Med-Surg Ch 47: Care of Patients with Anxiety, Mood, and Eating Disorders
The nurse is talking to an elderly patient who states, "Sometimes I wish that I would just fall asleep and never wake up again." What is the most therapeutic response? A. "Oh, don't say things like that, everyone would really miss you." B. "Are you thinking about committing suicide?" C. "Many people would agree that dying during sleep is the best way to go." D. "You seem a little sad today, is there anything I can do to help?"
"Are you thinking about committing suicide?"
Which statement by the patient's family indicates the need for more teaching about the treatment of anorexia nervosa? A. "If she'll just eat more, we can take her home and she'll be okay." B. "She will have to hospitalized if she has dehydration or electrolyte imbalance." C. "Therapy could take between 1-6 years for this disorder." D. "Support groups and family therapy are important aspects of treatment."
"If she'll just eat more, we can take her home and she'll be okay."
The depressed patient who has been taking amitriptyline (Elavil) for the past 2 weeks complains of still feeling depressed and wants to abandon the drug. How should the nurse respond? A. "I will ask the physician about a new order for a different drug." B. "You probably should quit taling Elavil if it is not helping you." C. "Sometimes drinking a small glass of wine with meals helps." D. "These drugs take several weeks to become effective."
"These drugs take several weeks to become effective." *Tricyclics may take up to 4 weeks before patients experience symptom relief. The patient has not been taking the medication long enough to request a new order. The nurse should not encourage the patient to discontinue the medication. This medication should not be combined with alcohol
The nurse is doing discharge teaching for a manic patient. The patient asks., "Will I have to take lithium forever?" The best answer would be A. "No, only until your symptoms are under control." B. "Yes, you will most likely need to take it for your lifetime." C. "Possible your health care provider will let you discontinue after 4-6 months." D. "No, most patients can usually do without it after about a year."
"Yes, you will most likely need to take it for your lifetime."
After having refused lunch and diner because her "regular" char was occupied at breakfast, the resident in a long-term care facility asks for a snack. How should the nurse respond? A. "You are hungry now. Is there something else you could have done earlier besides refusing to eat?" B. "Here is your snack. Maybe you won't be so quick to refuse meals the next time you don't get you way." C. "Refusing meals is not the answer. You must eat." D. "Tell me why you left the dining room without eating."
"You are hungry now. Is there something else you could have done earlier besides refusing to eat?" *After acute anxiety passes, the nurse should focus on helpling the resident recognize the behavior that was exhibited and how to deal more effectively with the anxiety. Scolding the patient, attempting to induce guilt, or cauing the patient to dwell on the trigger do not redirect the patient to consider different behaviors
A patient verbalizes an overwhelming feeling of worthlessness, difficulty in making decisions or concentrating, and suicidal thoughts. You determine the suicide risk by asking which questions? (select all that apply) A. "Are you feeling suicidal?" B. "Do you have a plan for taking your life? C. "Why do you want to commit suicide?" D. "What would you accomplush by killing yourself?" E. "Do you drink or use drugs on a regular basis?" F. "Have you considered how your family would feel?" G. "Have you recently given away any of your belongings?"
1. "Are you feeling suicidal?" 2. "Do you have a plan for taking your life? 3. "Do you drink or use drugs on a regular basis?" 4. "Have you recently given away any of your belongings?" *Suicidal feelings, having a plan, and substance abuse are factors that increase the likelihood of suicide attempt. Giving away belongings is a sign of the patient saying goodbye. (3, 4, 6) The other questions are less about risk than they are about motivation. The psychiatrist or psychologist can pursue these issues because of the depth and follow-up that are required.
A patient is considering having electroconvulsive therapy (ECT) to treat his severe depression. Which statement(s) indicate(s) the patient understands the procedure? (Select all that apply) A. "I will have treatments once every other month." B. "The shock will cause me to have a short seizure." C. "This treatment is often more successful than medications." D. "I will have to be hospitalized the day before and after the treatments for observation." E. "The treatments will be performed in the early morning hours."
1. "The shock will cause me to have a short seizure." 2. "This treatment is often more successful than medications." 3. "The treatments will be performed in the early morning hours." *ECT is the oldest form of brain stimulation therapy used for severe depression. After several regimens of medication are unsuccessful, or if the patient is severely depressed or actively suicidal, ECT is considered. Evidence suggests that ECT is more effecetive than pharmacotherapy. ECT consists of electric shock, delivered to the brain via electrodes applied to the temples. This shock artificially induces a grand mal seizure lasting 30 to 90 seconds. The patient typically receives 8 to 12 treatments spread over several weeks. ECT is frequently done on an outpatient basis in the early morning
The nurse outlines the treatment for a person with anxiety disorders, which include(s) which of the following? (select all that apply) A. Anxiolytic medication B. Education about disorder C. Individual therapy D. Relaxation techniques E. Stress management
1. Anxiolytic medication 2. Education about disorder 3. Individual therapy 4. Relaxation techniques 5. Stress management *All options are aspects of the treatment of the person with anxiety disorders
A mother confides in the nurse that she fears her daughter has anorexia nervosa. The nurse is aware that which of the mother's concerns are diagnostic criteria for anorexia nervosa? (Select all that apply.) A. Being 5 feet 9 inches and refusing to weigh more than 100 pounds B. Intense fear of gaining weight, so she runs 10 miles a day C. Not having a menstrual period for 6 months D. Hypersexuality E. Binge eating
1. Being 5 feet 9 inches and refusing to weigh more than 100 pounds 2. Intense fear of gaining weight, so she runs 10 miles a day *Causes for concern related to the diagnostic criteria for anorexia nervosa include intense fear of gaining weight, so she runs 10 miles a day; being 5 feet 9 inches and refusing to weigh more than 100 pounds. Hypersexuality is often associated with mania, and binge eating is associated with bulimia nervosa. The person with anorexia nervosa may have an irregular menstrual cycle but this is not diagnostic for the disease.
Which nursing considerations relate to the administration of lithium? (select all that apply) A. Administer the medication on an empty stomach B. Restrict fluids to 1000 mL daily C. Draw frequent blood levels D. Teach the importance of contraception while taking the drug E. Teach the importance of avoiding caffeine while taking this drug
1. Draw frequent blood levels 2. Teach the importance of contraception while taking the drug 3. Teach the importance of avoiding caffeine while taking this drug *Lithium should be taken with food, and fluids should be increased to 3000 mL daily
The nurse is reviewing the medical history of a patient who is being evaluated for anorexia nervosa. Which characteristic(s) would be consistent with the condition? (select all that apply) A. Weight loss of 2 to 3 pounds in the past month B. Binge eating C. Frequent mood changes D. Absence of three consecutive menstrual periods E. Body weight less than 85% of what is expected for height and weight
1. Frequent mood changes 2. Absence of three consecutive menstrual periods 3. Body weight less than 85% of what is expected for height and weight *Anorexia nervosa is characterized by the patient's refusal to maintain minimal body weight or eat adequate quantities of food. There is a disturbance in the perception of body shape and size and an extreme fear of becoming fat. The patient strives for perfection and control by controlling caloric intake. Defining characteristics include frequent mood fluctuation, absence of three consecutive menstrual periods, and body weight less than 85% of what is expected for height and weight
Which signs and symptoms are consistent with general anxiety disorder (GAD)? (Select all that apply) A. Heart rate of over 100 beats per minute B. Restlessness C. Urinary retention D. Fatigue E. Muscular tension
1. Heart rate of over 100 beats per minute 2. Restlessness 3. Fatigue 4. Muscular tension *A person who experiences persistent, unrealistic, or excessive worry about two or more life circumstances for 6 months or longer us exhibiting symptoms associated with GAD. GAD usually develops slowly and is chronic in nature. Dieresis rather than urinary retention is commonly seen with GAD.
The nurse is teaching the patient about lithium carbonate. What information is appropriate to include in the teaching? (Select all that apply) A. It takes 3-4 days to reach therapeutic levels B. It helps decrease the manic behavior C. There is a small margin of safety between a therapeutic level and a toxic level D. Maintain salt intake and drink adequate fluids; salt depletion may cause toxicity E. Take the medication on an empty stomach F. Do not become dehydrated
1. It helps decrease the manic behavior 2. There is a small margin of safety between a therapeutic level and a toxic level 3. Maintain salt intake and drink adequate fluids; salt depletion may cause toxicity 4. Do not become dehydrated
Which caracteristic(s) increase(s) the probability of suicidal ideations in a depressed patient? (select all that apply) A. Owning a gun collection B. Living with wife and three children C. Being an active member of the local church D. Having a plan to shoot himself in a motel E. Having a brother that recently committed suicide
1. Owning a gun collection 2. Having a plan to shoot himself in a motel 3. Having a brother that recently committed suicide *Suicidal risk increases if the patient has a plan, access to a weapon, and a recent loss
A patient has nightmares and thinks constantly about the sexual assault she experienced. She is seen constantly washing her hands, takes at least four showers a day, and does not go out with friends now because she is constantly cleaning her apartment. What disorders are most related to the symptoms she is experiencing? (Select all that apply.) A. PTSD B. Bipolar disorder C. Mild anxiety D. Generalized anxiety disorder E. Obsessive-compulsive disorder (OCD)
1. PTSD 2. Obsessive-compulsive disorder (OCD) *The symptoms this person is experiencing are related to PTSD and OCD. Mild anxiety increases alertness, motivation, and attentiveness and is not what she is experiencing. Bipolar disorder is a mood disorder. Generalized anxiety disorder is associated with a person who experiences persistent, unrealistic, or excessive worry about two or more life circumstances for 6 months or longer.
You are caring for four patients with major depressive disorder. Which patient do you identify as at highest risk for suicide? A. 23-year-old African American female B. 37-year-old Hispanic male C. 42-year-old Asian American female D. 57-year-old Caucasian male
57-year-old Caucasian male *Statistically, older adult white men are more likely to have suicide completion than any other demographic. (1, 2, 4) All of the other patients may attempt or complete suicide but they are not at the highest risk.
Which medication is mainly used to treat anxiety? A. Paroxetine (Paxil) B. Alprazolam (Xanax) C. Phenelzine (Nardil) D. Amitriptyline (Elavil)
Alprazolam (Xanax)
The nurse explains that anxiety disorders differ from normal anxiety. Which statement accurately describes anxiety disorders? A. Anxiety disorders develop into suicidal tendencies B. Anxiety disorders are seldom controlled C. Anxiety disorders interfere with effective functioning D. Anxiety disorders make maintenance of relationships impossible
Anxiety disorders interfere with effective functioning *Anxiety disorders interrupt normal day-to-day functioning in the workplace and in family settings
What information will best help the nurse determine whether the patient is experiencing a threat to his mental health? A. Opinion of the health care provider B. Opinion of family members C. Appropriateness of behavior to a situation D. Intelligence testing and educational level
Appropriateness of behavior to a situation *Appropriate behavior is an indicator of mental health. Although significant, the family's opinion, health care provider's opinion, and intelligence level may not consistently correlate with mental health status.
The nurse is educating a patient who has just been prescribed diazepam (Valium). The nurse cautions the patient that diazepam (Valium) may cause which problem? A. Dependency B. Urinary retention C. Severe dehydration D. Hallucinations
Dependency *Valium can cause a physiologic and a psychological dependence. Valium should not cause urinary retention, severe dehydration, or hallucinations
A patient is taking lithium. For which symptoms will you monitor? A. Hypertension and headache B. Diarrhea and slurred speech C. Confusion and blurred vision D. Convulsion and polyuria
Diarrhea and slurred speech *Diarrhea and slurred speech are early signs of lithium toxicity. (1) Hypertension and headache are more closely associated with the MAOI antidepressants. Sodium depletion and dehydration may cause toxicity. (3, 4) Confusion, blurred vision, convulsion, and polyuria are late signs of lithium toxicity.
The patient was given an SSRI about 60 minutes ago and is now having change of mental status, a rapid pulse, loss of muscular coordination, and hyperthermia. Which action should the nurse take first to address this life-threatening condition? A. Ensure that there is a patent IV access B. Initiate seizure precautions C. Obtain an order for anxiolytic medication D. Prepare the emergency respiratory equipment
Ensure that there is a patent IV access
A military veteran is admitted to your unit with a diagnosis of chronic post-traumatic stress disorder (PTSD). After being placed in the treatment room, he begins to pace frantically and make references to "Highway 1." As the nurse approaches him, he retreats to the corner and sits on the floor with his arms and legs pulled tightly to his body. This patient is most likely experiencing which occurrence? A. Flashback B. Hallucination C. Phobic reaction D. Delusion
Flashback *This patient's symptoms are consistent with a flashback secondary to PTSD. Hallucinations and delusions are associated with psychotic disorders such as schizophrenia. Phobic reactions are not associated with the symptoms this patient is exhibiting.
A 53-year-old female is diagnosed with generalized anxiety disorder. Which behavior do you anticipate? A. Runs out of the room when she notices a spider in the corner B. Continuously checks to see if doors are shut and locked C. Has difficulty concentrating and excessively worries about her family D. Wakes at night screaming because of recurrent nightmares
Has difficulty concentrating and excessively worries about her family *Difficulty concentrating and excessive worry are part of the diagnostic criteria for general anxiety disorder (GAD). (1) Excessive fear of spiders is an example of phobic disorder. (2) Repetitive checking and rechecking doors is an example of behavior associated with obsessive-compulsive disorder. (4) Recurrent nightmares are associated with post-traumatic stress disorder (PTSD).
The nurse is caring for a suicidal patient who has been treated effectively with antidepressant therapy. The patient verbalizes that he feels better. The nurse is alert that the patient is most at risk for which potential complication? A. Increased risk for self-harm B. Increased emotional fragility C. Increased potential for weight gain D. Increased activity intolerance
Increased risk for self-harm *The risk of suicide is greater now that the patient has increased energy to plan and complete the suicide. Effective antidepressant therapy should not cause an increase in emotional fragility, weight gain, or activity intolerance
Which classic behavior characterizes bulimia? A. Bingeing and purging B. Refusal to eat C. Excessive exercising D. Hiding food to make it appear it was eaten
Bingeing and purging *Patients with bulimia nervosa induce vomiting after consuming large quantities of food. This binge eating occurs in a frenzied state and usually in secrecy; afterward, the patient experiences feelings of shame and self-criticism. Laxatives may be taken to purge the system after the binge. 90% of patients with bulimia are young women
In planning care for the depressed patient, the nurse is aware that the risk for self-harm actually increases when the A. Patient is discharged and has to care for himself B. antidepressant medications begin to take effect C. family promises, but fails, to visit him in the hospital D. patient is first admitted and does not trust the staff
antidepressant medications begin to take effect
When a patient is showing signs of severe anxiety and it is time for him to bathe and dress, it is best if the nurse A. leave the patient alone B. asks the patient why he is feeling so anxious C. explains the rationale for practicing good hygiene D. gives simple directions
asks the patient why he is feeling so anxious
The patient who is taking an SSRI medication must be monitored for A. weight loss B. hypernatremia C. kidney dysfunction D. gastrointestinal bleeding
gastrointestinal bleeding
An MAO inhibitor such as phenelzine (Nardil) may cause life-threatening A. respiratory distress B. gastrointestinal bleeding C. cardiac arrhythmias D. hypertensive crisis
hypertensive crisis
A patient taking an SSRI suddenly develops a rapid pulse, fluctuating blood pressure, fever, loss of muscle coordination, and mental status changes. You prepare for which intervention? A. Infuse IV fkuids and administer an antipyretic B. Obtain an electrocardiogram and start oxygen through a nasal cannula C. Administer an antidote and encourage oral fluids D. Monitor the patient closely and continue the medication
Infuse IV fkuids and administer an antipyretic *The patient is manifesting symptoms of serotonin syndrome. This is a potentially life-threatening condition that could start 30 minutes to 48 hours after taking the medication. Treatment includes stopping medication, administering IV fluids, and decreasing temperature. (2) The health care provider may order an electrocardiogram (ECG) to rule out other problems and giving oxygen for change of mental status is acceptable if pulmonary problems are suspected or oxygenation as measured by pulse oximetry is decreased. (3) There is no single antidote for this condition, and oral fluids are inappropriate for patients who are unstable. (4) Close monitoring is necessary, but the medication should be discontinued.
Which symptoms are most characteristic of depression? A. Lack of interest, loss of libido, and a flight of ideas B. Insomnia, poor hygiene, and grandiose ideas C. Overeating, hyperactivity, and rapid speech D. Insomnia, anorexia, and lack of energy
Insomnia, anorexia, and lack of energy
When communicating with a severely depressed patient, what is the most therapeutic approach? A. Be quiet while assisting with activities of daily living B. Interact and talk with the patient and engage him in activities C. Make an extra effort to be cheerful and positive D. Speak in simple, direct sentences when necessary
Interact and talk with the patient and engage him in activities
The nurse is caring for a patient admitted with a diagnosis of serotonin syndrome. Which type of medication will most likely be included in the plan of treatment? A. Antihypertensive medications B. Intravenous (IV) therapy C. Antianxiety medications D. Sedatives
Intravenous (IV) therapy *Serotonin syndrome is a potential life-threatening condition that could start 30 minutes to 48 h after taking the medication. Symptoms include change of mental status, increase in pulse and fluctuation in blood pressure, loss of musclar coordination, and hyperthermia. Treatment includes stopping medication, administering IV fluids, and decreasing temperature
The nurse is educating a patient with a new prescription for lithium carbonate. Which information is most important for the nurse to include in the teaching plan? A. It can take up to 2 weeks for Lithium to reach a therapeutic level in the body B. Lithium is often given in conjunction with loop diuretics C. Carefully restrict sodium intake to less than 1 g/day D. Take medication before breakfast for maximum effectiveness
It can take up to 2 weeks for Lithium to reach a therapeutic level in the body *Lithium may take 7 to 14 days to reach therapeutic level in the body. Diuretics should be avoided while on Lithium therapy. Patients should not restrict sodium intake since low sodium levels could cause Lithium toxicity. Medication should be taken with meals to decrease gastric distress
The patient has bulimia nervosa. Which task would be appropriate to assign to the nursing assistant? A. Observe for marks on the knuckles during AM hygiene B. Listen outside the bathroom door for sounds of induced vomiting C. Check the patient's belonging for secret caches of snacks and good D. Escort the patient to group therapy or to occupational therapy
Observe for marks on the knuckles during AM hygiene
The nurse observes a coworker who is always behind because he checks and rechecks the accuracy of his medication dosages. Even after being assured his dosages are correct, he checks them again. The nurse suspects her coworker suffers from which disorder? A. Perfectionism B. Phobic disorder C. Obsessive-compulsive disorder (OCD) D. General anxiety disorder
Obsessive-compulsive disorder (OCD) *When a person has an OCD, he experiences an obsession, recurrent, or intrusive thoughts that he cannot stop thinking about, and these thoughts create anxiety. Time spent in these thought and rituals can become overwhelming to the point of interfering with normal life
A patient with flight of ideas and easy distractibility cannot sit through mealtime. Which nursing intervention is appropriate? A. Give three high-calorie meals on a regular schedule B. Offer finger foods such as a meat and cheese sandwich C. Provide a pleasant, odor-free environment D. Encourage family meals and socialization while eating
Offer finger foods such as a meat and cheese sandwich *Offering foods that can be consumed "on the run" will increase the likelihood that the patient will eat something. (1) High-calorie foods are a good idea, but a regular schedule is going to be difficult for this patient at this point. (3) A pleasant, odor-free environment will not hurt, but it is more appropriate for patients who have anorexia related to nausea or for older adult patients. (4) Socialization for this patient is likely to cause distraction and result in decreased intake.
A resident in a long-term care facility has been in a manic stage for 2 days. He has not slept and cannot focus long enough to eat a meal. How should the nurse best enhance the resident's nutrition? A. Insist he sit down and eat at the table B. Spoon-feed him at the table at regular mealtimes C. Offer him small glasses of high-protein drinks every hour D. Make up a game about who can finish a meal first
Offer him small glasses of high-protein drinks every hour *The patient displays an inability ti concentrate and a decreased need for sleep or nutrients. Offering a small amount of high-energy foods and drinks every hour will support nutrition until the manic behavior is under control. Because of the manic patient's abbreviated focus, eating an entire meal may not be possible. The nurse should not force the patient to sit and eat, demean him by spoon-feeding, or challenge him to process a new activity
A nurse is assessing a patient who has just returned to the unit after receiving ECT. Which assessment finding is of greatest concern? A. Patient complains of a headache B. Patient does not remember having ECT C. Patient displays a cardiac dysrhythmia D. Patient is disoriented to time
Patient displays a cardiac dysrhythmia
The nurse is caring for a patient who was admitted with fractures sustained during an MVC (Motor Vehicle Collision). The patient tearfully condfesses that she relives the accident in her dreams and is afrain to sleep. The nurse recognizes that this scenario is consistent with which disorder? A. Post-traumatic stress disorder (PTSD) B. Phobic disorder C. Obsessive-compulsive disorder (OCD) D. Panic level of anxiety disorder
Post-traumatic stress disorder (PTSD) *Individuals with PTSD have endured one or more extreme life-threatening events, and the remembrance of these events now produces feelings of intense horror, with recurrent symptoms of anxiety and nightmares or flashbacks
A long-term care facility resident with generalized anxiety disorder (GAD) enters the dining room and discovers that a visitor is sitting in her regular seat. The resident becomes agitated and insists that she cannot eat unless she sits in her chair. Which response is most appropriate? A. Instruct the visitor to move B. Reassure the resident that she can sit in her regular spot at supper C. Remind the resident that she will be hungry if she does not eat D. Insist that the resident eat
Reassure the resident that she can sit in her regular spot at supper *A calm approach and reassurance will help the anxious patient to mimic the nurse's behavior. Asking the visitor to move, telling the resident that she will go hungry, or insisting that the resident eat are not therapeutic and whll not help in reducing the patient's anxiety
Which nursing action is appropriate immediately after a patient receives electroconvulsive therapy (ECT)? A. Remaining with the patient until she becomes oriented B. Administering oxygen at 6 L/min C. Restraining the patient for 24 h D. Discharging the patient home with instructions to rest for the following 24 h
Remaining with the patient until she becomes oriented *Patients are often disoriented after ECT; maintaining safety is a primary goal at this time. Oxygen is not standard treatment after ECT. Restraints are unnecessary and inappropriate. The patient should not be discharged until she is oriented and safety is ensured.
A patient displaying mania is investigating the unit and overseeing the activities of other patients; because of these behaviors, she is unable to finish her dinner. The nurse should institute which intervention to ensure proper nourishment for this patient? A. Allow her in the unit kitchen for extra food whenever she wishes. B. Encourage her appetite by ordering out for her favorite foods. C. Serve high-calorie foods she can carry with her. D. Serve her small, attractively arranged portions.
Serve high-calorie foods she can carry with her. *During periods of mania, the patient may be unable to sit long enough to complete a meal. Providing high-calorie finger foods will allow the patient to move around the unit while maintaining adequate nutrition. Attractively arranged portions, providing the patient's favorite foods, and allowing the patient to enter the unit kitchen whenever she likes would not help this patient attain proper nourishment.
The nurse is caring for a patient receiving lithium for bipolar disorder. The nurse knows to monitor dietary intake of which electrolyte? A. Chloride B. Potassium C. Sodium D. Magnesium
Sodium *Sodium depletion or dehydration could cause lithium toxicity; therefore, monitor fluid intake and dietary sodium. Diuretics should be avoided. Lithium dosage is not related to chloride, potassium, or magnesium.
A patient is irritable, pacing, crying, and becoming increasingly agitated. Which is the appropriate nursing intervention? A. Discussing suicude openly B. Administering an ordered antidepressant medication C. Staying with the patient while making the surroundings less stimulating D. Offering small nourishing meals and finger foods to sustain nutrition
Staying with the patient while making the surroundings less stimulating *Making the area less stimulating and staying with the patient can lower anxiety. (1) The patient is not displaying signs of intending to commit suicide. (2) Antidepressant medication is not appropriate in this situation. (4) The patient is exhibiting signs of anxiety, not hyperactivity. Small nourishing meals and finger foods to sustain nutrition are more important for the patient with dementia who will not stay still.
A patient who is disheveled and disinterested in hygiene reports overwhelming feelings of sadness and loss of energy. Which nursing interventions are appropriate? (Select all that apply) A. Explain the importance of hygiene to health and appearance B. Encourage the patient to "look good and feel good." C. Plan extra time to help the patient complete hygiene ADLs D. Instruct the nursing assistant to do partial hygiene E. Encourage participation in performing ADLs F. Do everything for the patient until they have recovered G. Have the same caregiver assist daily if possible
1. Plan extra time to help the patient complete hygiene ADLs 2. Instruct the nursing assistant to do partial hygiene 3. Encourage participation in performing ADLs 4. Have the same caregiver assist daily if possible *Allowing for extra time, practicing partial hygiene (washing face, brushing teeth), and having the same caregiver will help the patient gradually resume self-care. In addition, the patient should be expected to do something for themself even if the action is very limited in the beginning (e.g., holds the washcloth), and the nurse must set the expectation that they will help as much as possible. (1) Explaining the importance of hygiene or trying to point out the relationship of appearance and feelings is not appropriate when the patient is deeply depressed. (2) Encouraging the patient to "look good and feel good" is not appropriate at this time. They do not need a pep talk. (6) Doing everything for a patient is never the best option unless the patient is unable to do anything for themself (comatose or catatonic).
Which signs and symptoms characterize a major depressive disorder? (select all that apply) A. Eurphora B. Psychomotor retardation C. Indecisiveness D. Sleep disturbances E. Suicidal ideation
1. Psychomotor retardation 2. Indecisiveness 3. Sleep disturbances 4. Suicidal ideation *Major depressive disorder is diagnosed when at least five symptoms characteristic of depression have been present for at least 2 weeks. These symptoms include an overwhelming feeling of sadness; inability to feel pleasure or experience interest in daily activities; weight gain or loss not attributed to dieting; sleep disturbances; fatigue or loss of energy; feelings of worthlessness; difficulty in making decisions or concentrating; and suicidal thoughts
The patient is admitted for anorexia nervosa. Which behaviors are most associated with this disorder? (select all that apply) A. shifts food around the plate B. Collects recipes C. Makes elaborate meals for others D. Has superstitions about food E. Uses laxatives and vomits in secret F. Practices excessive exercise
1. shifts food around the plate 2. Collects recipes 3. Makes elaborate meals for others 4. Has superstitions about food 5. Practices excessive exercise
What thought process underscores a patient's anorexia nervosa? A. A desire to be attractive by staying slender B. A desire to be involved with food preparation of food, but not eating it C. A desire to punish self by denial of adequate nutrition D. A desire to gain a sense of control by limiting food intake
A desire to gain a sense of control by limiting food intake *Anorexia nervosa is characterized by the patient's refusal to maintain minimal body weight or eat adequate quantities of food. There is a disturbance in the perception of body shape and size and an extreme fear of becoming fat. The patient strives for perfection and control by controlling calorie intake. The person with anorexia nervosa gains a sense of control by limiting food intake
Which response to anxiety is cause for concern? A. A nursing student stays up most of the night to study for an upcoming examination. B. A woman takes several deep breaths before going into the grocery store because shopping makes her nervous. C. A pilot has a small alcoholic drink before his scheduled flight. D. A man asks several of his friends for opinions before asking a woman out on a date.
A pilot has a small alcoholic drink before his scheduled flight. *Ingesting alcohol before a flight is likely to impair the pilot's judgment and put the pilot and others at high risk for injury. Staying up all night to study, asking several friends for opinions before asking a woman on a date, and taking deep breaths before doing something that causes anxiety are appropriate responses to anxiety.
You are caring for an 18-year-old patient who is diagnosed with anorexia nervosa. What is an appropriate expected outcome for the patient? A. Consume 35% or more of meals B. Develop improved eating behaviors C. Verbalize the importance of eating D. Identify barriers to eating
Consume 35% or more of meals *"Able to eat 35% or more of meals" is a concrete and realistic goal. (2) "Able to develop improved eating behaviors" is too vague and broad. (3) Focusing on the importance of food or the patient's resistance to eating will only lead to power struggles. (4) The primary barrier to eating is the patient.
The nurse is helping a patient get dressed to go to her dialysis treatement. The patient bursts into tears and says, "I can't go! I can't stand another day in that awful place. I will die if I have to go!" Which intervention is best? A. Stop the dressing process and calmly ask the patient to talk about her feelings B. Continue to dress the patient and reassure her that she will feel better after her treatment C. Stop the dressing process and remind the patient that missing a treatment can make her very sick D. Continue dressing the patient and remind her that she must stay on task in order to be on time
Stop the dressing process and calmly ask the patient to talk about her feelings *A calm and supportive attitude will help the patient identify feelings. The nurse should put the dressing process on hold so that the nurse can focus attention on a therapeutic response to the patient's concerns. The nurse shouls then ask an open-ended question to give the patient freedom to express her concerns. Making a threatening statement about consequences of missed treatements only exacerbates the patient's concern. Continuing to dress the patient while offering empty reassurance or changing the subject ignores the problem at hand
A patient is in the manic phase of bipolar disorder. He is talking very loudly and starting to argue with other patient. Which intervention is the most appropriate to try first? A. Instruct him to go sit down and watch television B. Take him for a walk down a quiet corridor C. Invite him to play cards or board games D. Advise him to lower his voice or lose privileges
Take him for a walk down a quiet corridor
The nurse is caring for a patient with moderate anxiety. Which activity should the nurse encourage to best manage the patient's anxiety? A. Taking a walk B. Learning a new game C. Watching an intense television show D. Reading a pamphlet about the negative effects of anxiety
Taking a walk *To best manage moderate level anxiety, the nurse should help provide outlets for tension. These activities include walking, crying, and working at simple, concrete tasks. Learning something new, watching an intense TV show, or reading information about the negative effects of anxiety are activities that may exacerbate anxiety rather than relieve it
While sitting at the nurse's station, the nurse observes a patient using a tissue to pick up magazines and change the television channels. The nurse recognizes this as a new behavior for this patient. Which nursing action would be most important? A. Taking the tissues away from the patient B. Recognizing the behavior as attention-seeking C. Talking with the patient about the behavior D. Providing the patient with nonsterile gloves
Talking with the patient about the behavior *The nurse should question the patient regarding any changes in behavior to determine responses to treatment. It would not be therapeutic for the patient to have the tissues taken away, to be provided with nonsterile gloves, or to have the behavior recognized as attention-seeking.
The nurse is educating a patient with generalized anxiety disorder (GAD) who has a new prescription for buspirone (BuSpar). Which information is most important for the nurse to include in the teaching plan? A. Use this medication as needed to manage your anxiety B. Taper this medication before discontinuing C. Allow 3 weeks before expecting any relief of symptoms D. This medication poses a great risk of tolerance and dependence
Taper this medication before discontinuing *Patients should not stop taking BuSpar abruptly, but should taper this medication according to health care provider instructions. BuSpar is always given as a sheduled drug (never on an as-needed basis). The patient should allow 7 to 10 days for symptoms to subside. No evidence exists tht BuSpar causes tolerance of physical dependence
A depressed patient is threatening to harm himself. Which nursing action indicates an understanding of the appropriate care of the suicidal patient? A. The nurse asks the patient if he has a plan. B. The nurse calls the family and asks them to visit the patient. C. The nurse administers a sedative. D. The nurse places the patient in seclusion.
The nurse asks the patient if he has a plan. *When a patient is threatening suicide, is it crucial to ask if the patient has a specific plan to determine the patient's risk. Sedative administration, seclusion, and family visits are not the appropriate interventions for a patient threatening suicide.
An older adult resident in a long-term care facility expresses multiple minor complaints at the nurse's station and wanders about aimlessly in the hallway. The nurse examines the patient's chart. Which newly prescribed drug may explain his behavior? A. Tylenol B. Theophylline C. Bisacodyl D. Lisinopril
Theophylline *The drig theophylline may make patients feel anxious and restless. Tylenol, biscodyl, and lisinopril do not typically have this effect
A patient has been taking lithium for 5 days. The nurse notes his gait is a little unsteady with a walker, and he complains of thirst and insomnia. Which finding is most important for the nurse to report? A. Manic behavior B. Unsteady gait C. Thirst D. Insomnia
Unsteady gait *While all findings should be reported, uncoordinated movement is a sign of lithium toxicity and the priority finding. The patient is likely taking lithium to treat manic behavior. Thirst and insomnia are expected side effects of lithium and not indicative of toxicity
The nurse is caring for an older adult patient with a history or anxiety. Which complaint could indicate that the patient may actually be experiencing emotional distress? A. Upset stomach B. Heightened tooth sensitivity C. Unpleasant taste in mouth D. Dizziness
Upset stomach *The older adult population often expresses somatic complaints rather than openly verbalizing emotional distress. You may observe the anxious older adult complaining of an upset stomach. Inability to sleep, fatigue, or increased need to urinate
You are admitting a young adult with a tentative diagnosis of bulimia. Which behavior do you anticipate? A. Vomiting after eating large quantities of food B. Obsessing over exercising constantly C. Stating suicidal thoughts to others D. Cutting food on the plate into tiny bites
Vomiting after eating large quantities of food *Bulimia involves vomiting after eating large quantities of food. (2) The patient with anorexia nervosa frequently performs excessive exercise because they believe that they are overweight. (3) Nurses should always be vigilant for suicidal ideations, but from the information given this is not the highest priority at this time. (4) Cutting food into tiny bites is more characteristic of the patient who has anorexia nervosa.
