Passpoint for mood disorder
A true crisis state, involving a period of severe disorganization, is difficult to endure emotionally and physically. The nurse recognizes that a client will only be able to tolerate being in crisis for how long?
4 to 6 weeks
A client with depression has just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" Which of the following is the correct response by the nurse? Blue cheese, red wine, raisins Black beans, garlic, pears Pork, shellfish, egg yolks Milk, peanuts, tomatoes
A
Jack is a new client on the psychiatric unit with a diagnosis of Antisocial Personality Disorder. Which of the following characteristics would you expect to assess in Jack? Lack of guilt for wrongdoing Insight into his own behavior Ability to learn from past experiences Compliance with authority
A
The physician orders lithium carbonate 600 mg tid for a client newly diagnosed with Bipolar I Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. What is the therapeutic range for acute mania? 1.0 to 1.5 mEq/L 10 to 15 mEq/L 0.5 to 1.0 mEq/L 5 to 10 mEq/L
A
Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder? Overly self-centered and exploitative of others Suspicious and mistrustful of others Rule conscious and disapproving of change Anxious and socially isolated
A
A client has just been admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply. Slumped posture Delusional thinking Feelings of despair Feels best early in the morning and worse as the day progresses Anorexia
A,B,C,E
Sally is admitted to the hospital with Major Depressive Disorder and repeatedly makes negative statements about herself. Which of the following interventions is identified as an approach that promotes positive self-esteem in the patient? Select all that apply. Teach assertive communication skills. Make observations to Sally when she completes a goal or task. Instruct Sally that you will not talk with her unless she stops talking negatively about herself. Offer to spend time with Sally using a nonjudgmental, accepting approach.
A,B,D
Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? Select all that apply. Olanzepine (Zyprexa) Oxycodone (Oxycontin) Carbamazepine (Tegretol) Gabapentin (Neurontin) Tranylcypromine (Parnate)
A,C,D
"Splitting" by the client with BPD denotes which of the following? Evidence of precocious development A primitive defense mechanism in which the client sees objects as all good or all bad A brief psychotic episode in which the client loses contact with reality Two distinct personalities within the borderline client
B
A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? Fever, sore throat, malaise Tinnitus, severe diarrhea, ataxia Occipital headache, palpitations, chest pain Skin rash, marked rise in blood pressure, bradycardia
B
An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client? "Do you like exercise?" "Come with me. I will go with you to group therapy." "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" "Why do you stay in your room all the time?"
B
Margaret, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the emergency department by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of which of the following? A delusion of grandeur A delusion of persecution A delusion of reference A delusion of control or influence
B
Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that Margaret quit taking her medication a few months ago, thinking she didn't need it anymore. Margaret is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Margaret is admitted to the psychiatric unit. What is the priority nursing diagnosis for Margaret? Imbalanced nutrition: less than body requirements related to not eating Risk for injury related to hyperactivity Disturbed sleep pattern related to agitation Ineffective coping related to denial of depression
B
Milieu therapy is a good choice for clients with antisocial personality disorder because it: Provides a system of punishment and rewards for behavior modification. Emulates a social community in which the client may learn to live harmoniously with others. Provides mostly one-to-one interaction between the client and therapist. Provides a structured setting in which the clients have very little input into the planning of their care.
B
Which of the following behavioral patterns is characteristic of individuals with schizotypal personality disorder? Belittling themselves and their abilities A lifelong pattern of social withdrawal Suspiciousness and mistrust of others Overreacting inappropriately to minor stimuli
B
The physician orders sertraline (Zoloft) 50 mg PO bid for Margaret, a 68-year-old woman with Major Depressive Disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? "Cheer up, Margaret. You have so much to be happy about." "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." "I'll report that to the physician, Margaret. Maybe he will order something different." "Try not to dwell on your symptoms, Margaret. Why don't you join the others down in the dayroom?"
B few weeks
The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses in order of the appropriate priority. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night Risk for injury related to manic hyperactivity Impaired social interaction evidenced by manipulation of others Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor
B, D, A, C
A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? Tell the client she cannot wear this outfit while she is in the hospital. Do nothing, and allow her to learn from the responses of her peers. Quietly walk with her back to her room and help her change into something more appropriate. Explain to her that if she wears this outfit, she must remain in her room.
C
A client whose husband died 6 months ago is diagnosed with Major Depressive Disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? "Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer." "I can understand how you must feel." "Those feelings are a normal part of the grief response." "Just think about the good times that you had while he was alive."
C
In evaluating the progress of Jack, a client diagnosed with Antisocial Personality Disorder, which of the following behaviors would be considered the most significant indication of positive change? Jack got angry only once in group this week. Jack was able to wait a whole hour for a cigarette without verbally abusing the staff. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight. Jack stated that he would not start any more fights.
C
Margaret, age 68, is diagnosed with Bipolar I Disorder, current episode manic. She is extremely hyperactive and has lost weight. What is one way to promote adequate nutritional intake for Margaret? Sit with her during meals to ensure that she eats everything on her tray. Have her sister-in-law bring all her food from home because she knows Margaret's likes and dislikes. Provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run." Tell Margaret that she will be on room restriction until she starts gaining weight.
C
Carol is a nurse who was floated to the psychiatric unit to cover for a staff nurse who called out sick. She encounters a patient who is diagnosed with BPD, and the patient states "Thank goodness they sent you to the unit. No one else here has taken the time to listen to my concerns." This may be an example of which symptom common in BPD? Impulsivity Self-harming behaviors Dissociation Splitting
D
Education for the client who is taking MAOIs should include which of the following? Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification
D
Kim has a diagnosis of BPD. She often exhibits alternating clinging and distancing behaviors. Which of the following is the most appropriate nursing intervention with this type of behavior? Encourage Kim to establish trust in one staff person with whom all therapeutic interaction should take place. Secure a verbal contract from Kim that she will discontinue these behaviors. Withdraw attention if these behaviors continue. Rotate staff members who work with Kim so that she will learn to relate to more than one person.
D
Kim, a client diagnosed with BPD, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except: Refusal to stay in room alone, stating, "It's so lonely." Asking Nurse Jones for cigarettes after 30 minutes, knowing the assigned nurse has explained she must wait 1 hour. Stating to Nurse Jones, "I really like having you for my nurse. You're the best one around here." Cutting arms with razor blade after discussing dismissal plans with physician.
D
A client who has been using benzodiazepines for anxiety wants to add an alternative therapy. The nurse suggests biofeedback. What is the best description of biofeedback?
It is a way to concentrate on the body's response during a stressful situation.
Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with a diagnosis of Major Depressive Disorder. Which of the following is the priority nursing diagnosis for Margaret? Imbalanced nutrition: less than body requirements Complicated grieving Risk for suicide Social isolation
Risk for suicide
A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to:
help the client cope with the anxiety associated with changes in body image.
A 40-year-old executive who was unexpectedly laid off from work 2 days earlier complains of fatigue and an inability to cope. He admits drinking excessively over the previous 48 hours. This behavior is an example of:
situational crisis.
