NCLEX for Mood Disorders, Bipolar & Adjustment Disorders Flashcards
The nurse learns at report that a newly admitted manic patient is demonstrating grandiosity. Which statement would be most consistent with this symptom?
a. “I can’t do anything anymore.”
b. “I’m the world’s most astute financier.”
c. “I can understand why my wife is upset that I overspend.”
d. “I can’t understand where all the money in our family goes.”
ANS: B
An individual who is demonstrating grandiosity has an exaggerated view of his abilities. The other options are more moderate statements and lack that element of exaggeration
The nurse will base a discussion of dysthymia on the fact that the condition:
a. Typically has an acute onset
b. Involves delusional thinking
c. Is chronic low-level depression
d. Does not include suicidal ideation
ANS: C
Dysthymia is identified as a chronic low-level depression frequently lasting over a period of several years without remitting. Dysthymia has a slow, insidious onset. Delusional thinking is not a common manifestation of dysthymia. Suicidal thoughts are seen among dysthymic patients.
What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include exaggerated physical activity, agitation, insomnia, and anorexia?
a. Risk for injury
b. Chronic low self-esteem
c. Noncompliance
d. Insomnia
ANS: A
Risk for injury is the priority diagnosis. Possible injuries include dehydration, which may result from not drinking and trauma, which may result from bumping into objects or from physical altercations. The other options are valid diagnoses, but not of highest priority.
A patient has been admitted with a diagnosis of atypical depression. In planning interventions, the nurse would expect to consider the characteristic symptom of:
a. Seasonal episodes
b. Leaden paralysis
c. Psychomotor agitation
d. Increased depression in the morning
ANS: B
Behavioral characteristics of atypical depression include the feeling that one’s limbs are so heavy they cannot be lifted or moved (leaden paralysis). Seasonal mood changes are characteristic of seasonal affective disorder. Psychomotor agitation and depression that is greater in the morning than in the evening are characteristics more likely to be observed in patients with melancholic depression
An inappropriately dressed patient has not slept for 3 days while making excessive, expensive long-distance phone calls. When the patient can be heard singing loudly in the examining room, the nurse makes initial plans to focus on:
a. Assessing needs for food, liquids, and rest
b. Setting strict limits on dress and behavior
c. Conducting an in-depth suicide assessment
d. Obtaining a complete psychosocial assessment
ANS: A
Patients with mania frequently ignore their basic physiologic needs, as evidenced by not sleeping for 3 days, thus making these assessments the priority. Limits, although appropriate to consider, are not the priority. The manic state precludes a thorough assessment initially. Suicide assessment is not a priority at this time but reckless behavior could result in personal injury.
Which statement by the patient would indicate the need for additional education regarding the prescribed lithium treatment regimen?
a. “I will restrict my daily salt intake.”
b. “I will take my medications with food.”
c. “I will have my blood drawn on schedule.”
d. “I will drink 8 to 12 glasses of liquids daily.”
ANS: A
Patients taking lithium must maintain a normal sodium intake or risk symptoms of lithium toxicity. The patient should have 2 to 3 liters of fluid daily. Taking lithium with food minimizes gastrointestinal side effects. Regular monitoring of lithium levels is important to prevent toxicity.
The nurse would evaluate that patient education regarding lithium therapy for an individual with bipolar disorder as effective if the patient states:
a. “I can stop my lithium when I feel better.”
b. “I can continue with my diuretic and cardiac medications.”
c. “I will probably need to take the lithium for the rest of my life.”
d. “I will taper my lithium when a therapeutic serum level is achieved.”
ANS: C
Most patients with bipolar disorder require long-term maintenance on lithium or other antimanic medication. Patients should never stop medication without consulting the physician. When a therapeutic level is achieved, the patient will continue on maintenance doses of lithium. Diuretics are contraindicated for the patient on lithium.
A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department with a list of medications he is taking. Which of the medications on the list would require re-evaluation of lithium dosage?
a. HydroDIURIL daily
b. Navane bid
c. Ativan at bedtime
d. Cefobid daily
ANS: A
Diuretics alter fluid and electrolyte balance, increasing risk for lithium toxicity; therefore HydroDIURIL is correct. Antipsychotic medications are frequently prescribed concurrently with lithium to manage acute symptoms of mania, so no re-evaluation of lithium dose is necessary for Navane. Antianxiety drugs are not contraindicated with concurrent lithium use, so no lithium dose re-evaluation is necessary for Ativan. Antibiotics do not alter fluid and electrolyte balance, so readjustment of lithium dosage is not required for Cefobid.
Which outcomes would be appropriate to determine early favorable response to antidepressant medication?
a. The patient will complete own self-care activities.
b. The patient will demonstrate assertive communication skills.
c. The patient will describe signs and symptoms of major depression.
d. The patient will make plans to attend one community social activity a week.
ANS: A
Ability to manage basic ADLs demonstrates improvement in major depression. Understanding the disorder may occur later when patient cognition has improved enough to be able to process information. Initiation of community social activity occurs when the patient has increased energy. Assertive communication is learned and practiced after the depression lifts
Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patient’s:
a. Mood and affect
b. Activity level
c. Cognitive ability to understand information about the medication
d. Support network and its members’ willingness to participate in treatment
ANS: C
Phenelzine (Nardil) administration requires strict adherence to a restricted diet. The patient must have the cognitive ability to understand the food and medication interactions that may cause a serious reaction.
A patient who has a history of bipolar disorder recently underwent orthopedic surgery and was discharged to return home. When visited by the home care nurse, the nurse documented the following: slow and soft speech; sad facial expression; and patient crying when describing extreme fatigue, low mood, and the feeling that he will never get well. He has refused to bathe and perform ADLs for several days. Which nursing diagnosis would be appropriate?
a. Self-care deficit secondary to possible depression
b. Situational low self-esteem related to immobility
c. Deficient knowledge related to depression and surgery
d. Disturbed thought processes related to bipolar disorder
ANS: A
Refusal to perform tasks of bathing, grooming, and other ADLs provides evidence of a self-care deficit. The other symptoms documented by the nurse are characteristic of depression. No data are present to suggest the diagnoses given in the other option
The nurse caring for an extremely withdrawn patient with depression wants to assist her to become more interactive. The best approach would be to say:
a. “I know you’ll feel better if you leave your room.”
b. “You look so gloomy sitting here all by yourself.”
c. “Let’s explore how it feels to sit alone here all day and feel sad.”
d. “I need another person for a card game and I’d like you to be my partner.”
ANS: D
This direct approach invites the patient to participate in a kind, but firm manner. The patient is not given an option to simply say “yes” or “no.” It is not therapeutic to give false reassurance. The remaining options focus too intensively on negative thoughts and feelings.
Which nursing diagnosis would relate to the primary nursing concern related to a recently written prescription for amitriptyline (Elavil) 50 mg tid?
a. Anxiety
b. Ineffective coping
c. Risk for self-injury
d. Chronic low self-esteem
ANS: C
Patients with depression are at increased risk for suicide when they have been on antidepressant medication for 2 weeks, because they are regaining some energy but may not have achieved full therapeutic effect with mood improvement. Poor coping is important but it is not the priority. Evidence of noncompliance is lacking. The medication is not prescribed for anxiety disorders.
What information concerning amitriptyline (Elavil) 50 mg tid would the nurse give the patient regarding the expected outcome of this medication therapy?
a. “Complying with this therapy will cure your depression.”
b. “This medication is expected to improve brain chemical imbalance.”
c. “Amitriptyline will help re-establish your ability to think clearly again.”
d. “Elavil will be particularly effective at assisting you in regaining your independence.”
ANS: B
Antidepressant medication works by re-establishing the balance of neurotransmitters in the brain, particularly serotonin and norepinephrine. Antidepressants do not promise a cure for depression. Cognitive therapy, rather than antidepressants, addresses thinking issues. Learned helplessness is addressed by cognitive therapy
Which principle should the nurse apply when planning nursing care for a patient who was voluntarily admitted after a suicide attempt?
a. Patients who attempt suicide and fail will not try again.
b. The more specific the plan, the greater the risk for suicide.
c. Patients who talk about suicide are less likely to attempt it.
d. Patients who attempt suicide and fail do not really want to die.
ANS: B
Patients whose suicidal ideation includes a vague, diffuse plan or no plan at all are not at as high a risk for attempting suicide as an individual who has a well-developed plan and the means to carry it out. The nurse will need to continually reassess the patient. None of the remaining options are true statements concerning suicide attempts.
An appropriate nursing strategy to assist a patient who was involuntarily admitted after a suicide attempt is::
a. Avoiding any focus on the topic of suicide
b. Encouraging patient to verbalize personal feelings
c. Supporting patient focus on others rather than self
d. Discussing the impact of suicidal thoughts on the family
ANS: B
Verbalization helps relieve pent-up feelings and emotional pain. Avoidance of the topic is nontherapeutic for a suicidal patient. The remaining options may serve to increase the patient’s feelings of guilt.
Which principle should the nurse apply when planning care for a patient who is diagnosed with bipolar disorder and currently in the manic phase?
a. Manic patients respond well to peer pressure.
b. Decreasing stimulation tends to diminish symptoms.
c. Increasing stimulation tends to encourage the patient to focus.
d. Detailed activities will facilitate the patient’s ability to self control behavior.
ANS: D
The only statement that is a valid principle is the option related to activity and its impact on controlling behavior. The other statements are inaccurate.
Which nursing intervention is most therapeutic when the nurse is managing the aggressive, disruptive behaviors of a manic patient whose attempts to control the milieu has been rejected by the other patients?
a. Advising that the patient to accept the wishes of the group
b. Suggesting that the patient either quiet down or leave the room
c. Accompanying the patient to a quieter part of the unit
d. Ignoring the patient’s outbursts because they are surly related to the mania
ANS: C
Escorting the patient to a less stimulating environment will assist the patient to remain in control of behavior. It is unlikely that the patient would respond to verbal suggestions to leave the area unaccompanied or accept the group’s wishes and would likely see the suggestions as a threat that would further escalate the impending loss of control. The behavior cannot be ignored since it will likely lead to an acceleration of the mania.
What information would serve as the basis for the nurse’s reply when asked whether the cycling of moods from depressed to manic is a constant pattern seen in bipolar disorders?
a. Clinical observation tells us that mood disorders tend to remit and recur.
b. Most cyclic behavior can be managed with the appropriate forms of therapy.
c. Mood disorders generally see a decrease in cyclic affecting within 5 years of onset.
d. Persons with higher cognitive abilities will generally exhibit fewer cyclic episodes.
ANS: A
Mood disorders tend to remit and recur throughout the patient’s lifetime. There is no current research to support the other options.
The individual who displays the history and symptoms most consistent with a medical diagnosis of seasonal affective disorder (SAD) is:
a. 26 years of age and complains of 3 consecutive years of depressed mood beginning in November and remitting in April
b. 64 years of age and complains of anhedonia, early morning awakening, psychomotor retardation, weight loss, and excessive feelings of guilt
c. 46 years of age and complains of dysphoric mood for 3 years, poor concentration, loss of interest in social activities, indecision, low energy, and low self-esteem
d. 38 years of age and complains of sadness, loss of ability to react to positive stimuli, weight gain, hypersomnia, leaden paralysis of limbs, and sensitivity to interpersonal rejection
ANS: A
Marked seasonal changes in mood typify seasonal affective disorder. Depression begins in October or November and lifts in March or April and must occur for at least 2 consecutive years. The other options are lacking in the identifying period of time when the symptoms are exhibited.
A patient with suspected seasonal affective disorder asks the nurse, “I’ve been feeling down for 3 months. Will I ever feel like myself again?” The response that builds on an understanding of this disorder is:
a. “Spontaneous improvement usually comes in 6 months to a year.”
b. “Can you tell me what you mean when you say ‘feel like myself’?”
c. “People who have seasonal mood changes often feel better when spring comes.”
d. “Usually patients with this disorder see improvement during the fall and winter.”
ANS: C
Seasonal affective disorder is a condition in which the patient experiences depression beginning in the fall, lasting throughout the winter, and remitting in spring in the northern hemisphere. Fall and winter is not reflective of any diagnostic category of mood disorder. Spontaneous improvement occurs only with the change of seasons and available sunlight. Questioning is a response that does not address the point of understanding SAD.
A Chinese-American patient comes to the mental health clinic after referral by her primary care physician. She complains of nervousness, headaches, fatigue, and vague GI symptoms for which no organic basis has been established. The symptoms began about 9 months ago when her favorite aunt died. The most appropriate independent nursing action would be to:
a. Prescribe a trial course of antianxiety medication.
b. Plan strategies for cognitive behavioral therapy.
c. Arrange admission to the inpatient unit for a complete workup and psychologic testing.
d. Confer with the psychiatrist about the cultural association between depression and somatic symptoms.
ANS: D
Expression of symptoms is influenced by ethnicity and culture. When depressed, Asian and Asian-American patients describe somatic symptoms, whereas patients of Western cultures may focus on mood and cognitive symptoms. Option d is an appropriate independent intervention the nurse should take. Options a, b, and c would be considered collaborative, rather than independent, interventions.
A patient with melancholic depression paces and wrings her hands for hours at a time while repeating, “I’m a bad person.” Staff members have been unsuccessful in their attempts to promote rest. Which intervention is most appropriate in promoting rest?
a. Instructing the patient to lie down for 15 minutes of every hour
b. Asking the patient to fold and stack bath towels and washcloths
c. Making the patient aware of the negative effects of fatigue on mood
d. Reassuring the patient that she is accepted and not considered a “bad” person
ANS: B
The psychomotor energy of agitation must be expended; it may be channeled into simple, repetitive activity. Standing in one place to fold towels is an improvement over pacing. This patient will be unable to comply with the request to lie down. A severely depressed patient will not be able to cognitively process this sort of information. Reassurance will not appreciably affect the need for psychomotor activity.
What measure will facilitate communication with a patient who is depressed and evidencing psychomotor retardation and withdrawal?
a. Ask the patient to indicate yes or no with finger signals.
b. Arrange to spend time with the patient at prearranged intervals.
c. Give concrete and concise directions rather than asking questions.
d. Speak loudly and rapidly to the patient to focus his or her attention.
ANS: B
This measure will promote the establishment of rapport and demonstrate respect and acceptance of the patient. It will facilitate patient willingness to communicate thoughts and feelings without making unnecessary demands on the patient; a headshake or nod would work as well. Patients should not simply be ordered about; they should be asked to respond without placing excessive demands. Patients with psychomotor retardation have the ability to hear, but their ability to process information may be slowed, requiring well-paced simple communication.
