Nursing Care of Clients with Disorders Related to Anxiety and Alterations in Mood

251. What therapeutic nursing intervention may redirect a hyperactive, manic client? 1. Suggesting that the client write a short story 2. Having the client initiate group social activities on the unit 3. Asking the client to guide other clients as they clean their rooms 4. Encouraging the client to tear pictures out of magazines for a scrapbook

4 Physical activity will help use some of the excess energy without requiring the client to make decisions or forcing other clients to deal with the behavior.

185. How should a nurse expect a client's anxiety to be manifested physiologically? 1. Constricted pupils 2. Narrowed bronchioles 3. Decreased blood pressure 4. Increased blood glucose level

4 The fight-or-flight responses of the sympathetic nervous system are stimulated, causing an increase in blood glucose through glycogenolysis and gluconeogenesis

225. A nurse sits with a depressed client twice a day, although there is little verbal communication. One afternoon, the client asks, "Do you think they'll ever let me out of here?" What is the nurse's best reply? 1. "We should ask your doctor." 2. "Everyone says you're doing fine." 3. "Do you think you are ready to leave?" 4. "How do you feel about leaving here?"

4 The nurse's response urges the client to reflect on feelings and encourages communication.

193. What characteristic uniquely associated with psychophysiologic disorders differentiates them from somatoform disorders? 1. Emotional cause 2. Feeling of illness 3. Restriction of activities 4. Underlying pathophysiology

4 The psychophysiologic response (e.g., hyperfunction or hypofunction) creates actual tissue change. Somatoform disorders are unrelated to organic changes.

200. What should a nurse consider when planning care for a client who is using ritualistic behavior? 1. Nurses must attempt to limit the ritualistic behavior. 2. Clients need to realize that ritualistic behavior serves no purpose. 3. Nurses should try to divert the ritual immediately after it is started. 4. Clients do not want to repeat the ritual but feel compelled to do so.

4 The repeated thought or act defends the client against even higher, more severe levels of anxiety.

243. When a nurse sits next to a depressed client and begins to talk, the client states, "I'm stupid and useless. Talk with the other people who are more important." Which response is most therapeutic? 1. "Everyone is important." 2. "Do you feel that you are not important?" 3. "Why do you feel you are not important?" 4. "I want to talk with you because you are important to me."

4 This response expresses the nurse's positive thoughts about the client while letting the client know that the nurse is concerned.

222. A client is admitted to the mental health unit after attempting suicide. When a nurse approaches, the client is tearful and silent. What is the nurse's best initial intervention? 1. Observe the behavior, record it, and notify the health care provider. 2. Sit quietly next to the client and wait for the client to start speaking. 3. Say, "You are crying. That means you feel badly about attempting suicide and really want to live." 4. Say, "I see you are tearful. Tell me about what is going on in your life, and we can work on helping you."

4 This response recognizes feelings and behavior and encourages the client to share feelings; it also promotes trust, which is essential to a therapeutic relationship.

208. A client who is being admitted to the mental health unit with bipolar disorder is depressed, avoids eye contact, responds in a very low voice, and is tearful. What is most therapeutic for a nurse to say during the assessment interview? 1. "You'll find that you'll get better faster if you try to help us to help you." 2. "Hold my hand. I know you are frightened. I will not allow anyone to harm you." 3. "I'm your nurse. I'll take you to the day room as soon as I get some information." 4. "I know this is difficult, but as soon as we are finished, I'll take you to your room."

4 This statement recognizes feelings and tells what is expected.

192. What characteristic of anxiety is associated with a diagnosis of conversion disorder? 1. Free floating 2. Relieved by the symptom 3. Consciously felt by the client 4. Projected onto the environment

2 The client's anxiety results from being unable to choose psychologically between two conflicting actions. The conversion to a physical disability removes the choice and therefore reduces the anxiety.

234. A nurse is assigned to care for a depressed client on a day when the client seems more withdrawn and depressed than usual. Which nursing intervention is most appropriate? 1. Remain visible to the client. 2. Involve the client in group activities. 3. Spend a few extra minutes with the client throughout the day. 4. Ask the client if it would help if you both sat together for a while.

3 Spending extra time with the client demonstrates that the client is worthy of the nurse's time and that the nurse cares.

233. A nurse moves into the working phase of a therapeutic relationship with a depressed client who has a history of suicide attempts. What question should the nurse ask the client when exploring alternative coping strategies? 1. "How have you managed your problems in the past?" 2. "What do you feel you have learned from this suicide attempt?" 3. "How will you manage the next time your problems start piling up?" 4. "Were there other things going on in your life that made you want to die?"

3 This question focuses the interaction toward the future and invites the client to explore alternative coping strategies.

235. A nurse is discharging a client from the mental health unit who has been treated for major depression. Which statement is most therapeutic at this time? 1. "I am going to miss you; we have become good friends." 2. "I know you are really going to be all right when you go home." 3. "Call the contact number you were given if you have an emergency." 4. "This is my phone number; call me to let me know how you are doing."

3 This statement demonstrates an understanding that the newly discharged client needs to have a support system when discharged. Clients need to feel that in a crisis there will be someone there for them.

177. In what situation should a nurse anticipate that a client will experience a phobic reaction? 1. Seeking attention from others 2. Thinking about the feared object 3. Coming into contact with the feared object 4. Being exposed to an unfamiliar environment.

3 With phobias, the individual transfers anxiety to a safer inanimate object or situation. Therefore, the anxiety and resulting feelings will be precipitated only when in direct contact with the object or situation.

184. What clinical findings may be expected when a nurse assesses an individual with an anxiety disorder? Select all that apply. 1. Worrying about a variety of issues 2. Acting out with antisocial behavior 3. Regressing to an earlier level of adjustment 4. Converting the anxiety into a physical symptom 5. Displacing the anxiety onto a less threatening object

Answer: 1, 3, 4, 5.

181. People who are involved in a bioterrorism attack exhibit immediate reactions to the traumatic event. Which responses can a nurse expect in survivors during the immediate period after a traumatic event? Select all that apply. 1. Guilt 2. Denial 3. Altruism 4. Confusion 5. Helplessness

Answer: 2, 4, 5.

179. An adult reports anxiety, palpitations, and a feeling of impending doom. After a thorough physical examination, the health care provider diagnoses a panic attack. Lorazepam (Ativan) 1.5 mg po stat is prescribed. The Ativan is available in 0.5 mg tablets. How many tablets should the nurse administer? Record your answer using a whole number.

Answer: 3 tablets. Use the "Desire over Have" formula of ratio and proportion to solve this problem. (look phone for calculation)

253. A client who is in a manic phase of bipolar disorder threatens staff and clients on an acute psychiatric unit. Place the following interventions in priority order from the least restrictive to the most restrictive. 1. _____ Seclusion 2. _____ Restraints 3. _____ Limit setting 4. _____ Diversional activities 5. _____ Medication administration

Answer: 4, 3, 5, 1, 2.

259. The nurse assesses a client with the diagnosis of bipolar disorder, manic episode. Which clinical findings support this diagnosis? Select all that apply. 1. Passivity 2. Dysphoria 3. Anhedonia 4. Grandiosity 5. Talkativeness 6. Distractibility

Answer: 4, 5, 6

260. A depressed client often sleeps past the expected time of awakening and spends excessive time resting and sleeping. Which nursing intervention is appropriate for this client? 1. Restrict the client's access to the bedroom. 2. Offer the client a series of relaxation tapes. 3. Reschedule the client's bedtime to an earlier hour. 4. Suggest that the client exercise before going to bed.

1 The goal is 6 to 8 hours of rest at night; too much time spent sleeping in the daytime will defeat the goal of adequate rest at night.

257. What is essential for the nurse to do when approaching a client during a period of overactivity? 1. Use a firm but caring and consistent approach. 2. Anticipate and physically control the hyperactivity. 3. Allow the client to choose the activities in which to participate. 4. Let the client know the staff will not tolerate destructive behavior.

1 This will help reduce the client's anxiety, thereby reducing hyperactivity.

191. A nurse is caring for a client who has a diagnosis of conversion disorder with paralysis of the lower extremities. Which is the most therapeutic nursing intervention? 1. Encouraging the client to try to walk 2. Explaining to the client that there is nothing wrong 3. Avoiding focusing on the client's physical symptoms 4. Helping the client follow through with the physical therapy plan

3 The physical symptoms are not the client's major problem and therefore should not be the focus for care. This is a psychologic problem, and the focus should be in this domain.

249. A client with bipolar disorder, manic episode, has a superior, authoritative manner and constantly instructs other clients about how to dress, what to eat, and where to sit. The nurse should intervene because these behaviors eventually will cause the other clients to feel: 1. angry. 2. dependent. 3. inadequate. 4. ambivalent.

1 A person with a condescending, superior attitude frequently evokes feelings of anger in others, which helps to decrease their anxiety.

212. What is most appropriate for a nurse to say when interviewing a newly admitted depressed client whose thoughts focus on feelings of worthlessness and failure? 1. "Tell me how you feel about yourself." 2. "Tell me what has been bothering you." 3. "Why do you feel so bad about yourself?" 4. "What can we do to help you while you are here?"

1 Because major depression is due to the client's feelings of selfrejection, it is important for the nurse to have the client initially identify these feelings before a plan of care can be developed. Later discussion should be on other topics to prevent reinforcement of negative thoughts and feelings.

195. A nurse is caring for a client diagnosed with an obsessive-compulsive disorder. What is the basis for the obsessions and compulsions? 1. Unconscious control of unacceptable feelings 2. Conscious use of this method to punish themselves 3. Acceptance of voices that tell them the doorknobs are unclean 4. Fulfillment of a need to punish others by carrying out an annoying procedure

1 By carrying out the compulsive ritual the client unconsciously tries to control anxiety by avoiding acting on unacceptable feelings and impulses.

187. A client comes to a mental health center with severe anxiety evidenced by crying, wringing the hands, and pacing. What should be the first nursing intervention? 1. Stay physically close to the client. 2. Gently ask what is bothering the client. 3. Tell the client to try to relax by sitting quietly. 4. Involve the client in a nonthreatening activity.

1 By staying physically close, the nurse conveys the message that someone cares enough to be there and that the client is a person worthy of care.

240. A severely depressed client is to have electroconvulsive therapy (ECT). What should a nurse include when discussing this therapy with the client? 1. Sleep will be induced and treatment will not cause pain. 2. Treatment is totally safe with the new methods of administration. 3. You can ask any question you like, but it is better not to talk about it. 4. There may be some unrecoverable short-term and long-term memory loss.

1 Clients fear this therapy because they think it will be painful. If they are reassured that they will be asleep and have no pain, there will be less anxiety.

207. A nurse is caring for a client with a somatoform disorder. What should the nurse anticipate that this client will do? 1. Redirect the conversation with the nurse to physical symptoms. 2. Monopolize conversations about the anxiety being experienced. 3. Write down conversations to assist in remembering information. 4. Start a conversation asking the nurse to recommend palliative care.

1 Clients with a somatoform disorder are preoccupied with the symptoms that are being experienced and usually do not want to talk about their emotions or relate them to their present situation.

239. What treatment should a nurse anticipate will be ordered for a client with severe, persistent, intractable depression and suicidal ideation? 1. Electroconvulsive therapy 2. Short-term psychoanalysis 3. Nondirective psychotherapy 4. High doses of anxiolytic drugs

1 Electroconvulsive therapy, which interrupts established patterns of behavior, helps relieve symptoms and limits possible suicide attempts in clients with severe, intractable depression that does not respond to antidepressant medication.

256. A client is admitted to a psychiatric hospital after a month of unusual behavior that included eating and sleeping very little, talking and singing constantly, and going on frequent shopping sprees. In the hospital, the client is demanding, bossy, and sarcastic. Which disorder does the nurse associate with these behaviors? 1. Bipolar disorder, manic phase 2. Antisocial personality disorder 3. Obsessive-compulsive disorder 4. Chronic undifferentiated schizophrenia

1 Hyperactive behavior in individuals such as this is typical of the manic flight into reality associated with mood disorders.

246. A client exhibiting manic behavior is admitted to the psychiatric hospital. In which room should the nurse manager place the client? 1. One that has basic simple furnishings 2. One with another client who is very quiet 3. A room that will provide a variety of stimuli 4. A room with another client exhibiting similar behavior

1 Overactive individuals are stimulated by environmental factors. A responsibility of the nurse is to simplify their surroundings as much as possible.

211. A nurse is planning care for a depressed client. Which approach is most therapeutic? 1. Allowing the client time to complete activities 2. Helping the client focus on the family support system 3. Encouraging the client to perform menial, repetitious tasks 4. Telling the client repeatedly that the staff views the client as worthwhile

1 Routines should be kept simple, and no demands should be made that the client cannot meet. The client is depressed, and all reactions will be slow. Putting pressure on the client will increase anxiety and feelings of worthlessness.

221. A client with major depression that includes psychotic features tells the nurse, "All my relatives have been killed because I have been sinful and need to be punished." What is the primary focus of nursing interventions? 1. Protect the client against any suicidal impulses. 2. Support the client's interest in the outside world. 3. Help the client manage the concern for family members. 4. Reassure the client that past behaviors are not being punished.

1 Suicidal impulses take priority, and the client must be stopped from acting on them while treatment is in progress. The client's safety is the focus of nursing interventions.

175. A client arrives at the mental health clinic disheveled, agitated, and demanding that the nurse "do something to end this feeling." What clinical manifestation is evident? 1. Feelings of panic 2. Suicidal tendencies 3. Narcissistic ideation 4. Demanding personality

1 The client can no longer control or tolerate overwhelming feelings and is seeking help.

194. A client believes that doorknobs are contaminated and refuses to touch them, except with a paper tissue. What nursing intervention is most therapeutic for this client? 1. Supply the client with paper tissues to help functioning until anxiety is reduced. 2. Have the client scrub the doorknobs with a strong antiseptic so that tissues are no longer needed. 3. Encourage the client to touch doorknobs by removing all available paper tissue until learning how to manage the situation. 4. Explain to the client that the idea about doorknobs being

1 The client is using this compulsive behavior to control anxiety and needs to continue with it until the anxiety is reduced and more acceptable methods are developed to handle it.

203. A client is using ritualistic behaviors. Why should a nurse allow the client ample time for the performance of the ritual? 1. Denial of this activity may precipitate panic levels of anxiety. 2. Anger turned inward on the self should be allowed to be expressed. 3. Successful performance of independent activities enhances self-esteem. 4. Ample time provides an opportunity to point out the inappropriate behavior.

1 The repeated act defends the client against severe anxiety; interruption of the ritual will result in increased anxiety.

224. A frail, depressed client frequently paces the halls, becoming physically tired from the activity. What action should the nurse take to help reduce this activity? 1. Have the client perform simple, repetitive tasks. 2. Ask the client's health care provider to prescribe a sedative. 3. Restrain the client in a chair, thus reducing the opportunity to pace. 4. Place the client in a single room, thus limiting pacing to a smaller area.

1 These clients usually can be distracted by planned involvement in repetitious, simple tasks.

245. A depressed client tells a nurse, "I want to die." Which is the nurse's most therapeutic response? 1. "You would rather not live." 2. "You are not alone in feeling this way." 3. "When was the last time you felt this way?" 4. "Do you believe that there is life after death?"

1 This response uses paraphrasing to demonstrate to the client that it is all right to talk about these feelings; it recognizes the client's sense of hopelessness without intensifying the feeling while providing an opportunity to verbalize further.

214. Which activity is most appropriate for a nurse to introduce to a depressed client during the early part of hospitalization? 1. Board game 2. Project involving drawing 3. Small aerobic exercise group 4. Card game with three other clients

2 An art-type project that may be worked on successfully at one's own pace is appropriate for a depressed client.

220. A nurse plans to evaluate a newly admitted depressed client's potential for suicide. What is the best approach to obtain this information? 1. Question the client about plans for the future. 2. Inquire whether the client is now considering suicide. 3. Discuss suicide with other clients while the client is in the group. 4. Ask family members whether the client has ever attempted suicide

2 Directness is the best approach at the first interview because this sets the focus and concern and lets the nurse know what the client is feeling now.

252. A nurse is caring for a hyperactive, manic client who exhibits flight of ideas and is not eating. What may be the reason why the client is not eating? 1. Feels undeserving of the food 2. Is too busy to take the time to eat 3. Wishes to avoid others in the dining room 4. Believes that there is no need for food at this time

2 Hyperactive clients frequently will not take the time to eat because they are overinvolved with everything in their environment.

180. A nurse speaks with a client who just experienced a panic attack. Which statement is most therapeutic when addressing the client's concerns? 1. "I would have been upset, too." 2. "You are concerned that this might happen again." 3. "Episodes like this can be upsetting even though they do end." 4. "Your family must have thought you were having a heart attack."

2 Recurrence of attacks is a common concern.

244. A client is admitted to a mental health facility for depression. What action should a nurse take to help the client develop a positive selfregard? 1. Set limits on the client's negative behaviors. 2. Involve the client in activities that promote success. 3. Demonstrate approval of the client's efforts at every opportunity. 4. Encourage the client to participate in activities with other clients.

2 Self-esteem and feelings of competence are increased when a person experiences success.

189. An anxious client reports experiencing pain in the abdomen and feeling empty and hollow. A diagnostic workup reveals no physical causes of these clinical findings. What term best reflects what the client is experiencing? 1. Dissociation 2. Somatization 3. Stress response 4. Anxiety reaction

2 Somatization is erroneously attributing an anxious feeling to a body system or part.

232. A client is admitted to the psychiatric hospital after many selfinflicted nonlethal injuries over the last month. Which level of suicidal behavior is reflective of the client's behavior? 1. Threats 2. Gestures 3. Attempts 4. Ideations

2 Suicidal gestures involve superficial, nonlethal injuries; the client has no intent to die as a result of the injuries.

174. A nurse is caring for a client with a generalized anxiety disorder. Which factor should be assessed to determine the client's present status? 1. Memory 2. Behavior 3. Judgment 4. Responsiveness

2 The client's current behavior is the best indicator of the client's current level of functioning; all behavior has meaning

178. A nurse is interviewing a client with a phobia. Which treatment should the nurse inform the client has the highest success rate? 1. Insight therapy to determine the origin of the fear 2. Systematic desensitization using relaxation techniques 3. Psychotherapy aimed at rearranging psychotic thought processes 4. Psychoanalytic exploration of repressed conflicts of an earlier developmental phase

2 The most successful therapy for clients with phobias involves behavior modification techniques using desensitization.

237. After 4 days on the inpatient psychiatric unit, a client on suicidal precautions tells the nurse, "Hey, look! I was feeling pretty depressed for a while, but I'm certainly not going to kill myself." What is the nurse's best response to this statement? 1. "You do seem to be feeling better." 2. "We should talk some more about this." 3. "We have to observe you until you are better." 4. "I don't understand what you mean by killing yourself."

2 This encourages the client to talk about feelings without the nurse setting the focus for the discussion.

227. A depressed client states, "I am no good. I'm better off dead." What is the priority nursing intervention? 1. Stating, "I think you're good; you should think of living." 2. Alerting the staff to schedule 24-hour observation of the client 3. Responding, "I will stay with you until you are less depressed." 4. Unobtrusively removing those articles that may be used in a suicide attempt

2 This is the most therapeutic approach to prevent suicide. A staff member also provides special attention to help the client meet dependency needs and reduce a self-defeating attitude.

215. A withdrawn client refuses to get out of bed and becomes upset when asked to do so. What nursing action is most therapeutic? 1. Require the client to get out of bed. 2. Stay with the client until the client calms down. 3. Give the client the prn antipsychotic that is prescribed. 4. Leave the client alone in bed for as long as the client wishes.

2 This provides support and security without rejecting the client or placing value judgments on the behavior.

196. A nurse is developing a care plan for a client with an obsessive compulsive behavior disorder. Which nursing intervention will most likely increase the client's anxiety? 1. Helping the client understand the nature of the anxiety 2. Limiting the client's ritualistic acts to three times a day 3. Involving the client in establishing the therapeutic plan 4. Providing the client with a nonjudgmental environment

2 This sets an unrealistic limit that will increase anxiety by removing a defense the client needs.

217. During a special meeting to discuss the unexpected suicide of a recently discharged client, a nurse overhears another client moan softly, "I'm next. Oh, my God, I'm next. They couldn't protect that person, and they can't protect me." What is the nurse's most therapeutic response? 1. "That person was a lot sicker than you are." 2. "You seem to be afraid you will hurt yourself." 3. "It's different. The other person was home, while you are here." 4. "There is no need to worry. We will protect you even after you are discharged."

2 This statement identifies the importance of feelings and provides an opening for the client to talk about them.

172. A client's admitting history indicates signs of akathisia. What clinical finding should the nurse expect when assessing for akathisia? 1. Facial tics 2. Motor restlessness 3. Maintaining a body position for hours 4. Repeating the movements of another person

2 With akathisia the client exhibits a constant state of movement; this is characterized by restlessness and difficulty sitting still, including constant jiggling of the arms and/or legs.

255. How should the nursing staff provide for the nutritional needs of a client experiencing periods of extreme mania and hyperactivity? 1. Accept that the client will eat if hungry. 2. Allow the client to prepare meals to eat when desired. 3. Offer high-calorie snacks frequently that the client can hold. 4. Leave food in the client's room that can be eaten when desired.

3 Hyperactive clients burn up many calories, which must be replenished. Since these clients will not take the time to sit down to eat, providing them with food they can carry with them sometimes helps.

250. A client with the diagnosis of bipolar disorder, manic episode, is extremely active, talks constantly, and tends to badger the other clients, some of whom are now becoming agitated. What is the best strategy for a nurse to use with this client? 1. Humor 2. Sympathy 3. Distraction 4. Confrontation

3 During periods of hyperactivity the client has a short attention span and can be distracted easily; this is a therapeutic intervention for all the clients.

202. A nurse is caring for a client who uses ritualistic behavior. What common antiobsessional medication does the nurse anticipate will be prescribed? 1. Benztropine 2. Amantadine 3. Fluvoxamine 4. DiphenhydrAMINE

3 Fluvoxamine (Luvox) blocks the uptake of serotonin, which leads to a decrease in obsessive-compulsive behaviors.

216. A client with the diagnosis of bipolar disorder, depressive episode, has been hospitalized on a psychiatric unit for 1 week. What is the most appropriate activity for this client? 1. Complete a jigsaw puzzle alone. 2. Play a game of cards with several other clients. 3. Talk with the nurse several times during the day. 4. Engage in a game of Ping-Pong with another client.

3 Involving the client in a one-on-one conversation provides individualized, low-anxiety-producing attention and gives the message that the client is important, which supports self-esteem.

186. What is an appropriate way a nurse can help a client to decrease anxiety? 1. Avoid unpleasant events. 2. Prolong exposure to fearful situations. 3. Acquire skills with which to face stressful events. 4. Introduce an element of pleasure into fearful situations.

3 Learning a variety of coping mechanisms helps reduce anxiety in stressful situations.

248. What is the best nursing intervention when the language of a client in the manic phase of a bipolar disorder becomes vulgar and profane? 1. State, "We do not like that kind of talk around here." 2. Ignore it, since the client is using it to gain attention. 3. Recognize that the behavior is part of the illness, but set limits on it. 4. State, "We will talk to you when you can speak in an acceptable way."

3 Recognizing the language as part of the illness makes it easier to tolerate, but limits must be set for the benefit of the staff and other clients. Setting limits also shows the client that the nurse cares enough to stop the behavior.

188. A nurse considers that in a conversion disorder pseudoneurologic symptoms such as paralysis or blindness: 1. are unconscious methods for getting attention. 2. will subside if the client is helped to focus on getting healthy. 3. are generally necessary for the client to cope with a stressful situation. 4. will usually resolve when the client learns to cope with ongoing family conflicts.

3 The client is experiencing a psychological conflict that is manifested by a change in body function. Paralysis or blindness justifies the inability to move in any direction.

182. The parents of an adolescent who is experiencing posttraumatic stress disorder have decided to care for their child at home. What is the priority intervention that the home health nurse must include in the plan of care? 1. Encourage the parents to keep their child within the home environment. 2. Help the parents identify their child's problems that cause them to be fearful. 3. Assist the parents to understand that their child may avoid emotional attachments. 4. Discuss with the parents their feelings of ambivalence about what their child is enduring.

3 The client will tend to avoid emotional attachment to significant others because this is a common way to protect the self from the experience of potential future losses. The priority at this time is to have family members develop an understanding of what is happening to the client.

190. A client newly diagnosed with a conversion disorder is manifesting paralysis of a leg. The nurse can expect this client to: 1. demonstrate a spread of paralysis to other body parts. 2. require continuous psychiatric treatment to maintain independent functioning. 3. recover the use of the affected leg but, under stress, again develop similar symptoms. 4. follow an unpredictable emotional course in the future, depending on exposure to stress.

3 The conversion type of defense tends to be a learned behavioral response that the individual will use when experiencing excessive stress.

258. What should the nurse include when developing a plan of care for a client in the manic phase of bipolar disorder? 1. Focus the client's interest in reality. 2. Encourage the client to talk as much as needed. 3. Redirect the client's excess energy to constructive channels. 4. Persuade the client to complete any task that has been started.

3 The hyperactive client usually is easily distracted, so the excess energy can be redirected into constructive channels.

176. A client's severe anxiety and panic are often considered to be "contagious." What action should be taken when a nurse's personal feelings of anxiety are increasing? 1. Refocus the conversation on some pleasant topics. 2. Say to the client, "Calm down. You are making me anxious, too." 3. Say, "Another staff member is coming in. I will leave and return later." 4. Remain quiet so that personal feelings of anxiety do not become apparent to the client.

3 The nurse who is anxious should leave the situation after providing for continuity of care; the client will be aware of the nurse's anxiety, and the nurse's presence will be nonproductive and nontherapeutic.

241. An extremely depressed client signed the consent for electroconvulsive therapy (ECT) but continues to express anxiety about the procedure. What is most important for a nurse to emphasize when discussing ECT with the client? 1. "The procedure may cause a headache." 2. "The procedure will make you feel better." 3. "You will not be left alone during the procedure." 4. "You will have periods of amnesia after the procedure."

3 The staff's presence provides continued emotional support and helps relieve anxiety.

228. What is a therapeutic nursing action when caring for a depressed client? 1. Playing a game of chess with the client 2. Allowing the client to make personal decisions 3. Sitting down next to the client at frequent intervals 4. Providing the client with frequent periods of time for reflection

3 This gives the client the nonverbal message that someone cares and views the client as being worthy of attention and concern.

209. A depressed older client has not been eating well since admission to the hospital. The client repeatedly states, "No one cares." What is the nurse's most appropriate response? 1. "We all care about you; now please eat." 2. "We all care about you; you have to eat to stay alive." 3. "I care about you. What are some foods you especially like?" 4. "I care about you. Will you please eat some of this food for me?"

3 This is a direct response to the client's concern and allows some exploration of food choices.

201. What is the priority discharge criterion for a client who is using ritualistic behaviors? 1. Verbalizes positive aspects about the self 2. Follows the rules of the therapeutic milieu 3. Intervenes to maintain increasing anxiety at a manageable level 4. Recognizes that hallucinations occur at times of extreme anxiety

3 This outcome will result from teaching the client to recognize situations that provoke ritualistic behavior and from the client learning how to interrupt the pattern

236. On the second day after admission, a suicidal client asks a nurse, "Why am I being watched around the clock, and why can't I walk around the entire unit?" Which reply is most appropriate? 1. "Why do you think we are observing you?" 2. "What makes you think we are observing you?" 3. "We are concerned that you might try to harm yourself." 4. "We are following your doctor's orders, so there must be a reason."

3 This statement is honest and helps establish trust. Also, the client may realize that staff members care.

226. A nurse is working with a client with a major depressive episode. What is a long-term goal for this client? 1. Talk openly about the depressed feelings. 2. Identify and use new defense mechanisms. 3. Discuss the unconscious source of the anger. 4. Verbalize realistic perceptions of self and others.

4 A major part of depression involves an inability to accept the self as it is, which leads to making demands on others to meet unrealistic needs

206. Which is the best nursing intervention during the working phase of the therapeutic relationship to meet the needs of individuals who demonstrate obsessive-compulsive behavior? 1. Restricting their movements 2. Calling attention to the behavior 3. Keeping them busy to distract them 4. Supporting rituals while setting realistic limits

4 Accepting these clients and their symptomatic behavior sets the foundation for the nurse-client relationship. Setting limits provides external controls and helps lower anxiety. This intervention is appropriate during the working phase, not the initial phase, of a therapeutic relationship.

238. During a group discussion, it is learned that a group member hid suicidal urges and committed suicide several days ago. The nurse leading the group should be prepared to manage the: 1. guilt of the co-leaders that they failed to anticipate and prevent the suicide. 2. guilt that group members feel because they could not prevent another's suicide. 3. lack of concern over the suicide expressed by several of the members in the group. 4. fear by some members that their own suicidal urges may go unnoticed and unprotected.

4 Ambivalence about life and death plus the introspection commonly found in clients with emotional problems can lead to increased anxiety and fear among the group members.

210. A client is admitted to the mental health unit because of a progressively increasing depression over the past month. What clinical finding does a nurse expect during the initial assessment of the client? 1. Elated affect related to reaction formation 2. Loose associations related to thought disorder 3. Physical exhaustion resulting from decreased physical activity 4. Diminished verbal expression caused by slowed thought processes

4 As depression increases, thought processes become slower and verbal expression decreases.

213. A client whose depression is beginning to lift remains aloof from the other clients on the mental health unit. How can a nurse help the client to participate in an activity? 1. Find solitary pursuits that the client can enjoy. 2. Speak to the client about the importance of entering into activities. 3. Ask the health care provider to speak to the client about participating. 4. Invite another client to take part in a joint activity with the nurse and the client.

4 Bringing another client into a set situation is the most therapeutic, least-threatening approach.

183. A client with a general anxiety disorder says to the nurse, "What can I do to prevent overreacting to stress?" What is the nurse's best response? 1. "Hone your problem-solving skills." 2. "Improve your time management skills." 3. "Ignore situations that you cannot change." 4. "Develop a wide variety of coping strategies."

4 This increases the individual's ability to cope with stress; different defenses can be used in various situations.

254. A psychologist has been a client on a mental health unit for 3 days. The client has questioned the authority of the treatment team, advised other clients that their treatment plans are wrong, and has been disruptive in group therapy. What is the nurse's most appropriate intervention? 1. Tell the other clients to disregard what the client is saying. 2. Ignore the client's disruptive behavior and wait until it subsides. 3. Restrict the client's contact with other clients until the disruptive behavior ceases. 4. Accept that the client is unable to control this behavior, and set appropriate limits

4 Clients who are out of control need controls set for them. The staff must understand that the client is not deliberately trying to disrupt the unit.

230. A client with a diagnosis of major depression refuses to participate in unit activities because of being "just too tired." What is the nurse's best approach? 1. Plan one rest period during each activity. 2. Explain why the staff believes the activities are therapeutic. 3. Encourage the client to express negative feelings about the activities. 4. Accept the client's feelings about activities calmly, while setting firm limits.

4 Fatigue and apathy are symptoms of depression and should be accepted; however, limits should be set to facilitate participation in unit activities.

205. A nurse is preparing to care for a client who engages in ritualistic behavior. What should the plan of care include? 1. Redirect energy into activities to help others. 2. Teach the client that the behavior is not serving a realistic purpose. 3. Administer antianxiety medications that block out the memory of internal fears. 4. Help the client to understand that the behavior is caused by maladaptive coping to increased anxiety.

4 Helping clients understand that a behavior is being used to control anxiety usually makes them more amenable to psychotherapy

198. What should a nurse include in the initial plan of care for a client with the long-standing, obsessive-compulsive behavior of hand washing? 1. Determine the purpose of the ritualistic behavior. 2. Limit the time allowed for the ritualistic behavior. 3. Suggest a symptom substitution technique to refocus the ritualistic behavior. 4. Develop a routine schedule of activities to reduce the need for the ritualistic behavior.

4 Knowledge of a schedule allows the client to prepare for transitions; hurrying can increase anxiety and the performance of the ritual. Routines will also decrease anxiety and the need for the ritual.

173. A client is diagnosed with generalized anxiety disorder. For what behavior should the nurse assess a client to determine the effectiveness of therapy? 1. Participates in activities 2. Learns how to avoid anxiety 3. Takes medication as prescribed 4. Identifies when anxiety is developing

4 Recognition of anxiety or symptoms of increasing anxiety is an indication that the client is improving.

247. During the orientation tour for three new staff members, a young, hyperactive manic client greets them by saying, "Welcome to the funny farm. I'm Jo-Jo, the head yo-yo." Which meaning can the nurse assign to the client's statement? 1. Trying to fill the "life-of-the-party" role 2. Looking for attention from the new staff 3. Unable to distinguish fantasy from reality 4. Anxious over the arrival of new staff members

4 The client's behavior demonstrates increased anxiety. Since it was directed toward the new staff, it was probably precipitated by their arrival.

204. A nurse is caring for a client with an obsessive-compulsive personality disorder that involves rituals. What should the nurse conclude about the ritual? 1. Has a purpose but is useless 2. Is performed after long urging 3. Appears to be performed willingly 4. Seems illogical but is needed by the person

4 The client's exact adherence to carrying out the compulsive ritual relieves anxiety, at least temporarily. Furthermore, it meets a need and is necessary to the client.

242. A nurse is assisting with the administration of electroconvulsive therapy (ECT) to a severely depressed client. What side effect of the therapy should the nurse anticipate? 1. Loss of appetite 2. Postural hypotension 3. Complete temporary loss of memory 4. Confusion immediately after the treatment

4 The electrical energy passing through the cerebral cortex during electroconvulsive therapy (ECT) results in a temporary state of confusion after treatment.

199. A client with a history of obsessive-compulsive behaviors has a marked decrease in symptoms and expresses a wish to obtain a parttime job. On the day of a job interview the client arrives at the mental health center displaying signs of anxiety. What is the nurse's best response to the client's behavior? 1. "I know you're anxious, but by forcing yourself to go to the interview, you may conquer your fear." 2. "If going to an interview makes you this anxious, it seems as though you're not ready to go back to work." 3. "It must be that you really don't want that job after all. I think you should reconsider going to the interview." 4. "Going for your interview triggered some feelings in you. Perhaps you could call a friend to drive you there."

4 The symptoms are a defense against anxiety resulting from decision making, which triggers old fears; the client needs support.

197. Hospitalization or day-treatment centers are often indicated for the treatment of a client with an obsessive-compulsive disorder because these settings: 1. prevent the client from completing rituals. 2. allow the staff to exert control over the client's activities. 3. resolve the client's anxiety because decision making is minimal. 4. provide the neutral environment the client needs to work through conflicts.

4 These clients can work through their underlying conflicts more easily or productively when demands are reduced and the routine is simple.

223. A nurse has been assigned to work with a depressed client on a oneto-one basis. The next morning the client refuses to get out of bed, stating, "I'm too sick to be helped, and I don't want to be bothered." What is the nurse's best response? 1. "You will not feel better unless you make the effort to get up and get dressed." 2. "I know you will feel better again if you could just make an attempt to help yourself." 3. "Everyone feels this way in the beginning as they confront their feelings. I'll sit down with you." 4. "I know you don't feel like getting up, but you may feel better if you do. Let me help you get started."

4 This acknowledges the client's feelings, offers hope, and assists the client to a higher level of functioning.

231. A nurse stops by the room of a tearful, newly admitted depressed client and offers to walk with the client to the evening meal. The client looks intently at the nurse, saying nothing. What is the nurse's best response? 1. "I'll be at the desk if you need me." 2. "You must tell me what you are feeling now." 3. "We will walk together to dinner when you calm down." 4. "It may be very difficult for you to be on a psychiatric unit."

4 This statement lets the client know the nurse realizes the client is having difficulty without asking direct questions or focusing on specific behavior.

218. A depressed client is concerned about many fears that are upsetting and frightening and expresses a feeling of having committed the "unpardonable sin." What is the nurse's most therapeutic response? 1. "Your family loves you very much." 2. "You do understand that you really are not a bad person." 3. "You know these feelings are in your imagination and are not true." 4. "Your thoughts are part of your illness and will change as you improve."

4 This statement points out reality while accepting that the client believes the feelings and thoughts are real.

219. A client who attempted suicide by slashing the wrists is transferred from the emergency department to a mental health unit. What are the important nursing interventions when the client arrives on the unit? Select all that apply. 1. Obtain vital signs. 2. Assess for suicidal thoughts. 3. Institute continuous monitoring. 4. Initiate a therapeutic relationship. 5. Inspect the bandages for bleeding

Answer: 1, 2, 3, 4, 5.

229. A teenager recently committed suicide, and grief counselors have been working with students. What behaviors indicate to the school nurse that a student may be considering suicide? Select all that apply. 1. Withdrawing from friends 2. Giving away prized possessions 3. Memorializing the dead teenager 4. Talking excessively about the event 5. Becoming involved in student activities

Answer: 1, 2.