Mental health nursing Exam 2

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." The best approach for the nurse to use would be a. "What an offensive thing to suggest!" b. "I don't have sex with clients." c. "It's time to work on your art project." d. "Let's walk down to the seclusion room."

"It's time to work on your art project." Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client.

Clients with bipolar 1, bipolar 2, or cyclothymic disorders exhibit different types of: 1.Mania 2.Anxiety 3.Dysthymia 4.Regression

1.Mania

The client has recently started antidepressant drug therapy. He approaches the nurse complaining of a headache, palpitations, and stiffness in the neck. What is the nurse's priority action? 1.Notify the physician immediately 2.Notify the physician when convenient 3.Give the client two aspirin tablets and monitor his headache and heart rate 4.Reassure the client that these are common side effects of his medication

1.Notify the physician immediately

Feelings of worthlessness, guilt, and despair are expressed in a female client's every thought, movement, and activity. Her physical appearance has declined, and she is commonly unable to eat. What is the client experiencing? 1.Mild depression 2.Severe depression 3.Moderate depression 4.A normal emotional state

2.Severe depression

To assess a client's potential for engaging in inappropriate behaviors, the caregiver should perform as soon as possible after admission a: 1.physical examination 2.mental status assessment 3.review of laboratory tests and other results 4.psychosocial examination

2.mental status assessment

Clients who are taking lithium must monitor their water and salt intake because: 1.Lithium competes with water in the body 2.Large amounts of water concentrate lithium in the blood 3.Lithium is excreted by the kidneys more rapidly than sodium 4.Sodium is excreted by the kidneys more rapidly than lithium

3.Lithium is excreted by the kidneys more rapidly than sodium

Most depressive responses in children are tied to: 1.their moods 2.their environment 3.general events or situations 4.a specific event or situation

4.a specific event or situation

Which of the following is a common psychological characteristic of seriously mental ill individuals? A. Depression B. Anxiety C. Sociability D. Trust

A. Depression

Which instruction should the nurse give a client who is prescribed lithium carbonate (lithium)? A. Maintain stable fluid intake. B. Exercise in hot weather. C. Restrict fluid. D. Restrict salt.

A. Maintain stable fluid intake

A nurse is planning care for a client following surgical implantation of a vagus nerve stimulation (VNS) device. The nurse should plan to monitor for which of the following adverse effects? (Select all that apply.) A. Voice changes B. Seizure activity C. Disorientation D. Dysphagia E. Neck pain

A. Voice changes D. Dysphagia E. Neck pain

A charge nurse is discussing transcranial magnetic stimulation (TMS) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "TMS is indicated for clients whose depression is not relieved by medication." B. "I will provide postanesthesia care following TMS." C. "TMS is usually performed as an outpatient procedure." D. "I will schedule the client for daily TMS treatments for the first several weeks."

B. "I will provide postanesthesia care following TMS.

An adult male obsesses about cleanliness and avoidance of germs. Which group of medications would be most appropriate for this client? A. Antipsychotic medications B. Antidepressant medications C. Antianxiety medications D. Anticonvulsant medications

B. Antidepressant medications

1. A teenager reacts with anxiety in relatively low-stress situations and gives reasons for the behavior, even when not requested. What is the teenager exhibiting? A. Signal anxiety B. Anxiety trait C. Anxiety state D. Mild anxiety

B. Anxiety trait

An abuser with severe aggression is prescribed medication for his condition. Which of the following may be prescribed? A. Antabuse B. Atypical antipsychotic C. Hypnotic D. Antipyretics

B. Atypical antipsychotic

Assessment of a client reveals severe and sudden mood swings from mania to depression. Which diagnosis should the nurse suspect? A. Dysthymic disorder B. Bipolar disorder C. Major depressive disorder D. Personality disorder

B. Bipolar disorder

Which of the following is a common trigger of an acute psychotic episode? A. Mild anxiety B. Infection C. Subordinate behavior D. Intense exercise

B. Infection

Which neurotransmitter imbalance has been shown to have a relation to impulsive aggression? A. Low levels of γ-aminobutyric acid B. Low levels of serotonin C. High levels of dopamine D. High levels of acetylcholine

B. Low levels of serotonin

Which client would the nurse expect to prepare for electroconvulsive therapy (ECT)? A. A female client with dysthymic disorder B. A male client with major depressive disorder and history of heart disease C. A male client with major depression and at risk for suicide D. A female client with major depression and brain metastasis

C. A male client with major depression and at risk for suicide

1. The process of deinstitutionalization of long-term patients into the community occurred because of what change in the 1960s? A. Closure of long-term mental health facilities B. Antianxiety medication C. Antipsychotic medication D. Establishment of group homes

C. Antipsychotic medication

A client is given the diagnosis of generalized anxiety disorder and is prescribed a benzodiazepine. The client should be instructed on which of the following? A. Monthly laboatory tests are needed to monitor drug level. B. Benzodiazepines do not cause physical dependence. C. Benzodiazepines and alcohol can be dangerous. D. Foods that contain tyramine should be avoided.

C. Benzodiazepines and alcohol can be dangerous.

A nurse is leading a peer group discussion about the indications for electroconvulsive therapy (ECT). Which of the following is appropriate to include in the discussion? A. Borderline personality disorder B. Acute withdrawal related to a substance use disorder C. Bipolar disorder with rapid cycling D. Dysthymic disorder

C. Bipolar disorder with rapid cycling

Which of the following individuals is more likely to experience depression? A. Older adult with pet B. Male older adult C. Medically ill older adult D. Older adult living alone

C. Medically ill older adult

A nurse is assessing a client immediately following an electroconvulsive therapy (ECT) procedure. Which of the following are expected findings? (Select all that apply.) A. Hypotension B. Paralytic ileus C. Memory loss D. Nausea E. Tachycardia

C. Memory loss D. Nausea E. Tachycardia

Which client on the mental health unit is at highest risk for violence directed at others? A. Mr. A, who has a history of recurrent severe depression B. Mr. B, who is in an alcohol rehabilitation program C. Mr. C, who has delusions of persecution and has assaulted his brother D. Mr. D, who has somatic symptoms for which no organic basis is found

C. Mr. C, who has delusions of persecution and has assaulted his brother

A depressed client has been prescribed a selective serotonin reuptake inhibitor. Which medication may have been prescribed? A. Amitriptyline (Elavil) B. Clonazepam (Klonopin) C. Sertraline (Zoloft) D. Lorazepam (Ativan)

C. Sertraline (Zoloft)

A nurse is providing teaching for a client who is scheduled to receive electroconvulsive therapy (ECT) for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching A. "It is common to treat depression with ECT before trying medications." B. "I can have my depression cured if I receive a series of ECT treatments." C. "I will have seizures lasting 1½ to 2 min during ECT." D. "I will receive a muscle relaxant to protect me from injury during ECT."

D. "I will receive a muscle relaxant to protect me from injury during ECT."

A young seriously mental ill client has a mood disorder. Which drug is the client likely to abuse? A. Alcohol B. Marijuana C. Heroin D. Cocaine

D. Cocaine

A middle-aged man has lost all sources of income. He is unable to function, cares about nothing, and feels powerless. His feelings of worthlessness and despair have lasted 3 weeks. He is suffering from which of the following? A. Dysthymia B. Mild depression C. Moderate depression D. Major depressive episode

D. Major depressive episode

Which of the following chronic mental health problems may begin in adolescence? A. Obsessive-compulsive disorder B. Hypochondriasis C. Conduct disorder D. Personality disorder

D. Personality disorder

A client characteristically experiences fatigue, gloom, and loss of energy during the winter months. Which diagnosis should the nurse suspect? A. Cyclothymic disorder B. Mild depressive disorder C. Mood disorder D. Seasonal affective disorder

D. Seasonal affective disorder

A client experiencing manic hyperactivity stands up, glares challengingly at clients and staff, and shouts, "This food is garbage! I'll fight anyone who says it's not!" The nurse's most relevant assessment is that the client A. is upset with the quality of the food. B. is getting rid of tension in a harmless way. C. is frustrated by limits imposed by hospitalization. D. has a high potential for other-directed violence.

D. has a high potential for other-directed violence.

Which of the following describe the symptoms of the manic phase of bipolar disorder? (select all that apply): a. Excessive energy b. Fatigue and increased sleep c. Low self-esteem d. Pressured speech e. Purposeless movement f. Racing thoughts g. Withdrawal from environment h. Distractibility

Excessive energy, Pressured speech, Purposeless movement, Racing thoughts, Distractibility

Which side effects of lithium can be expected at therapeutic levels? a. Fine hand tremor and polyuria b. Nausea and thirst d. Coarse hand tremor and gastrointestinal upset Incorrect e. Ataxia and hypotension

Fine hand tremor and polyuria

Which behavior would be most characteristic of a client during a manic episode? a.Going rapidly from one activity to another b.Taking frequent rest periods and naps during the day c. Being unwilling to leave home to see other people d. Watching others intently and talking little

Going rapidly from one activity to another Correct

A client comes in demonstrating increased activity and agitation and gives much more importance to thoughts and ideas. This client is demonstrating ________.

Mania

Anxiety Level

Mild - breathing and awake Moderate -attentive learning Severe - Fixing to take a test, focus is narrowed, problem solving becomes difficult - pupils are dialated, dry mouth, diarrhea Panic - full sympathetic release, unable to solve a problem, no logical thinking, disorganized BP is down.. pg 203

Which of the following is true of the relationship between bipolar disorder and suicide? a. Patients need to be monitored only in the depressed phase because this is when suicides occur. b. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. c. Patients with bipolar disorder are not considered high risk for suicide. d. As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide

A bipolar client whose continuing phase treatment consists of lithium therapy and cognitive-behavioral therapy may become noncompliant with medication. Which factor would be of least concern to the nurse developing a psychoeducation plan to foster compliance? a. The side-effects are unpleasant. b. The voices tell the client to stop taking it. c. The client prefers to feel "high" and energetic d. The client feels well and denies the possibility of recurrence

The voices tell the client to stop taking it. Manic clients may hallucinate during the delirious state but generally do not hear voices. Psychoeducation would not be going on during the time the client is delirious

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? a. Withhold medication and notify the physician. b. Continue to administer medication as ordered. c. Advise the client to limit fluids for 12 d. Advise the client to curtail salt intake for 24 hours.

Withhold medication and notify the physician.

postpartum depression

a condition characterized by symptoms of tearfulness, irritability, hypochondria, sleeplessness, impairment of concentration, and headache in the days and weeks following childbirth...

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of standard antipsychotic medication. tricyclic antidepressant medication. anticholinergic medication. a short-acting benzodiazepine medication.

a short-acting benzodiazepine medication.

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal a history of childhood trauma. a sibling with the disorder. an eating disorder. a phobia as well.

a sibling with the disorder.

A desired outcome for the maintenance phase of treatment for a manic client would be that the client will a. exhibit optimistic, energetic, playful behavior. b. adhere to follow-up medical appointments. c. take medication more than 50% of the time. d. use alcohol to moderate occasional mood "highs."

adhere to follow-up medical appointments.

A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat a. avocado salad plate. b. fruit and cottage cheese plate. c. kielbasa and sauerkraut. d. liver and onion sandwich.

b. fruit and cottage cheese plate

bipolar disorder

behavioral problems associated with sudden, dramatic shifts in emotional extremes...

manic depression

behavioral problems caused by sudden, dramatic shifts in emotional extremes; once called bipolar disorder...

panic attack

brief period of intense fear or discomfort accompanied by various physical and emotional reactions...

A person who has numerous hypomanic and dysthymic episodes can be assessed as demonstrating characteristics of a. bipolar II disorder. b. bipolar I disorder. c, cyclothymia. d. seasonal affective disorder.

cyclothymia

mood swings involving hypomania and dysthymia of 2 years' duration. The mood swings are not severe enough to prompt hospitalization.

cyclothymia.

A client is experiencing manic hyperactivity. In the dining room she stands up and shouts "This food is garbage! I'll fight anyone who says it's not! I can fight all of you at one time and win with one hand tied behind my back!" She is flushed, her fists are clenched, and she glares challengingly at clients and staff. The nurse's most relevant assessment is that the client A. is upset with the quality of the food. B. is getting rid of tension in a harmless way. C. is frustrated by limits imposed by hospitalization. D. has a high potential for other-directed violence.

d. has a high potential for other-directed violence. The client's offers to fight are suggestive of a high potential for violence. Clients may have coping skills that are adequate for day-to-day events in their lives but are overwhelmed by the stresses of illness or hospitalization. Other clients may have a pattern of maladaptive coping, which is marginally effective and consists of a set of coping strategies that have been developed to meet unusual or extraordinary situations. Page 516-517

dysthymia

daily moderate depression that lasts for longer than 2 years

religiosity

delusions of great spirituality; believing one has powers to communicate with God or be a spirit...

situational depression

depressive responses tied to a specific event or situation that can be traced to a recognizable cause...

depression

emotional state characterized by feelings of sadness, disappointment, and despair

hypomania

exaggerated sense of cheerfulness and well-being...

mania

extreme emotional state characterized by excitement, great elation, over-talkativeness, increased motor activity, fleeting grandiose ideas, and agitated behaviors...

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying a. flight of ideas. b. distractibility. c. limit testing. d. grandiosity.

grandiosity

Tyler is a 31-year-old patient admitted with acute mania. He tells the staff and the other patients that he is on a secret mission given to him by the President of the United States to monitor citizens for terrorist activity. He states, "I am the only one he trusts, because I am the best!" For documentation purposes you know that this behavior is referred to as: a. unpredictability. b. rapid cycling. c. grandiosity. d. flight of ideas.

grandiosity

Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity.

grandosity

The client at highest risk for violence directed at others is one who a. has a history of recurrent severe depression. b. is in an alcohol rehabilitation program. c. has delusions of persecution d. who has somatic symptoms for which no organic basis is found

has delusions of persecution

signal anxiety

learned anxiety response to an anticipated event...

seasonal affective disorder

levels of mild to moderate depression experienced during long winter days; symptoms begin to lift with the coming of spring...

The first-line drug used to treat mania is a. lithium carbonate (Lithium) b. carbamazepine (Tegretol). c. lamotrigine (Lamictal). d. clonazepam (Klonopin).

lithium carbonate (Lithium) mood stabalizer

emotion

nonintellectual reaction to various stimuli, based on individual's perceptions...

affect

outward manifestation of a person's feelings or emotions...

cyclothymic disorder

pattern of behaviors involving repeated mood swings, alternating between hypomania and depressive symptoms

obsession

persistent, recurring, inappropriate, and distressing thoughts...

mood disorder

prolonged emotional state that influences one's whole personality and life functioning

The priority nursing diagnosis for a hyperactive manic client during the acute phase is a.risk for injury. b. ineffective role performance. c. risk for other-directed violence. d. impaired verbal communication.

risk for injury

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as mild. moderate. severe. panic.

severe

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to suddenly tremble severely. exhibit stoic behavior. report both nausea and vomiting. laugh inappropriately

suddenly tremble severely Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity.

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should question the physician's order because the dose is excessive. explain the long-term nature of benzodiazepine therapy. teach the client to limit caffeine intake. tell the client to expect mild insomnia.

teach the client to limit caffeine intake.

A depressed client tells the nurse he is in the "acute phase" of his treatment for depression. The nurse recognizes that the client has been in treatment a. for more than 4 months. b. that is directed toward relapse prevention. c. that focuses on prevention of future depression d. to reduce depressive symptoms.

to reduce depressive symptoms

An acute phase nursing intervention aimed at reducing hyperactivity is redirecting the client to a. write in a diary. b. exercise in the gym. c. direct unit activities. d. orient a new client to the unit.

write in a diary.