Mood Disorder Practice Questions
10. A client is admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder. Which of the following data would the nurse expect to assess? Select all that apply. 1. Loss of interest in almost all activities and anhedonia. 2. A change of more than 5% of body weight in 1 month. 3. Fluctuation between increased energy and loss of energy. 4. Psychomotor retardation or agitation. 5. Insomnia or hypersomnia.
1, 2, 4, 5 1. Loss of interest in almost all activities and anhedonia, the inability to experience or even imagine any pleasant emotion, are symptoms of major depressive disorder (MDD). 2. Significant weight loss or gain of more than 5% of body weight in 1 month is one of the many diagnostic criteria for MDD. 4. Psychomotor retardation or agitation, occurring nearly every day, is a diagnostic criterion for MDD. These symptoms should be observable by others and not merely subjective feelings of restlessness or lethargy. 5. Sleep alterations, such as insomnia or hypersomnia, that occur nearly every day are diagnostic criteria for MDD.
31. A client diagnosed with bipolar II disorder has a nursing diagnosis of impaired social interactions R/ T egocentrism. Which short-term outcome is an appropriate expectation for this client problem? 1. The client will have an appropriate one-on-one interaction with a peer by day 4. 2. The client will exchange personal information with peers at lunchtime. 3. The client will verbalize the desire to interact with peers by day 2. 4. The client will initiate an appropriate social relationship with a peer.
1. A client's having an appropriate one-onone interaction with a peer is a successful outcome for the nursing diagnosis of impaired social interaction. The test taker should note that this outcome is specific, client-centered, positive, realistic, and measurable, and includes a timeframe.
2. Which client statement is evidence of the etiology of major depressive disorder from a genetic perspective? 1. "My maternal grandmother was diagnosed with bipolar affective disorder." 2. "My mood is a 7 out of 10, and I won't harm myself or others." 3. "I am so angry that my father left our family when I was 6." 4. "I just can't do anything right. I am worthless."
1. A family history of mood disorder indicates a genetic predisposition to the development of major depressive disorder. Twin, family, and adoptive studies further support a genetic link as an etiological influence in the development of mood disorders
59. Which symptoms would the nurse expect to assess in a client suspected to have serotonin syndrome? 1. Alterations in mental status, restlessness, tachycardia, labile blood pressure, and diaphoresis. 2. Hypomania, akathisia, cardiac arrhythmias, and panic attacks. 3. Dizziness, lethargy, headache, and nausea. 4. Orthostatic hypotension, urinary retention, constipation, and blurred vision.
1. Alterations in mental status, restlessness, tachycardia, labile blood pressure, and diaphoresis all are symptoms of serotonin syndrome. If this syndrome were suspected, the offending agent would be discontinued immediately
13. Which symptom is an example of an affective alteration exhibited by clients diagnosed with severe depression? 1. Apathy. 2. Somatic delusion. 3. Difficulty falling asleep. 4. Social isolation.
1. Apathy is defined as indifference, insensibility, and lack of emotion. Apathy is an affective alteration exhibited by clients diagnosed with severe depression.
40. A client experiencing mania states, "Everything I do is great." Using a cognitive approach, which nursing response would be most appropriate? 1. "Is there a time in your life when things didn't go as planned?" 2. "Everything you do is great." 3. "What are some other things you do well?" 4. "Let's talk about the feelings you have about your childhood."
1. By asking, "Is there a time in your life when things didn't go as planned?" the nurse is using a cognitive approach to challenge the thought processes of the client
41. A client newly admitted to an in-patient psychiatric unit who is experiencing a manic episode. The client's a nursing diagnosis is imbalanced nutrition, less than body requirements. Which meal is most appropriate for this client? 1. Chicken fingers and French fries. 2. Grilled chicken and a baked potato. 3. Spaghetti and meatballs. 4. Chili and crackers.
1. Chicken fingers and French fries are finger foods, which the client would be able to eat during increased psychomotor activity, such as pacing. Because these foods are high in caloric value, they also meet the client's increased nutritional needs
37. Which intervention takes priority when working with newly admitted clients experiencing suicidal ideations? 1. Monitor the client at close, but irregular, intervals. 2. Encourage the client to participate in group therapy. 3. Enlist friends and family to assist the client to remain safe after discharge. 4. Remind the client that it takes 4 to 6 weeks for antidepressants to be fully effective.
1. Clients who experience suicidal ideations must be monitored closely to prevent suicide attempts. By monitoring at irregular intervals, the nurse would prevent the client from recognizing patterns of observation. If a client does recognize patterns of observations, the client can use the time in which he or she is not observed to plan and implement a suicide attempt
12. Which symptom is an example of physiological alterations exhibited by clients diagnosed with moderate depression? 1. Decreased libido. 2. Difficulty concentrating. 3. Slumped posture. 4. Helplessness.
1. Decreased libido is a physiological alteration exhibited by clients diagnosed with moderate depression.
45. A client diagnosed with bipolar I disorder experienced an acute manic episode and was admitted to the in-patient psychiatric unit. The client is now ready for discharge. Which of the following resource services should be included in discharge teaching? Select all that apply. 1. Financial and legal assistance. 2. Crisis hotline. 3. Individual psychotherapy. 4. Support groups. 5. Family education groups.
1. During a manic episode, clients are likely to experience impulse control problems, which may lead to excessive spending. Having access to financial and legal assistance may help the client assess the situation and initiate plans to deal with financial problems. 2. During a manic episode, a client may not eat or sleep and may abuse alcohol or other drugs. The client's hyperactivity may lead to ambivalence regarding his or her desire to live. Having access to a crisis hotline may help the client to de-escalate and make the difference between life and death decisions. 3. During a manic episode, a client most likely would have had difficulties in various aspects of interpersonal relationships, such as family, friends, and coworkers. Individuals experiencing mania may be difficult candidates for psychotherapy because of their inability to focus. When the acute phase of the illness has passed, the client may decide to access an available resource to deal with interpersonal problems. Psychotherapy, in conjunction with medication maintenance treatment, and counseling may be useful in helping these individuals. 4. During a manic episode, a client would not be a willing candidate for any type of group therapy. However, when the acute phase of the illness has passed, this individual may want to access support groups to benefit therapeutically from peer support. 5. During a manic episode, a client may have jeopardized marriage or family functioning. Having access to a resource that would help this client restore adaptive family functioning may improve not only relationships, but also noncompliance issues and dysfunctional behavioral patterns, and ultimately may reduce relapse rates. Family therapy is most effective with the combination of psychotherapeutic and pharmacotherapeutic treatment
54. Which of the following medications may be administered before electroconvulsive therapy? Select all that apply. 1. Glycopyrrolate (Robinul). 2. Thiopental sodium (Pentothal). 3. Succinylcholine chloride (Anectine). 4. Lorazepam (Ativan). 5. Divalproex sodium (Depakote).
1. Glycopyrrolate (Robinul) is given to decrease secretions and counteract the effects of vagal stimulation induced by electroconvulsive therapy (ECT). 2. Thiopental sodium (Pentothal) is a shortacting anesthetic medication admini tered to produce loss of consciousness during ECT. 3. Succinylcholine chloride (Anectine) is a muscle relaxant administered to prevent severe muscle contractions during the seizure, reducing the risk for fractured or dislocated bones.
52. A nurse working with a client diagnosed with bipolar I disorder attempts to recognize the motivation behind the client's use of grandiosity. Which is the rationale for this nurse's action? 1. Understanding the reason behind a behavior would assist the nurse to accept and relate to the client, not the behavior. 2. Change cannot occur until the client can accept responsibility for behaviors. 3. As self-esteem is increased, the client will meet needs without the use of manipulation. 4. Positive reinforcement would enhance self-esteem and promote desirable behaviors
1. Grandiosity, which is defined as an exaggerated sense of self-importance, power, or status, is used by clients diagnosed with bipolar affective disorder to help reduce feelings of insecurity by increasing feelings of power and control. When the nurse understands the origin of this behavior, the nurse can better work with, and relate to, the client.
22. Which nursing diagnosis takes priority for a client immediately after electroconvulsive therapy (ECT)? 1. Risk for injury R/ T altered mental status. 2. Impaired social interaction R/ T confusion. 3. Activity intolerance R/ T weakness. 4. Chronic confusion R/ T side effect of ECT.
1. Immediately after electroconvulsive therapy (ECT), risk for injury R/ T altered mental status is the priority nursing diagnosis. The most common side effect of ECT is memory loss and confusion, and these place the client at risk for injury.
32. A suicidal Jewish-American client is admitted to an in-patient psychiatric unit 2 days after the death of a parent. Which intervention must the nurse include in the care of this client? 1. Allow the client time to mourn the loss during this time of shiva. 2. To distract the client from the loss, encourage participation in unit groups. 3. Teach the client alternative coping skills to deal with grief. 4. Discuss positive aspects the client has in his or her life to build on strengths.
1. In the Jewish faith, the 7-day period beginning with the burial is called shiva. During this time, mourners do not work, and no activity is permitted that diverts attention from thinking about the deceased. Because this client's parent died 2 days ago, the client needs time to participate in this religious ritual.
35. A newly admitted client diagnosed with major depressive disorder isolates self in room and stares out the window. Which nursing intervention would be the most appropriate to implement initially, when establishing a nurse-client relationship? 1. Sit with the client and offer self frequently. 2. Notify the client of group therapy schedule. 3. Introduce the client to others on the unit. 4. Help the client to identify stressors of life that precipitate life crises.
1. Offering self is one technique to generate the establishment of trust with a newly admitted client diagnosed with major depressive disorder (MDD). Trust is the basis for the establishment of any nurseclient relationship
28. A client has a nursing diagnosis of risk for suicide R/ T a past suicide attempt. Which outcome, based on this diagnosis, would the nurse prioritize? 1. The client will remain free from injury throughout hospitalization. 2. The client will set one realistic goal related to relationships by day 3. 3. The client will verbalize one positive attribute about self by day 4. 4. The client will be easily redirected when discussion about suicide occurs by day 5.
1. Remaining free from injury throughout hospitalization is a priority outcome for the nursing diagnosis of risk for suicide R/ T a past suicide attempt. Because this outcome addresses client safety, it is prioritized.
9. Which client is at highest risk for the diagnosis of major depressive disorder? 1. A 24-year-old married woman. 2. A 64-year-old single woman. 3. A 30-year-old single man. 4. A 70-year-old married man.
1. Research indicates that depressive symptoms are highest among young, married women of low socioeconomic backgrounds. Compared with the other clients presented, this client is at highest risk for the diagnosis of major depressive disorder (MDD).
25. A client diagnosed with bipolar I disorder and experiencing a manic episode is newly admitted to the in-patient psychiatric unit. Which nursing diagnosis is a priority at this time? 1. Risk for violence: other-directed R/ T poor impulse control. 2. Altered thought process R/ T hallucinations. 3. Social isolation R/ T manic excitement. 4. Low self-esteem R/ T guilt about promiscuity.
1. Risk for violence: other-directed is defined as behaviors in which an individual demonstrates that he or she can be physically, emotionally, or sexually harmful to others. Because of poor impulse control, irritability, and hyperactive psychomotor behaviors experienced during a manic episode, this client is at risk for violence directed toward others. Keeping all clients in the milieu safe is always a nursing priority.
1. Which nursing diagnosis supports the psychoanalytic theory of development of major depressive disorder? 1. Social isolation R/ T self-directed anger. 2. Low self-esteem R/ T learned helplessness. 3. Risk for suicide R/ T neurochemical imbalances. 4. Imbalanced nutrition less than body requirements R/ T weakness.
1. Social isolation R/T self-directed anger supports the psychoanalytic theory in the development of major depressive disorder (MDD). Freud defines melancholia as a profoundly painful dejection and cessation of interest in the outside world, which culminates in a delusional expectation of punishment. He observed that melancholia occurs after the loss of a love object. Freud postulated that when the loss has been incorporated into the self (ego), the hostile part of the ambivalence that has been felt for the lost object is turned inward toward the ego. Another way to state this concept is that the client turns anger toward self.
6. A client expresses frustration and hostility toward the nursing staff regarding the lack of care his or her recently deceased parent received. According to Kubler-Ross, which stage of grief is this client experiencing? 1. Anger. 2. Disequilibrium. 3. Developing awareness. 4. Bargaining.
1. The client in the question is exhibiting anger surrounding the death of a parent. Kubler-Ross describes anger as the second stage in the normal grief response. This stage occurs when clients experience the reality of the situation. Feelings associated with this stage include sadness, guilt, shame, helplessness, and hopelessness
43. A client diagnosed with bipolar I disorder in the manic phase is yelling at another peer in the milieu. Which nursing intervention takes priority? 1. Calmly redirect and remove the client from the milieu. 2. Administer prescribed PRN intramuscular injection for agitation. 3. Notify the client to lower voice. 4. Obtain an order for seclusion to help decrease external stimuli
1. When a client experiencing mania is yelling at other peers, it is the nurse's priority to address this situation immediately. Behaviors of this type can escalate into violence toward clients and staff members. By using a calm manner, the nurse avoids generating any further hostile behaviors, and by removing the client from the milieu, the nurse protects other clients on the unit.
16. The nurse in the emergency department is assessing a client suspected of being suicidal. Number the following assessment questions, beginning with the most critical and ending with the least critical. ___ "Are you currently thinking about suicide?" ___ "Do you have a gun in your possession?" ___ "Do you have a plan to commit suicide?" ___ "Do you live alone? Do you have local friends or family?"
16. The correct order of these assessment questions is 1, 3, 2, 4. (1) Assessment of suicidal ideations must occur before any other assessment data are gathered. If the client is not considering suicide, continuing with the suicide assessment is unnecessary. (2) Assessment of a suicide plan is next. A client's risk for suicide increases if the client has developed a specific plan. (3) Assessment of the access to the means to commit suicide is next. The ability for the client to access the means to carry out the suicide plan is an important assessment for the nurse to intervene appropriately. If a client has a loaded gun available to him or her at home, the nurse would be responsible to assess this information and initiate actions to decrease the client's access. (4) Assessment of the client's potential for rescue is next. If a client has an involved support system, even if a suicide attempt occurs, there is a potential for rescue. Without an involved support system, the client is at higher risk.
44. A client newly admitted with bipolar I disorder has a nursing diagnosis of risk for injury R/T extreme hyperactivity. Which nursing intervention is appropriate? 1. Place the client in a room with another client experiencing similar symptoms. 2. Use PRN antipsychotic medications as ordered by the physician. 3. Discuss consequences of the client's behaviors with the client daily. 4. Reinforce previously learned coping skills to decrease agitation
2. A newly admitted client experiencing an extremely hyperactive episode as the result of bipolar I disorder would benefit from an antipsychotic medication to sedate the client quickly. Lithium carbonate (lithium) should be given concurrently for maintenance therapy and to prevent or diminish the intensity of subsequent manic episodes.
49. A nursing instructor is presenting statistics regarding suicide. Which student statement indicates that learning has occurred? 1. "Approximately 10,000 individuals in the United States commit suicide each year." 2. "Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder." 3. "Suicide is the eighth leading cause of death among young Americans 15 to 24 years old." 4. "Depressive disorders account for 70% of all individuals who commit or attempt suicide."
2. Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder. Most suicides are associated with mood disorders
4. Which statement about the development of bipolar disorder is from a biochemical perspective? 1. Family studies have shown that if one parent is diagnosed with bipolar disorder, the risk that a child will have the disorder is around 28%. 2. In bipolar disorder, there may be possible alterations in normal electrolyte transfer across cell membranes, resulting in elevated levels of intracellular calcium and sodium. 3. Magnetic resonance imaging studies have revealed enlarged third ventricles, subcortical white matter, and periventricular hyperintensity in individuals diagnosed with bipolar disorder. 4. Twin studies have indicated a concordance rate among monozygotic twins of 60% to 80%
2. Alterations in normal electrolyte transfer across cell membranes, resulting in elevated levels of intracellular calcium and sodium, is an example of a biochemical perspective in the development of bipolar disorder.
27. Which client would the charge nurse assign to an agency nurse working on the inpatient psychiatric unit for the first time? 1. A client experiencing passive suicidal ideations with a past history of an attempt. 2. A client rating mood as 3/10 and attending but not participating in group therapy. 3. A client lying in bed all day long in a fetal position and refusing all meals. 4. A client admitted for the first time with a diagnosis of major depression.
2. Although this client rates mood low, there is no indication of suicidal ideations, and the client is attending groups in the milieu. Because this client is observable in the milieu by all staff members, assignment to an agency nurse would be appropriate
38. A client notifies a staff member of current suicidal ideations. Which intervention by the nurse would take priority? 1. Place the client on a one-to-one observation. 2. Determine if the client has a specific plan to commit suicide. 3. Assess for past history of suicide attempts. 4. Notify all staff members and place the client on suicide precautions.
2. Assessment is the first step in the nursing process. Assessing a client's plan for suicide would give the nurse the information needed to intervene appropriately and therefore should be prioritized.
14. Major depressive disorder would be most difficult to detect in which of the following clients? 1. A 5-year-old girl. 2. A 13-year-old boy. 3. A 25-year-old woman. 4. A 75-year-old man
2. Assessment of depressive disorders in 13- year-old children would include feelings of sadness, loneliness, anxiety, and hopelessness. These symptoms may be perceived as normal emotional stresses of growing up. Many teens whose symptoms are attributed to the "normal adjustments" of adolescence, are not accurately diagnosed and do not get the help they need.
55. A client diagnosed with major depressive disorder is prescribed phenelzine (Nardil). Which teaching should the nurse prioritize? 1. Remind the client that the medication takes 4 to 6 weeks to take full effect. 2. Instruct the client and family about the many food-drug and drug-drug interactions. 3. Teach the client about the possible sexual side effects and insomnia that can occur. 4. Educate the client about the need to take the medication even after symptoms have improved.
2. Because there are numerous drug-food and drug-drug interactions that may precipitate a hypertensive crisis during treatment with MAOIs, it is critical that the nurse prioritize this teaching
58. A client diagnosed with major depressive disorder is newly prescribed sertraline (Zoloft). Which of the following teaching points would the nurse review with the client? Select all that apply. 1. Monitor the client for suicidal ideations related to depressed mood. 2. Discuss the need to take medications, even when symptoms improve. 3. Instruct the client about the risks of abruptly stopping the medication. 4. Alert the client to the risks of dry mouth, sedation, nausea, and sexual side effects. 5. Remind the client that the medication's full effect does not occur for 4 to 6 weeks.
2. Discussing the need for medication compliance, even when symptoms improve, is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline. 3. Instructing the client about the risk for discontinuation syndrome is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline. 4. Alerting the client to the risks of dry mouth, sedation, nausea, and sexual side effects is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline. 5. Reminding the client that sertraline's full effect does not occur for 4 to 6 weeks is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline
18. A nurse on an in-patient psychiatric unit receives report at 1500 hours. Which client would need to be assessed first? 1. A client on one-to-one status because of active suicidal ideations. 2. A client pacing the hall and experiencing irritability and flight of ideas. 3. A client diagnosed with hypomania monopolizing time in the milieu. 4. A client with a history of mania who is to be discharged in the morning.
2. Most assaultive behavior that occurs on an in-patient unit is preceded by a period of increasing hyperactivity. A client's behavior of pacing the halls and experiencing irritability should be considered emergent and warrant immediate attention. Because of these symptoms, this client would need to be assessed first.
33. A client denying suicidal ideations comes into the emergency department complaining about insomnia, irritability, anorexia, and depressed mood. Which intervention would the nurse implement first? 1. Request a psychiatric consultation. 2. Complete a thorough physical assessment including lab tests. 3. Remove all hazardous materials from the environment. 4. Place the client on a one-to-one observation.
2. Numerous physical conditions can contribute to symptoms of insomnia, including irritability, anorexia, and depressed mood. It is important for the nurse to rule out these physical problems before assuming that the symptoms are psychological in nature. The nurse can do this by completing a thorough physical assessment including lab tests.
21. A client's outcome states, "The client will make a plan to take control of one life situation by discharge." Which nursing diagnosis documents the client's problem that this outcome addresses? 1. Impaired social interaction. 2. Powerlessness. 3. Knowledge deficit. 4. Dysfunctional grieving.
2. Powerlessness is defined as the perception that one's own action would not significantly affect an outcome—a perceived lack of control over a current situation or immediate happening. Because the client outcome presented in the question addresses the lack of control over life situations, the nursing diagnosis of powerlessness documents this client's problem.
57. A client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of dilute urine, tremors, and muscular irritability. These symptoms would lead the nurse to expect that the client's lithium serum level would be which of the following? 1. 0.6 mEq/L. 2. 1.5 mEq/L. 3. 2.6 mEq/L. 4. 3.5 mEq/L.
3. A client with a lithium serum level of 2.6 mEq/L may experience an excessive output of dilute urine, tremors, muscular irritability, psychomotor retardation, and mental confusion. The client's symptoms described in the question support a lithium serum level of 2.6 mEq/L.
36. A client diagnosed with major depressive disorder is being considered for electroconvulsive therapy (ECT). Which client teaching should the nurse prioritize? 1. Empathize with the client about fears regarding ECT. 2. Monitor for any cardiac alterations to avoid possible negative outcomes. 3. Discuss with the client and family expected short-term memory loss. 4. Inform the client that injury related to induced seizure commonly occurs
3. An expected and acceptable side effect of ECT is short-term memory loss. It is important for the nurse to teach the client and family members this information to avoid unnecessary anxiety about this symptom.
42. A provocatively dressed client diagnosed with bipolar I disorder is observed laughing loudly with peers in the milieu. Which nursing action is a priority in this situation? 1. Join the milieu to assess the appropriateness of the laughter. 2. Redirect clients in the milieu to structured social activities, such as cards. 3. Privately discuss with the client the inappropriateness of provocative dress during hospitalization. 4. Administer PRN antianxiety medication to calm the client.
3. Because dressing provocatively can precipitate sexual overtures that can be dangerous to the client, it is the priority of the nurse to discuss with the client the inappropriateness of this clothing choice.
15. Which is the key to understanding if a child or adolescent is experiencing an underlying depressive disorder? 1. Irritability with authority. 2. Being uninterested in school. 3. A change in behaviors over a 2-week period. 4. Feeling insecure at a social gathering.
3. Change in behavior is an indicator that differentiates mood disorders from the typical stormy behaviors of adolescence. Depression can be a common manifestation of the stress and independence conflicts associated with the normal maturation process. Assessment of normal baseline behaviors would help the nurse recognize changes in behaviors that may indicate underlying depressive disorders.
24. A client diagnosed with cyclothymia is newly admitted to an in-patient psychiatric unit. The client has a history of irritability and grandiosity and is currently sleeping 2 hours a night. Which nursing diagnoses takes priority? 1. Altered thought processes R/ T biochemical alterations. 2. Social isolation R/ T grandiosity. 3. Disturbed sleep patterns R/ T agitation. 4. Risk for violence: self-directed R/ T depressive symptoms.
3. Disturbed sleep patterns is defined as a time-limited disruption of sleep amount and quality. Because the client is sleeping only 2 hours a night, the client is meeting the defining characteristics of the nursing diagnosis of disturbed sleep patterns. This sleep problem is usually due to excessive hyperactivity and agitation.
23. A client diagnosed with major depressive disorder has been newly admitted to an inpatient psychiatric unit. The client has a history of two suicide attempts by hanging. Which nursing diagnosis takes priority? 1. Risk for violence directed at others R/ T anger turned outward. 2. Social isolation R/ T depressed mood. 3. Risk for suicide R/ T history of attempts. 4. Hopelessness R/ T multiple suicide attempts.
3. Risk for suicide R/ T history of attempts is a priority nursing diagnosis for a client who is diagnosed with major depression and has a history of two suicide attempts by hanging. A history of a suicide attempt increases a client's risk for future attempts. Because various means can be used to hang oneself, the client is at risk for accessing these means, even on an inpatient unit. These factors would cause the nurse to prioritize this safety concern.
26. A client admitted with major depressive disorder has a nursing diagnosis of ineffective sleep pattern R/ T aches and pains. Which is an appropriate short-term outcome for this client? 1. The client will express feeling rested on awakening. 2. The client will rate pain level at or below a 4/10. 3. The client will sleep 6 to 8 hours at night by day 5. 4. The client will maintain a steady sleep pattern while hospitalized.
3. The appropriate short-term outcome for the nursing diagnosis of ineffective sleep pattern R/T aches and pains is to expect the client to sleep 6 to 8 hours a night by day 5. This outcome is client-specific, realistic, and measurable, and includes a timeframe.
7. A client plans and follows through with the wake and burial of a child lost in an automobile accident. Using Engel's model of normal grief response, in which stage would this client fall? 1. Resolution of the loss. 2. Recovery. 3. Restitution. 4. Developing awareness.
3. The client in the question is exhibiting signs associated with Engel's stage of restitution. Restitution is the third stage of Engel's model of the normal grief response. In this stage, the various rituals associated with loss within a culture are performed. Examples include funerals, wakes, special attire, a gathering of friends and family, and religious practices customary to the spiritual beliefs of the bereaved.
39. A client seen in the emergency department is experiencing irritability, pressured speech, and increased levels of anxiety. Which would be the nurse's priority intervention? 1. Place the client on a one-to-one to avoid injury. 2. Ask the physician for a psychiatric consultation. 3. Assess vital signs, and complete physical assessment. 4. Reinforce relaxation techniques to decrease anxiety.
3. The nurse first should assess vital signs and complete a physical assessment to rule out a physical cause for the symptoms presented. Many physical problems manifest in symptoms that seem to be caused by psychological problems
11. A client is exhibiting behavioral symptoms of depression. Which charting entry would appropriately document these symptoms? 1. "Rates mood as 4/10." 2. "Expresses thoughts of poor self-esteem during group." 3. "Became irritable and agitated on waking." 4. "Rates anxiety as 2/10 after receiving lorazepam (Ativan)."
3. When the client becomes irritable and agitated on awakening, the client is exhibiting behavioral symptoms of depression. Other behavioral symptoms include, but are not limited to, tearfulness, restlessness, slumped posture, and withdrawal.
50. A client diagnosed with major depressive disorder has an outcome that states, "The client will verbalize a measure of hope about future by day 3." Which client statement indicates this outcome was successful? 1. "I don't want to die because it would hurt my family." 2. "I need to go to group and get out of this room." 3. "I think I am going to talk to my boss about conflicts at work." 4. "I thank you for your compassionate care."
3. When the client begins to plan how to deal with conflicts at work, the client is focusing on a hopeful future. This indicates that the outcome of verbalizing a measure of hope about the future by day 3 has been successful.
17. Which nursing charting entry is documentation of a behavioral symptom of mania? 1. "Thoughts fragmented, flight of ideas noted." 2. "Mood euphoric and expansive. Rates mood a 10/10." 3. "Pacing halls throughout the day. Exhibits poor impulse control." 4. "Easily distracted, unable to focus on goals."
3. When the nurse documents, "Pacing halls throughout the day. Exhibits poor impulse control," the nurse is charting a behavioral symptom of mania. Psychomotor activities and uninhibited social and sexual behaviors are classified as behavioral symptoms.
48. A nursing instructor is teaching about the cause of mood disorders. Which statement by a nursing student best indicates an understanding of the etiology of mood disorders? 1. "When clients experience loss, they learn that it is inevitable and become hopeless and helpless." 2. "There are alterations in the neurochemicals, such as serotonin, which cause the client's symptoms." 3. "Evidence continues to support multiple causations related to an individual's susceptibility to mood symptoms." 4. "There is a genetic component affecting the development of mood disorders."
3. When the student states that there is support for multiple causations related to an individual's susceptibility to mood symptoms, the student understands the content presented about the etiology of mood disorders.
19. A nurse is planning to teach about appropriate coping skills. The nurse would expect which client to be at the highest level of readiness to participate in this instruction? 1. A newly admitted client with an anxiety level of 8/10 and racing thoughts. 2. A client admitted 6 days ago for a manic episode refusing to take medications. 3. A newly admitted client experiencing suicidal ideations with a plan to overdose. 4. A client admitted 6 days ago for suicidal ideations following a depressive episode
4. A client admitted 6 days ago for suicidal ideations has begun to stabilize because of the treatment received during this timeframe. Compared with the other clients described, this client would have the highest level of readiness to participate in instruction.
47. A client has a nursing diagnosis of dysfunctional grieving R/ T loss of a job AEB inability to seek employment because of sad mood. Which would support a resolution of this client's problem? 1. The client reports an anxiety level of 2 out of 10 and denies suicidal ideations. 2. The client exhibits trusting behaviors toward the treatment team. 3. The client is noted to be in the denial stage of the grief process. 4. The client recognizes and accepts the role he or she played in the loss of the job.
4. Accepting responsibility for the role played in a loss indicates that the client has moved forward in the grieving process and resolved the problem of dysfunctional grieving.
5. Which statement describes a major difference between a client diagnosed with major depressive disorder and a client diagnosed with dysthymic disorder? 1. A client diagnosed with dysthymic disorder is at higher risk for suicide. 2. A client diagnosed with dysthymic disorder may experience psychotic features. 3. A client diagnosed with dysthymic disorder experiences excessive guilt. 4. A client diagnosed with dysthymic disorder has symptoms for at least 2 years.
4. An individual suspected to have dysthymic disorder needs to experience symptoms for at least 2 years before a diagnosis can be made. The essential feature is a chronically depressed mood (or possibly an irritable mood in children and adolescents) for most of the day, more days than not, for at least 2 years (1 year for children and adolescents). Clients with a diagnosis of MDD show impaired social and occupational functioning that has existed for at least 2 weeks.
29. A client diagnosed with bipolar I disorder has a nursing diagnosis of disturbed thought process R/ T biochemical alterations. Based on this diagnosis, which outcome would be appropriate? 1. The client will not experience injury throughout the shift. 2. The client will interact appropriately with others by day 3. 3. The client will be compliant with prescribed medications. 4. The client will distinguish reality from delusions by day 6.
4. Distinguishing reality from delusions by day 6 is an appropriate outcome for the nursing diagnosis of disturbed thought processes R/T biochemical alterations. Altered thought processes have improved when the client can distinguish reality from delusions.
34. A client diagnosed with major depressive disorder has a nursing diagnosis of low self-esteem R/ T negative view of self. Which cognitive intervention by the nurse would be appropriate to deal with this client's problem? 1. Promote attendance in group therapy to assist client to socialize. 2. Teach assertiveness skills by role-playing situations. 3. Encourage the client to journal to uncover underlying feelings. 4. Focus on strengths and accomplishments to minimize failures.
4. Focusing on strengths and accomplishments to minimize failures is a cognitive intervention by the nurse. Cognitive interventions focus on altering distortions of thoughts and negative thinking.
46. A nursing student is studying major depressive disorder. Which student statement indicates that learning has occurred? 1. "1% of the population is affected by depression yearly." 2. "2% to 5% of women experience depression during their lifetimes." 3. "1% to 3% of men become clinically depressed." 4. "Major depression is a leading cause of disability in the United States."
4. Major depression is one of the leading causes of disability in the United States. This is not to be confused with an occasional bout with the "blues," a feeling of sadness or downheartedness. Such feelings are common among healthy individuals and are considered a normal response to everyday disappointments in life.
60. Which medication would be classified as a tricyclic antidepressant? 1. Bupropion (Wellbutrin). 2. Mirtazapine (Remeron). 3. Citalopram (Celexa). 4. Nortriptyline (Pamelor).
4. Nortriptyline (Pamelor) is classified as a tricyclic antidepressant. Other tricyclic antidepressants include amitriptyline (Elavil), doxepin (Sinequan), and imipramine (Tofranil).
3. During an intake assessment, which client statement is evidence of the etiology of major depressive disorder from an object-loss theory perspective? 1. "I am so angry all the time and seem to take it out on myself." 2. "My grandmother and great-grandfather also had depression." 3. "I just don't think my life is ever going to get better. I can't do anything right." 4. "I don't know about my biological family; I was in foster care as an infant."
4. Object-loss theorists suggest that depressive illness occurs as a result of being abandoned by or otherwise separated from a significant other during the first 6 months of life. The client in the question experienced parental abandonment, and according to object loss theory, this loss has led to the diagnosis of MDD
53. A nursing instructor is teaching about the criteria for the diagnosis of bipolar II disorder. Which student statement indicates that learning has occurred? 1. "Clients diagnosed with bipolar II disorder experience a full syndrome of mania and have a history of symptoms of depression." 2. "Clients diagnosed with bipolar II disorder experience numerous episodes of hypomania and dysthymia for at least 2 years." 3. "Clients diagnosed with bipolar II disorder have mood disturbances that are directly associated with the physiological effects of a substance." 4. "Clients diagnosed with bipolar II disorder experience recurrent bouts of depression with episodic occurrences of hypomania."
4. Recurrent bouts of depression and episodic occurrences of hypomania are diagnostic criteria for bipolar II disorder. Experiencing a full manic episode would indicate a diagnosis of bipolar I disorder and rule out a diagnosis of bipolar II disorder.
20. A newly admitted client has been diagnosed with major depressive disorder. Which nursing diagnosis takes priority? 1. Social isolation R/ T poor mood AEB refusing visits from family. 2. Self-care deficit R/ T hopelessness AEB not taking a bath for 2 weeks. 3. Anxiety R/ T hospitalization AEB anxiety rating of an 8/10. 4. Risk for self-directed violence R/ T depressed mood.
4. Risk for self-directed violence is the priority diagnosis for a newly admitted client diagnosed with MDD. Risk for self-directed violence is defined as behaviors in which the individual demonstrates that he or she can be physically harmful to self. This is a life-threatening problem that requires immediate prioritization by the nurse.
56. A client diagnosed with bipolar I disorder is experiencing auditory hallucinations and flight of ideas. Which medication combination would the nurse expect to be prescribed to treat these symptoms? 1. Amitriptyline (Elavil) and divalproex sodium (Depakote). 2. Verapamil (Calan) and topiramate (Topamax). 3. Lithium carbonate (Eskalith) and clonazepam (Klonopin). 4. Risperidone (Risperdal) and lamotrigine (Lamictal).
4. Risperidone (Risperdal), an antipsychotic, directly addresses the auditory hallucinations experienced by the client. Lamotrigine (Lamictal), a mood stabilizer, would address the classic symptoms of bipolar I disorder.
51. A nursing instructor is teaching about the psychosocial theory related to the development of bipolar disorder. Which student statement would indicate that learning has occurred? 1. "The credibility of psychosocial theories in the etiology of bipolar disorder has strengthened in recent years." 2. "Bipolar disorder is viewed as a purely genetic disorder." 3. "Following steroid, antidepressant, or amphetamine use, individuals can experience manic episodes." 4. "The etiology of bipolar disorder is unclear, but it is possible that biological and psychosocial factors are influential."
4. The etiology of bipolar disorder is unclear; however, research evidence shows that biological and psychosocial factors are influential in the development of the disorder.
8. Which charting entry most accurately documents a client's mood? 1. "The client expresses an elevation in mood." 2. "The client appears euthymic and is interacting with others." 3. "The client isolates self and is tearful most of the day." 4. "The client rates mood at a 2 out of 10."
4. The use of a mood scale objectifies the subjective symptom of mood as a pain scale objectifies the subjective symptom of pain. The use of scales is the most accurate way to assess subjective data.
30. The nurse is reviewing expected outcomes for a client diagnosed with bipolar I disorder. Number the outcomes presented in the order in which the nurse would address them. ___ The client exhibits no evidence of physical injury. ___ The client eats 70% of all finger foods offered. ___ The client is able to access available out-patient resources. ___ The client accepts responsibility for own behaviors.
addressed is 1, 2, 4, 3. (1) The nurse would address the outcome that states, "The client exhibits no evidence of physical injury," first because this outcome deals with client physical safety. (2) Next, the nurse would address the outcome that states, "The client eats 70% of all finger foods offered," because this outcome deals with the client's physical needs. (3) The nurse would address next the outcome that states, "The client accepts responsibility for own behaviors," because this outcome is realistic only later in treatment. (4) Finally, the nurse would address the outcome that states, "The client is able to access available out-patient resources," because this outcome would be appropriate only during the discharge process.
