Depression and Bipolar

C

Priority interventions for a patient diagnosed with major depressive disorder and feelings of worthlessness should include A. opportunities to assume a leadership role in the therapeutic milieu. B. allowing the patient to spend long periods alone in meditation. C. careful unobtrusive observation around the clock. D. distracting the patient from self -absorption.

D

A client recently admitted to the hospital in the manic phase of bipolar disorder is unkempt, taking antipsychotic medications, and complaining of abdominal fullness and discomfort. Which intervention addresses the priority sign/symptom? A. Teach self-grooming skills B. Monitor the adequacy of the antipsychotic dosage C. Reward cleanliness with unit privileges D. Encourage frequent fluid intake and a high-fiber diet

A

Major depressive disorder resulted after a patient's employment was terminated. The patient now says to the nurse, "I'm not worth the time you spend with me. I am the most useless person in the world." Which nursing diagnosis applies? A. Situational low self-esteem B. Powerlessness C. Disturbed personal identity D. Defensive coping

D

An adult diagnosed with major depressive disorder was treated with medication and cognitive-behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? A. Use of complementary therapy B. Desensitization techniques C. Relaxation training classes D. Social skills training

D

An outpatient diagnosed with bipolar disorder takes lithium carbonate 300 mg three times daily. The patient reports nausea. To reduce the nausea most effectivelythe nurse suggests that the lithium be taken with A. An antiemetic B. A large glass of juice C. An antacid D. Meals

D

A disheveled patient in the acute phase of major depressive disorder is withdrawn, has psychomotor retardation, and has not showered for several days. The nurse will a) make observations about the patient's poor personal hygiene. b) calmly tell the patient, "You must bathe daily." c) bring up the issue at the community meeting. d) firmly and neutrally assist the patient with showering.

B

A health teaching plan for a patient taking lithium should include instructions to A. Avoid eating aged cheese, processed meats, and red wine B. Maintain normal salt and fluids in the diet C. Double the lithium dose if diarrhea or vomiting occurs D. Drink twice the usual daily amount of fluid

B

A manic client begins to make sexual advances toward visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which intervention should the nurse implement? a) Tell the client that the behavior is inappropriate . b) Escort the client to their room, with the assistance of other staff. c) Place the client in seclusion for 30 minutes. d) Tell the client that their telephone privileges are revoked for 24 hours.

D

A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of A. cardiac dysrhythmia . B. cardiogenic shock . C. hypotensive shock. D. hypertensive crisis.

B

A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve ? A. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake B. Mashed potatoes , ground beef patty , corn, green beans, apple pie C. Macaroni and cheese , hot dogs, banana bread , caffeinated coffee D. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast roils

A

A nurse worked with a patient diagnosed with major depressive disorder, severe withdrawal, and psychomotor retardation . After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of A. ineffectiveness and frustration . B. interest and pleasure. C. over-involvement. D. guilt and despair .

D

A patient became depressed after the last of the family's six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment. The patient will A. agree to take an antidepressant medication regularly by (date). B. initiate social interaction with another person daily by (date) C. identify two personal behaviors that alienate others by (date) D. verbalize realistic positive characteristics about self by (date).

D

A patient being treated for depression has taken sertraline daily for a year. The patient calls the clinic nurse and says, "stopped taking my antidepressant 2 days ago. Now I am having nausea, nervous feelings, and I can't sleep." The nurse will advise the patient to: A. "Go to the nearest emergency department immediately." B. "Do not be alarmed. Take 2 aspirin and drink plenty of fluids." C. "Resume taking your antidepressants for 2 more weeks and then discontinue them again." D. "Take a dose of your antidepressants now and come to the clinic to see the health care provider."

D

A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate? A. "If you do that one more time, you will be secluded immediately." B. "You know we will not let you hit anyone. Why do you continue this behavior?" C. "Stop that! No one did anything to provoke an attack by you" D. "Do not hit anyone. If you are unable to control yourself, we will help you."

D

A patient diagnosed with bipolar disorder will be discharged tomorrow. The patient is taking a mood stabilizing medication . What is the priority nursing intervention for the patient as well as the patient's family during this phase of treatment ? A. Decreasing physical activity B. Increasing food and fluids C. Meeting self-care needs D. Attending psychoeducation sessions

A

A patient diagnosed with depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about A. reporting increased suicidal thoughts . B. minimizing exposure to bright sunlight C. maintaining a tyramine-free diet. D. restricting sodium intake to 1 gram daily.

A

A patient diagnosed with major depressive disorder began taking a tricyclic antidepressant 1 week ago. Today the patient says, "don't think can keep taking these pills. They make me so dizzy, especially when I stand up" The nurse will A. teach the patient strategies to manage postural hypotension . B. update the patient's mental status examination. C. withhold the drug, force oral fluids, and notify the health care provider. D. limit the patient's activities to those that can be performed in a sitting position.

C

A patient diagnosed with major depressive disorder does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective ? A. Frequently reassure the patient to reduce guilt feelings. B. Phrase questions to require yes or no answers . C. Make observations. D. Ask the patient direct questions.

D

A patient diagnosed with major depressive disorder refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient? A. Orange juice B. Tomato juice C. Hot tea D. Milk

D

A patient diagnosed with major depressive disorder repeatedly tells staff, have cancer. It's my punishment for being a bad person." Diagnostic tests reveal no cancer. Select the priority nursing diagnosis. A. Spiritual distress B. Powerlessness C. Stress overload D. Risk for suicide

C

A patient diagnosed with major depressive disorder says, "No one cares about me anymore. I'm not worth anything" Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient ? A. "I like the shirt you are wearing." B. "You look nice this morning ." C. "You're wearing a new shirt." D. "You must be feeling better today "

D

A patient diagnosed with major depressive disorder tells the nurse "Bad things that happen are always my fault." Which response by the nurse will best assist the patient to reframe this overgeneralization ? A. "Are you saying that you don't have any good things happen?" B. "You are being extremely hard on yourself. Try to have a positive focus." C. "I really doubt that one person can be blamed for all the bad things that happen." D. "Let's look at one bad thing that happened to see if another explanation exists."

A

A patient experiencing acute mania is dancing atop a pool table in the recreation room. The patient waves a cue in one hand and says, "throw the pool balls if anyone comes near me." To best assure safety, the nurse's first intervention is to A. clear the room of all other patients . B. assemble a show of force . C. help the patient down from the table. D. tell the patient, "You need to be secluded."

D

A patient is experiencing psychomotor agitation associated with major depressive disorder. Which observation would the nurse associate with this symptom ? The patient a) complains of prickly skin sensations. b) demonstrates slowed verbal responses . c) asks the nurse to repeat instructions. d) paces aimlessly around the room.

D

A patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of A. anergia. B. dysthymia. C. euphoria . D. anhedonia.

A

A patient waves a newspaper and says, "must have my credit card and use the computer right now. A store is having a big sale, and I need to order 10 dresses and four pairs of shoes" Select the nurse's appropriate intervention . A. The nurse invites the patient to sit together and look at new fashion magazines. B. tells the patient computer use is not allowed until self -control improves. C. asks whether the patient has enough money to pay for the purchases . D. suggests the patient have a friend do the shopping and bring purchases to the unit.

C

A patient with diagnosed bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patient's behavior? A. Ask the health care provider to prescribe an increased dose and frequency of lithium B. Continue to monitor and document the patient's speech patterns and motor activity C. Consider the need to check the lithium level. The patients may not be swallowing medications D. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing

D

Four new patients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. Which patient will need the most watchful supervision? A. A patient diagnosed with bipolar disorder. B. cyclothymic disorder. C. dysthymic disorder. D. bipolar disorder.

C

Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on A. sleep pattern stabilization. B. developing an optimistic outlook. C. distorted thought self-control . D. interest in the environment .

C

The exact cause of bipolar disorder has not been determined; however, for most patients A. brain structures were altered by stress early in life. B. excess sensitivity in dopamine receptors may trigger episodes. C. several factors , including genetics , are implicated . D. Inadequate norepinephrine reuptake disturbs circadian rhythms .

C

The nurse is caring for a client just admitted to the mental health unit and diagnosed with catatonic stupor. The client is lying on the bed in a fetal position. Which is the most appropriate nursing intervention? a) Leave the client alone so as to minimize external stimuli. b) Take the client into the dayroom with other clients to provide stimulation. c) Sit beside the client in silence with simple open-ended questions . d) Ask direct questions to encourage talking

C

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client? a) Chess b) Group exercise c) Writing d) Board games

A

The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, which is the nurse's immediate priority of care? a) Provide safety for the client and other clients on the unit. b) Provide the clients on the unit with a sense of comfort and safety. c) Assist the staff in caring for the client in a controlled environment d) Offer the client a less stimulating area in which to calm down and gain control.

D

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy (ECT) treatment? A. Nutrition and hydration B. Reducing disorientation and confusion C. Assisting the patient to identify and test negative thoughts D. Supporting physiological stability

C

Which documentation for a patient diagnosed with major depressive disorder indicates the treatment plan was effective? A. Slept 10 hours uninterrupted. Attended craft group; stated "project was a failure, just like me" B. Slept 5 hours with brief interruptions . Personal hygiene adequate with assistance Weight loss of 1 pound. C. Slept 6 hours uninterrupted . Sang with activity group. Anticipates seeing grandchild . D. Slept 7 hours uninterrupted . Preoccupied with perceived inadequacies . States feel tired all the time ."

B, C

Which information provided by the nurse accurately describes electroconvulsive therapy? Select all that apply . a) The average series involves 8 to 12 treatments . b) Some confusion may be noted after the procedure . c) Memory loss may occur but will resolve with time. d) This treatment is a permanent cure to the condition . e) This treatment is tried before the use of medication.

A, C, F

Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply. a) Communicate expected behaviors to the client. b) Ensure that the client knows that they are not in charge of the nursing unit. c) Assist the client in identifying ways of setting limits on personal behaviors. d) Follow through about the consequences of behavior in a non-punitive manner. e) Enforce rules by informing the client that he/she will not be allowed to attend therapy groups f) Have the client state the consequences for behaving in ways that are viewed as unacceptable