EAQ Mood and Affect
A client hospitalized with a severe myocardial infarction tells the nurse, "My life is over. I may as well just give up." What is the best response by the nurse? 1 "You feel your life is over?" 2 "Have you nothing to live for?" 3 "We are not going to let you die." 4 "Everything will be fine. Do not worry."
1 "You feel your life is over?" The response "You feel your life is over?" invites the client to expand on the statement, and feelings and fears may be discussed. The response "Have you nothing to live for?" addresses the future rather than the present; the statement may make the client defensive and may close off communication. The response "We are not going to let you die" is not a client-centered response and is false reassurance; the nurse does not know whether the client will recover. The nurse's statement "Everything will be fine. Do not worry." is also giving the client false reassurance.
A client is admitted to a psychiatric hospital after a month of unusual behavior that has 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 Bipolar disorder, manic phase This kind of hyperactive behavior is typical of the manic flight into reality associated with mood disorders. The behaviors are more indicative of a mood disorder than a personality disorder. Ritualistic, not manic, behavior is indicative of obsessive-compulsive disorder. A flat affect and apathy are more indicative of a schizophrenic disorder.
A nurse is planning care for a client admitted to the unit with a diagnosis of bipolar disorder, manic phase. In which type of room should the nurse tell the admissions clerk to place this client? 1 Private 2 Isolation 3 Semi-private 4 Negative-airflow
1 Private The client who is manic needs a nonstimulating environment. A person who is bipolar is not contagious and does not require an isolation room. The presence of another person in the room is considered stimulating and may interfere with the rest and sleep of both clients. A client who is bipolar does not need a negative-airflow room. This type of room is appropriate for a client with a communicable disease, such as tuberculosis, that requires airborne precautions.
What is essential for the nurse to do when approaching a client during a period of overactivity? 1 Using a firm but caring and consistent approach 2 Anticipating and physically controlling the hyperactivity 3 Allowing the client to choose the activities in which to participate 4 Letting the client know that the staff will not tolerate destructive behavior
1 Using a firm but caring and consistent approach Using a firm but caring and consistent approach will help reduce the client's anxiety, thereby reducing hyperactivity. It is not possible to physically control hyperactivity. The client is not capable of choosing activities at this time. The client may not be capable of controlling overactive behavior; setting verbal limits may not be effective.
A nurse identifies that a client who had a myocardial infarction is struggling with an alteration in self-concept. The nurse intervenes to promote client autonomy. The behavior that demonstrates an increase in client autonomy is when the client: 1 1. Actively participates in providing self-care 2 Verbalizes realistic expectations of caregivers 3 Discusses necessary lifestyle changes with family members 4 Lists the indicators of recovery after a myocardial infarction
1. Actively participates in providing self-care Planning self-care demonstrates decision making by the client; participating in care enhances feelings of self-worth and autonomy. Expectations do not reflect autonomy. Discussing necessary lifestyle changes with family members does not reflect autonomy; it may be intellectualization. Listing the indicators for recovery after a myocardial infarction does not reflect autonomy; it may be intellectualization
A practitioner plans to have a client with the diagnosis of bipolar disorder continue taking lithium after discharge. The nurse confirms that the teaching about the medication plan is understood when the client states: 1 "I know that I should stop the medication if I think I'm getting sick." 2 "I know that I may need to take the medication for the rest of my life." 3 "I know that this drug causes no serious side effects when it's taken correctly." 4 "I know that I'll have to increase the dosage at the beginning of a manic episode."
2 "I know that I may need to take the medication for the rest of my life." In clients with bipolar disorders, it has been shown that long-term lithium therapy flattens the highs of the euphoric episodes and minimizes the lows of the depressed episodes. The practitioner should be notified before the medication is stopped. The therapeutic level and the toxic level are very close, and serious side effects may occur. Clients should never adjust their own dosages.
A nurse on a psychiatric unit has been working with a suicidal college student for 2 days. The comment by the student that indicates relief from suicidal thinking is: 1 "I can be a burden to others." 2 "I feel very alone sometimes." 3 "I plan to go to school next semester." 4 "I don't know whether I can talk about my feelings."
3 "I plan to go to school next semester." The suicidal client cannot think about a positive future; therefore focusing on the future indicates improvement. Feeling like a burden to others reflects low self-esteem, which also increases the risk for suicide. Feeling alone reflects a perceived lack of support, which increases the risk for suicide. Not being able to talk about feelings increases the risk for suicide because the client must be able to verbalize feelings to reduce anxiety, seek help, or engage in therapy.
A client with chronic renal failure has been on hemodialysis for two years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely: 1 An attempt to punish the nursing staff 2 A constructive method of accepting reality 3 A defense against underlying depression and fear 4 An effort to maintain life and to live it as fully as possible
3 A defense against underlying depression and fear Both hostility and noncompliance are forms of anger that are associated with grieving. The client's behavior is not a conscious attempt to hurt others but a way to relieve and reduce anxiety within the self. The client's behavior is a self-destructive method of coping, which can result in death. The client's behavior is an effort to maintain control over a situation that is really controlling the client; it is an unconscious method of coping, and noncompliance may be a form of denial.
A client with the diagnosis of manic episode of bipolar disorder attends a mental health day treatment program. What supervised activity will be most therapeutic for this client during the early phase of treatment? 1 Doing a needlepoint project 2 Joining a brief swimming competition 3 Walking around the facility with a nurse 4 Playing a board game with another client
3 Walking around the facility with a nurse Walking around the facility with a nurse does not involve an element of competition and still allows the client to channel excess energy safely. A needlepoint project requires fine motor skills of a client who is hyperactive and whose attention span is limited. The sense of competition and added stimulation provided by a swimming competition may increase the client's anxiety. The client is too hyperactive to play a board game and may respond with distractibility or aggressiveness toward others.
A nurse sits with a depressed client twice a day, but there is little verbal communication. One afternoon the client asks, "Do you think they'll ever let me out of here?" What is the best reply by the nurse? 1 "We should ask your doctor." 2 "Everyone says you're doing fine." 3 "Do you think you're ready to leave?" 4 "How do you feel about leaving here?"
4 "How do you feel about leaving here?" The nurse's response urges the client to reflect on feelings and encourages communication. "We should ask your doctor" shifts responsibility from the nurse to the health care provider; it is an evasive response. "Everyone says you're doing fine" is not what the client is asking the nurse; it closes the door to further communication. "Do you think you're ready to leave?" may elicit a yes or no answer; it does not encourage communication.
An older client who lost a spouse 20 years ago comes to the community health center with a vague list of complaints and a brief life history. The couple's only child died at birth. The client lives alone and is able to perform all the activities of daily living. The client has had an active social life in the past but has outlived many friends and family members. What is an important question for the nurse to ask when taking this client's health history? 1 "Are you all alone?" 2 "How did your son die?" 3 "Do you still miss your spouse?" 4 "How do you feel about your life now?"
4 "How do you feel about your life now?" The answer to "How do you feel about your life now?" will provide the nurse with an idea of the client's hopes and frustrations without being threatening or probing. "Are you all alone?" is probing and provides little information for the nurse to use in planning care. "How did your son die?" and "Do you still miss your spouse?" are both probing, disregard the client's present situation, and provide little information for the nurse to use in planning care.
A nurse has been assigned to work with a depressed client on a one-on-one basis. The next morning the client refuses to get out of bed, saying, "I'm too sick to be helped, and I don't want to be bothered." What is the best response by the nurse? 1 "You won't feel better unless you make the effort to get up and get dressed." 2 "I know you'll feel better again if you just make an attempt to help yourself." 3 "Everyone feels this way in the beginning as they confront their feelings. I'll sit with you." 4 "I know you don't feel like getting up, but you might feel better if you did. Let me help you get started."
4 "I know you don't feel like getting up, but you might feel better if you did. Let me help you get started." The statement "I know you don't feel like getting up, but you might feel better if you did. Let me help you get started" acknowledges the client's feelings, offers hope, and helps the client to a higher level of function. The statement "You won't feel better unless you make the effort to get up and get dressed" ignores the client's feelings and may not be true. The statement "I know you'll feel better again if you just make an attempt to help yourself" denies the client's feelings, and feeling better cannot be guaranteed. The statement "Everyone feels this way in the beginning as they confront their feelings. I'll sit with you" minimizes the client's feelings; also the client is not interested in how others feel.
A nurse identifies the establishment of trust as a major nursing goal for a depressed client. How can this goal best be accomplished? 1 By spending a day with the client 2 By asking the client at least one question daily 3 By waiting for the client to initiate the conversation 4 By visiting frequently for short periods with the client each day
4 By visiting frequently for short periods with the client each day Frequent short visits with the client each day demonstrate to the client that the nurse feels that the client is worth spending time with and helps restore and build trust. Spending a day with the client may be impossible on a regular basis unless the client is potentially suicidal. Asking the client at least one question a day will do little to establish communication between the nurse and the client and may be seen as threatening. The depressed client may never speak to the nurse and, left alone, will withdraw even further.
A client has become increasingly depressed, and the practitioner prescribes an antidepressant. After 20 days of therapy, the client returns to the clinic. The client appears relaxed and smiles at the nurse. The most significant conclusion that the nurse can draw from this behavior is that the client: 1 Wants to please the staff 2 Has resolved her conflicts 3 May be in denial of her problems 4 Is responding to the antidepressant therapy
4 Is responding to the antidepressant therapy Improvement in mood can be seen in about 3 weeks with antidepressants. There are insufficient data to draw the conclusion that the client wants to please the staff. It is unlikely that conflicts have resolved in such a short time. Because the client has been depressed and sought treatment, it is unlikely that she is in denial.
client is hospitalized because of severe depression. The client refuses to eat, stays in bed most of the time, does not talk with family members, and will not leave the room. The nurse attempts to initiate a conversation by asking questions but receives no answers. The nurse is frustrated and tells the client that if there is no response, the nurse will leave and the client will remain alone. How should the nurse's behavior be interpreted? 1 A system of rewards and punishment is being used to motivate the client. 2 Leaving the client alone allows time for the nurse to think of other strategies. 3 This behavior indicates the client's desire for solitude that the nurse is respecting. 4 This threat is considered assault, and the nurse should not have reacted in this manner.
4 This threat is considered assault, and the nurse should not have reacted in this manner. This response is a threat (assault) because the nurse is attempting to put pressure on the client to speak or be left alone. This is not a reward and punishment technique that is used in behavior modification therapy. Clients in emotional crisis should not be left alone.
The nurse identifies that a client who had extensive abdominal surgery appears depressed. The most appropriate nursing action is: 1 Talking with the client and encouraging exploration of feelings 2 Asking the client's primary health care provider to prescribe an antidepressant medication 3 Understanding that the client's depression is an expected response to surgery 4 Reassuring the client that feelings of depression will lift after returning home
1 Talking with the client and encouraging exploration of feelings The nurse must first explore the client's feelings; an honest discussion with emphasis on concerns helps promote adjustment. Asking the client's health care provider to prescribe an antidepressant medication may be necessary if the depression continues. Postoperative depression is not an expected response to surgery. Reassuring the client that feelings of depression will lift after returning home is false reassurance because there is no guarantee that the depression will lift at home.
An 8-year-old child is found to have oppositional defiant disorder. What behavior noted by the nurse supports this diagnosis? 1 Easily distracted 2 Argues with adults 3 Lies to obtain favors 4 Initiates physical fights
2 Argues with adults Oppositional defiant disorder is a repeated pattern of negativistic, disobedient, hostile, defiant behavior toward authority figures, usually exhibited before 8 years of age. Easy distraction, associated with attention deficit-hyperactivity disorder, reflects an inability to sustain focus on a task. Lying to obtain favors is associated with conduct disorder and reflects a violation of a societal norm. Initiating physical fights and violating the rights of others are associated with conduct disorder.
A nurse is caring for a female client during the manic phase of a bipolar disorder. What should the nurse do to help the client with personal hygiene? 1 Suggest that she wear hospital clothing 2 Guide her to dress appropriately in her own clothing 3 Allow her to apply makeup in whatever manner she chooses 4 Keep makeup away from her because she will apply it too freely
2 Guide her to dress appropriately in her own clothing Having these clients wear personal clothing helps keep them more in touch with reality. The client may need direction to dress appropriately. Suggesting that she wear hospital clothing does not help the client learn new ways to cope with problem situations. Allowing her to apply makeup in whatever manner she chooses may set up the client as a target of ridicule by other clients. The client may use makeup but with supervision.
A frail, depressed client who frequently paces the halls becomes physically tired from the activity. What action should the nurse take to help reduce this activity? 1 Restrain the client in a chair 2 Have the client perform simple, repetitive tasks 3 Ask the client's health care provider to prescribe a sedative 4 Place the client in a single room to limit pacing to a smaller area
2 Have the client perform simple, repetitive tasks Clients who pace can usually be distracted by planned involvement in repetitious, simple tasks. The client's health care provider should be asked to prescribe a sedative only if the client's restlessness cannot be controlled with other measures and the physical exhaustion creates a danger. Restraining the client in a chair is abusive treatment for a client with a need to pace and reinforces the client's belief that punishment is required for redemption. The client may perceive being placed in a single room as a punishment, and it will limit the staff's ability to observe the client.
A withdrawn client refuses to get out of bed and becomes upset when asked to do so. What nursing action is most therapeutic? 1 Requiring the client to get out of bed 2 Staying with the client until the client calms down 3 Giving the client the PRN antipsychotic that is prescribed 4 Leaving the client alone in bed for as long as the client wishes
2 Staying with the client until the client calms down Staying with the client until the client calms down provides support and security without rejecting the client or placing value judgments on the behavior. Eventually limits will have to be set in giving care, but staying with the client and showing acceptance are immediate nursing actions. Although giving the client the PRN antipsychotic will calm the client, it does not address the problem. Leaving the client alone in bed for as long as the client wishes ignores the problem; isolation implies punishment.
A client has been hospitalized for 3 weeks while receiving a tricyclic medication for severe depression. One day the client says to the nurse, "I'm really feeling better; my energy level is up." After the encounter an aide tells the nurse that the client has given away his favorite jacket. What should the nurse conclude that the client's statement indicates? 1 Improved mood 2 Improved socialization 3 Increased risk for suicide 4 Heightened need for independence
3 Increased risk for suicide When the energy level improves in the depressed client, the risk for suicide increases; also, the client has given away a personal belonging, which may indicate a plan to commit suicide. Elevated mood may be true, but the gift of a cherished personal belonging decreases the possibility that the client's statement simply reflects an improvement in mood. The client's socialization may be improved, but the gift of a valuable personal belonging decreases the possibility that the act simply reflects an improved level of socialization. Giving something away is unrelated to independence.
How should the nursing staff fulfill the nutritional needs of a client experiencing periods of extreme mania and hyperactivity? 1 Accepting that the client will eat when hungry 2 Allowing the client to prepare meals to eat when desired 3 Offering high-calorie snacks frequently that the client can hold 4 Leaving food in the client's room that can be eaten when desired
3 Offering high-calorie snacks frequently that the client can hold Hyperactive clients burn up many calories, which must be replenished. Because such clients will not take the time to sit down to eat, providing them with food that they can carry sometimes helps. The client will probably not be aware of hunger and may go without food for a dangerously long time. The client is not capable of preparing food at this time. The client probably will not be aware of hunger and will not independently initiate eating.
A client has just awakened from her first electroconvulsive therapy (ECT) treatment. What is the most appropriate initial intervention by the nurse? 1 Immediately getting the client out of bed and back into the unit's routine 2 Sitting the client up and arranging for the dietary staff to deliver a lunch tray 3 Orienting the client to time and place and explaining that the treatment is over 4 Taking the client's pulse and blood pressure every 15 minutes until the client is fully awake
3 Orienting the client to time and place and explaining that the treatment is over Clients are confused when they awaken after ECT. They have loss of recent memory, so it is important to orient them to time, place, and situation. The client should be monitored until vital signs are stable and the client is alert, oriented, and able to walk without assistance; this generally takes 1 to 3 hours. Sitting the client up may be done later action if the client asks for food. Vital signs are monitored until stable; they may become stable before the client is fully awake.
A client who has been attending a day treatment facility for 1 month with the diagnosis of major depression is to be discharged in a week. Because the nurse and the client are aware of this, what is the most appropriate comment by the nurse? 1 "We have just a few sessions left. I'm really pleased at your progress." 2 "Your discharge date has been set for next week. That's wonderful news." 3 "We have five sessions remaining. We need to start making plans to end our sessions." 4 "I understand that your discharge is set for next week. I'm wondering how you feel about that."
4 "I understand that your discharge is set for next week. I'm wondering how you feel about that." Plans for termination that take emotional needs into account are best made after exploration of the client's thoughts and feelings about discharge. Noting that there are just a few sessions left and expressing pleasure at the client's progress acknowledges the future termination but focuses on the nurse's, not the client's, feelings. Noting that the client's discharge date has been set for next week and calling this wonderful news acknowledges the future termination but suggests that the client should feel wonderful about the discharge, which may or may not be true. Although noting that the client and nurse have five sessions remaining and that the two need to start making plans to end the sessions acknowledges the future termination, plans for termination should be made after a discussion of the client's emotional response to the pending discharge
A client in an acute mental health unit appears severely depressed. The client does not initiate conversations or perform personal care. Questions are answered with a barely audible one- or two-word response. The nurse sits with the client and makes no demands. On what premise is the nurse's intervention for this client based? 1 Nurses are required to spend time with assigned clients. 2 Environmental stimulation helps depressed clients feel more worthwhile. 3 Nurses are expected to initiate one-to-one interactions on an acute care unit. 4 Spending time with depressed clients demonstrates that they are worthy of attention.
4 Spending time with depressed clients demonstrates that they are worthy of attention A severely depressed client has low self-esteem; this intervention demonstrates that the client is important and worthy of attention. Although it is true that nurses are required to spend time with assigned clients, it does not address the needs of this client. Although depressed clients do need stimulation, that alone will not improve self-esteem. Although it is true that nurses are expected to initiate one-to-one interactions on an acute care unit, it does not address the needs of the client.
