NU271 Week 5 PrepU: Mood & Affect / Mental Health Concepts

The nurse is caring for a client who has been prescribed oxazepam. What statement by the client would suggest an increased risk of CNS depression to the nurse? "I'm also taking baby Aspirin each day for my heart." "I take an over-the-counter antihistamine each day for my allergies." "I'm almost finished my course of antibiotics for this sinus infection." "If I get constipated, I sometimes take a stool softener for a couple of days."

"I take an over-the-counter antihistamine each day for my allergies." Antihistamines, combined with benzodiazepines, create a heightened risk for CNS depression. Aspirin, antibiotics and stool softeners would be unlikely to have this effect. Reference: Chapter 20: Anxiolytic and Hypnotic Agents - Page 343

A nurse identifies a nursing diagnosis of spiritual distress for a patient based on assessment of which of the following? Select all that apply. Ambivalence Peacefulness Anger Despair Acceptance

Ambivalence & Anger & Despair Spiritually distressed patients may show despair, discouragement, ambivalence, detachment, anger, resentment, or fear. They may question the meaning of suffering or life and express a sense of emptiness. Reference: N/A

A 70-year-old client has just been diagnosed with a major depressive episode. For what other condition should the nurse assess? Psychotic disorder Neurocognitive disorder Wernicke-Korsakoff syndrome Metabolic syndrome

Neurocognitive disorder Depression occurring after 65 years of age can be a precursor to neurocognitive disorder and, therefore, the nurse should assess for these conditions to enable early intervention and prolong the client's independence and quality of life. Metabolic syndrome is a cluster of risk factors, including dyslipidemia, abdominal obesity, insulin intolerance, and hypertension, that are associated with diabetes, heart disease, and some cancers. Psychotic disorders are not common as a comorbidity with depression. Wernicke-Korsakoff syndrome is a dementia disorder associated with chronic alcohol consumption. Reference: Chapter 18: Disorders of Thought, Emotion, and Memory - Page 470

The nurse is caring for a child with special health needs. The nurse is aware that which risks are increased by the parents in this population? Select all that apply. The parents may be experiencing financial difficulties. The father is probably most burdened by the child's care. The parents may struggle with finding appropriate educational services for the child. The parents are more likely to participate in health screening activities. The parents have a higher risk of developing depression.

The parents may be experiencing financial difficulties. & The parents may struggle with finding appropriate educational services for the child. & The parents have a higher risk of developing depression. Parents of children with special health needs have an elevated risk for developing depression, experiencing financial difficulties, and obtaining the educational services that are appropriate for the child. Mothers carry most of the burden of care. Parents of children with special health needs are less likely to perform health promotion activities. Reference: Ricci, S.S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 34: Caring for the Special Needs Child, p. 1240. Chapter 34: Caring for the Special Needs Child - Page 1240

A nurse in a residential foster home is caring for a 17-year-old client with oppositional defiant disorder. The client is using profanity and refusing to complete assigned chores. The nurse reminds the client that there are only 5 minutes in which to finish the chores. The client throws a dirty plate at the wall. How should the nurse respond? "You only have a few minutes to complete your chores." "If you calm down right now I will give you a few extra minutes to complete your chores." "I find your language offensive and you need to stop talking that way." "I am sorry you are feeling so angry tonight but you must still complete your chores."

"I am sorry you are feeling so angry tonight but you must still complete your chores." An adolescent with an oppositional defiant disorder can frequently demonstrate active defiance, has frequent anger and is noncompliant with adult requests or limits. In this situation the nurse's goal is to clearly but empathetically explain the rules and firmly adhere to them. Telling the adolescent there are only a few minutes to complete the chores does not exhibit empathy. Nor does the statement "I find your language offensive." It also does not address the rules. Letting the adolescent have a few extra minutes only reinforces the negative behavior and does not respect the rules of the facility. Reference: Ricci, S.S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 50: Nursing Care of the Child With an Alteration in Behavior, Cognition, Development, or Mental Health/Cognitive or Mental Health Disorder, p. 1968. Chapter 50: Nursing Care of the Child With an Alteration in Behavior, Cognition, Development, or Mental Health/Cognitive or Mental Health Disorder - Page 1968

A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns? "It's only a little stick. It'll be over before you know it." "When your thyroid levels are stable, we won't have to draw your blood as often." "I'll stay here with you while the technician draws your blood." "The physician has ordered this test so you can get better sooner."

"I'll stay here with you while the technician draws your blood." The nurse should tell the client that she will stay with him as the blood is drawn. This response provides the client with the reassuring presence of the nurse and enhances the therapeutic alliance, possibly providing a greater opportunity to educate the client. Although telling the client that blood won't need to be drawn as often when thyroid levels are stable provides the client with a rationale for needing blood work, it's more appropriate for the nurse to stay with the client. Saying that the procedure will be over quickly or that the physician has ordered the blood draw ignores the client's stated fear. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 52: Assessment and Management of Patients With Endocrine Disorders, Medical Management, p. 1515. Chapter 52: Assessment and Management of Patients With Endocrine Disorders - Page 1515

Which situation should concern the nurse treating a postpartum client within a few days of birth? The client is nervous about taking the baby home. The client would like the nurse to take her baby to the nursery so she can sleep. The client feels empty since she gave birth to the neonate. The client would like to watch the nurse give the baby her first bath.

The client feels empty since she gave birth to the neonate. A client experiencing postpartum blues may say she feels empty now that the infant is no longer in her uterus. She may also verbalize that she feels unprotected now. The other options are considered normal and would not be cause for concern. Many first-time mothers are nervous about caring for their neonates by themselves after discharge. New mothers may want a demonstration before doing a task themselves. A client may want to get some uninterrupted sleep, so she may ask that the neonate be taken to the nursery. Reference: Ricci, S. S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 22: Nursing Management of the Postpartum Woman at Risk, p. 858. Chapter 22: Nursing Management of the Postpartum Woman at Risk - Page 858

The nurse is attending a client with chronic renal failure. The client is experiencing a loss of appetite and reports feeling like everyday situations have become more stressful. The client reports feeling disappointed and frustrated with the condition, and says the family is not getting any help. What is the most important nursing intervention that the nurse needs to carry out at this point? schedule a family meeting offer nutritional counseling administer immunosuppressant coordinate with resources for client support

coordinate with resources for client support Promotion of psychological comfort is one of the most important aspects of the care of a client with chronic renal failure. Coordination of resources for client support is an appropriate nursing intervention in this situation. Scheduling a family meeting is a start, but more resources for the client may be needed. Nutritional counseling and administration of immunosuppressant drugs are medical management tasks. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 3: Critical Thinking, Ethical Decision Making, and the Nursing Process, p. 39. Chapter 3: Critical Thinking, Ethical Decision Making, and the Nursing Process - Page 39

The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication? Have the child lying down with the head elevated on a pillow. Let the child hold the medication cup. Ask the parent to hold the child's arms during administration. Administer the medication using a dropper.

Let the child hold the medication cup. Droppers and oral syringes can be used to administer medications to infants and young children. Medication cups and spoons can be used to administer liquid medications to the older child. The child can hold the medication cup and drink the liquid medication. Depending upon the age of the child, he or she may still prefer to take liquid medications via the syringe. It makes taking the medication fun when the child can squirt it into the mouth by himself or herself. The child who is lying down when being given medications should have the head of the bed elevated to at least 45 degrees A 5-year-old child does not need to be restrained for medication administration. Reference: Ricci, S.S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 35: Key Pediatric Nursing Interventions, p. 1263. Chapter 35: Key Pediatric Nursing Interventions - Page 1263

A nurse is teaching a client and family about best practice to minimize the cycling of bipolar disorder. Which instruction should be included in this teaching plan? Maintain a steady pattern of sleep and activity. Drink alcoholic beverages in moderation. Participate in exercise in the evening. Take antidepressant medications regularly.

Maintain a steady pattern of sleep and activity. To minimize disruptions of the bipolar cycle, the client should maintain a routine for sleep and activity. Strenuous physical activity should be in the morning so the client can relax before bedtime. Because antidepressants have been known to trigger mania, they are not encouraged unless there is profound unrelieved depression. Alcohol increases the risk of another manic episode, and so should be avoided. Reference: Chapter 18: Disorders of Thought, Emotion, and Memory - Page 466

A nurse is caring for a young adult in the mental health clinic. The client tells the nurse that the client was physically neglected as a child. The nurse should assess the client for symptoms of what? Panic disorder Schizophrenia Narcissistic personality disorder Major depression

Major depression An important outcome of nursing intervention with survivors is appropriate treatment of any disorder resulting from abuse, such as acute stress disorder, posttraumatic stress disorder, anxiety disorders, dissociative identity disorder, major depression, or substance abuse. Reference: Chapter 12: Abuse and Violence - Page 193

A 20-year-old college student presents to the campus medical clinic because of unshakable despondency in recent months and is diagnosed with depression. What treatments should the nurse expect to be prescribed? Medication that inhibits the reuptake of serotonin in his pre-synaptic space. Cholinesterase inhibitors that potentiate the action of available acetylcholine. Benzodiazepines such as clonazepam that modulate his GABA receptors. Drugs that inhibit the accumulation of cyclic adenosine monophosphatase (cAMP).

Medication that inhibits the reuptake of serotonin in his pre-synaptic space. Selective serotonin reuptake inhibitors (SSRIs) are common pharmacologic treatment modalities for depression. Drugs that inhibit the accumulation of cAMP are usually used in the treatment of bipolar depression. Benzodiazepines address anxiety while cholinesterase inhibitors are used in the treatment of dementia. Reference: Chapter 18: Disorders of Thought, Emotion, and Memory - Page 468

A nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder? Delirium Mood disturbance Anxiety Substance abuse

Mood disturbance When psychosis and mood disturbance occur at the same time, a diagnosis of schizoaffective disorder is made. Substance abuse, delirium, or anxiety are not involved with the diagnosis of schizoaffective disorder. Reference: Chapter 16: Schizophrenia - Page 256

A nurse is caring for a client diagnosed with bipolar disorder. The client is experiencing a manic episode. The nurse would be especially alert for signs indicating what? Weight loss Dehydration Sleep disruption Self-injury

Self-injury During a manic episode, client safety is a priority. Risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may believe that life is not worth living. During a manic episode, the client may believe that he or she has supernatural powers, such as the ability to fly. Although changes in sleep, fluid balance (such as dehydration), and inadequate nutrition manifested by weight loss would be important to assess, safety and prevention of self-injury are the priority. Reference: Chapter 17: Mood Disorders and Suicide - Page 312

A client suffers from low mood and disturbed sleep. This client is most likely experiencing a change in which neurotransmitter? Serotonin Calcitonin Parathyroid Melatonin

Serotonin Abnormalities of serotonin are involved in mental depression and sleep disorders. Calcitonin is a hormone produced by the thyroid gland. Melatonin is a peptide hormone not a neurotransmitter. Parathyroid is a gland that secretes parathyroid hormone. Reference: Chapter 2: Neurobiologic Theories and Psychopharmacology - Page 17-18

A patient reports depression and insomnia. A patient with these issues could have an abnormality of which neurotransmitter? Calcitonin Serotonin Melatonin Parathyroid

Serotonin Abnormalities of serotonin are involved in mental depression and sleep disorders. Calcitonin is a hormone produced by the thyroid gland. Melatonin is a peptide hormone, not a neurotransmitter. Parathyroid is a gland that secretes parathyroid hormone. Reference: Chapter 19: Introduction to Nerves and the Nervous System - Page 332

A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired? Acetylcholine Insulin Epinephrine Serotonin

Serotonin Serotonin helps regulate several behaviors that are disturbed in depression. Acetylcholine is a neurotransmitter with action in the cardiac and skeletal muscle. Acetylcholine has a limited impact in depression. Epinephrine is not associated with depression, though norepinephrine is implicated. Insulin is released by the pancreas to regulate blood sugar. Reference: Chapter 21: Antidepressant Agents - Page 363

A nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented, and she frequently indulges in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which condition? postpartum psychosis postpartum panic disorder postpartum blues postpartum depression

postpartum psychosis The client's signs and symptoms suggest that the client has developed postpartum psychosis. Postpartum psychosis is characterized by clients exhibiting suspicious and incoherent behavior, confusion, irrational statements, and obsessive concerns about the baby's health and welfare. Delusions, specific to the infant, are present. Sudden terror and a sense of impending doom are characteristic of postpartum panic disorders. Postpartum depression is characterized by a client feeling that her life is rapidly tumbling out of control. The client thinks of herself as an incompetent parent. Emotional swings, crying easily—often for no reason—and feelings of restlessness, fatigue, difficulty sleeping, headache, anxiety, loss of appetite, decreased ability to concentrate, irritability, sadness, and anger are common findings are characteristic of postpartum blues. Reference: Ricci, S. S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 22: Nursing Management of the Postpartum Woman at Risk, p. 860. Chapter 22: Nursing Management of the Postpartum Woman at Risk - Page 860

A nurse is caring for a client with severe depression. The client reports changes in appetite and sleep pattern and loss of a job because of the effects of the depression. The client has two young children at home and states, "I just wish things could be like they were. I feel so helpless that I can't even get out of bed in the morning." The physician has ordered electroconvulsive therapy (ECT) for the client in addition to the client's current antidepressant medications. A nurse evaluates the ECT therapy as effective when the client is suddenly cheerful, is very social at the nurses' station, and wants to see all the family members. is discharged from the hospital. sleeps through the night, eats 80% of meals, and is out of bed. begins to have memory loss about the depression and seems happier.

sleeps through the night, eats 80% of meals, and is out of bed. Return to normal sleeping patterns and eating habits shows improvement in depressive symptoms. Memory loss is an adverse effect of ECT but doesn't demonstrate symptom improvement. The client can be discharged from the hospital without ECT being effective. If a client exhibits a total change in behavior, the nurse should assess for suicidal thoughts. Reference: N/A

A new mother gave birth to her baby 24 hours ago and today has been content to rest in her hospital bed, hold her baby, allow the nurse to care for her, and to discuss her labor and birth experience with visitors. Which phase of the postpartum restorative period is this client in? rooming-in phase letting-go phase taking-hold phase taking-in phase

taking-in phase The taking-in phase is largely a time of reflection. During this 1- to 3-day period, a woman is largely passive. She prefers having a nurse attend to her needs and make decisions for her, rather than do these things herself. As a part of thinking and pondering about her new role, the woman usually wants to talk about her pregnancy, especially about her labor and birth. After a time of passive dependence, a woman enters the taking-hold phase and begins to initiate action. She prefers to get her own washcloth or to make her own decisions. In the letting-go phase, a woman finally redefines her new role. She gives up the fantasized image of her child and accepts the real one; she gives up her old role of being childless or the mother of only one or two (or however many children she had before this birth). Rooming-in is a feature offered by hospitals in which the infant is allowed to stay in the same hospital room as the mother following birth; it is not a phase of the postpartum period. Reference: Ricci, S. S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 15: Postpartum Adaptations, p. 548. Chapter 15: Postpartum Adaptations - Page 548

During a health history assessment, the mother of a 10-year-old girl tells you that her daughter does not have time to "play" because she is busy going to gymnastics, cheerleading, art class, flute lessons, reading club, and soccer. What should the nurse's response be? "It is understandable not playing any more with all these other activities." "Play helps children to develop cognitively, socially, physically, and emotionally." "Wow, that is a lot of stuff for a girl her age." "All of these other activities teach you as much as traditional play."

"Play helps children to develop cognitively, socially, physically, and emotionally." It is important to recognize that the child is busy with other activities but that this does not replace the need to engage in play. Children need time to play because it helps them to develop cognitively, socially, physically, and emotionally. Play at this age embodies the needs for rules and structures. Engaging in group activities allows children to be part of a social group. Reference: Ricci, S.S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 28: Growth and Development of the School-Age Child, p. 1057. Chapter 28: Growth and Development of the School-Age Child - Page 1057

After teaching a client who is prescribed imipramine about the drug, the nurse determines that the education was effective when the client states: "I need to avoid foods with fiber because diarrhea can occur." "I might notice some excess saliva in my mouth at different times." "I don't have to worry about getting dizzy when I get up from lying down." "I need to be careful because the drug can make me sleepy."

"I need to be careful because the drug can make me sleepy." Imipramine is a tricyclic antidepressant and is associated with sedation, orthostatic hypertension, and anticholinergic effects such as dry mouth and constipation. The client needs to be careful with activities because the drug is sedating. The client should change positions slowly to minimize orthostatic hypotension. Sugarless candies, good oral hygiene, and frequent rinsing of the mouth are helpful to combat dry mouth. A high fiber intake would be appropriate to decrease possible constipation. Reference: Chapter 2: Neurobiologic Theories and Psychopharmacology - Page 28

A 5-year-old girl is pretending to be a crocodile during a physical examination. Her mother just smiles and rolls her eyes at the nurse. What would be the best response for the nurse to give the child? "Oh no! I have a crocodile in my room. Please don't bite me!" "What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." "My dear, you are a girl, not a crocodile. Now sit still so that I can examine you." "What happened to my client? Did you eat her?"

"What a wonderful imagination you have! I've never seen anyone who was so good at pretending to be a crocodile." Parents sometimes strengthen a fantasy role without realizing it. A preschooler might be pretending she is a crocodile. If the nurse plays along, the child may be frightened she has actually become a crocodile. A better response is to support the imitation—this is age-appropriate behavior and a good way of exploring roles—by saying, "What a nice crocodile you're pretending to be." This both supports the fantasy and reassures the child she is still herself. Reference: Ricci, S.S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 27: Growth and Development of the Preschooler, p. 1032. Chapter 27: Growth and Development of the Preschooler - Page 1032

A client has just been diagnosed with bipolar disorder and is upset with the diagnosis. The client tells the nurse, "It is probably my mother's fault, she has bipolar too." Which is the best response by the nurse? "While bipolar disorders are genetic, there are other causes as well." "While bipolar disorders are genetic, the gene can only be passed on by a father." "Genetics are a minor factor in bipolar; it is more heavily influenced by psychological factors." "Bipolar disorders have not been found to be genetic."

"While bipolar disorders are genetic, there are other causes as well." Although a single definitive cause has not been pinpointed, scientists agree that a combination or interaction of genes, neurobiology, environment, life history, and development can result in bipolar disorders. Bipolar disorders are highly inheritable. Reference: Chapter 17: Mood Disorders and Suicide - Page 285-286

A 38-year-old client has been diagnosed with major depressive disorder. The client is being placed on an antidepressant and the nurse is providing medication teaching. Which would be appropriate information to provide to the client? You should notice an immediate improvement in your mood." "The antidepressant's ability to affect the neurons in your brain will take between 2 to 6 weeks." "If you do not notice an improvement in your symptoms in 1 to 2 weeks, a different antidepressant will be prescribed." "You may not notice an improvement in your symptoms for 2 to 6 weeks."

"You may not notice an improvement in your symptoms for 2 to 6 weeks." In general, all antidepressants act at the level of the neuron. Their effects include changing the receptor itself, altering metabolism and breakdown of the neurochemical, or blocking reuptake of the neurochemical at the presynaptic receptor. These changes occur soon after the medication is administered; however, reduction in depressive signs and symptoms usually takes between 2 to 6 weeks, depending on the drug. Reference: Chapter 17: Mood Disorders and Suicide - Page 288-289

A client with bipolar disorder is receiving lithium therapy. The nurse is reviewing the client's serum plasma drug levels and determines that the client's level is therapeutic based on what? 1.6 mEq/L 1.0 mEq/L 2.6 mEq/L 2.0 mEq/L

1.0 mEq/L Serum plasma lithium levels should range from 0.6 to 1.2 mEq/L. Levels above that suggest toxicity (moderate toxicity for levels 1.5 to 2.5 mEq/L; severe toxicity for levels greater than 2.5 mEq/L). Reference: Chapter 17: Mood Disorders and Suicide - Page 306

The perioperative nurse provides care to a diverse group of clients. Which client is most likely to benefit from the administration of a neuromuscular junction (NMJ) blocker in order to prevent musculoskeletal injury? A client with benign prostatic hyperplasia (BPH) who is preoperative for a transurethral prostatic resection A client who will have peripherally inserted central catheter (PICC) placed An older adult client who will undergo total hip arthroplasty A client with major depression who has been scheduled for electroconvulsive therapy (ECT)

A client with major depression who has been scheduled for electroconvulsive therapy (ECT) NMJ blockers are indicated during ECT to prevent injury from excessive muscle contraction. There would be no obvious reason to administer an NMJ blocker to facilitate insertion of a PICC, since reflex muscle movement does not normally present a challenge. NMJ blockers may be given during prostate or hip surgery, but as an adjunct to anesthesia rather than an injury prevention measure. Reference: Chapter 28: Neuromuscular Junction Blocking Agents - Page 482

A client exhibits hostility toward the persons from whom she wants love and approval. Which of the following states the client's condition? Ambidexterity Dual personality Split personality Ambivalence

Ambivalence Ambivalence means feeling or acting in two opposing ways at the same time. Split personality and dual personality refer to changes that occur in clients' personalities where they behave like different people. Ambidexterity means the ability to work equally well with both hands. Reference: N/A

After assessing a client with schizophrenia, the nurse notes that the client exhibits signs and symptoms related to being unable to experience pleasure. The nurse documents this finding as what? Anhedonia Avolition Alogia Diminished emotional expression

Anhedonia Anhedonia refers to the inability to experience pleasure. Diminished emotional expression is reflected by a restriction or flattening in the range and intensity of emotion. Alogia refers to a reduced fluency and productivity of thought and speech. Avolition refers to withdrawal and inability to initiate and persist in goal-directed activity. Reference: Chapter 16: Schizophrenia - Page 256

Which is not an action expected of a benzodiazepine? Muscle relaxant Antidepressant Anticonvulsant Antianxiety

Antidepressant Benzodiazepines do not function as an antidepressant. This drug classification has anticonvulsant, muscle relaxant, and antianxiety properties. Reference: Chapter 2: Neurobiologic Theories and Psychopharmacology - Page 31-32

At the present time there is only one diagnosis in the DSM-5 that has a causative factor. Which diagnosis has a causative factor? Posttraumatic stress disorder Depression Obsessive-compulsive disorder Anxiety Schizophrenia

Posttraumatic stress disorder The DSM-5 states that posttraumatic stress disorder (PTSD) is caused by exposure to a traumatic event. Depression, anxiety, obsessive-compulsive disorder, and schizophrenia do not have causative factors. Reference: Chapter 18: Disorders of Thought, Emotion, and Memory - Page 460

A client's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action? Perform a Mini Mental Status Examination (MMSE) Assess the client's jugular venous pressure Assess the client's blood pressure Call an emergency code

Assess the client's blood pressure Combining phenelzine with beer can precipitate a hypertensive crisis. There is no immediate indication that an emergency code is needed. The client's jugular venous pressure is less likely to be affected and is not a priority for assessment. Performing the MMSE is not a short-term priority. Reference: Chapter 17: Mood Disorders and Suicide - Page 290

A nurse therapist feels sad after sessions with a client. The client's passiveness reminds the nurse of a family member who led a very unhappy life. What is the term for this emotional dynamic? Free association Transference Countertransference Reaction formation

Countertransference Countertransference occurs when nurses have extreme emotional responses (positive or negative) to clients. Reference: Chapter 3: Psychosocial Theories and Therapy - Page 44

A nurse is preparing to administer pharmacotherapy as part of the treatment plan for a client with bipolar disorder. The nurse understands that this therapy is designed to achieve which goal? Select all that apply. Decreased severity of manic episodes Prevention of future episodes Rapid control of symptoms Cure of the disorder Decreased frequency of manic episodes

Decreased severity of manic episodes & Prevention of future episodes & Decreased frequency of manic episodes & Rapid control of symptoms Pharmacotherapy is essential to the successful management of bipolar disorder to achieve the goals of rapid control of symptoms and prevention of future episodes, or, at least, reduction in their severity and frequency. Reference: Chapter 17: Mood Disorders and Suicide - Page 285

Which is the most common disorder found in clients diagnosed with bulimia nervosa? Psychosis Anxiety Depression Substance abuse

Depression Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common. Reference: Chapter 20: Eating Disorders - Page 381-382

A client states, "I'm worthless, and I don't deserve to live." This theme in the client's expressed thought may signal a maladaptive response to which disorder? Delirium tremens Attention deficit hyperactivity disorder Mania Depression

Depression This theme in the client's expressed thoughts may signal unhealthy responses to depression. The other options are not indicative of a depressed state. Reference: Chapter 17: Mood Disorders and Suicide - Page 285

Which correctly describes the primary effect of a selective serotonin reuptake inhibitor (SSRI) antidepressant drug? The increase in the number of serotonin receptor sites in the central nervous system The management of the symptomology related to depression The inhibition of the hormonal cascade that affects the release of serotonin Its ability to block the reuptake of serotonin

Its ability to block the reuptake of serotonin An SSRI antidepressant drug's primary effect typically involves its ability to block the reuptake of serotonin, not the management of the symptomology related to depression, the inhibition of the hormonal cascase, nor the increase in the number of serotonin receptor sites. Reference: Chapter 2: Neurobiologic Theories and Psychopharmacology - Page 27-28

The partner of a pregnant client in her first trimester asks the nurse about the client's behavior recently, stating that she is very moody, seems happy one moment and is crying the next and all she wants to talk about is herself. What response would correctly address these concerns? Her body is changing and she may be angry about it. Pregnant women often experience mood swings and self-centeredness but this is normal. What you are describing may be normal but we need to talk to her more in depth. Moodiness and irritability are not usual responses to pregnancy.

Pregnant women often experience mood swings and self-centeredness but this is normal. During the first trimester of pregnancy, the woman often has mood swings, bouts of irritability and is hypersensitive. The partner needs to know that these are all normal behaviors for a pregnant woman. Reference: N/A

The partner of a pregnant client in her first trimester asks the nurse about the client's behavior recently, stating that she is very moody, seems happy one moment and is crying the next and all she wants to talk about is herself. What response would correctly address these concerns? Pregnant women often experience mood swings and self-centeredness but this is normal. What you are describing may be normal but we need to talk to her more in depth. Her body is changing and she may be angry about it. Moodiness and irritability are not usual responses to pregnancy.

Pregnant women often experience mood swings and self-centeredness but this is normal. During the first trimester of pregnancy, the woman often has mood swings, bouts of irritability and is hypersensitive. The partner needs to know that these are all normal behaviors for a pregnant woman. Reference: N/A

The nurse is caring for a mental health client who exhibits passive-aggressive behavior when interacting with the nursing staff. When reporting client behaviors to the next shift, which actions are consistent with this assessment? Select all that apply. The client pouts when they do not get their way. The client feels angry about the group session so the client scatters papers in the lunchroom. The client agrees with the staff but then complains to others. The client attacks the nurse and later cries feeling remorse. The client states that problems are not their fault.

The client feels angry about the group session so the client scatters papers in the lunchroom. & The client agrees with the staff but then complains to others. The client experiencing passive-aggressive behavior does not confront a situation directly but does something negative and potentially not even related to the situation in which they were upset. At times, the client may verbalize one thing and act in a different manner. A client who states that problems are not their fault may be refusing to accept responsibility for actions. Pouting reflects immature behavior. Attacking a nurse and then feeling remorse reflects aggressive behavior. Reference: N/A

A client asks the nurse which vitamins should be taken daily for feelings of fatigue, anxiety, and depression 1 week before menses. Which of the following is the correct response by the nurse? Vitamin D Vitamin A Vitamin B6 Vitamin C

Vitamin B6 The nurse should encourage taking Vitamin B6 daily, as it may be effective at relieving symptoms of irritability, fatigue, and depression related to the premenstrual period. Vitamin A supports growth and bone development, vision, reproduction, and development and maintenance of skin tissue. Vitamin C protects against immune system deficiencies, cardiovascular disease, prenatal health problems, eye disease, and even skin wrinkling. Vitamin C may protects against immune system deficiencies, cardiovascular disease, prenatal health problems, eye disease, and even skin wrinkling. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019.

A psychiatric-mental health nurse is teaching the family members of a client about strategies for engaging with their family member who has recently been diagnosed with posttraumatic stress disorder (PTSD). The nurse should encourage the client's family to: ensure the client takes benzodiazepines at the same time each day. expect that the client will sleep for short periods of time, several times per day. anticipate that the client is likely to be irritable and withdrawn at times. create social interaction for the client even if the client is actively opposed to socializing.

anticipate that the client is likely to be irritable and withdrawn at times. Clients with PTSD are prone to irritability and social withdrawal. In most cases, it is counterproductive and unethical to force a client into social situations if he or she is openly opposed to them. Sleep disruptions are expected, but there is no recognized pattern of frequent naps; insomnia is typical. Benzodiazepines are not normally used for the treatment of PTSD. Reference: Chapter 13: Trauma and Stressor-Related Disorders - Page 208

A client with schizoaffective disorder is prescribed medication therapy. Which type of medications would be most likely be ordered? typical antipsychotics antidepressants atypical antipsychotics mood stabilizers

atypical antipsychotics Although numerous drugs may be prescribed, atypical antipsychotics are generally prescribed because of their efficacy for psychosis and for their thymoleptic (mood stabilizing) properties. Atypical antipsychotics have been used more often than typical antipsychotics. If depressive symptoms persist despite antipsychotic use, antidepressants may be prescribed. Mood stabilizers are an alternative adjunct for mood states associated with the bipolar type of the disorder. Reference: Chapter 16: Schizophrenia - Page 258

Which type of elder mistreatment involves harm of self-worth? physical neglect emotional abandonment

emotional The six types of elder mistreatment are physical (injury by hitting, kicking, pushing, slapping, burning, and so on), sexual (unconsented sexual act), emotional (harm of self-worth or emotional well-being), neglect (failure to meet the older adult's basic needs of shelter, food, and so on), abandonment (leaving an older adult alone and no longer providing care), and financial (illegally misusing money, property, or assets). Reference: Ricci, S. S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 9: Violence and Abuse, p. 306. Chapter 9: Violence and Abuse - Page 306

The nurse is teaching a 15-year-old boy with type 2 diabetes and his parents how to monitor glucose levels. Which communication technique is least effective? using the adolescent's words during the conversation using reflection to clarify the parents' understanding paraphrasing the parents' comments before responding ignoring the adolescent's tirade about his therapy

ignoring the adolescent's tirade about his therapy The least effective technique is ignoring the adolescent's tirade about his therapy. He is expressing frustration over his lack of control, and his emotions should be acknowledged. Paraphrasing the parents' comments recognizes their feelings. Using the teen's words during the conversation indicates active listening and interest. Reflection clarifies the parents' understanding and point of view. Reference: Ricci, S. S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 30: Atraumatic Care of Children and Families, p. 1119. Chapter 30: Atraumatic Care of Children and Families - Page 1119

Which result is an expected outcome when unipolar and bipolar disorders are treated with an selective serotonin reuptake inhibitor (SSRI) antidepressant? blocking the degradation of norepinephrine blocking the degradation of serotonin inhibiting the reuptake of norepinephrine inhibiting the reuptake of serotonin

inhibiting the reuptake of serotonin The result of SSRI therapy is the delayed reuptake of the neurotransmitter serotonin. The other options do not accurately describe the outcome of SSRI therapy. Reference: Chapter 18: Disorders of Thought, Emotion, and Memory - Page 466

A 16-year-old girl is being seen for a long-overdue checkup. Her caregiver has come with her. She is calm, pleasant, and in good spirits. The caregiver reports to the nurse that she is relieved because for the past 6 months the teenager has been lethargic, angry, and sad. The mother reports that since she got her driver's license two days earlier, her child's mood has changed dramatically. Rather than resist this appointment, the girl had simply smiled and said, "It won't matter much, but okay, I'll be ready in a minute." The nurse recognizes that the child's seeming well-being and drastic change in behavior should be further investigated to determine if the child: has been smoking marijuana. is excited that she can drive now. is experimenting with alcohol. is planning to commit suicide.

is planning to commit suicide. Attempted suicide rarely occurs without warning and usually is preceded by a long history of emotional problems, difficulty forming relationships, feelings of rejection, and low self-esteem. Suicidal adolescents may appear suddenly elated after a long period of acting dejected, and might verbalize their hopelessness with statements such as "I won't be around much longer," or "After Monday, it won't matter anyhow." Some deaths reported as accidents, particularly one-car accidents, are thought to be suicides. Reference: Ricci, S.S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 50: Nursing Care of the Child With an Alteration in Behavior, Cognition, Development, or Mental Health/Cognitive or Mental Health Disorder, p. 1972. Chapter 50: Nursing Care of the Child With an Alteration in Behavior, Cognition, Development, or Mental Health/Cognitive or Mental Health Disorder - Page 1972

The nurse is preparing to teach a community class to a group of first-time parents. Which information should the nurse include concerning what the pregnant woman's partner may experience as a normal response? feeling distanced from the mother no changes, only the mother has changes during pregnancy desire to be the woman and give birth physical symptoms similar to the mother

physical symptoms similar to the mother Couvade syndrome is the occurrence of physical symptoms by the partner, similar to the physical symptoms of the mother. Other emotional symptoms may occur, but they are typically on a person-to-person basis. Reference: Ricci, S. S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 11: Maternal Adaptation During Pregnancy, p. 388. Chapter 11: Maternal Adaptation During Pregnancy - Page 388

A woman who gave birth to a healthy baby 5 days ago is experiencing fatigue and weepiness, lasting for short periods each day. Which condition does the nurse believe is causing this experience? postpartum reaction postpartum depression postpartum anxiety postpartum baby blues

postpartum baby blues Postpartum baby blues is common in women after giving birth. It is a mild depression; however, functioning usually is not impaired. Postpartum blues usually peaks at day 4 or 5 after birth. Postpartum anxiety and postpartum depression do not usually start until at least 3 to 4 weeks and up to 1 year following the birth of a baby. Postpartum reaction is a term to include postpartum depression, anxiety, and psychosis. Reference: Ricci, S. S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 15: Postpartum Adaptations, p. 548. Chapter 15: Postpartum Adaptations - Page 548

A 2-year-old toddler holds his breath until passing out when he wants something the parent does not want him to have. The nurse would decide whether these temper tantrums are a form of seizure based on the fact that: seizures rarely occur in toddlers. seizures are not provoked; temper tantrums are. with seizures, cyanosis rarely develops. seizures typically occur with fever; temper tantrums do not.

seizures are not provoked; temper tantrums are. Temper tantrums are the natural result of toddler frustration. Toddlers are eager to explore new things but their efforts can be thwarted, especially for safety reasons. Toddlers do not behave badly on purpose. Temper tantrums occur out of anger and frustration. Seizures do not. Seizures can occur at any age. The client may or not be febrile. Depending upon how long a seizure lasts, cyanosis can occur. Reference: Ricci, S.S., Kyle, T., Carman, S. Maternity and Pediatric Nursing, 3rd ed. Philadelphia: Wolters Kluwer Health, 2017, Chapter 26: Growth and Development of the Toddler, p. 1014. Chapter 26: Growth and Development of the Toddler - Page 1014