Psychiatric and Mental Health Nursing - Mood, Adjustment, and Dementia Disorders

The client with a cognitive disorder tells the nurse, "Everyone is after me. They want to kill me." How should the nurse respond? "You're frightened. This is a hospital and these people are staff members. You're safe here." "Why do you think someone wants to kill you?" "Tell me who do you mean when you say 'everyone' wants to kills you." "Don't worry, we'll protect you. No one can come here to harm you."

"You're frightened. This is a hospital and these people are staff members. You're safe here."

A client with severe depression states, "My heart has stopped and my blood is black ash." The nurse interprets this statement to be evidence of which problem? hallucination illusion delusion paranoia

delusion

A client is taking lithium carbonate. The client asks for explanations of why regular blood tests are needed. The nurse explains that it is to detect lithium toxicity. Which statement, if made by the client, indicates to the nurse that the teaching about lithium toxicity has been effective? "There may be too much medication in my bloodstream." "This blood test tells the doctor if the medication is effective." "I should get my blood checked if I don't feel well." "Blood tests will prevent common side effects of taking the medication."

"There may be too much medication in my bloodstream."

A nurse working on a unit with individuals who have eating disorders is interviewing a new female client. The client has lost a significant amount of weight over the past months and complains of being "sick to my stomach" when around food. The client reports that she hasn't menstruated in 3 months. What is the priority nursing intervention? giving the client her newly ordered antidepressant medication requesting an order for a pregnancy test involving the client in group activities requesting an as-needed medication for gastric distress

requesting an order for a pregnancy test

A client states, "I feel so sad. I don't think I can go on anymore." Which is the most therapeutic response the nurse can offer the client? "Things will look better tomorrow." "You feel like you can't go on anymore?" "Why do you feel like that?" "I will tell your doctor about your feelings."

"You feel like you can't go on anymore?"

Which response is most helpful for a client who is euphoric, intrusive, and interrupts other clients engaged in conversations to the point where they get up and leave or walk away? "When you interrupt others, they leave the area." "You're being rude and uncaring." "You should remember to use your manners." "You know better than to interrupt someone."

"When you interrupt others, they leave the area."

The unlicensed assistive personnel (UAP) approaches the nurse and states, "The client doesn't know what caused him to be so depressed. He must not want to tell me because he doesn't trust me yet." In responding to this staff member, which statement by the nurse will help the UAP understand the client's illness? "Endogenous depression is biochemical and isn't caused by an outside stressor or problem. The client can't tell you why he's depressed because he really doesn't know." "Endogenous depression can be caused by various stressors. Perhaps the client isn't willing to tell you at this time." "Endogenous depression comes from within the person. It's a reaction to a loss. You need to give the client more time to identify the cause or loss." "Endogenous depression usually derives from past childhood conflicts. It really isn't important for the client to remember what happened years ago."

"Endogenous depression is biochemical and isn't caused by an outside stressor or problem. The client can't tell you why he's depressed because he really doesn't know."

The client with mania is irritable and insulting to an unlicensed assistive personnel (UAP). The UAP states, "I cannot believe this client is so rude. Should he not be overly happy?" Which response by the nurse should help the UAP understand the client's behavior? "It is our responsibility to listen even though we might not like what the client is saying." "We must reprimand the client for doing that because there is no reason to behave like that." "I will go and speak to the client about this behavior and make sure he understands that he needs to control what he is saying." "I know it is difficult, but being irritable is a sign of the client's mania."

"I know it is difficult, but being irritable is a sign of the client's mania."

The client with acute mania has been admitted to the inpatient unit voluntarily. The nurse approaches the client with medication to be taken orally as prescribed by the health care provider. The client states, "I don't need that stuff." Which response by the nurse is best? "You can't refuse to take this medication." "If you don't take it orally, I'll give you a shot." "The medication will help you feel calmer." "I'll get you some written information about the medication."

"The medication will help you feel calmer."

The client has been taking the monoamine oxidase inhibitor (MAOI) phenelzine, 10 mg twice a day. The healthcare provider prescribes a selective serotonin reuptake inhibitor (SSRI), paroxetine 20 mg to be given every morning. What action should the nurse take? Give the medication as prescribed. Question the health care provider about the prescription. Question the dosage prescribed. Ask the health care provider to prescribe benztropine for adverse effects.

Question the health care provider about the prescription. The nurse should question the health care provider about the prescription because the client who has been taking an MAOI such as phenelzine must wait 14 days after stopping the MAOI before starting an SSRI such as paroxetine. Serotonin syndrome, a potentially lethal consequence, can occur when combining an MAOI and an SSRI. Serotonin syndrome is characterized by hyperreflexia, hyperthermia, myoclonus, and other symptoms similar to neuroleptic malignant syndrome. Giving the medication as prescribed can result in serious adverse consequences, as described previously. The dosage is accurate. Benztropine is not given with an SSRI; it is an antiparkinsonian agent usually prescribed for the adverse effects of antipsychotic medication.

A nurse is assigned to a client who, after a medication teaching session, began receiving amitriptyline hydrochloride to treat depression. One week after starting this drug, the client refuses to take the medication, reporting that it has caused blurred vision, dry mouth, and constipation, but it hasn't improved the client's mood. Which nursing diagnosis is appropriate for this client? noncompliance (treatment regimen) related to treatment resistance deficient knowledge (treatment regimen) related to inadequate understanding of teaching anxiety related to unconscious conflict ineffective coping related to personal vulnerability

deficient knowledge (treatment regimen) related to inadequate understanding of teaching

After interviewing a client diagnosed with recurrent depression, the nurse determines the client's potential to commit suicide. Which factors should the nurse consider as contributors to the client's potential for suicide? Select all that apply. psychomotor retardation impulsive behaviors overwhelming feelings of guilt chronic, debilitating illness decreased physical activity repression of anger

impulsive behaviors overwhelming feelings of guilt chronic, debilitating illness repression of anger

A client is brought to the crisis intervention center by the partner, who states that the client has recently become increasingly listless and less involved with the family. The partner reports that the client sleeps poorly, eats little, and can barely perform basic self-care. The partner also reveals that 3 months ago the client was in a car accident in which the client's best friend was killed. After the physician diagnoses acute depression, the nurse should anticipate administering: paroxetine, 20 mg by mouth (P.O.) every morning. amitriptyline hydrochloride, 20 mg P.O. daily. doxepin, 500 mg daily. imipramine, 500 mg daily.

paroxetine, 20 mg by mouth (P.O.) every morning. Paroxetine, amitriptyline, doxepin, and imipramine are all antidepressants that may be ordered for this client. However, paroxetine, 20 mg P.O. every morning, is the only correct dosage. Amitriptyline is usually started at 75 to 150 mg P.O. daily in divided doses. Doxepin is started at 25 to 50 mg daily and may be titrated upward to a maximum daily dose of 300 mg. Imipramine is started at 50 to 75 mg daily and, if tolerated, titrated upward to a maximum daily dose of 300 mg.

A 16-year-old client has been taking the antidepressant fluoxetine for the past week. The client's parent is concerned that the client is not showing any signs of improvement and may be having increased suicidal thoughts. Which statement would the nurse include when replying to the parent's concern? "There is no concern for higher suicidal risk in teenagers who take an antidepressant." "Antidepressants are not fatal if an overdose is taken." "The risk of suicide in teenagers is higher after the first month of taking an antidepressant." "Antidepressants can take 2 to 4 weeks before any improvement in symptoms occur."

"Antidepressants can take 2 to 4 weeks before any improvement in symptoms occur."

A client with Alzheimer's disease is going to live with his daughter who does not work outside of the home. The nurse determines that the daughter needs further education when she makes which statement? "I've put special locks on all the doors that Dad will not be able to unlock." "Dad said that what he missed most while he was here was using his aftershave." "Dad will be in a bedroom that has nothing for him to trip over getting to the bathroom." "I've taken the knobs off of the stove so he won't be able to turn it on."

"Dad said that what he missed most while he was here was using his aftershave."

A client has been diagnosed with multi-infarct (or vascular) dementia (MID). When preparing a teaching plan for the client and family, the nurse should indicate which action as the most critical for slowing MID? administering anticoagulants such as warfarin administering benzodiazepines such as lorazepam to decrease choreiform movements managing related symptoms such as depression managing the symptoms by increasing dopamine availability

administering anticoagulants such as warfarin

The nurse is about to administer lithium carbonate to a client with bipolar disorder in a mania state. What is the nurse's action after assessing the client's lithium level to be 1.0 mEq/L (mmol/L)? Notify the healthcare provider. Hold the lithium carbonate. Administer the lithium carbonate. Repeat the lithium level.

Administer the lithium carbonate. To treat acute mania, the client's serum lithium level should be between 0.6 and 1.2 mEq/L (mmol/L). The serum lithium level shouldn't exceed 2 mEq/L (mmol/L). The nurse must monitor the client continuously for signs and symptoms of lithium toxicity, such as diarrhea, vomiting, drowsiness, muscular weakness, ataxia, stupor, and lethargy. The nurse must also keep in mind that even a normal lithium level can become toxic. Notifying the healthcare provider of the normal level with a client in mania is not appropriate. There are no signs and symptoms of toxicity, so the medication should not be held. There is no reason to repeat the level.

A client with dementia is eating off of other clients' meal trays. After the client with dementia is asked to stop, which action should be taken? Set firm limits and inform the client that this will not be tolerated. Explain the risk of infection from eating others' food. Distract the client. Restrain the client.

Distract the client.

A client with erectile disorder is taking sildenafil. What instructions should the nurse give the client? Take the medication 8 hours before having intercourse. Use nitroglycerine if chest pains occur during intercourse. Take up to three tablets within 24 hours. Expect an erection that may last up to 4 hours.

Expect an erection that may last up to 4 hours.

Which laboratory value will require intervention in a client who is receiving lithium? sodium 130 mEq/L creatinine 1.8 mg/dL potassium 4.0 mEq lithium level 1.2 mEq/L

sodium 130 mEq/L

A client diagnosed with major depression has started taking amitriptyline hydrochloride, a tricyclic antidepressant. What is a common adverse effect of this drug? weight loss dry mouth hypertension muscle spasms

dry mouth

The nurse is caring for a client with bipolar disorder who was recently admitted to an inpatient unit and is experiencing a manic episode. What is a priority nursing intervention for this client? Prescribe and administer all medications in a liquid form. Base permission for family visits on the client's attendance at therapy groups. Closely monitor the client's eating and sleeping habits. Encourage the client to keep a journal about feelings and emotions.

Closely monitor the client's eating and sleeping habits.

Which nursing strategy would be effective in managing a client who has Alzheimer's disease and wanders? Encourage participation in activities such as board games. Discourage wandering by allowing the behavior at selected intervals. Involve the client in activities that promote walking. Promote safety by restricting the client in a geriatric chair.

Involve the client in activities that promote walking.

When preparing a client for electroconvulsive therapy (ECT), the nurse should make sure that the client: sees family members immediately before the procedure. is scheduled for a brain scan immediately after the procedure. has undergone a thorough medical evaluation. has been on nothing-by-mouth (NPO) status for no more than 2 hours before the procedure.

has undergone a thorough medical evaluation.

The nurse is assisting a client diagnosed with dementia during meal time. Which nursing would best prevent complications? Provide a plate with a variety of foods to give a more complete choice of foods. Serve one course at a time with the appropriate utensil. Keep mealtimes short to prevent loss of attention. Encourage the client to open containers to allow for independence.

Serve one course at a time with the appropriate utensil.

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 client goal would be most appropriate? The client will identify two trusted staff members to help the client choose appropriate dress. The client will record the number of clothing changes per day. The client will refrain from hugging other clients and change clothing only twice per day. The client will verbalize feelings of low self-esteem with nursing staff.

The client will refrain from hugging other clients and change clothing only twice per day.

The nurse is assessing a client who has been admitted to the acute care facility. The client experiences an acute onset of altered level of consciousness and recent memory loss. What does the nurse anticipate the client will be evaluated for? dementia tertiary syphilis delirium depression

delirium

The nurse is admitting a client with a history of bipolar mania. Which assessment finding is the priority when developing a plan of care? bizarre, colorful, inappropriate dress grandiose thinking, poor concentration insulting, provocative behavior directed at staff hyperactivity, ignoring eating, and sleeping

hyperactivity, ignoring eating, and sleeping

A client is in the first stage of Alzheimer's disease. The nurse should plan to focus this client's care on: offering nourishing finger foods to help maintain the client's nutritional status. providing emotional support and individual counseling. monitoring the client to prevent minor illnesses from turning into major problems. suggesting new activities for the client and family to enjoy together.

providing emotional support and individual counseling.