. 156, Table 14.5

Which complaint regarding sleep would the nurse expect from a patient diagnosed with major depression? a. "I usually take a nap for about 30 minutes in the afternoon." b. "It takes me about 15 minutes to fall asleep. I often have vivid dreams." c. "I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." d. "I often fall asleep in the middle of an activity. When I wake up, I feel better."

Chapter 14 c. "I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." Rationale Change in sleep patterns is a cardinal sign of depression. Often, people experience insomnia, wake frequently, and have a total reduction in sleep, especially deep-stage sleep. One of the hallmark symptoms of depression is waking at 3 or 4 AM and then staying awake or sleeping for only short periods. Napping, vivid dreams, and falling asleep in the middle of an activity identify normal sleep variations and narcolepsy. p. 252

A depressive patient is prescribed tricyclic antidepressants. What appropriate advice does the nurse give to the patient's family? a. Stop the medication if hypotension occurs. b. Do not give full dose to the patient at bedtime. c. Advise the patient to be cautious while driving. d. Double the dose if the patient forgets to take the bedtime dose.

Chapter 14 c. Advise the patient to be cautious while driving. Rationale Tricyclic antidepressants (TCAs) cause side effects such as drowsiness or dizziness. So the patient must be advised to be cautious while crossing the road, driving, or working with machines. The patient must take a full dose at bed time, so that the side effects are less during the day. If the patient forgets to take the dose, the next dose should be taken at the scheduled time. A double dose should be avoided. The medication should not be stopped if there is reduction in blood pressure as it can cause nausea, altered heartbeat, cold sweats, and nightmares. p. 261, Box 14.5

A depressed patient is noted to pace most of the time, pull at his or her clothes, and wring his or her hands. These behaviors are consistent with a. Senile dementia b. Hypertensive crisis c. Psychomotor agitation d. Central serotonin syndrome

Chapter 14 c. Psychomotor agitation Rationale These behaviors describe the psychomotor agitation sometimes seen in patients with the agitated type of depression. p. 252

Which statement made by a depressed patient would provide insight into a common feeling associated with depression? a. "I still pray and read my Bible every day." b. "I've heard others say that depression is a sign of weakness." c. "My mother wants to move in with me, but I want to be independent." d. "I still feel bad about my sister dying of cancer. I should have done more for her!"

Chapter 14 d. "I still feel bad about my sister dying of cancer. I should have done more for her!" Rationale Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; wanting independence and feeling that depression is a weakness do not describe a common accompaniment to depression. p. 251

A patient has been taking citalopram for two years for depression. The patient's outcomes have been achieved and the patient wants to discontinue the medication. Which information should the nurse provide? a. "Citalopram is an antidepressant medication that usually is taken for life." b. "Stopping this medication all of a sudden can cause serotonin syndrome." c. "Because your depression is alleviated, you may discontinue the medication." d. "It's important for you to gradually stop taking this drug over two to four weeks."

Chapter 14 d. "It's important for you to gradually stop taking this drug over two to four weeks." Rationale Selective serotonin reuptake inhibitors (SSRIs) should be tapered off gradually over a period of two to four weeks to avoid a withdrawal syndrome. Symptoms of the withdrawal syndrome include headache, gastrointestinal upset, dizziness, insomnia, anxiety, and flulike symptoms. Serotonin syndrome is a potentially life-threatening consequence of drug interactions with SSRIs. p. 259, Table 14.6

The nurse cares for an adult who repeatedly says, "My dead relatives try to talk to me and penetrate my body." This comment is most associated with which of the following disorders? a. Seasonal affective disorder b. Disruptive mood dysregulation disorder c. Substance-induced depressive disorder d. Major depressive disorder with psychosis

Chapter 14 d. Major depressive disorder with psychosis Rationale Depressive disorders are classified according to symptoms or the situations under which they occur. During a major depressive episode, the person's ability to think clearly is negatively affected and evidence of delusional thinking may be seen. Delusional thinking is an aspect of psychosis. Seasonal affective disorder is characterized by marked seasonal differences in mood associated with decreased daylight. Substance-induced depressive disorder applies when symptoms of a major depressive episode arise in association with drug or alcohol intoxication or withdrawal. Disruptive mood dysregulation disorder relates to children and refers to situations in which a person has frequent temper tantrums, resulting in verbal or behavioral outbursts out of proportion to the situation. pp. 251-252

A nurse is performing an assessment of a patient with depression who is prescribed antidepressants. The patient reports to the nurse, "I have to drink a lot of water now as I am feeling very thirsty and I'm not able to pass urine properly." What does the nurse interpret from these observations? a. The patient is nonadherent to the medications. b. The patient is experiencing food-drug interactions. c. The patient is experiencing side effects of mirtazapine. d. The patient is experiencing side effects of amitriptyline.

Chapter 14 d. The patient is experiencing side effects of amitriptyline. Rationale The patient with depression may be prescribed amitriptyline, which is a tricyclic antidepressant. The side effects of amitriptyline are dry mouth, urinary retention, and hypotension, which may make the patient crave water. If the patient is nonadherent to the medications, then the patient will have depressive symptoms, like loss of appetite and insomnia rather than dry mouth and urinary retention. Photosensitivity or rash would be indications of food-drug interaction. The side effects of norepinephrine and mirtazapine, or serotonin-specific antidepressants, include weight gain and sexual dysfunction rather than dry mouth. p. 260, Table 14.6

A depressed male patient tells the nurse he is in the 'acute phase' of his treatment for depression. The nurse recognizes that the client has been in treatment a. For more than four months b. That is directed toward relapse prevention c. That focuses on prevention of future depression d. To reduce depressive symptoms

Chapter 14 d. To reduce depressive symptoms Rationale The acute phase of depression therapy (6-12 weeks) is directed toward the reduction of symptoms and restoration of psychosocial and work function and may require some hospitalization. p. 253

A nurse is caring for a depressed patient who is prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse reports to the primary health care provider that the patient has delirium, seizures, and elevated blood pressure after taking the medication. The primary health care provider prescribes a new medication and says to the nurse, "Stop the previous prescribed medications immediately, and administer this medication to the patient after 5 weeks." Which new drug has been prescribed to the patient? a. Paroxetine b. Citalopram c. Vilazodone d. Phenelzine

Chapter 14 d. Phenelzine Rationale This patient who has taken an SSRI drug has serotonin syndrome, which is characterized by elevated blood pressure, delirium, and seizures. In this situation the SSRI drug must be stopped immediately and should be replaced by another antidepressant drug, such as a monoamine oxidase inhibitor like phenelzine. Monoamine oxidase inhibitors like phenelzine cannot be administered until 2 to 5 weeks after discontinuing a selective serotonin reuptake inhibitor. If phenelzine is immediately administered without a waiting period, the effects of serotonin syndrome may be enhanced due to drug accumulation. Citalopram, paroxetine, and vilazodone are all selective serotonin reuptake inhibitor drugs and thus cannot be prescribed to the patient. p. 260

A nurse conducts an initial interview with a veteran of two tours in the war with Iraq. The veteran says, "The war was years ago, but I still remember my friends who were killed. I don't know why I lived and they died." What is the nurse's priority response? a. "Are you having any thoughts of harming yourself?" b. "It's important to think about how good your life is now." c. "Are you saying you have some guilt about being a survivor?" d. "The outcomes of war are tragic and stay with us for many years."

Chapter 16 a. "Are you having any thoughts of harming yourself?" Rationale The incidence of suicide is high among war veterans. The nurse's highest priority is to assess the risk for suicide or self-harm. Using reflection is therapeutic, but assessing the risk of suicide is a higher priority. Giving advice and false reassurance are nontherapeutic communication techniques. pp. 305-306, 310, Case Study and Nursing Care Plan

When a toddler's mother is hospitalized for several months, the nursing diagnosis risk for impaired parent/child attachment is related to prolonged separation, which has been included in the child's plan of care. The most appropriate outcome would be that: a. Mother and child show signs of healthy bonding b. The father is able to assume the mother's role in her absence c. The mother is discharged and returned home as soon as possible d. The child is able to transfer nurturing needs to another available adult

Chapter 16 a. Mother and child show signs of healthy bonding Rationale An overall attachment outcome would be for the parent and infant/child to demonstrate an enduring affectionate bond. p. 300

A nurse is assessing a child who has witnessed violence at home. What should the nurse document when completing an admission genogram of the child? Select all that apply. a. Relationships b. Investigations c. Family history d. Laboratory testing e. Family composition

Chapter 16 a. Relationships c. Family history e. Family composition Rationale Assessment and data collection on a child is very important and may include several methods. These include interviewing, screening, testing, observing, and interacting with the patient. Relationships, family history, and family composition are documented in a genogram where information can be obtained about family relations and interactions. Testing and investigations are not related to creating a genogram. p. 299

Which symptom can the nurse expect a patient with depersonalization disorder to demonstrate? a. Aimless wandering with confusion and disorientation. b. A feeling of detachment from one's body or mental processes. c. Existence of two or more personalities that take control of behavior. d. Anxiety about having a serious disease based on symptom misinterpretation.

Chapter 16 b. A feeling of detachment from one's body or mental processes. Rationale Depersonalization is characterized by a sense of unreality or self-estrangement. p. 307

Which behavior best supports the diagnosis of posttraumatic stress disorder (PTSD) in a 4-year-old child? a. Overeating b. Hypervigilance c. A drive to be perfect d. Passivity

Chapter 16 b. Hypervigilance Rationale Posttraumatic stress disorder in preschool children may manifest as irritability, aggressive or self-destructive behavior, sleep disturbances, problems concentrating, and hypervigilance. p. 296

A patient with dissociative identity disorder is hospitalized for the fourth time after overdosing. The patient does not remember overdosing. What is the best initial nursing outcome for this situation? a. Patient will discuss childhood issues that relate to anxiety. b. Patient will inform staff when feeling the urge to harm self. c. Patient will not switch personalities for the next seven days. d. Patient will assume a decision-making role for his or her health care needs.

Chapter 16 b. Patient will inform staff when feeling the urge to harm self. Rationale The patient must first be safe and contract with staff to inform them when feeling unsafe. Not switching personalities, discussing childhood issues, and assuming a role in decision making would be appropriate later in the patient's care. A person with dissociative identity disorder demonstrates two or more distinct identities or personality states, each with a continued pattern of perceiving, relating to, and thinking about the environment and self. Second, at least two of these personality states recurrently take control of the person's behavior. The individual is unable to recall important personal information that is too extensive for ordinary forgetting to explain. These behavior patterns and thoughts do not result from the effects of a substance, such as blackouts or chaotic behavior during alcohol intoxication or a general medical condition, (i.e., complex partial seizures). In children, the symptoms are not caused by imaginary playmates or other fantasy play. p. 310

A nurse is performing an assessment of a child diagnosed with disinhibited social engagement disorder. Which behavior should the nurse expect to find in the child? a. The child throws stones at strangers. b. The child willingly goes with a stranger. c. The child cries when touched by a stranger. d. The child hides when a stranger approaches

Chapter 16 b. The child willingly goes with a stranger. Rationale Disinhibited social engagement disorder is characterized by absence of normal fear toward strangers and unresponsiveness to separation from a caregiver. A child throwing stones at a stranger is indicative of antisocial behavior. A child crying on being touched by a stranger demonstrates sensitive behavior. A child hiding when approached by a stranger reflects shyness and is not a symptom of disinhibited social engagement disorder. p. 302

A man was killed during a robbery 10 days ago. His widow, who has a long history of mental illness, cries spontaneously when talking to the nurse about her loss. What is the nurse's most therapeutic response? a. "This loss is harder to accept because you have mental illness. Try to focus on other activities." b. "I'm concerned that you are crying so much. Your grief over your husband's death has gone on too long." c. "The sudden death of your husband is hard to accept. I am glad you are able to tell me about how you are feeling." d. "Your tears let me know you are not coping appropriately with your loss. Let's make an appointment with your health care provider."

Chapter 16 c. "The sudden death of your husband is hard to accept. I am glad you are able to tell me about how you are feeling." Rationale Regardless of mental illness, this patient has experienced a traumatic event. Through sharing her experience, the patient can begin to heal and integrate what happened into her life. The nurse demonstrates caring and compassion by using therapeutic communication techniques. Symptoms after only 10 days are expected. p. 303

Which child is at greatest risk for developing attachment problems as a result of a neurobiological development? a. A 7-year-old male b. A 13-year-old male c. A 4-year-old female d. A 10-year-old female

Chapter 16 c. A 4-year-old female Rationale The developing brain is particularly vulnerable to adverse events because the most rapid brain development occurs in the first five years of life. The right hemisphere is involved in processing social-emotional information, promoting attachment functions, regulating body functions, and in supporting the individual in survival and in coping with stress. Because the right brain develops first and is involved with developing templates for relationships and regulation of emotion and bodily function, early attachment relationships are particularly important for healthy development and life-long health. p. 298

Parents express concern when their 5-year-old child, who is receiving treatment for cancer, keeps referring to an imaginary friend, Candy. The nurse explains that: a. Children this age usually have imaginary friends b. The child needs more of their one-on-one attention c. The imaginary friend is a coping mechanism the child is using d. It is nothing to worry about unless the child starts to isolate socially

Chapter 16 c. The imaginary friend is a coping mechanism the child is using Rationale Often, traumatized children feel responsible for what happened to them and are frightened by flashbacks, amnesia, or hallucinations that may be caused by trauma. For example, a child may use imaginary friends as a coping mechanism. p. 301

A war veteran was diagnosed with dissociative disorder after returning home. The veteran's family asks the nurse, "Is this diagnosis the same as schizophrenia?" What is the nurse's correct response? a. "These symptoms are sometimes a cry for help. Many of our war veterans have difficulty asking for help." b. "Schizophrenia is a thought disorder with a genetic origin, but a dissociative disorder results in delusions and hallucinations." c. "Persons diagnosed with dissociative disorders and schizophrenia are both out of touch with reality. Normal function will resume when the medication reaches a therapeutic level." d. "It is not the same as schizophrenia. The trauma of war can cause overwhelming anxiety, which then leads to a form of mental disconnection. With treatment, a return to optimal functioning is expected."

Chapter 16 d. "It is not the same as schizophrenia. The trauma of war can cause overwhelming anxiety, which then leads to a form of mental disconnection. With treatment, a return to optimal functioning is expected." Rationale It is a common misconception that dissociative disorders and schizophrenia are the same. The nurse has a responsibility to educate the family and offer the hope for optimal functioning. Delusions and hallucinations often occur in schizophrenia, but a patient diagnosed with a dissociative disorder would not be expected to have delusions. Persons diagnosed with dissociative disorders have cognitive distortions that result from trauma, but reality testing is intact. Medication is not used commonly to treat dissociative disorders. p. 307

A patient says to the nurse, "Sometimes I feel like I'm floating above my body, watching it from the outside." When documenting this observation, which term applies? a. Fugue b. Amnesia c. Derealization d. Depersonalization

Chapter 16 d. Depersonalization Rationale Depersonalization is an uncomfortable feeling of being an observer of one's own body or mental processes. Fugue refers to a memory loss associated with travel away from home. Amnesia refers to the loss of memory. Derealization is the recurring feeling that one's surroundings are unreal or distant. The person may feel mechanical, dreamy, or detached from the body. p. 307

Which statement about dissociative disorders is true? a. Dissociative symptoms are always negative. b. Dissociative symptoms are usually a cry for attention. c. Dissociative symptoms are under the person's conscious control. d. Dissociative symptoms are not under the person's conscious control.

Chapter 16 d. Dissociative symptoms are not under the person's conscious control. Rationale Dissociation is involuntary and results in failure of normal control over a person's mental processes and normal integration of conscious awareness. Dissociative symptoms are not a cry for attention and are not always negative. p. 307

Which nursing diagnosis would be most useful for patients with anxiety disorders? a. Excess fluid volume b. Disturbed body image c. Disturbed personal identity d. Ineffective role performance

Chapter 16 d. Ineffective role performance Rationale Anxiety disorders often interfere with the usual role performance of patients. Consider the patient with agoraphobia who cannot go to work, or the patient with obsessive-compulsive disorder who devotes time to the ritual rather than to parenting. p. 310, Table 16.1

Dissociative identity disorder is characterized by: a. The inability to recall important information b. Recurring feelings of detachment from one's body or mental processes c. Sudden, unexpected travel away from home and inability to remember the past d. The existence of two or more subpersonalities, each with its own patterns of thinking

Chapter 16 d. The existence of two or more subpersonalities, each with its own patterns of thinking Rationale Dissociation is an unconscious defense mechanism that protects the individual against overwhelming anxiety through an emotional separation. However, this separation results in disturbances in memory, consciousness, self-identity, and perception. p. 308

A nurse is evaluating the effects of treatment for a patient with dissociative identity disorder. Which factor would indicate success of the treatment? a. The patient is anxious. b. The patient no longer daydreams. c. The patient has increased appetite. d. The patient has integrated past events.

Chapter 16 d. The patient has integrated past events. Rationale Dissociative identity disorder is characterized by the presence of two or more distinct personality states that recurrently take control of the patient's behavior. Integration of past events or fragmented memories is a positive sign of successful treatment. For the treatment to be successful the patient's anxiety should be reduced and the patient should use coping methods to return to a functional state. The appetite is not affected by dissociative identity disorder, so increased appetite would not be an indication of success. Dissociative identity disorder should not be thought of as daydreaming and the absence of daydreaming in the patient would not indicate a measure of successful treatment. p. 310, Table 16.1

Which statement about structural dissociation of the personality is true? a. An organic basis exists for this type of disorder. b. Nurses perceive patients with this disorder as easy to care for. c. No known link exists between this disorder and early childhood loss or trauma. d. This disorder results in a split in the personality, causing a lack of integration.

Chapter 16 d. This disorder results in a split in the personality, causing a lack of integration. Rationale The theory of structural dissociation of the personality proposes that patients with complex trauma have different parts of their personality, the apparently normal part and the emotional part, that are not fully integrated with each other. Each part has its own responses, feelings, thoughts, perceptions, physical sensations, and behaviors. These different parts may not be aware of each other, with only one dominant personality operating depending on the situation and circumstance of the moment. p. 309

A patient diagnosed with posttraumatic stress disorder shows little symptom improvement after being prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse expects that the next medication to be prescribed will be a a. Sedative b. Barbiturate c. Beta blocker d. Tricyclic antidepressant (TCA)

Chapter 16 d. Tricyclic antidepressant (TCA) Rationale TCAs or mirtazapine may be prescribed if SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) are not tolerated or do not work. p. 305