Delmars Mood Disorders

23. the nurse is caring for a client who is in the manic state of a bipolar disorder. which of the following should the nurse prioritize as the most appropriate nursing outcome? 1. the client will be free of agitation, hyperactivity, and restless behavior 2. the client will appropriately verbalize feelings of anger 3. the client will be free of aggression and threatened behavior toward others 4. the client will demonstrate lessened buying sprees and grandiosity

23. 3. the priority nursing outcome for a client in the manic state of a bipolar disorder is that the client will be free from aggression and threatened behavior toward others

26. the registered nurse is preparing to delegate clinical assignments on a psychiatric unit. which of the following assignments should the nurse delegate to a licensed practical nurse? 1. Develop a plan of care for a client with hypomania 2. ensure a client is npo for electroconvulsive therapy 3. teach a class on bipolar disorders 4. organize the care to be provided to a client with a bipolar

26. 2. a licensed practical nurse may ensure a client is npo for electroconvulsive therapy. Developing a plan of care, teaching a class, and organizing

3. when assessing a client for a bipolar disorder, the nurse should include which of the following in the mental status exam to make a positive diagnosis of a bipolar disorder? assessment of 1. gait. 2. mood. 3. emotional developmental level . 4. nutritional status.

3. 2. although it is necessary to assess the client's gait, emotional developmental level, and nutritional status, these are not part of a mental status exam. assessing the client's mood (either mania, hypomania, or depression) would provide the information needed to assist in verifying a diagnosis of a bipolar disorder.

8. the nurse is preparing to care for a client with major depression. the priority nursing intervention is to assess the client's 1. response to medication administration. 2. current mood and activity level. 3. appetite and weight. 4. risk of suicide

8. 4. although it is important for the nurse to assess the client's areas of functioning, current mood, and fluid/electrolyte balance, assessing the suicide risk of the client with major depression takes priority

10. a client scheduled to receive phototherapy asks the nurse what phototherapy is. the nurse should respond with which of the following statements? 1. "it is a camera that takes pictures of your brain to see why you are becoming depressed." 2. "it is a bright white light that is used to help treat depression in the winter months." 3. "it assists in decreasing stress and will help you function better at work in the winter months." 4. "it is used to treat depression that is resistant to electroconvulsive therapy."

. 10. 2. phototherapy is a bright white light that is used to treat seasonal affective depression in the winter months, generally between september and march. the light (approximately 2500 to 10,000 lux) can be used from 30 minutes to 2 hours each day during the winter months. it does not decrease stress and most likely would be used prior to or after electroconvulsive therapy treatments.

24. the nurse is caring for a client with a mood disorder caused by a medical condition. which of the following are most important for the nurse to assess? 1. serum drug screen 2. electrocardiogram (ecg) 3. bowel sounds 4. Dental hygiene

. 24. 2. approximately 20% to 25% of clients with certain medical conditions, such as myocardial infarction, cancer, stroke, and diabetes mellitus, will develop a major depressive disorder. an electrocardiogram (ecg) would assess the client's cardiac status.

. 9. a client has been making derogatory remarks about herself and states, "i'm not able to get a boyfriend because i am worthless." which of the following cognitive nursing interventions would be most appropriate at this time? 1. encourage the client to explore feelings of worthlessness 2. instruct the client not to feel that way 3. encourage the client to explore positive thoughts about self 4. instruct the client to take an antidepressant drug as prescribed

. 9. 1. instructing a client who is feeling worthless not to feel that way and exploring positive thoughts about herself minimizes and discourages the exploration of the client's thoughts and feelings about feeling worthless. instructing the client to take an antidepressant drug disregards the comment made by the client. by exploring feelings of worthlessness, the client will more easily identify the source of the feelings. the client will also feel a sense of having been heard by the nurse, thus increasing trust

1. the nurse is assessing the client who is suicidal. which of the following is the priority nursing intervention? 1. ask the client, "Do you have a plan to kill yourself?" 2. get the client to the hospital for further evaluation 3. assess the client for suicidal risk, method, and ability to carry the plan out 4. assess for past suicide attempts

1. 3. assessing the client is necessary before determining if the client needs to be hospitalized or not. assessing for past suicide attempts is very important, but the priority is to determine if the client has a plan.

11. the client asks the nurse how long phototherapy should be used each day. which of the following is the appropriate response by the nurse? 1. "if you get a headache, then you have sat in front of the light for too long." 2. "each individual is different. sit in front of the light just long enough so that you do not get a headache." 3. "sit in front of the light while reading, preferably in the evening." 4. "you may sit in front of the light as long as you are comfortable doing so."

11. 2. if a client sits in front of the phototherapy light for too long, the client will develop a headache. the length of time is different for each individual. some individuals may experience a headache within 30 minutes. sitting in front of the light while reading or comfortable are statements of when, not how long, the client should use phototherapy each day. During the first one or two treatments, the client may get a headache because the period of treatment has not yet been established and the client does not yet know yet what reaction he or she will have to the treatment.

12. which of the following is the priority intervention to encourage a client who is depressed to discuss any suicidal thoughts, plan, or intent? 1. instruct the client about the consequences of hidden anger 2. focus on the need to keep the client safe 3. avoid discussion of depressing topics 4. encourage the client to verbalize feelings

12. 4. the best plan for a nursing intervention for the client who may be contemplating suicide is to encourage the client to discuss feelings, because this will allow the nurse to understand the client's emotional state and the client's mood. although instructing the client about the consequences for hidden anger and talking to the client about the need to keep safe are important, neither of these is a priority nursing intervention. avoiding depressing topics is not the priority nursing intervention, because there may be depressing topics or situations that may be contributing to the depression.

13. while assessing a client in the emergency room after an attempted suicide, the priority question the nurse should ask the client is which of the following? 1. "what is happening in your life that would cause you to attempt to kill yourself?" 2. "how are you feeling since you have awakened after your overdose?" 3. "where is the pill bottle of the medications that you had taken?" 4. "what can be done to make your life better?"

13. 1. although asking a client how he or she is feeling after an overdose, where the pill bottle is, and what can be done to make life better are appropriate interventions, the priority is to ask the client what has led to the attempted suicide. this gets at the heart of the matter of a suicide attempt and encourages the building of the nurse-client relationship. this encouragement will allow the client to further express personal thoughts and feelings.

14. the priority intervention for an outpatient nurse to perform for a client who is depressed and has told the nurse that "i am worthless and there is nothing to live for" would be 1. immediately seek a psychiatric hospitalization for the client. 2. explore feelings of worthlessness and hopelessness. 3. encourage the client to identify selfdeprecating thoughts. 4. remove all potentially dangerous objects from the immediate area.

14. 2. although it is important to encourage the client to identify self-defeating thoughts, it is not the most appropriate intervention in the outpatient setting. while exploring the client's feelings of worthlessness and hopelessness, the nurse can assist the client in exploring a sense of worth, value, and hope. there are numerous clients living in the community who are chronically suicidal and can be managed on an outpatient basis. removing all potentially dangerous objects from the immediate area and seeking immediate psychiatric hospitalization are premature.

15. the nurse who is caring for a client who is manic and exhibiting psychomotor agitation implements which of the following interventions as the priority? 1. explore alternative behaviors with the client for use when feeling anxious or hyperactive 2. provide limits for the client while allowing the client space 3. explore stressors that precipitate manic behavior 4. assist the client in identifying negative consequences of behavior

15. 2. a client who is manic and exhibiting the clinical manifestation of psychomotor agitation is only minimally able to have insight into those behaviors or ways to change the behaviors. this client requires limits within provided

16. when completing an admissions assessment of a client with schizoaffective disorder, the nurse should assess for the presence of which of the following clinical manifestations? select all that apply: [ ] 1. increased use of substances [ ] 2. Decreased libido [ ] 3. hallucinations [ ] 4. feelings of entitlement [ ] 5. Decreased energy [ ] 6. anhedonia

16. 3. 5. 6. schizoaffective disorder is characterized by elements of schizophrenia and manicdepressive disorder. clinical manifestations include hallucinations, decreased energy, and anhedonia (lack of interest in pleasure or daily activities).

17. a client diagnosed with a bipolar disorder and who has a superimposed seasonal affective depression is using phototherapy as a treatment to lift the depression. the client calls the nurse at the outpatient mental health clinic, reporting, "my mood, libido, and interest in shopping have improved dramatically." based on this information, which of the following is the priority to assess first? 1. explore energy level and level of appetite 2. ascertain how much money the client is spending 3. identify the time of day the client is utilizing the phototherapy treatment 4. encourage the client to explore thoughts of improved self-worth

17. 3. a client with a bipolar disorder and a superimposed seasonal affective depression needs to be careful about the time of day that the phototherapy is utilized. because of circadian rhythms, it has been found that bipolar clients with seasonal depression do best if they utilize the phototherapy treatment in the later afternoon. if the phototherapy is used in the morning, manic manifestations may result. exploring appetite, energy level, feelings of self-worth, and how much money the client is spending may all be important interventions, but determining the time of day the client is using the phototherapy allows the nurse to obtain the information that may be causing the dramatic change and elevation in mood.

18. Discharge plans are being made for a client hospitalized for depression. which of the following is the priority outcome for a diagnosis of depression? 1. share more realistic expectations of the client and the situation 2. identify negative, unrealistic thoughts about oneself and ways to counteract those thoughts 3. Discuss reasons why the client has turned the anger inward 4. openly express thoughts and feelings of depression

18. 4. the priority outcome for a client with depression would be to openly express thoughts and feelings of depression. although not the priority, it may prove beneficial to share a more realistic expectation of the client, to help the client identify negative and unrealistic thoughts about him- or herself, and discuss reasons why the client has turned the anger inward.

19. the nurse evaluates a client who stays at home with the assistance of significant others and friends and is undergoing outpatient treatment to have how many points on the sad persons suicide assessment scale? ___________________

19. 0-2 0-2. a client who stays at home with assistance of significant others, has friends, and is undergoing outpatient treatment would score 0-2 points.

2. the nurse should instruct a client that of the following, which would be an expected clinical manifestation for up to 2 months following an electroconvulsive therapy treatment? 1. Dizziness 2. heartburn 3. nausea and vomiting 4. short-term memory loss

2. 4. short-term memory loss would be an expected clinical manifestation post electroconvulsive therapy (ect), occurring after treatment and lasting for 1 week to 2 months or more. unilateral placement of the electrodes may decrease the amount of short-term memory loss, because the current passes through only the nondominant side of the brain. unilateral placement is less effective in treating depression than bilateral placement. although dizziness, heartburn, and nausea and vomiting may be experienced post ect, they would not be expected clinical manifestations for 1 week to 2 months post ect.

20. the nurse receives a report on a client with dysthymia. it would be most important for the nurse to make which of the following assessments? select all that apply: [ ] 1. chronic feelings of low self-esteem [ ] 2. poor concentration [ ] 3. flight of ideas [ ] 4. hallucinations [ ] 5. Depressed mood [ ] 6. increased libido

20. 1. 2. 5. Dysthymia is a chronic depressive disorder lasting for several years. clinical manifestations of dysthymia include chronic feelings of low self-esteem, poor concentration, and depressed mood. flight of ideas and increased libido are clinical manifestations found in the manic phase of a bipolar affective disorder. hallucinations can be found in schizoaffective disorder.

21. which of the following interventions should the nurse implement when treating delusional thinking in a schizoaffective disorder? select all that apply: [ ] 1. instruct the client on socialization techniques [ ] 2. identify difficult experiences and assist to decrease anxiety [ ] 3. provide reality testing [ ] 4. Develop a regular schedule with the client [ ] 5. set realistic goals [ ] 6. encourage exercise

21. 2. 3. 5. nursing interventions for delusional thinking based on the clinical manifestations of schizoaffective disorder include the following: identify difficult experiences and assist to decrease anxiety, provide reality testing, and set realistic goals. instructing the client on socialization techniques is an intervention for anhedonia and flat affect. encouraging exercise is an intervention for decreased energy. Developing a regular schedule with the client is an intervention in the treatment for difficulty making decisions.

. the nurse assesses which of the following to be negative clinical manifestations in a client with a schizoaffective disorder? select all that apply [ ] 1. auditory hallucinations [ ] 2. anhedonia [ ] 3. Difficulty making decisions [ ] 4. Delusional thinking [ ] 5. Decreased ability in carrying on a conversation [ ] 6. tactile

22. 2. 3. 5. negative clinical manifestations for schizoaffective disorder include anhedonia, difficulty making decisions, and a decreased ability in carrying on a conversation. positive clinical manifestations for schizoaffective disorder include auditory and tactile hallucinations and delusional thinking.

25. which of the following clinical manifestations of schizoaffective disorder should the nurse assess the client for? select all that apply: [ ] 1. flat affect [ ] 2. hallucinations [ ] 3. Decreased energy [ ] 4. Delusional thinking [ ] 5. anhedonia [ ] 6. anorexia

25. 1. 3. 5. schizoaffective disorder is a disorder characterized by a major depressive, manic, or mixed episode that coincides with a diagnosis of schizophrenia. the clinical manifestations must not be the result of abuse or a medical condition. the main clinical manifestations are flat affect, decreased energy, and anhedonia.

. the parents of a client diagnosed with major depression and who attempted suicide ask the nurse what the difference is between major depression and a bipolar disorder. the most appropriate response by the nurse is which of the following? 1. "major depression and bipolar disorder are two different mood disorders, but the treatment is the same." 2. "bipolar disorder is an upswing of mood, whereas major depression is a downward mood swing. they require very similar treatment modalities." 3. "major depression is a downward swing of mood with treatment, including mood stabilizers, whereas bipolar depression is an upward swing of mood with antidepressants given to bring the mood down." 4. "major depression is a depressed mood state that requires antidepressant medication, whereas bipolar disorder is an upward swing of mood that requires mood stabilizers for treatment."

4. 4. major depression and bipolar disorder are two different mood disorders with different treatment regimens. major depression is a downward swing of mood, and bipolar disorder is an upward swing of mood (mania) and a downward swing of mood (hypomania). major depression is treated with an antidepressant, whereas bipolar disorder is treated with a mood stabilizer such as gabapentin (neurontin) or divalproex sodium (Depakote).

5. During an admission interview, which of the following clinical manifestations should the nurse report as indicative of hypomania? select all that apply: [ ] 1. Decreased delusions of grandeur [ ] 2. Decreased self-esteem [ ] 3. pressured speech [ ] 4. talkativeness [ ] 5. Decreased motivation [ ] 6. flight of ideas

5. 3. 4. 6. hypomania is a form of mania in which the clinical manifestations are less severe than those of mania. clinical manifestations of hypomania include pressured speech, talkativeness, flight of ideas, delusions of grandeur, inflated self-esteem, and increased motivation.

6. a female client expresses that she has had difficulties with irritability, depressed mood, and decreased interest during the last week of luteal phase during most of her menstrual cycles in the past year. which of the following nursing interventions is most appropriate when planning nursing care for this client with premenstrual dysphoric disorder? 1. instruct the client to avoid focusing on mood, sleep, and appetite during the month 2. administer vitamin b6 100 mg per day for 2 weeks prior to the menstrual cycle 3. encourage intake of water and juice 4. instruct the client to consume caffeinecontaining beverages and chocolate

6. 2. instructing a client to monitor mood, sleep, and appetite during the month is an appropriate nursing intervention to assist the nurse in knowing when the client is having difficulty with clinical manifestations. encouraging the intake of fluids will increase water retention and will increase irritability. administering vitamin b6 100 mg per day for 2 weeks prior to the menstrual cycle is the most appropriate intervention. vitamin b6 is a precursor to serotonin, which can assist in decreasing clinical manifestations of depressed mood and irritability. instructing the client to consume caffeine-containing beverages and chocolate would not be appropriate because it would increase fluid retention and therefore increase clinical manifestations of irritability and depression.

7. the nurse is planning the care of a client with cyclothymia. currently, the client has a hypomanic mood episode. which of the following nursing interventions would be a priority when caring for this client? 1. set limits with the client if the client is getting into the personal space of others 2. increase stimuli in the environment to prevent the client from becoming depressed 3. ask the client about issues related to selfesteem 4. encourage the client to decrease physical activity

7. 1. cyclothymia is a mood disorder that is generally chronic, lasting at least 2 years, and involves hypomanic and dysthymic mood swings. setting limits for a client with hypomania is a priority nursing intervention, because the client is unaware of the intrusiveness and the annoyance of this behavior to other clients. the client who is hypomanic presents an inflated self-esteem or grandiosity but is using it to cover chronic feelings of low self-esteem. asking about issues related to self-esteem would be an appropriate nursing intervention but is not the priority at this time. encouraging the client to perform relaxation techniques during the hypomanic state is also appropriate but not a priority. increasing stimuli in the environment will not prevent the client who is hypomanic from becoming depressed and would not be an appropriate nursing intervention, because it would further increase the irritable or elevated mood.