Psych Videbeck Chapter 17: Mood disorders and Suicide

A client admitted to the inpatient psychiatric unit changes clothes eight or nine times a day, wears heavy eye makeup, is intrusive with other clients, and makes inappropriate sexual advances toward staff members. Which goal would be most appropriate for this client? The client will refrain from being intrusive with others and change clothing only twice per day. The client will verbalize feelings of low self-esteem with nursing staff. The client will record the number of clothing changes per day. The client will identify two trusted staff members of the opposite sex to help choose appropriate dress.

The client will refrain from being intrusive with others and change clothing only twice per day.

The client's family is questioning the nurse about bipolar disorder. Which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply. Norepinephrine levels may be increased in mania. Acetylcholine seems to be implicated in mania. The id takes over the ego and acts as an undisciplined hedonistic being (child). Manic episodes are a "defense" against underlying depression.

The id takes over the ego and acts as an undisciplined hedonistic being (child). Manic episodes are a "defense" against underlying depression.

A client is taking lithium carbonate and asks why regular blood tests are needed. The nurse explains that it is to detect lithium toxicity. The nurse can best explain lithium toxicity in what way? The level at which the medication is most effective Too much medication in the blood serum Not enough of the medication in the blood A common side effect of taking the medication

Too much medication in the blood serum

A client with bipolar disorder begins taking lithium carbonate (lithium), 300mg QID. After 3 days of therapy, the client says, "My hands are shaking." The best response by the nurse is which of the following? a) "Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks." b) "It is nothing to worry about unless it continues for the next month." c) "Tremors can be an early sign of toxicity, but we'll keep monitory your lithium level to make sure you're okay." d) "You can expect tremors with lithium. You seem very concerned about such a small tremor."

a) "Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks."

A client is to receive three treatments of electroconvulsive therapy (ECT) per week for 3 weeks. After the third treatment, the client is forgetful and confused. When the client's husband arrives to take her home, the nurse discusses his wife's condition with him. Which of the following statements is best? a) "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." b) "Confusion after ECT is not expected. Though it will resolve, she probably will not be a candidate for ECT in the future." c) "Some confusion after ECT is normal. She will regain her memory in a few hours." d) "Some confusion after ECT is normal. Withhold her medications for today and call tomorrow to let us know how she's doing."

a) "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer."

Which of the following sleep patterns is suggestive of a manic episode? a) A client stays awake for several days and nights before "crashing" and sleeping for a long period. b) A client takes multiple short naps at varied times throughout the day and night. c) A client reports having fitful sleep that is characterized by frequent awakenings and nightmares. d) A client experiences day-night reversal, sleeping until late in the afternoon, and going to bed near dawn.

a) A client stays awake for several days and nights before "crashing" and sleeping for a long period.

Cheryl is a 46-year-old woman who thinks she might be suffering from depression. Which of the following must be present for a diagnosis of major depressive disorder to be made? a) A loss of interest or inability to derive pleasure for previously enjoyed activities b) Disregard for personal hygiene including cleanliness and appearance c) A lack of energy, impaired sleep, and social withdrawal d) A stooped posture and nonverbal signs of a depressed mood

a) A loss of interest or inability to derive pleasure for previously enjoyed activities

what are the most common types of side effects from SSRIs? a) Dizziness, drowsiness, and dry mouth b) Convulsions and respiratory difficulties c) Diarrhea and weight gain d) Jaundice and agranulocytosis

a) Dizziness, drowsiness, and dry mouth

Which of the following typifies the speech of a person in the acute phase of mania? a) Flight of ideas b) Psychomotor retardation c) Hesitant d) Mutism

a) Flight of ideas

You are conducting an admission assessment with Alberto, a 45-year-old man, who has been demonstrating signs of bipolar disorder. While conducting the assessment, Alberto starts speaking in illogical rhymes and uses word associations. What is the name for this thought pattern? a) Flight of ideas b) Delusions of grandeur c) Expansive ideas d) Excessive euphoric speech

a) Flight of ideas

Which of the following would be a finding related to perceptual disturbances during the mental status exam in the client with mania? a) Hallucinations b) Limited insight c) Inappropriate affect d) Increased motor activity

a) Hallucinations

A client who has been taking lithium for bipolar disorder is admitted to the hospital with the following symptoms: dry mouth, nausea and vomiting, blurred vision, dizziness, and muscle twitching. What should the nurse suspect? a) Moderate lithium toxicity b) Common side effects of the drug c) Interaction of lithium with another medication d) Need for an increased dose of medication

a) Moderate lithium toxicity

Which of the following biogenic amines have been implicated in depression? a) Norepinephrine and serotonin b) Epinephrine and dopamine c) Epinephrine and serotonin d) Dopamine and histamine

a) Norepinephrine and serotonin

Although its therapeutic mechanism of action is unknown, electroconvulsive therapy (ECT) is effective treatment for severe depression in some clients. The nurse is aware that ECT would be contraindicated in which of the following clients? a) Patients with recent cerebrovascular accidents (CVAs) b) Patients who had acute renal failure c) Patients with recent retinal detachment d) Patients who had recent myocardial infarctions (MIs) e) Patients with increased intracranial pressure f) Patients at risk for complications of anesthesia

a) Patients with recent cerebrovascular accidents (CVAs) c) Patients with recent retinal detachment d) Patients who had recent myocardial infarctions (MIs) e) Patients with increased intracranial pressure f) Patients at risk for complications of anesthesia

Robin is a 42-year-old woman who is experiencing depression. Robin's mother died by suicide 20 years ago. Which of the following statements regarding Robin's risk for suicide is correct? a) Robin has a greater risk for suicide than the general population. b) Robin would have a greater risk for suicide if her father had died by suicide. c) Robin's risk for suicide will increase when she reaches the age of 50. d) Robin's risk is equivalent to that of the general population.

a) Robin has a greater risk for suicide than the general population.

In a therapy session, a client with a diagnosis of major depression admits to the nurse-therapist, "I actually went out driving on the interstate this morning and had every intention of getting up to speed and plowing right into the overpass by my exit. Maybe tomorrow." The nurse would recognize the client's statement as what? a) Suicidal intent b) Suicidal threat c) Suicidal ideation d) Suicidal gesture

a) Suicidal intent

A father of four small children lost his wife in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since his wife's death, his mood has been somber; until now, he has refused treatment. For what is this client at high risk? a) Suicide b) Dysthymic disorder c) Bipolar disorder d) Schizophrenia

a) Suicide

A client who has just been prescribed lithium for bipolar disorder is getting instructions from the nurse about this medication. Which of the following is important for the nurse to include in teaching? a) The higher the sodium level, the lower the lithium level will be. b) The higher the potassium level, the lower the lithium level will be. c) Lithium has few interactions with other drugs. d) Changes in diet will not affect lithium levels.

a) The higher the sodium level, the lower the lithium level will be.

Which of the following would indicate and increased suicidal risk? a) an abrupt improvement in mood b) calling family members to make amends c) crying when discussing sadness d) feeling overwhelmed by simple daily tasks e) statements such as "I'm such a burden for everyone" f) statements such as "everything will be better soon"

a) an abrupt improvement in mood b) calling family members to make amends f) statements such as "everything will be better soon"

Which of the following activities would be appropriate for a client with mania? a) drawing a picture b) modeling clay c) playing bingo d) playing table tennis e) stretching exercises f) stringing beads

a) drawing a picture b) modeling clay e) stretching exercises

A client with mania begins dancing around the day room. When she twirled her skirt in front of the male clients, it was obvious she had no underpants on. The nurse distracts her and takes her to her room to put on underpants. The nurse acted as she did to a) minimize the client's embarrassment about her present behavior. b) keep her from dancing with other clients. c) avoid embarrassing the male clients who are watching. d) teach her about proper attire and hygiene.

a) minimize the client's embarrassment about her present behavior.

The nurse working on a mental health unit is teaching a nursing student learning about depression. The student asks the nurse about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response? a) "The physician diagnosis depression when a client has feelings of sadness several times a year." b) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present." c) "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression." d) "Depression is a mood variation to life events."

b) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

Identify the serum lithium level for maintenance and safety. a) 0.1 - 1.0 mEq/L b) 0.5 - 1.5 mEq/L c) 10 - 50 mEq/L d) 50 - 100 mEq/L

b) 0.5 - 1.5 mEq/L

The mental health nurse appropriately provides education on phototherapy to a ... a) 50-year-old farmer whose major depression has not responded to any treatment modality b) 20-year-old college student who reports being "too tired, sad and unfocused" to enroll for classes in the winter term c) 45-year-old lawyer whose medication therapy needs an additional treatment d) 58-year-old showing signs of early Alzheimer's disease

b) 20-year-old college student who reports being "too tired, sad and unfocused" to enroll for classes in the winter term

After being diagnosed with a chronic disease, Muriel has been feeling depressed. Which of the following diagnoses has the strongest association with an increased suicide risk? a) Congestive heart failure b) Acquired immunodeficiency syndrome c) Coronary heart disease d) Chronic obstructive pulmonary disease

b) Acquired immunodeficiency syndrome

A client who lost a child 6 years ago as a result of an automobile accident caused by a drunk driver is seen for counseling. During the session, the mental health nurse recognizes the priority need to ... a) Express condolences over the loss of the child b) Assess the client for suicidal ideations c) Assess the client for feelings regarding the driver responsible for the death d) Encourage the client to become an activist in organizations such as Mothers Against Drunk Driving (MADD)

b) Assess the client for suicidal ideations

A patient with severe depression is being treated with medications and is told to increase activity and to exercise at least 4 times a week. Which of the following domains would these nursing interventions address? a) Spiritual b) Biologic c) Psychological d) Social

b) Biologic

What is the difference between depressive disorders and bipolar disorders? a) Depressive disorders involve times of elation that are not found in bipolar disorder. b) Bipolar disorders involve mood swings ranging from depression to euphoria. c) Bipolar disorders do not involve periods of sadness or unhappiness. d) Depressive disorders cannot be treated but bipolar disorders are treatable.

b) Bipolar disorders involve mood swings ranging from depression to euphoria.

After educating a class on factors that enhance the risk of suicide, the instructor determines the need for additional education when the class identifies which of the following? a) Delusions b) Cautiousness c) Loss d) Family member committing suicide

b) Cautiousness

A nurse working on a gerontology floor tells a co-worker that all elderly clients have depression. In reality, depression in older clients is often associated with chronic illness. Therefore, differential diagnosis for older clients is critical, because often symptoms in this age group are confused with symptoms related to which of the following? Select all that apply. a) Urinary tract infection b) Cerebrovascular accident (CVA) c) Dementia d) Dehydration e) Pneumonia

b) Cerebrovascular accident (CVA) c) Dementia

Which client population has the highest risk for suicide? a) Adolescent girls b) Elderly men c) Adolescent boys d) Elderly women

b) Elderly men

The nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the greatest risk for a suicide attempt? a) Man with bipolar I disorder b) Man with major depressive disorder c) Woman with somatoform disorder d) Woman with acute stress disorder

b) Man with major depressive disorder

A client is happy one month and sad and depressed the next. This client has rapid shifts in moods that leave people confused. What is the client demonstrating? a) Irritable mood b) Mood lability c) Manic episode d) Expansive mood

b) Mood lability

A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of which of the following? a) Toxic effect b) Side effect c) Therapeutic effect d) Desired effect

b) Side effect

When assessing a client who reports mild symptoms of depression, the nurse expects that the diagnostic tests ordered will include a) Coagulation time b) Thyroid Stimulating Hormone (TSH) c) Platelet count d) Liver function test

b) Thyroid Stimulating Hormone (TSH)

Kalie is a 42-year-old woman who has been prescribed a monoamine oxidase inhibitor (MAOI). Kalie should be informed to avoid foods containing which of the following? a) Calcium b) Tyramine c) Sodium d) Arganine

b) Tyramine

The monoamine hypothesis of depression ... a) relates to bipolar disorders, not to depression. b) holds that depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines. c) holds that depression is caused by sociocultural and psychological factors. d) holds that depression is caused by only one of the biogenic amines.

b) holds that depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines.x

The nurse has been asked to assess a client to determine if she has a suicide plan. Which of the following questions would assist the nurse in assessing this area? a) "Have you ever had thoughts of harming yourself?" b) "Do you have people in your life who are supportive of you?" c) "Are you thinking about killing yourself right now?" d) "How do you generally cope with problems in your life?"

c) "Are you thinking about killing yourself right now?"

The nurse observes that a client with depression sat at a table with two tother clients during lunch. The best feedback the nurse could give the client is which of the following? a) "Do you feel better after talking with others during lunch?" b) "I'm so happy to see you interacting with other clients." c) "I see you were sitting with others at lunch today." d) "You must feel much better than yo were a few days ago."

c) "I see you were sitting with others at lunch today."

While caring for a client in the hospital, you become concerned that the client may be having thoughts of suicide. Which of the following statements would be most therapeutic? a) "Are you feeling sad?" b) "Have you tried taking medication?" c) "What is concerning you?" d) "Do you have support at home?"

c) "What is concerning you?"

Which of the following clients is most likely to benefit from electroconvulsive therapy (ECT)? a) A client whose recent strange behavior has been attributed to cyclothymic disorder b) A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy c) A woman whose major depression has not responded appreciably to antidepressants d) A man with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode

c) A woman whose major depression has not responded appreciably to antidepressants

A client with bipolar disorder has been ordered a medication whose classification is anticonvulsant. Which of the following drugs does the nurse know falls within this class of medications? a) Methyldopa b) Lithium c) Carbamazepine d) Mannitol

c) Carbamazepine

An elderly client is admitted to the hospital with fatigue and weight loss of 20 pounds in 1 month. Upon further assessment the client is diagnosed with depression. What other thing should the nurse assess this client for based on the weight loss? a) Sleep disturbance b) Suicide c) Dehydration d) Decreased energy

c) Dehydration

Which mental health disorder is a major risk factor for suicide? a) Schizophrenia b) Anxiety c) Depression d) Mania

c) Depression

A nursing student learning about mood disorders correctly identifies which of the following to mean exaggerated feelings of well-being? a) Irritability b) Expansiveness c) Euphoria d) Paranoia

c) Euphoria

A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of which of the following? a) Depression b) Anxiety c) Grandiosity d) Anorexia

c) Grandiosity

Based on current research, the psychiatric nurse expects that a newly diagnosed bipolar client with suicidal ideations will be prescribed a) Clozapine (Clozaril) b) Naltrexone (ReVia) c) Lithium d) (Prozac)

c) Lithium

The nurse is reviewing the medical records of several clients diagnosed with major depression. The nurse identifies which client as least likely to commit suicide? a) Widowed woman b) Single woman c) Married man d) Divorced man

c) Married man

Jackson is a 56-year-old man who suffers from seasonal affective disorder. Which of the following treatments is the most effective type of treatment for this condition? a) Antidepressant therapy b) Electroconvulsive therapy c) Phototherapy d) Psychotherapy

c) Phototherapy (light therapy)

A client on the inpatient psychiatric-mental health unit was discovered attempting to asphyxiate himself using a blanket. Which of the following measures should the care team prioritize in the client's immediate care? a) Assessing the specific motivation for the client's attempted suicide b) Managing the client's anxiety c) Placing the client on suicide precautions d) Teaching the client improved coping skills

c) Placing the client on suicide precautions

Which of the following is the greatest predictor of a future suicide attempt? a) Degree of hopelessness b) Seriousness of suicidal ideation c) Previous attempt d) Suicide planning

c) Previous attempt

After observing James, a bipolar client on the mental health unit, the nurse determines that the client is at risk for violence. Which of the following would be an appropriate intervention? a) Encourage James to participate in an activity with other clients. b) Ask James to sit alone and write a letter. c) Restrict James to his room until he calms down. d) Tell James that if he is violent, he will be sent home.

c) Restrict James to his room until he calms down.

Which of the following is a true statement regarding depressive disorders? a) Depression in older adults is easier to diagnosis. b) They are more prevalent in men than women. c) The monoamines norepinephrine, dopamine, and serotonin have been implicated. d) It is the leading cause of U.S. disability in clients older than 44 years of age.

c) The monoamines norepinephrine, dopamine, and serotonin have been implicated.

A client says to the nurse, 'You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse? a) "Thank you. I think you are special too." b) "I suspect you want something from me. What is it?" c) "You probably say that to all your nurses." d) "Are you thinking of suicide?"

d) "Are you thinking of suicide?"

The wife of a client diagnosed recently with a mood disorder calls the nurse therapist to report a change in her husband's mood. She states, "He is clearly in a better mood than usual. I would say he seems mildly elated. He's functioning fine at work and home. He's energetic, up and doing things at 5:00 AM and really confident in himself again. It seems fantastic, but unusual. Is this something to worry about?" Which of the following potential responses by the nurse accurately assesses the situation? a) "It sounds as though the antidepressants are working well. Just ask him if he is experiencing any side effects and let me know." b) "I'm concerned. Sometimes depressed people seem contented when they have decided to commit suicide. Let's schedule an appointment for tomorrow." c) "Since he is eating, sleeping, and not behaving inappropriately, there's nothing to worry about. Just let me know if he starts getting irritable or has trouble sleeping." d) "He sounds hypomanic. Let's schedule an appointment for this week for an evaluation. He may need additional or different medication."

d) "He sounds hypomanic. Let's schedule an appointment for this week for an evaluation. He may need additional or different medication."

The nurse is caring for a white man age 30 years whose wife has recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important? a) Refer the client for long-term psychotherapy. b) Determine the client's risk of psychosis. c) Determine if anyone in the client's family has had depression. d) Ask the client if he is thinking about killing himself.

d) Ask the client if he is thinking about killing himself.

A client is admitted to the unit in an acute manic episode. He has had three major depressive episodes in the past 10 years and two other hospitalizations for mania. Which of the following disorders would reflect the client's symptom profile? a) Euthymic state b) Bipolar II c) Cyclothymic disorder d) Bipolar I

d) Bipolar I

When teaching a client with newly diagnosed bipolar I disorder, the nurse states that the difference between bipolar I disorder and bipolar II disorder is what? a) Bipolar I disorder involves altered moods of anger and paranoia. b) Bipolar I disorder more often affects women. c) Bipolar I disorder is characterized by hypomanic episodes. d) Bipolar I disorder is often more disruptive than bipolar II disorder.

d) Bipolar I disorder is often more disruptive than bipolar II disorder

Which of the following statements regarding depression and gender is correct? a) Depressive disorders affect young men more than older women. b) Depressive disorders are more common in men than women. c) Depressive disorders equally affect men and women. d) Depressive disorders are more common in women than men.

d) Depressive disorders are more common in women than men.

A client who has liver damage is receiving lithium for treatment of bipolar disorder. The nurse understands that which of the following may occur when the client is receiving lithium? a) No alteration in plasma levels b) Monitoring of plasma levels is not needed c) Decreased plasma concentration d) Increased plasma concentration

d) Increased plasma concentration

What is the rationale for a person taking lithium to have enough water and salt in his/her diet? a) Salt and water are necessary to dilute lithium to avoid toxicity. b) Water and salt convert lithium into a usable solute. c) Lithium is metabolized in the liver, necessitating increased water and salt. d) Lithium is a salt that has greater affinity for receptor sites than sodium chloride.

d) Lithium is a salt that has greater affinity for receptor sites than sodium chloride.

A client with severe depression has experienced anhedonia for the past 3 months. The nurse caring for this client understands that this term describes which of the following? a) Feelings of hopelessness b) Feelings of sadness c) Loss of sexual drive d) Loss of interest or pleasure

d) Loss of interest or pleasure

A nurse who works primarily with clients who have bipolar disorder identifies which group of clients as not being candidates to take lithium as treatment? a) Patients who drink decaffeinated coffee b) Patients who take bronchodilators c) Patients with diabetes who take oral antidiabetic agents d) Patients who take ACE inhibitors

d) Patients who take ACE inhibitors

The nurse observes that a client with bipolar disorder is pacing the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which of the following? a) Aggression b) Anger c) Anxiety d) Psychomotor agitation

d) Psychomotor agitation

When developing the plan of care for a client with major depression, which of the following is the highest priority? a) Activity level b) Nutrition c) Sleep d) Safety

d) Safety

A nursing student is caring for an elderly client who is taking sertraline for depression. The instructor quizzes the student about the medication and its actions. To what classification of drugs should the student assign sertraline? a) Cyclic antidepressant b) Monoamine-oxidase inhibitor c) Serotonin 2 antagonist d) Selective serotonin reuptake inhibitor

d) Selective serotonin reuptake inhibitor

The nurse is providing a presentation for a group of health professionals about suicide. Which of the following would the nurse address as a major contributing factor to the rising suicide rate among men? a) Parenting practices b) Lack of conflict resolution skills c) Media influences d) Substance abuse

d) Substance abuse

Which of the following terms describes a nonfatal, self-inflicted destructive act with an explicit or implicit intent to die? a) Suicidal ideation b) Parasuicide c) Suicidality d) Suicide attempt

d) Suicide attempt

Susan was abandoned by her parents at age 3, resulting in her perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of ... a) why Susan has become lesbian at the age of 23. b) a feminist viewpoint of depression. c) a biophysiological explanation for Susan's depressive disorder. d) a psychodynamic interpretation of Susan's major depressive disorder.

d) a psychodynamic interpretation of Susan's major depressive disorder.

What is the priority nursing diagnosis for a depressed client exhibiting signs of acute mania that include agitation, insomnia, increased physical activity, and anorexia? noncompliance risk for injury chronic low self-esteem insomnia

risk for injury

The family of a 22-year-old client with bipolar disorder is having difficulty coping with the client's rapid mood swings, irritability, grandiose delusions, and overly intrusive behaviors. Following a visit to the unit, the parents discuss their frustration and anger with the nurse and ask what they should do to help the client. Which reply by the nurse is most appropriate? "Help the client monitor medication adherence and watch for changes in mood and sleep." "Let the client move back in with you and take away the client's checkbook and driver's license." "Call the police when the client becomes manic and have the client involuntarily committed." "Make sure the client is taking the medication correctly and help the client get out of debt."

"Help the client monitor medication adherence and watch for changes in mood and sleep."

At 1 a.m., the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. What would be the nurse's most therapeutic response? "Go to the day room and wait while I call your psychiatrist." "Don't be unreasonable. I can't call the psychiatrist at this time of night." "You must really be upset to want a pass immediately; I'll give you some medication." "I can't call the psychiatrist now, but you and I can talk about your request for a pass."

"I can't call the psychiatrist now, but you and I can talk about your request for a pass."

A client who is manic states, "What time is it? I have to see the doctor. Is breakfast here yet? I've got to see the doctor first. Can I get my cereal out of the kitchen?" Which response by the nurse would be most appropriate ? "Are you hungry?" "Your thoughts seem to be racing this morning." "You will have to be quiet and have breakfast after the doctor comes." "Please slow down. I'm not sure what you need first."

"Please slow down. I'm not sure what you need first."

The spouse of a client diagnosed recently with a mood disorder calls the nurse therapist to report a change in the client's mood. The spouse states, "The client is clearly in a better mood than usual. I would say the client seems mildly elated. The client is functioning fine at work and home. The client is energetic, up and doing things at 5:00 a.m. and really confident again. It seems fantastic, but unusual. Is this something to worry about?" Which potential response by the nurse accurately assesses the situation? "Since the client is eating, sleeping, and not behaving inappropriately, there's nothing to worry about. Just let me know if the client starts getting irritable or has trouble sleeping." "The client sounds hypomanic. Let's schedule an appointment for this week for an evaluation. The client may need additional or different medication." "It sounds as though the antidepressants are working well. Just ask the client if the client is experiencing any side effects and let me know." "I'm concerned. Sometimes depressed people seem contented when they have decided to commit suicide. Let's schedule an appointment for tomorrow."

"The client sounds hypomanic. Let's schedule an appointment for this week for an evaluation. The client may need additional or different medication."

A client whose mania is related to a medical condition asks why the physician has prescribed carbamazepine instead of lithium. Which is the nurse's best response? "You will be fine taking this drug, so don't worry." "This drug is best for clients who do not respond to lithium or whose mania is related to a medical condition, as is yours." "I don't know. Make sure you discuss this with your doctor as soon as you can." "This drug may be preferred by your physician for many reasons."

"This drug is best for clients who do not respond to lithium or whose mania is related to a medical condition, as is yours."

For maintenance therapy of mania, the therapeutic serum level of lithium is ... 1.6-2.0 mEq/L. 0.6-1.2 mEq/L. 2.1-2.5 mEq/L. greater than 2.6 mEq/L.

0.6_1.2 mEq/L.

A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When monitoring the client's blood concentration of this drug, which level would alert the nurse to the need to change the dosage? 115 ng/mL 75 ng/mL 55 ng/mL 30 ng/mL

30 ng/mL

The nurse is caring for a psychiatric-mental health client who has just been diagnosed with bipolar disorder. The physician has ordered medication for for the client. Which class of medications, if prescribed, would the nurse question? Mood stabilizers Atypical antipsychotics Anticonvulsant medications Antidepressants

Antidepressants

A nursing instructor is reviewing a case study with students about a client with mania who was admitted to a mental health unit. The instructor asks the students what medical diagnosis is most likely responsible for the mania. Which would be the best answer by a student? Anxiety disorder Adolescent conduct disorder Many psychiatric disorders have symptoms of mania Bipolar disorder

Bipolar disorder

A client who suffers from bipolar disorder is admitted to a mental health unit for a manic episode. The nurse knows that which takes priority? Distraction therapy Cognitive-behavioral therapy Phamacotherapy Client safety

Client safety

Which question by a depressed, inpatient, psychiatric-mental health client should the nurse interpret as a potential suicide clue? "Are clients allowed to keep drugstore medications at their bedside?" "When is my next scheduled electroconvulsive therapy session?" "When do you think the doctor will let me get my street clothes back?" "Are we allowed to use the client kitchen whenever we want?"

Correct response: "Are clients allowed to keep drugstore medications at their bedside?" Explanation: Asking whether medications can be kept at the bedside is a suspicious question if a client is depressed and may precede an attempted overdose. The other questions are not necessarily suggestive of suicidal ideation.

The nurse is told by a client that the client is having suicidal thoughts. Which intervention has lowest priority? Assessing the client for past history of suicidal attempts Determining the client's concerns and if the client has a plan Administering a mental status exam to assess for psychosis Maintaining a safe, secure environment

Correct response: Administering a mental status exam to assess for psychosis Explanation: About 50% to 80% of people who commit suicide have previously attempted suicide; the more violent and lethal the plan, the higher the potential for suicide. Assessment of past attempts and current plan (not psychosis) as well as maintaining client safety would be priorities. Maintaining a safe, secure environment is an important intervention by the nurse to prevent a suicide attempt.

The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what? Assist him or her in the expression of sad and helpless feelings. Assess the cause of his or her depression. Develop rapport based on trust and understanding. Prevent self-destructive behavior.

Correct response: Prevent self-destructive behavior. Explanation: Preventing self-destructive behavior is the primary nursing goal. Other important goals, such as assisting the client in expressing feelings, assessing for causes of depression, and developing rapport, may be important for intervention after the primary goal of maintaining safety is met.

After assessing a client, the nurse identifies that the client is at risk for suicide. Which would be the nurse's priority intervention? Communicate a desire to help the client. Remove means of suicide from the client's access. Determine the course of the client's suicidal thoughts. Provide mood-stabilizing medications per physician order.

Correct response: Remove means of suicide from the client's access. Explanation: Immediate interventions involve removing the means of suicide to reduce the risk of it happening. If the person is hospitalized, methods may include ensuring pills or medications are not available to clients or that they are not taking any measures to accumulate needed drugs. If in a community or home care setting, nurses may enlist the help of family or friends to remove the means and to provide immediate support.

The nurse is assessing a client for warning signs of suicide. Which would be a concern? The client has decreased substance use. The client is reaching out to family and friends. The client has forgiven those who have caused emotional pain. The client has engaged in risky behaviors and tends to be impulsive.

Correct response: The client has engaged in risky behaviors and tends to be impulsive. Explanation: According to the "Is Path Warm" mnemonic, a risk factor for suicide is risk-taking behavior without thinking.

When assessing risk of suicide, which are important assessment components? Select all that apply. seriousness of suicidal ideation degree of hopelessness previous attempt lethality of method Unemployment

Correct response: seriousness of suicidal ideation degree of hopelessness previous attempt lethality of method Explanation: Assessing for suicide risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, disorders, previous attempt, suicide planning and implementation, and availability and lethality of the suicide method.

A client diagnosed with bipolar disorder is admitted to an inpatient psychiatric facility with acute mania and threats of attacking others in the household. Which would be the priority? Administering mood stabilizers Ensuring safety Removing the client to a quiet environment Challenging the client's behavior

Ensuring safety

A client with a history of bipolar disorder is at home with family. The family calls the mental health clinic because they suspect that the client may be experiencing a relapse of mania. Which would support the family's suspicions? Avoidance of people Lack of appetite Excessive energy levels Focus on one topic

Excessive energy levels

On admission to the psychiatric unit, a client is dressed in a red leotard and exercise bra, with an assortment of chains and brightly colored scarves on the client's head, waist, wrists, and ankles. The client's first words to the nurse are, "I'll punch you, munch you, crunch you," as the client dances into the room, shadow boxing. The client shakes the nurse's hand and says cheerfully, "We need to become better acquainted. I have the world's greatest intellect, and you are probably an intellectual midget." How can the nurse document the client's mood? Belligerent and blunted. Anxious and unpredictable. Expansive and grandiose. Suspicious and paranoid.

Expansive and grandiose.

A client has been on lithium for 3 weeks now. The client approaches the nurse, saying, "I feel like I'm going to throw up, and I can't even hold this cup of coffee straight. Why can't I do the crossword puzzle? I usually can do them in about 5 minutes." What is the appropriate nursing intervention at this time? Explain to the client that these are normal side effects of the lithium and the client will get accustomed to them over time. Further assess the client's symptoms, call the physician, hold the client's next dose of lithium, and have a blood level drawn because the client is showing symptoms of toxicity. Talk with a colleague about the client's symptoms and get assistance in deciding what to do next. Try to refocus the client onto another task because the client's mania is causing the client to be agitated.

Further assess the client's symptoms, call the physician, hold the client's next dose of lithium, and have a blood level drawn because the client is showing symptoms of toxicity.

The police bring a client to the hospital. They found the client in a hospital gown, swimming in a local creek. The client states that the client was "being baptized by Mother Nature, who loves and worships me." How would the nurse describe the client's current alterations in mental status? Grandiose delusions Visual hallucinations Dysphoria Neologisms

Grandiose delusions

The client suffers from bipolar disorder. The client is experiencing a downward spiral. For which drug should the nurse expect the client to require serum level monitoring? Anticonvulsants Lithium fluoxetine Bupropion

Lithium

A nurse is developing a plan of care for a client with bipolar disorder. When preparing to administer medications, which agent would the nurse anticipate as being prescribed as the mainstay of pharmacotherapy? Select all that apply. Lithium carbonate Lamotrigine Divalproex Fluoxetine Carbamazepine

Lithium carbonate Lamotrigine Divalproex Carbamazepine

A 52-year-old client with bipolar disorder tells the nurse, "I read that there are chemicals in my brain that can cause my symptoms." Knowing that the client is referring to neurotransmitters, which would be the best response by the nurse? "Low levels of the neurotransmitter serotonin are associated with mania." "Recent studies have found that neurotransmitters do not play a role in bipolar disorders." "Low levels of the neurotransmitter dopamine are associated with mania." "Clients with bipolar disorder often have high levels of gamma-aminobutyric acid (GABA) in manic states."

Low levels of the neurotransmitter serotonin are associated with mania."

A 30-year-old woman has been brought to the emergency department after causing a disturbance. She is wearing a pair of tight, pink yoga pants, high heels, a sports bra, and a bright-colored hat. The woman's care providers would recognize that the woman's dress may suggest what? Acute confusion Antisocial personality disorder Mania Chronic low self-esteem

Mania

A nurse is preparing to administer pharmacotherapy as part of the treatment plan for a client with bipolar disorder. The nurse understands that this therapy is designed to achieve which goal? Select all that apply. Rapid control of symptoms Decreased severity of manic episodes Decreased frequency of manic episodes Cure of the disorder Prevention of future episodes

Rapid control of symptoms Decreased severity of manic episodes Decreased frequency of manic episodes Prevention of future episodes

In the past year, a client's parent reports the client has experienced six manic episodes, each lasting for 3 weeks. This is best described as what? Hypomania Cyclothymic disorder Hypermania Rapid cycling

Rapid cycling

The nurse is caring for a client diagnosed with bipolar disorder. During a manic episode, which takes priority? Social needs Security Physiologic needs Safety

Safety

A client with bipolar disorder has a plasma lithium concentration of 2.7 mE/L. Which finding would a nurse most likely assess in this client? Select all that apply. Incoordination Fasciculations Nystagmus Tinnitus Seizures

Seizures Nystagmus Fasciculations

In response to a change in the community health nurse, a client has recently discontinued use of lithium. As a result of the discontinuation of the medication, the client has began to exhibit early signs of mania. The client is brought to the emergency department at the hospital for assessment. Which is the best nursing approach for this client? Insisting that the client remain active throughout the day so the client will sleep Offering high-calorie meals and insisting the client finish all meals Allowing the client maximum opportunity for freedom and self-expression Setting limits, providing a low-stimulation environment, and maintaining a neutral attitude

Setting limits, providing a low-stimulation environment, and maintaining a neutral attitude