Chapter 8

Question 1

The nurse learns at report that a newly admitted manic patient is demonstrating grandiosity. Which statement would be most consistent with this symptom?

Answer 1

Im the worlds most astute financier.

Question 2

The nurse will base a discussion of dysthymia on the fact that the condition:

Answer 2

Is chronic low-level depression

Question 3

What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include exaggerated physical activity, agitation, insomnia, and anorexia?

Answer 3

Noncompliance

Question 4

A patient has been admitted with a diagnosis of atypical depression. In planning interventions, the nurse would expect to consider the characteristic symptom of:

Answer 4

Leaden paralysis

Question 5

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:

Answer 5

Assessing needs for food, liquids, and rest

Question 6

Which statement by the patient would indicate the need for additional education regarding the prescribed lithium treatment regimen?

Answer 6

I will restrict my daily salt intake

Question 7

The nurse would evaluate that patient education regarding lithium therapy for an individual with bipolar disorder as effective if the patient states:

Answer 7

I will probably need to take the lithium for the rest of my life.

Question 8

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 themedications on the list would require re-evaluation of lithium dosage?

Answer 8

HydroDIURIL daily

Question 9

Which outcomes would be appropriate to determine early favorable response to antidepressant medication?

Answer 9

The patient will complete own self-care activities.

Question 10

Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patients:

Answer 10

Cognitive ability to understand information about the medication

Question 11

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?

Answer 11

Self-care deficit secondary to possible depression

Question 12

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:

Answer 12

I need another person for a card game and Id like you to be my partner.

Question 13

Which nursing diagnosis would relate to the primary nursing concern related to a recently written prescription for amitriptyline (Elavil) 50 mg tid?

Answer 13

Risk for self-injury

Question 14

What information concerning amitriptyline (Elavil) 50 mg tid would the nurse give the patient regarding the expected outcome of this medication therapy?

Answer 14

This medication is expected to improve brain chemical imbalance.

Question 15

Which principle should the nurse apply when planning nursing care for a patient who was voluntarily admitted after a suicide attempt?

Answer 15

The more specific the plan, the greater the risk for suicide.

Question 16

An appropriate nursing strategy to assist a patient who was involuntarily admitted after a suicide attempt is:

Answer 16

Encouraging patient to verbalize personal feelings

Question 17

Which principle should the nurse apply when planning care for a patient who is diagnosed with bipolar disorder and currently in the manic phase?

Answer 17

Detailed activities will facilitate the patients ability to self control behavior.

Question 18

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?

Answer 18

Accompanying the patient to a quieter part of the unit

Question 19

What information would serve as the basis for the nurses reply when asked whether the cycling of moods from depressed to manic is a constant pattern seen in bipolar disorders?

Answer 19

Clinical observation tells us that mood disorders tend to remit and recur.

Question 20

The individual who displays the history and symptoms most consistent with a medical diagnosis of seasonal affective disorder (SAD) is:

Answer 20

26 years of age and complains of 3 consecutive years of depressed mood beginning in November and remitting in April

Question 21

A patient with suspected seasonal affective disorder asks the nurse, Ive been feeling down for 3 months. Will I ever feel like myself again? The response that builds on an understanding of this disorder is:

Answer 21

People who have seasonal mood changes often feel better when spring comes.

Question 22

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:

Answer 22

Confer with the psychiatrist about the cultural association between depression and somatic symptoms.

Question 23

A patient with melancholic depression paces and wrings her hands for hours at a time while repeating, Im a bad person. Staff members have been unsuccessful in their attempts to promote rest. Which intervention is most appropriate in promoting rest?

Answer 23

Asking the patient to fold and stack bath towels and washcloths

Question 24

What measure will facilitate communication with a patient who is depressed and evidencing psychomotor retardation and withdrawal?

Answer 24

Arrange to spend time with the patient at prearranged intervals.

Question 25

Which measure consistent with the use of cognitive therapy could the nurse incorporate into the treatment plan of a chronically depressed patient?

Answer 25

Identify negative evaluations and challenge pessimistic beliefs.

Question 26

Which symptom related to thought-flow disturbance is the nurse most likely to assess in a newly admitted patient who is diagnosed with bipolar disorder, manic episode?

Answer 26

Flight of ideas

Question 27

Therapeutic interactions between the nurse and a manic patient will be facilitated when the nurse:

Answer 27

Uses a calm, matter-of-fact approach to structuring

Question 28

A patient who is experiencing a manic episode approaches the nurse and with pressured speech states, I hate oatmeal. Lets get everybody together to do exercises. Im thirsty and Im burning up. Get out of my way; I have to see that guy. The priority nursing action is to:

Answer 28

Measure the patients temperature and pulse.

Question 29

A patient with bipolar disorder reveals to the clinic nurse that she may be 4 weeks pregnant. Which action will the nurse take?

Answer 29

Confer with the physician about ordering a pregnancy test and discontinuing lithium.

Question 30

Which nursing measure would be relevant to protecting the physiologic integrity of a patient during a manic episode when marked hyperactivity is present?

Answer 30

Monitor the patients weight at the same time daily.

Question 31

Care planned for a patient with adjustment disorder will be most effective if the nurse knows adjustment disorders are a group of disorders that:

Answer 31

Manifest as transient episodes of dysfunction in response to specific stressors

Question 32

The nurse manager, teaching a class to new staff members about working with patients with adjustment disorders, will specify that the intervention most helpful in working with patients with this diagnosis is:

Answer 32

Identifying the precipitating stressful event and current problems

Question 33

When a father states, I dont understand what the doctor means by saying my daughter has an adjustment disorder. The nurse explains that this disorder often results from:

Answer 33

Failure of existing coping skills

Question 34

Which question would be most effective in helping a patient with an adjustment disorder identify the event that triggered the maladaptive response?

Answer 34

Did you experience any stressful events recently?

Question 35

A teenager is admitted to the adolescent unit with a diagnosis of adjustment disorder with depression. Which information collected from the assessment interview will be given highest priority when planning the patients care?

Answer 35

Patient states she finds no pleasure in living.

Question 36

The nurse has been working with a patient who has adjustment disorder with depressed mood. Which finding would permit the nurse to accurately evaluate that the crisis has been resolved?

Answer 36

Absence of presenting symptoms

Question 37

Which of the following statements would correctly serve as a basis for teaching a family the usual outcome of an adjustment disorder?

Answer 37

The symptoms will likely resolve completely.

Question 38

Which activity would be a constructive outlet for tension and anxiety while enhancing self-esteem for a patient with adjustment disorder with anxious mood?

Answer 38

Engaging in regular, age-appropriate physical exercise

Question 39

The major rationale for careful ongoing assessment of a patient with adjustment disorder is:

Answer 39

The disorder may be a precursor to a more serious mental health problem.

Question 40

When assessing a patient diagnosed with a mood disorder, which abnormal diagnostic tests would be considered a possible factor in the manifestation of the disorder? Select all that apply
a. RBC (red blood cell)
b. ECG (electrocardiogram)
c. BUN ( blood urea nitrogen)
d. TSH (thyroid stimulating hormone)
e. Blood glucose

Answer 40

A,D,E

Question 41

Which statements regarding a hypomanic episode are true? Select all that apply.
a. Behavior has been observed in the patient for at least 4 days.
b. Patient appears unaware of potentially dangerous situations.
c. Hospitalization is generally required to stabilize the behavior.
d. Patient is engaging in behaviors that are normally uncharacteristic of them.
e. Primary difference between mania and hypomania is the nature of the activity.

Answer 41

A,B,D