ADN 450 - Mood/Affect

A client is brought to the emergency department (ED) after ingesting an unknown quantity of antidepressant medication and sleeping pills. A family member tells the nurse that the client has recently experienced several significant losses. The client is stabilized in the ED and transferred to a psychiatric unit. What is the nurse's best response when the client sobs uncontrollably and refuses to come to breakfast?

"Your feelings are real. I'll bring your breakfast and sit with you if you want."

Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis?

Borderline personality disorder

A client with paranoid schizophrenia is recently admitted to the psychiatric unit. The client is hesitant to eat the food provided and states "I know they poisoned this food before putting it on my plate." What is the priority nursing action?

Bring the client food in unopened containers

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?

Closely monitor the client's eating and sleeping habits.

Which cluster of disorders corresponds to symptoms of being dramatic and emotional?

Cluster B

A 16-year-old client is highly disruptive in class and has been in trouble at home. The parent recently found the adolescent torturing a cat. When questioned, the adolescent laughed. What condition might the client be suffering from?

Conduct disorder

An 11-year-old client has come to the school nurse more than 15 times for somatic complaints during the first quarter of school and has subsequently left school after each visit. What should the school nurse do?

Contact the child's parents to discuss the situation.

In which phase of the aggression cycle can techniques of seclusion or restraint be used to deal with the aggression quickly?

Crisis

A depressed client on a psychiatric unit asks the nurse to call the hospital lawyer to discuss writing out a will. What is the nurse's priority intervention?

Discuss thoughts and explore intent for suicide with the client.

Which is an anticonvulsant used as a mood stabilizer?

Divalproex

A pregnant teenager is not certain that she will like home care because she is afraid she will feel lonely. The nurse should suggest that:

Everyone should eat together

A nurse is assessing a client diagnosed with avoidant personality disorder. Which would the nurse expect to find? Select all that apply.

Feelings of inadequacy Shyness

The nurse is conducting an admission assessment with a 45-year-old client who has been demonstrating signs of bipolar disorder. While conducting the assessment, the client starts speaking in illogical rhymes and using word associations. What is the name for this thought pattern?

Flights of ideas

A nurse at the health care facility is caring for an older adult client who complains of sleeplessness. Which condition is a manifestation of depression in an older client?

Insomnia

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client?

Iron-deficiency anemia

The nurse is conducting a postparum examination on a client who reports pain and is unable to sit comfortably. The perineal exam reveals an episiotomy appropriately approximated without signs of a hematoma. Which action should the nurse prioritize?

Place an ice pack

An admitting nurse on a rehabilitation unit notices that an elderly client with a fractured hip and severe hypothyroidism is dirty and disheveled and that their personal hygiene is very poor. As the nurse gathers admission data, the nurse further notes that the client has few personal connections, is depressed, and doesn't seem to care about personal appearance. How should the nurse improve the client's performance of self-care activities?

Provide initial and routine hygienic care, then evaluate the client daily as treatment progresses.

A client suffers from low mood and disturbed sleep. This client is most likely experiencing a change in which neurotransmitter?

Serotonin

During the interview at a crisis center, a newly widowed client reveals the wish "to join my spouse in heaven." The nurse determines that the client does not plan self-harm. What is the best response by the nurse?

"What feelings have you been experiencing?"

Police officers bring a client to the mental health unit for admission. The client had been directing traffic on a busy city street, shouting rhymes such as "to work, you jerk, for perks" and making obscene gestures at cars that came close to the client. When the client's spouse is contacted at work, the spouse reports that the client stopped taking lithium 3 weeks ago and has not slept or eaten for 3 days. With which two features characteristic of the manic phase of bipolar disorder can the nurse identify?

Poor judgement and hyperactivity

Which of the following would a nurse least likely assess in a client experiencing anxiety?

Positive self talk

A woman who gave birth to a healthy baby 5 days ago is experiencing fatigue and weepiness, lasting for short periods each day. Which condition does the nurse believe is causing this experience?

Postpartum baby blues

A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply.

Strict intake and output Neurologic function Urine and blood chemistry

The nurse is talking to a client who is a survivor of intimate partner violence. The client relates that the spouse has been told that about having the characteristics of an antisocial personality disorder. The client also informs the nurse that the spouse has an extensive criminal record. The nurse interprets this information and suspects that the client's spouse would demonstrate which behavior?

moderate to severe violence with people both within and outside the family

A nurse is caring for a client with schizoaffective disorder. The client is scheduled for the first round of electroconvulsive therapy (ECT). What is the priority nursing action post-ECT?

perform a respiratory assessment

A client at an outpatient psychiatric clinic has been experiencing anxiety. The nurse would like to suggest activities for the client to do in their spare time. What would be an appropriate activity for the nurse to suggest to the client? Select all that apply.

taking up a hobby daily walks stretching exercises

A client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. What assessment data obtained by the nurse correlates with the client's disorder?

unpredictable actions and intense interpersonal relationships

A woman in a prenatal clinic tells the nurse that her pregnancy was unplanned and unwanted. At what point in pregnancy does the average woman change her mind about an unwanted pregnancy?

when quickening occurs

A nurse is performing a psychosocial assessment on a 14-year-old adolescent. Which response to the assessment questions is not typical during early adolescence?

"I'm sorry for how I acted earlier. Let's finish these questions."

A nurse documents that "the client describes the recent breakup of a dating relationship with an emotionless tone and a flat facial expression." In which section of the mental status exam would the nurse have documented this statement?

Affect

What advice should the nurse provide the parent of a toddler, regarding how to handle temper tantrums?

Appear to ignore the toddler

A client with hypothyroidism reports feeling sad and depressed about the bodily changes experienced and states "I wonder if there is any reason to go on." What is the most appropriate response by the nurse?

Ask if the client has had thoughts about self harm

A patient has a deficiency of the neurotransmitter serotonin. The nurse is aware that this deficiency can lead to:

Depression

Which is the most common disorder found in clients diagnosed with bulimia nervosa?

Depression

Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what?

Hypertensive crisis

In recent years, the client has been experiencing increasing levels of anxiety when in large crowds. The client has recently begun behavioral therapy, which will emphasize which component?

Identifying and promoting adaptive behaviors to reduce anxiety

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?

Nervousness, diaphoresis, and confusion

Which is a true statement regarding depressive disorders?

Norepinephrine, dopamine, and serotonin have been implicated.

A nurse is caring for a client with agoraphobia. Which signs and symptoms would the nurse anticipate? Select all that apply.

Panic attacks Inability to leave the home

The nurse is assessing a client at a postpartum visit and notes the client is emotionally sensitive, complains about being a failure, and appears extremely sad. The nurse concludes the client is presenting with which potential condition?

Postpartum depression

A client was admitted to the psychiatric unit after being picked up by police officers who found the client frantically running back and forth across the freeway. The client's spouse reports that the client stayed up all night, ate very little, and talked incessantly. Additional assessment findings that indicate a manic episode include what?

Pressured speech, combative behavior, and impaired judgment

A client is admitted with severe depression after the loss of a child. The nurse documents what findings as supporting the diagnosis of depression?

Slow physical movements and slow speech

An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care?

The adolescent will become fatigued easily

The nurse knows this is a description of peritoneal dialysis when compared to hemodialysis:

The child can live a more normal lifestyle.

Which sign or symptom suggests that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)?

The child constantly open and closes his hands

Which situation should concern the nurse treating a postpartum client within a few days of birth?

The client feels empty since she gave birth to the neonate.

A client with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation?

The client is experiences catatonia

A nurse is assessing a client at a mental health clinic who threatens suicide and describes having a plan. Which should the nurse recognize as the priority goal for the client?

Working with the client to resolve the immediate crisis

A nurse is assessing a severely depressed adolescent. Which finding indicates the highest risk of suicide?

a preoccupation with death

The nurse is assessing a 38-year-old client at risk for suicide. Which are significant assessment data when determining whether a client will require hospitalization? Select all that apply.

being intoxicated with alcohol having an organized plan a description of command hallucinations

A client has recently received a diagnosis of depression and has been prescribed citalopram. The nurse is providing health education and the client states, "I'm relieved to have some medication to help with my mood, because it's my daughter's wedding next weekend and I'll be feeling better." What is the nurse's best response?

"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits."

The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message?

"At what time did you take the last dose of the antianxiety drugs?"

A client with a diagnosis of schizophrenia and paranoid personality disorder asks the nurse, "How do I know what's really in those pills?" Which response by the nurse is best?

"How would you feel if I allowed you to open the individual medication wrappers?"

Which statement made by a client raises the greatest concern that the client may be experiencing relationship violence?

"I don't know what else I can do to keep him from getting angry at me."

When reviewing a client's chart, the nurse notes that the client is in the disorganization stage of grief. Which assessment finding would support this diagnosis?

"I feel like I have absolutely no idea what to do next."

The nurse is teaching a client with schizoaffective disorders (SAD) about the client's prescribed medication therapy. The nurse determines that additional education is needed when the client states what?

"One day, I won't have to worry about taking any medication."

A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?

"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."

A nurse is caring for children in a children's hospital. Which child would the nurse expect to develop separation anxiety?

A newly hospitalized toddler

A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which is the nurse's priority intervention for this client?

Ensuring that the client is not permitted to use anything that would be potentially dangerous.

When a client who is generally pleasant and cooperative begins to show aggressive behavior toward most clients in a community care facility, the nurse suspects the client has experienced cerebral trauma. Which brain structure is responsible?

Frontal lobes

A 7-year-old child with sickle-cell disease who comes to the hospital frequently appears withdrawn and depressed. The client refuses to talk to anyone or even admit to feeling sad. What would be the best thing for the nurse to do that might help the child deal with his or her feelings?

Get the client to draw a picture.

Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder?

Hyperactivity, dismissing meals, and sleep disturbance

When describing the hypothalamic-pituitary axis, which event would occur first?

Hypothalamus secretion of releasing factor

The nurse is instructing a client with dysmenorrhea on how to manage her symptoms. Which suggestions should the nurse include in the teaching plan? Select all that apply.

Increase water consumption. Use heating pads or take warm baths. Increase exercise and physical activity.

A nurse is caring for a client who has been prescribed entacapone for the treatment of Parkinson disease. The client informs the nurse that he is taking MAOI antidepressants for the management of depression. The nurse would anticipate which effect from the administration of these two drugs?

Increased risk of toxicity of both drugs

The nurse recognizes which statement is true of chronic pain?

It may cause depression in clients

A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition?

Light therapy

The structure of the brain associated with emotional control, memory, and learning is what?

Limbic system

When assessing a client who has been referred to the outpatient mental health clinic with symptoms of depression, the psychiatric nurse should closely observe the client's affect and which assessment component?

Physical appearance

A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client's feelings of sadness and hopelessness, the nurse would expect to assess what?

Psychomotor retardation

A client is experiencing major depressive disorder. Which neurotransmitter is most likely implicated?

Serotonin

A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis?

The client will reframe negative thoughts in a more positive way.

A 2-month-old infant has inconsolable crying, is gassy, and constantly draws the legs up. It has been determined that the infant has colic. What intervention should the nurse recommend to treat colic?

The infant is bottle fed, so the parent needs to try a different formula to assess for sensitivity.

When caring for a client with mania, which would the nurse most likely assess?

Unusual self-confidence

The nurse is working with a client with depression in a mental health clinic. During the interaction, the nurse uses the technique of self-disclosure. In order for this technique to be therapeutic, which step must be a priority for the nurse?

ensuring relevance to, and quickly refocusing upon, the client's experience

When planning how to respond to a 3-year-old child about telling stories ("tall tales"), the nurse would base the statement on the fact that:

imagination in a 3-year-old is at its peak.

The nurse is caring for a client who is postoperative 24 hours from an appendectomy. The client is hesitant to get out of bed. How should the nurse respond?

"Can you describe what you are feeling when you try to move?"

A client is in the preoperative area and states, "I am not sure about having surgery." What is the nurse's best response?

"Can you tell me what your feelings are about the surgery?"

The nurse is interviewing a 13-year-old girl with depression. During the course of the interview, the girl reveals that her best friend is thinking about committing suicide. Which response by the nurse would be most appropriate?

"Do you know how she is planning to kill herself?"

A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns?

"I'll stay here with you while the technician draws your blood."

The physician has placed a client who has suffered the loss of a child on a selective serotonin reuptake inhibitor (SSRI) for depression. The nurse is aware that the greatest risk for suicide would be:

10 to 14 days after the initial medication regime is implemented.

A community health nurse follows many clients, several of whom have depression and who are taking antidepressants. What assessment finding should the nurse prioritize for reporting to the care provider?

A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug

A nurse documents, "The client described the partner's abuse in an emotionless tone and with a flat facial expression." This statement describes the client's:

Affect

A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder?

Affective instability

A health care provider suspects a client has developed posttraumatic stress disorder (PTSD). Select the necessary criterion to validate the diagnosis.

At least 1 month of clinically significant distress affecting a person after witnessing or experiencing a traumatic event that affects other parts of his or her life

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called?

Couvade syndrome

A professional boxer has suffered several concussions while boxing. Since retirement, the client has experienced periods of depression and suffers from short-term memory loss. Which provides the best explanation for the neurological basis of the client's symptoms?

Damage to the hippocampus

A nurse is assessing a client's state of awareness and finds the client to be disoriented and restless. The client is also agitated and alternates from confusion to excessive drowsiness to extreme excitability. The nurse would document this as:

Delirium

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 what?

Grandiosity

Which would be a finding related to perceptual disturbances during the mental status exam in the client with mania?

Hallucinations

A nurse is caring for clients with posttraumatic stress disorder (PTSD). Negative alterations in cognition and mood associated with the traumatic event are important features of PTSD. Knowing this, which symptoms is the nurse likely to find in such clients? Select all that apply.

Having negative beliefs about oneself Getting angry with little or no provocation Inability to remember important aspects of the traumatic event

During therapy, a client on the mental health unit is restless and is starting to make sarcastic remarks to others in the therapy session. The nurse responds by saying, "you look angry." Which communication techniques is the nurse using?

Making observations

A nurse caring for a client with borderline personality disorder (BPD) consistently informs the client of the length of the relationship and routinely prepares the client for termination and the end of hospitalization. Which is the nurse trying to prevent?

Mal-adaptive expression of emotions

A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication?

The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.

The nurse is observing the parents of a 4-year-old child who has been admitted to the hospital. Which of the following actions indicate that the parents understand how to best minimize anxiety during their child's hospitalization? Select all that apply.

The parents remain at the child's side during the hospitalization. The parents bring the child's siblings for a brief visit. The parents bring the child's favorite toy to the hospital.

A nurse is conducting an awareness session on sexual abuse, and she is explaining the psychological profile of an average abuser. Which trait is often displayed by abusers?

They exhibit antisocial behaviors

The following statements are heard in a group: "You can't say that because you don't really know me." "I wonder if the therapist is going to leave?" and "I'm not sure whether or not I can really talk freely." These best reflect which group theme?

Trust and belonging

Psychodynamic theory attributes the development of mood disorders to what?

Unexpressed and unconscious anger

A client asks the nurse which vitamins should be taken daily for feelings of fatigue, anxiety, and depression 1 week before menses. Which of the following is the correct response by the nurse?

Vitamin B6 (The nurse should encourage taking Vitamin B6 daily, as it may be effective at relieving symptoms of irritability, fatigue, and depression related to the premenstrual period. Vitamin A supports growth and bone development, vision, reproduction, and development and maintenance of skin tissue. Vitamin C protects against immune system deficiencies, cardiovascular disease, prenatal health problems, eye disease, and even skin wrinkling. Vitamin C may protects against immune system deficiencies, cardiovascular disease, prenatal health problems, eye disease, and even skin wrinkling.)

To confirm that a client is experiencing a manic episode, the nurse must eliminate the possibility that the client's symptoms are related to which problem?

Substance use

The nurse is caring for a client who has a new prescription for amitriptyline for depression and is preparing to be discharged. What assessment is the nurse's priority?

Suicidal ideation

When learning about the nervous system, students learn that which nervous system regulates the expenditure of energy?

Sympathetic Sympathetic Nervous System: This division of the autonomic nervous system regulates the expenditure of energy.

A nurse is caring for a 17-year-old female client with bulimia. Which complication of this disease may the nurse see in this child?

Menstral problems

Serotonin abnormalities are thought to be involved in the following disorders:

Mental depression and sleep disorders.

Morbidity data indicates that support is needed from pediatric nursing groups to establish improved and additional services for children with what health issues?

Mental health and behavioral disorders

A patient with a history of major depressive disorder is brought to the emergency department by a friend, who reports that the patient took an overdose of prescribed amitriptyline. Which of the following findings would the nurse expect to assess? Select all that apply.

Tachycardia Visual hallucinations Clonus