Suicide, Depression, Bipolar Disoder

Question: A nurse is caring for a client with major depressive disorder. The nurse understands that which neurobiological mechanism is associated with decreased metabolic activity and reduced gray-matter volume in the medial prefrontal cortex (MPFC)? Answer Choices: A) Pathological overactivation of cerebellar motor pathways. B) Hyperactivity of the limbic system due to poor regulatory control by the MPFC. C) Hyperactivity of the occipital lobe leading to sleep disruptions. D) Complete shutdown of glial cells in the basal ganglia.

Option A is incorrect because cerebellar motor pathways are involved in motor processing, not the direct regulation of depressive symptoms by the prefrontal cortex [p. 1953]. Option B is correct because individuals with depression exhibit increased limbic system activity along with decreased gray-matter volume and lower metabolic activity in the MPFC, which normally regulates limbic system activity [p. 1953, 1971]. Option C is incorrect because the occipital lobe is responsible for visual processing, not the emotional and neurobiological regulation of mood disorders [p. 1953]. Option D is incorrect because while glial cells play a role in mood, there is no evidence of a complete shutdown of these cells in the basal ganglia as the primary pathophysiology of MPFC alterations [p. 1953]. Correct Answer: B

Question: A nurse is assessing a client with bipolar disorder. The nurse understands that cerebellar and basal ganglia dysfunctions are associated with which clinical manifestation of different mood states in this population? Answer Choices: A) Irreversible sensory-neural hearing loss and tinnitus. B) Altered metabolic functioning and structural changes in motor and emotional processing regions. C) Severe respiratory depression and neuromuscular paralysis. D) Hypoglycemia and acute renal failure.

Option A is incorrect because sensory-neural hearing loss and tinnitus are not associated with basal ganglia or cerebellar dysfunctions in bipolar disorder [p. 1953]. Option B is correct because studies have found a connection between bipolar disorder and cerebellar and basal ganglia dysfunctions, including altered metabolic functioning and structure, which could contribute to different mood states [p. 1953]. Option C is incorrect because respiratory depression and neuromuscular paralysis are not manifestations of cerebellar or basal ganglia dysfunction in bipolar disorder [p. 1953]. Option D is incorrect because hypoglycemia and renal failure are systemic metabolic and endocrine issues, not cerebellar or basal ganglia manifestations of bipolar mood states [p. 1953]. Correct Answer: B

Question: A nurse is reviewing the laboratory results of a client with major depressive disorder and notes elevated levels of cortisol and corticotropin-releasing hormone. Which physiological mechanism explains this finding? Answer Choices: A) Hypoactivity of the endocrine thyroid pathways. B) Severe underactivity of the adrenal medulla. C) Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis and limbic system. D) Hyperthyroidism leading to rapid renal excretion of hormones.

Option A is incorrect because thyroid pathways do not directly produce cortisol or corticotropin-releasing hormone [p. 1971]. Option B is incorrect because underactivity of the adrenal medulla is not responsible for elevated cortisol, which is produced by the adrenal cortex under HPA axis stimulation [p. 1971]. Option C is correct because individuals with depression tend to have increased levels of cortisol and corticotropin-releasing hormone, which are indicative of HPA axis and limbic system hyperactivity [p. 1971]. Option D is incorrect because hyperthyroidism is a separate thyroid disorder and does not account for HPA axis hyperactivity and elevated cortisol in depression [p. 1971]. Correct Answer: C

Question: A nurse is discussing the neurobiology of suicide with a colleague. Which neurochemical finding is commonly associated with increased impulsivity and suicidal behavior in depressed individuals? Answer Choices: A) Excessively high levels of acetylcholine in the cerebral cortex. B) Decreased levels of the neurotransmitter serotonin. C) Hyperactivity of the dopamine pathways in the cerebellum. D) Prolonged depletion of gamma-aminobutyric acid (GABA) in the occipital lobe.

Option A is incorrect because excess acetylcholine is not the primary neurotransmitter finding associated with impulsivity and suicidal behavior [p. 2001]. Option B is correct because suicidal individuals have been found to have decreased levels of serotonin, which is thought to be connected to increased impulsivity and suicidal behavior [p. 2001]. Option C is incorrect because dopamine pathways in the cerebellum are involved in motor control, not the cognitive and emotional regulation of suicidal impulsivity [p. 2001]. Option D is incorrect because GABA depletion in the occipital lobe is not the neurochemical mechanism responsible for suicidal behaviors [p. 2001]. Correct Answer: B

Question: A client asks the nurse, "Does depression have a genetic link, or is it completely caused by stress?" Which evidence-based statement should guide the nurse's response? Answer Choices: A) Depression has zero heritability, meaning genetics play no role in its onset. B) Genetics interacting with environmental stimuli, such as bullying or trauma, can result in the manifestation of depression. C) A single genetic variation guarantees that an individual will develop depression regardless of life events. D) Genetic factors are only relevant for seasonal affective disorder, not major depressive disorder.

Option A is incorrect because genetics clearly plays some role in the etiology of depression [p. 1971]. Option B is correct because a genetic risk for developing depressive symptoms does not necessarily guarantee that an individual will develop depression; rather, genetics interacting with environmental stimuli (such as bullying or trauma) may result in its manifestation [p. 1972]. Option C is incorrect because there is no single gene that guarantees depression, and environmental interaction is key [p. 1972]. Option D is incorrect because genetics is a risk factor for various forms of depression, not just seasonal affective disorder [p. 1972]. Correct Answer: B

Question: A nurse is explaining the Cognitive Theory of depression to a client. Which statement correctly summarizes a core principle of this theory? Answer Choices: A) Depression is caused solely by an imbalance of liver enzymes. B) Depression results from learned behaviors where individuals seek positive reinforcement through crying. C) Depressed individuals have deeply held negative views of themselves, their environment, and their future based on cognitive distortions. D) Depression is an innate, unchangeable trait that is unaffected by cognitive therapies.

Option A is incorrect because the cognitive theory focuses on psychological thoughts, not liver enzymes [p. 1971]. Option B is incorrect because seeking positive reinforcement through crying is not a component of Beck's cognitive theory, which focuses on negative cognitive distortions [p. 1971]. Option C is correct because according to cognitive theory, individuals with depression have skewed core views of themselves, of their environment, and of the future, which tend to be based on cognitive distortions rather than reality [p. 1971]. Option D is incorrect because cognitive theory suggests these views are learned and can be successfully altered using cognitive-behavioral therapy [p. 1971, 1977]. Correct Answer: C

Question: A client with depression states, "No matter what I do, my life is a mess, and I have absolutely no control over anything that happens to me. Why should I even try to get better?" The nurse recognizes this statement as characteristic of which psychological theory? Answer Choices: A) Sociocultural Theory of economic stressors. B) Cognitive Theory of rapid cycling. C) Theory of Learned Helplessness. D) Psychosexual Development Theory of regression.

Option A is incorrect because while sociocultural theory focuses on economic stressors, it does not specifically address the psychological belief of having no control over outcomes [p. 1971]. Option B is incorrect because cognitive theory focuses on automatic negative thoughts, not the specific three-deficit construct of learned helplessness [p. 1971]. Option C is correct because the theory of learned helplessness asserts that as individuals are exposed to pain and suffering and fail to resolve it, they eventually stop trying and develop a belief that they have no control over what is happening to them [p. 1971]. Option D is incorrect because psychosexual theory is not associated with this clinical model of depression [p. 1971]. Correct Answer: C

Question: A postpartum nurse is caring for a client who reports a sudden onset of severe tearfulness and sadness. The nurse understands that which endocrine factor plays a major role in peripartum mood alterations in women? Answer Choices: A) Decreased levels of estrogen. B) Excessively elevated levels of testosterone. C) Undersecretion of insulin by the pancreas. D) Hyperactivity of the adrenal medulla.

Option A is correct because decreased estrogen levels seem to play a role in women's greater likelihood of depressive symptoms at certain points in the menstrual cycle, at the onset of menopause, and during the postpartum period [p. 1971]. Option B is incorrect because testosterone is not the primary endocrine factor implicated in maternal peripartum mood alterations [p. 1971]. Option C is incorrect because insulin levels are associated with blood glucose regulation, not the hormonal etiology of peripartum depression [p. 1971]. Option D is incorrect because HPA axis hyperactivity involves the adrenal cortex (cortisol), not the adrenal medulla [p. 1971]. Correct Answer: A

Question: A client presents with a history of low mood, poor appetite, and fatigue that has persisted for 3 years. The client notes they have not been symptom-free for more than 1 month at a time, but their symptoms are not severe enough to require hospitalization. Which depressive disorder should the nurse suspect? Answer Choices: A) Major Depressive Disorder (MDD). B) Seasonal Affective Disorder (SAD). C) Persistent Depressive Disorder (Dysthymia). D) Adjustment Disorder with Depressed Mood.

Option A is incorrect because MDD requires symptoms to be present for a minimum of 2 weeks with severe distress or functional impairment, and is typically characterized by acute episodes rather than a continuous 3-year low-level course [p. 1973, 1974]. Option B is incorrect because SAD is a specifier where symptoms occur in relation to seasons, typically winter, which does not match a year-round 3-year course [p. 1974]. Option C is correct because persistent depressive disorder (dysthymia) is characterized by chronic depression for the majority of most days for at least 2 years, with symptoms that tend to be less severe than those of MDD [p. 1974]. Option D is incorrect because adjustment disorder typically begins within 3 months of a stressor and lasts no more than 6 months [p. 1975]. Correct Answer: C

Question: A client reports experiencing low energy, increased periods of sleep, carbohydrate cravings, and weight gain that occur exclusively during the winter months, with complete remission of symptoms during the spring and summer. The nurse should identify these symptoms as characteristic of which disorder? Answer Choices: A) Persistent Depressive Disorder (Dysthymia). B) Seasonal Affective Disorder (SAD). C) Adjustment Disorder with Depressed Mood. D) Bipolar I Disorder with rapid cycling.

Option A is incorrect because dysthymia is a chronic year-round mood disturbance lasting at least 2 years [p. 1974]. Option B is correct because Seasonal Affective Disorder (SAD) is a specifier of MDD where depressive symptoms occur in relation to the seasons, usually during the winter months [p. 1974]. Option C is incorrect because adjustment disorder is triggered by an identifiable stressor like divorce or loss, not seasonal light changes [p. 1975]. Option D is incorrect because rapid cycling involves four or more mood episodes within a year, not a seasonal pattern of winter depression and summer euthymia [p. 1954]. Correct Answer: B

Question: A client is experiencing a change in mood and affect, including insomnia and difficulty at work, that began 2 months after the devastating loss of their home in a natural disaster. The client has no history of mental illness. How should the nurse classify this presentation? Answer Choices: A) Persistent Depressive Disorder (Dysthymia). B) Seasonal Affective Disorder (SAD). C) Adjustment Disorder with Depressed Mood. D) Bipolar II Disorder with hypomania.

Option A is incorrect because dysthymia requires a 2-year duration of chronic low mood [p. 1974]. Option B is incorrect because SAD is related to seasonal changes in natural light, not situational trauma [p. 1974]. Option C is correct because adjustment disorder with depressed mood represents a change in mood and affect following an identifiable stressor, beginning within 3 months of the event and lasting no more than 6 months [p. 1975]. Option D is incorrect because there is no evidence of hypomanic or manic episodes in this client's presentation [p. 1954]. Correct Answer: C

Question: A nurse is assessing a client who recently lost their spouse. The client is weeping and reports feeling empty inside but notes that they are still able to enjoy visits from their grandchildren and have an intact sense of self-worth. How should the nurse differentiate this client's state from clinical depression? Answer Choices: A) The client is demonstrating clinical depression, which always features feelings of emptiness that come in waves. B) The client is experiencing grief, as evidenced by an intact self-worth and a preserved capacity for positive feelings. C) The client is showing signs of postpartum psychosis and needs immediate hospitalization. D) The client is displaying a flat affect and requires immediate electroconvulsive therapy.

Option A is incorrect because clinical depression is characterized by general, persistent feelings of hopelessness and a sustained loss of self-worth, not emptiness in waves [p. 1975 Table 28.2]. Option B is correct because in grief, the onset follows a loss, the affect involves emptiness in waves with self-worth intact, and the capacity to experience positive feelings remains [p. 1975 Table 28.2]. Option C is incorrect because postpartum psychosis occurs after childbirth, not after the loss of a spouse [p. 1957]. Option D is incorrect because a weeping client is displaying a weeping affect, not a flat affect (no cues), and ECT is not indicated for uncomplicated grief [p. 1953, 1967]. Correct Answer: B

Question: A nurse in the emergency department is evaluating a client using the Columbia-Suicide Severity Rating Scale (C-SSRS). The client reports having thoughts of killing themselves but denies any intent or plan. Which nursing triage action is most appropriate? Answer Choices: A) Restrain the client physically and arrange for immediate involuntary inpatient commitment. B) Coordinate a mental health referral at discharge, as the client has thoughts but no active intent. C) Instruct the client that their thoughts are normal and require no further follow-up. D) Administer a rapid-acting antidepressant and discharge the client to home immediately.

Option A is incorrect because physical restraints and involuntary commitment are highly restrictive and not indicated for a client with no active intent or plan [p. 2007]. Option B is correct because a patient who has thought about killing himself but does not express any intent requires, at minimum, a mental health referral at discharge [p. 2007]. Option C is incorrect because suicidal thoughts are never considered normal, and failing to provide a referral is a safety failure [p. 2007]. Option D is incorrect because antidepressants are not rapid-acting, and discharging without a mental health referral is unsafe [p. 1966, 2007]. Correct Answer: B

Question: A clinic nurse is completing a suicide risk assessment using the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T). According to this tool, what is the correct sequence of steps for the nurse to perform? Answer Choices: A) Ask about suicide intent, assess risk factors, determine risk level, document, assess protective factors. B) Assess risk factors, assess protective factors, ask about intent, determine risk level and intervention, document. C) Document the plan, determine risk level, assess protective factors, ask about intent, assess risk factors. D) Assess protective factors, ask about intent, document the plan, determine risk level, assess risk factors.

Option A is incorrect because it does not follow the correct order of the five steps, which begins with assessing risk factors [p. 2008]. Option B is correct because the five steps involved in the SAFE-T assessment are: (1) Assess risk factors, (2) Assess protective factors, (3) Directly ask the patient about intent to commit suicide, (4) Determine the patient's risk level and intervention, and (5) Document the patient's risk level and treatment plan [p. 2008]. Option C and D are incorrect because they list the steps in an incorrect and unsafe order [p. 2008]. Correct Answer: B

Question: A client with severe mood swings asks the clinic nurse which laboratory blood test will be used to definitively diagnose their Bipolar I disorder. Which response by the nurse is correct? Answer Choices: A) "A complete blood count is used to measure white blood cell ratios that confirm bipolar disorder." B) "No diagnostic laboratory or medical tests exist to confirm a diagnosis of a mood disorder, but tests are done to rule out medical causes." C) "We will perform a serum serotonin level test to confirm the biological diagnosis." D) "A cerebrospinal fluid analysis is the gold-standard diagnostic test for bipolar disorder."

Option A is incorrect because CBCs do not diagnose psychiatric mood disorders [p. 1962, 1985]. Option B is correct because there is no diagnostic test to determine bipolar and related disorders; diagnosis is made on the basis of clinical manifestations and patient history, though physical exams and labs rule out medical causes [p. 1962, 1985]. Option C is incorrect because serum serotonin levels are not used clinically to diagnose bipolar disorder [p. 1962, 1985]. Option D is incorrect because CSF analysis is not a diagnostic tool or standard test for bipolar disorder [p. 1985]. Correct Answer: B

Question: A home health nurse is assessing an 81-year-old client who lives alone and reports recent social withdrawal and sleep disturbances. Which screening tool is most appropriate for the nurse to use to evaluate this client for depression? Answer Choices: A) Children's Depression Inventory (CDI-2). B) Patient Health Questionnaire for Adolescents (PHQ-A). C) Geriatric Depression Scale (GDS). D) Edinburgh Postnatal Depression Scale (EPDS).

Option A is incorrect because the CDI-2 is designed for children [p. 1960]. Option B is incorrect because the PHQ-A is designed for adolescents [p. 1960]. Option C is correct because the Geriatric Depression Scale (GDS) is a validated and useful screening tool specifically designed to evaluate older adults for depression [p. 1960, 1978]. Option D is incorrect because the EPDS is designed to screen postpartum women [p. 1960]. Correct Answer: C

Question: During a physical examination of a client with suspected major depressive disorder, which systemic regulatory patterns must the nurse prioritize for assessment? Answer Choices: A) Handgrip strength, visual acuity, and patellar reflexes. B) Sleep, nutrition, activity, and elimination patterns. C) Hearing acuity, range of motion, and baseline oxygen saturation. D) Bone density, cranial nerve function, and vital capacity.

Option A is incorrect because muscle strength and reflexes are not the primary systemic regulatory systems disrupted by depression [p. 1962, 1979]. Option B is correct because when conducting a physical examination of patients with mood disorders, the nurse must obtain vital signs and baseline weight, and also be sure to assess sleep, nutrition, activity, and elimination patterns, as these are frequently disrupted [p. 1962, 1979]. Option C is incorrect because range of motion and hearing are not the priority assessments for depression manifestations [p. 1962]. Option D is incorrect because bone density and vital capacity are not priority physiological indicators of depression severity [p. 1962]. Correct Answer: B

Question: A nurse is reviewing a client’s history and notes they are taking a prescribed corticosteroid for chronic asthma. Which understanding of comorbidities and pharmacology should guide the nurse’s assessment? Answer Choices: A) Corticosteroids can have depression as a side effect, which may mimic or exacerbate a mood disorder. B) Corticosteroids increase the metabolism of antidepressants, rendering them completely ineffective. C) Asthmatic clients are genetically immune to the development of depressive symptoms. D) Corticosteroids prevent antidepressants from crossing the blood-brain barrier.

Option A is correct because the nurse should assess the use of prescription medications to determine if the patient is taking anything that may have depression as a side effect, such as corticosteroids or beta-adrenergic blockers [p. 1979]. Option B is incorrect because corticosteroids do not render antidepressants ineffective through metabolic acceleration [p. 1979]. Option C is incorrect because chronic illnesses like asthma actually increase (not decrease) the risk of developing depression [p. 1979]. Option D is incorrect because corticosteroids do not prevent antidepressants from crossing the blood-brain barrier [p. 1979]. Correct Answer: A

Question: A nurse is assessing a client with depression who reports drinking alcohol daily to "numb the pain." Which clinical rationale explains why the nurse must assess for and address this comorbid substance use? Answer Choices: A) Alcohol acts as a CNS stimulant that causes a rapid switch to mania. B) Alcohol and other substances that act as CNS depressants can complicate and worsen depression. C) Daily alcohol use prevents the liver from metabolizing all psychotropic drugs. D) Alcohol use causes a structural deficiency in the prefrontal cortex within 24 hours of use.

Option A is incorrect because alcohol is a CNS depressant, not a stimulant, and does not cause a manic switch [p. 1979]. Option B is correct because alcohol and other substances that act as CNS depressants can complicate depression, and co-occurring depression and substance use can complicate recovery from both conditions [p. 1979]. Option C is incorrect because while alcohol affects the liver, it does not completely prevent the metabolism of all psychotropic medications [p. 1979]. Option D is incorrect because alcohol does not cause acute structural prefrontal cortex destruction within 24 hours [p. 1979]. Correct Answer: B

Question: A pediatric nurse is assessing a 2-year-old toddler suspected of experiencing depression due to severe family disruption. Which developmental manifestation of depression should the nurse expect to find in this toddler? Answer Choices: A) Self-care neglect and changes in peer groups. B) Decreased academic performance and boredom. C) Regression from independence to dependence in some activities, such as toileting. D) Outbursts of pressured speech and grandiosity.

Option A is incorrect because peer group changes and self-care neglect are manifestations of depression in adolescents, not toddlers [p. 1978]. Option B is incorrect because academic performance and boredom are clinical manifestations seen in school-age children [p. 1978]. Option C is correct because toddlers experiencing depression may regress from independence to dependence in some activities, such as toileting [p. 1978]. Option D is incorrect because pressured speech and grandiosity are symptoms of mania, not toddler depression [p. 1954]. Correct Answer: C

Question: A nurse at a pediatric clinic is assessing a 4-year-old preschooler. The parents report the child has been Whining constantly, playing destructively, and showing a lack of interest or confidence in activities. How should the nurse interpret these signs? Answer Choices: A) Normal developmental behaviors of early childhood that require no follow-up. B) Manifestations of depression in a preschool-aged child. C) Early-onset Bipolar I disorder characterized by manic hyperactivity. D) Signs of severe cognitive regression due to a physical head injury.

Option A is incorrect because persistent whining, destructive play, and lack of interest represent alterations in mood and behavior rather than normal developmental patterns [p. 1978]. Option B is correct because preschoolers with depression may display symptoms including increased irritability, whining, destructive play themes, and a lack of interest or confidence related to activities [p. 1978]. Option C is incorrect because these are depressive symptoms, not manic hyperactivity [p. 1978]. Option D is incorrect because there is no evidence of a head injury, and these are classic emotional/behavioral manifestations of preschooler depression [p. 1978]. Correct Answer: B

Question: A school nurse is assessing a 9-year-old child whose grades have suddenly dropped. The child complains of vague stomachaches, has stopped playing at recess, and recently told a friend they "want to run away." How should the nurse interpret these findings? Answer Choices: A) Behavioral manifestations of adolescent identity crisis. B) Manifestations of depression in a school-age child. C) Side effects of toxic exposure to environmental chemicals. D) Normal behavioral adjustments to school curriculum changes.

Option A is incorrect because identity crises are developmental tasks of adolescence, not 9-year-old children [p. 1978]. Option B is correct because school-age children with depression may present with decreased academic performance, changes in physical activity, somatic complaints (such as stomachaches), boredom, and talk of running away [p. 1978]. Option C is incorrect because these symptoms are classic psychiatric indicators of child depression rather than toxic chemical exposure [p. 1978]. Option D is incorrect because somatic complaints and talking about running away are serious symptoms of depression, not normal adjustments [p. 1978]. Correct Answer: B

Question: A nurse is assessing a 16-year-old adolescent with a history of depression. The parents report that the adolescent has stopped hanging out with their usual friends, has poor school performance, neglected their hygiene, and is in constant conflict with them. How should the nurse classify these manifestations? Answer Choices: A) Developmental regressions typical of preschool-aged children. B) Normal developmental milestones of healthy teenage independence. C) Manifestations of depression in an adolescent. D) Behavioral side effects of an endocrine thyroid tumor.

Option A is incorrect because these behaviors are complex peer and academic disruptions, not the basic regressions (like toileting) seen in early childhood [p. 1978]. Option B is incorrect because severe hygiene neglect, failing grades, and extreme, constant relational conflict represent functional impairment, not healthy development [p. 1978]. Option C is correct because adolescents experiencing depression frequently display changes in peer groups, decreased self-care, poor school performance, and increasing conflict with parents and teachers [p. 1978]. Option D is incorrect because these are well-established psychiatric symptoms of adolescent depression, not endocrine tumor effects [p. 1978]. Correct Answer: C

Question: A pediatric nurse is reviewing Bipolar Disorder manifestations in children. Which presentation is characteristic of a child experiencing a manic episode? Answer Choices: A) Slow, monotone speech and sleeping up to 14 hours a day. B) Silly or joyful mood that is highly unusual for the child, along with lengthy, violent temper tantrums. C) Regression in toileting skills and persistent, quiet withdrawal. D) Severe, constant somatic complaints such as chronic joint pain.

Option A is incorrect because monotone speech and hypersomnia are depressive symptoms, not manic ones [p. 1973, 1987]. Option B is correct because children with bipolar disorders present with mood changes, such as being overly silly or joyful when that is unusual for the child, behavioral changes (racing thoughts, little sleep), and some may exhibit lengthy, violent temper tantrums [p. 1987]. Option C is incorrect because regression in toileting and quiet withdrawal are depressive signs, not manic ones [p. 1978]. Option D is incorrect because somatic joint pain is not a primary diagnostic manifestation of a pediatric manic episode [p. 1987]. Correct Answer: B

Question: A pregnant client with Bipolar I disorder asks the nurse about the risks of continuing her prescribed lithium carbonate during pregnancy. Which safety information should the nurse provide? Answer Choices: A) Lithium is completely safe and carries zero risk to the fetus throughout pregnancy. B) Lithium use during the first trimester increases the risk of potential fetal heart defects. C) Lithium must be discontinued immediately without tapering at the onset of pregnancy. D) Lithium should be replaced with high-dose valproic acid before conception.

Option A is incorrect because no psychotropic medication is completely safe with zero risk during pregnancy [p. 1969, 1988]. Option B is correct because the fetus should be assessed for potential heart defects, as risk for them increases with lithium use during the first trimester [p. 1988]. Option C is incorrect because abruptly stopping lithium can cause severe symptom relapse; any adjustment should be done via a careful taper under a provider's guidance [p. 1988]. Option D is incorrect because valproic acid is associated with a high risk of neural tube, cardiac, and craniofacial defects and should be avoided [p. 1988]. Correct Answer: B

Question: A female client of reproductive age with bipolar disorder is planning to become pregnant. She is currently taking divalproex (valproic acid) for mood stabilization. Which instruction should the nurse anticipate the provider giving this client? Answer Choices: A) "Continue taking divalproex as prescribed, as it is the safest option during pregnancy." B) "Double your divalproex dose during the first trimester to protect against postpartum psychosis." C) "Switch to another mood stabilizer before conception due to high risks of neural tube, cardiac, and craniofacial defects." D) "Discontinue all medications and manage symptoms using St. John's wort."

Option A is incorrect because divalproex is highly teratogenic and is not the safest option [p. 1988]. Option B is incorrect because doubling the dose of a teratogenic drug is dangerous and clinically inappropriate [p. 1988]. Option C is correct because women taking divalproex (Depakote) or carbamazepine (Tegretol) should be switched to another mood stabilizer before conception because of the higher-than-average risk for neural tube, cardiac, and craniofacial defects [p. 1988]. Option D is incorrect because St. John's wort is not a mood stabilizer, has no proven efficacy in bipolar disorder, and can trigger manic switches [p. 1966, 1968]. Correct Answer: C

Question: A geriatric nurse is caring for an 84-year-old client with bipolar disorder who has developed chronic kidney disease. Which pharmacological guideline should the nurse prioritize? Answer Choices: A) Increase the lithium dose to compensate for reduced renal filtration. B) Lithium is contraindicated in older patients with kidney disease, and must be avoided. C) Lithium is the preferred first-line therapy for all older adults with renal failure. D) Instruct the client to restrict all fluid intake to prevent lithium dilution.

Option A is incorrect because reduced filtration causes drug accumulation, meaning an increased dose would cause severe toxicity [p. 1986, 1988]. Option B is correct because lithium is contraindicated in older patients with kidney disease, and should be used cautiously in patients with thyroid disease [p. 1988]. Option C is incorrect because renal failure is an absolute contraindication to lithium, not an indication [p. 1988]. Option D is incorrect because restricting fluid intake is dangerous and can precipitate acute lithium toxicity [p. 1986]. Correct Answer: B

Question: An older adult client with depression has recently lost their driving privileges due to cognitive changes. The client’s adult children ask the nurse how this will affect their parent. Which clinical response by the nurse is correct? Answer Choices: A) "Losing driving privileges is a minor inconvenience that older adults adapt to within 24 hours." B) "The loss of driving privileges is a huge loss to older adults, often putting a great deal of strain on family members." C) "Driving cessation completely eliminates the older adult's risk of developing suicidal ideation." D) "Older adults who have a positive outlook are completely unaffected by this type of stressor."

Option A is incorrect because driving cessation is a major, life-altering loss, not a minor inconvenience [p. 1978]. Option B is correct because the loss of driving privileges is a huge loss to older adults, often putting a great deal of strain on family members who must accommodate them, as well as providing support as they learn to cope [p. 1978]. Option C is incorrect because such major losses actually increase (not decrease) the risk of depression and suicidal ideation in older adults [p. 1978, 2002]. Option D is incorrect because even older adults who "see the glass as half full" are challenged by these types of stressors [p. 1978]. Correct Answer: B

Question: A nurse is assessing a client 1 week postpartum. The client’s partner reports that the client has not slept, is hearing voices, and claims the baby is "possessed by a demon." Which action must the nurse take first? Answer Choices: A) Educate the parents on normal newborn crying patterns and basic sleep hygiene. B) Secure the immediate safety of the infant and coordinate urgent psychiatric intervention for suspected postpartum psychosis. C) Schedule a routine follow-up appointment in the clinic for next month. D) Advise the client to increase their dietary intake of folic acid and vitamin B12.

Option A is incorrect because sleep hygiene and baby care education are completely inadequate and unsafe for an acute psychotic episode with active delusions [p. 1957]. Option B is correct because postpartum psychosis is a severe psychiatric emergency that frequently involves command hallucinations or delusions (such as the mother feeling the baby is possessed), representing an extreme safety emergency that requires immediate safety measures for the infant and urgent psychiatric care [p. 1957]. Option C is incorrect because waiting a month is a critical safety failure that leaves the infant at severe risk of harm [p. 1957]. Option D is incorrect because vitamins do not treat acute postpartum psychosis and fail to address immediate safety concerns [p. 1957]. Correct Answer: B

Question: A nurse is caring for a client in an acute manic state who is pacing the unit continuously and has not eaten or slept in 36 hours. Which nursing intervention should the nurse prioritize? Answer Choices: A) Place the client in a highly competitive sports activity to exhaust their excess energy. B) Provide high-calorie finger foods and nutritional beverages that can be consumed on the go, and promote rest. C) Engage the client in a lengthy, detailed discussion about their financial spending sprees. D) Insist that the client sit down at the dining table for a full three-course meal.

Option A is incorrect because highly competitive interactions such as sports should be avoided, as these activities can result in hostility and aggression [p. 1989]. Option B is correct because during manic episodes, patients may not stop to eat and are at risk for compromised nutrition; therefore, finger foods and high-calorie nutritional beverages are good options that can be consumed on the go, while establishing rest is a priority [p. 1989, 1990]. Option C is incorrect because detailed discussions about delusions or reckless behavior can be overstimulating and are not the priority during acute hyperactivity [p. 1989]. Option D is incorrect because manic clients are unable to sit still for a meal, and forcing them to do so will cause frustration and potential agitation [p. 1989]. Correct Answer: B

Question: A nurse is caring for a client on an inpatient unit who is determined to be at high risk for suicide. Which immediate safety intervention must the nurse implement? Answer Choices: A) Provide the client with a private room at the end of a quiet hallway and check on them every 30 minutes. B) Ensure the client is never left alone, with a healthcare worker present at all times. C) Ask the client to sign a "no-harm contract" as a replacement for close observation. D) Limit family visits completely to prevent emotional distress.

Option A is incorrect because placing a high-risk suicidal client at the end of a quiet hallway with 30-minute checks provides too much opportunity for self-harm [p. 2008]. Option B is correct because the nurse must ensure that the patient at high risk for suicide is never left alone; a nurse, healthcare professional, or other healthcare worker should be with the patient at all times [p. 2008]. Option C is incorrect because there is a lack of evidence to support the use of no-harm contracts, and they should never be used as a substitute for active clinical monitoring and safety precautions [p. 2007, 2008]. Option D is incorrect because family and community support are key protective factors, and visits should be structured safely rather than banned [p. 2002, 2008]. Correct Answer: B

Question: A client is admitted to the psychiatric unit with a history of a suicide attempt. During triage, the nurse learns the attempt occurred 3 days ago. According to evidence-based protocols, which triage action is indicated? Answer Choices: A) Refer the client to an outpatient mental health provider to be seen within the next month. B) Provide a list of local crisis hotlines and discharge the client to home. C) Initiate immediate, close safety monitoring and arrange for a psychiatric consultation. D) Instruct the client to sign a no-harm contract and place them on a standard 15-minute check.

Option A is incorrect because a recent attempt (within the last week) requires immediate acute hospitalization and safety monitoring, not outpatient referral [p. 2007]. Option B is incorrect because discharging a client who attempted suicide 3 days ago without stabilization is highly unsafe [p. 2007]. Option C is correct because for patients with a history of a previous suicide attempt, interventions are determined by the time elapsed; an attempt within the last week requires immediate monitoring for safety with a psychiatric consultation [p. 2007]. Option D is incorrect because no-harm contracts lack evidence, and standard 15-minute checks may be insufficient for an actively suicidal client who needs immediate safety monitoring [p. 2007, 2008]. Correct Answer: C

Question: A nurse is providing teaching to a client who is newly prescribed vilazodone (Viibryd) for major depressive disorder. Which dietary instruction is essential for this medication? Answer Choices: A) Avoid all tyramine-containing foods like aged cheese and red wine. B) Take the medication with food to avoid gastrointestinal upset and ensure proper absorption. C) Restrict fluid intake to less than 1 liter a day while taking the drug. D) Take the medication exclusively on an empty stomach first thing in the morning.

Option A is incorrect because tyramine restrictions apply to MAOIs, not SSRIs like vilazodone [p. 1976 Table]. Option B is correct because most SSRIs can be taken with or without food, except vilazodone (Viibryd), which should be taken with food to avoid GI upset [p. 1976 Table]. Option C is incorrect because restricting fluid intake is unnecessary and can cause dehydration [p. 1976]. Option D is incorrect because taking vilazodone on an empty stomach can cause significant GI distress and impair drug efficacy [p. 1976 Table]. Correct Answer: B

Question: A client with major depressive disorder and a history of epilepsy is prescribed an antidepressant. Which medication is contraindicated for this client due to its known side effect of lowering the seizure threshold? Answer Choices: A) Fluoxetine (Prozac). B) Bupropion (Wellbutrin). C) Mirtazapine (Remeron). D) Duloxetine (Cymbalta).

Option A is incorrect because fluoxetine is an SSRI and does not carry a prominent contraindication for seizure disorders [p. 1976 Table]. Option B is correct because bupropion (Wellbutrin) should be used with caution—or is contraindicated—in patients with seizure disorders because it lowers the seizure threshold [p. 1976 Table]. Option C is incorrect because mirtazapine is a tetracyclic antidepressant that does not significantly lower the seizure threshold [p. 1976 Table]. Option D is incorrect because duloxetine is an SNRI and is not contraindicated due to seizure risks [p. 1976 Table]. Correct Answer: B

Question: A client with major depressive disorder reports experiencing chronic musculoskeletal pain and fibromyalgia. Which antidepressant medication should the nurse anticipate the provider prescribing, given its FDA approval for managing chronic pain? Answer Choices: A) Fluvoxamine. B) Duloxetine (Cymbalta). C) Phenelzine. D) Trazodone.

Option A is incorrect because fluvoxamine is used primarily for OCD and depression, and is not approved for chronic musculoskeletal pain [p. 1976 Table]. Option B is correct because duloxetine (Cymbalta) is an SNRI that is FDA-approved and commonly prescribed for depression, fibromyalgia, chronic musculoskeletal pain, and neuropathic pain [p. 1976 Table]. Option C is incorrect because phenelzine is an MAOI and is not a standard first-line treatment for chronic pain [p. 1976 Table]. Option D is incorrect because trazodone is an atypical antidepressant used primarily for insomnia and depression, not chronic pain [p. 1976 Table]. Correct Answer: B

Question: A client is prescribed trazodone for depression and insomnia. Which critical safety instruction should the nurse provide to this client to prevent injury? Answer Choices: A) Avoid all dietary sodium to prevent rapid drug accumulation. B) Stand up slowly from a sitting or lying position because this medication can cause orthostatic hypotension. C) Restrict fluid intake to prevent severe water retention. D) Take the medication only in the morning to prevent daytime drowsiness.

Option A is incorrect because sodium restriction is not associated with trazodone therapy [p. 1976 Table]. Option B is correct because trazodone blocks histamine and alpha1 receptors, and patients should be instructed on changing positions slowly secondary to the potential for orthostatic hypotension [p. 1976 Table]. Option C is incorrect because fluid restriction is not indicated [p. 1976]. Option D is incorrect because trazodone causes excessive drowsiness and should be taken at bedtime, not in the morning [p. 1976 Table]. Correct Answer: B

Question: A nurse is assessing an older adult client who takes amitriptyline (a tricyclic antidepressant). The client reports experiencing dry mouth, blurred vision, severe constipation, and urinary hesitancy. How should the nurse classify these symptoms? Answer Choices: A) Manifestations of life-threatening Serotonin Syndrome. B) Classic anticholinergic side effects of tricyclic antidepressants (TCAs). C) Symptoms of acute lithium toxicity. D) Normal physiological signs of the natural aging process.

Option A is incorrect because Serotonin Syndrome is characterized by neuromuscular excitability, altered mental status, and autonomic hyperactivity, not dry mouth and constipation [p. 1964]. Option B is correct because TCAs cause classic anticholinergic side effects, including dry mouth, constipation, blurred vision, urinary retention, and increased heart rate [p. 1976 Table]. Option C is incorrect because these are not the classic signs of lithium toxicity (which include tremors, diarrhea, ataxia, and polyuria) [p. 1985 Table]. Option D is incorrect because while these can occur in older adults, they are prominent, drug-induced anticholinergic side effects of amitriptyline that require clinical management [p. 1976 Table]. Correct Answer: B

Question: A 45-year-old client is being evaluated for treatment of severe major depressive disorder, and the provider is considering prescribing a tricyclic antidepressant (TCA). Which diagnostic assessment should the nurse ensure is completed prior to starting this medication? Answer Choices: A) A 24-hour urine collection for catecholamines. B) An electroencephalogram (EEG). C) An electrocardiogram (ECG). D) A baseline computed tomography (CT) scan of the brain.

Option A is incorrect because a 24-hour urine catecholamine test is not indicated for starting TCAs [p. 1976 Table]. Option B is incorrect because EEGs are not routine pre-TCA diagnostic assessments [p. 1976 Table]. Option C is correct because for patients over the age of 40, an ECG may be ordered prior to the initiation of TCA treatment to detect preexisting arrhythmias, as TCAs affect cardiac conduction and are contraindicated in acute MI recovery, heart block, or history of dysrhythmias [p. 1976 Table]. Option D is incorrect because a brain CT scan is not a routine requirement for starting a TCA [p. 1976 Table]. Correct Answer: C

Question: A client taking phenelzine (an MAOI) is admitted to the emergency department with a severe, throbbing headache, chest pain, and a blood pressure of 210/120 mmHg. The nurse suspects a hypertensive crisis. Which dietary indiscretion should the nurse suspect as the trigger? Answer Choices: A) Consuming foods high in tyramine, such as aged cheese, draft beer, or cured meats. B) Drinking grapefruit juice with the medication. C) Restricting daily sodium intake to less than 1.5 grams. D) Consuming high amounts of refined sugars and simple carbohydrates.

Option A is correct because MAOIs inhibit monoamine oxidase and interact with a number of foods containing tyramine (like aged cheese, draft beer, cured meats), which can cause a life-threatening hypertensive crisis [p. 1976 Table]. Option B is incorrect because while grapefruit juice affects TCAs, it is not the primary cause of a hypertensive crisis with MAOIs [p. 1976 Table]. Option C is incorrect because sodium restriction does not cause a hypertensive crisis [p. 1976 Table]. Option D is incorrect because refined sugars do not contain tyramine and do not trigger a hypertensive crisis [p. 1976 Table]. Correct Answer: A

Question: A nurse is preparing to administer intranasal esketamine to a client with treatment-resistant depression. Which clinical monitoring protocol must the nurse implement during and after administration? Answer Choices: A) Perform continuous pulse oximetry and keep the client on bedrest for 24 hours. B) Monitor the client’s blood pressure, sedation, and dissociation in the clinic for at least 2 hours. C) Restrict the client's oral fluids for 6 hours prior to and 4 hours after the dose. D) Administer a high-dose oral sedative immediately before esketamine to prevent anxiety.

Option A is incorrect because 24-hour bedrest is unnecessary and not a standard monitoring protocol [p. 1976]. Option B is correct because due to safety concerns and risks, esketamine is only administered through a restricted distribution system, where an HCP must be present and the patient must be monitored, including blood pressure measurements, for at least 2 hours afterward due to the risk of sedation and dissociation [p. 1976]. Option C is incorrect because fluid restriction is not standard [p. 1976]. Option D is incorrect because giving a sedative before esketamine would dangerously compound the sedative effects and risk severe respiratory depression [p. 1976]. Correct Answer: B

Question: A client with Bipolar I disorder is initiated on lithium carbonate. The nurse is discussing the narrow therapeutic range of this medication. Which range should the nurse identify as therapeutic for this client? Answer Choices: A) 0.1 to 0.5 mEq/L. B) 0.6 to 1.2 mEq/L. C) 1.5 to 2.0 mEq/L. D) 2.5 to 3.5 mEq/L.

Option A is incorrect because levels below 0.6 mEq/L are generally subtherapeutic [p. 1985, 1986]. Option B is correct because lithium has a narrow therapeutic range, which is 0.6 to 1.2 mEq/L [p. 1985, 1986]. Option C is incorrect because lithium toxicity begins at blood levels of 1.5 mEq/L [p. 1985, 1986]. Option D is incorrect because levels above 2.0 mEq/L indicate severe, life-threatening lithium toxicity [p. 1985 Table]. Correct Answer: B

Question: A client taking lithium carbonate reports experiencing severe joint pain from a recent injury and asks the nurse if they can take over-the-counter ibuprofen (an NSAID) for relief. Which response by the nurse is correct? Answer Choices: A) "Yes, ibuprofen is safe to take with lithium and will not affect your blood levels." B) "No, do not take NSAIDs like ibuprofen concurrently with lithium because they increase lithium absorption and can cause toxicity." C) "Yes, but you must double your lithium dose while taking the ibuprofen to prevent a manic switch." D) "No, because ibuprofen blocks the therapeutic action of lithium in the brain, causing a depressive relapse."

Option A is incorrect because NSAIDs are highly interactive with lithium and are not safe [p. 1985 Table]. Option B is correct because patients should not use lithium concurrently with NSAIDs, as this can increase the absorption of lithium and cause toxicity [p. 1985 Table]. Option C is incorrect because doubling a lithium dose is highly dangerous and would precipitate severe, life-threatening toxicity [p. 1985, 1986]. Option D is incorrect because the interaction is due to increased lithium levels and toxicity, not drug blocking [p. 1985 Table]. Correct Answer: B

Question: A client taking lithium carbonate is admitted with confusion, coarse hand tremors, persistent vomiting, and severe diarrhea. The nurse should identify these findings as indicating which level of lithium toxicity? Answer Choices: A) Subtherapeutic status requiring a dose increase. B) Mild lithium toxicity. C) Moderate lithium toxicity. D) Severe, life-threatening lithium toxicity.

Option A is incorrect because these are prominent signs of toxic accumulation, not subtherapeutic levels [p. 1985 Table]. Option B is incorrect because mild toxicity is characterized by GI upsets, thirst, fatigue, polyuria, and fine hand tremors [p. 1985 Table]. Option C is correct because moderate toxicity is characterized by confusion, poor coordination, coarse tremors, persistent vomiting, and diarrhea [p. 1985 Table]. Option D is incorrect because severe toxicity is characterized by extreme polyuria, blurred vision, tinnitus, ataxia, seizures, severe hypotension, coma, and potential death [p. 1985 Table]. Correct Answer: C

Question: A client with bipolar disorder is prescribed lamotrigine (Lamictal). Which critical instruction should the nurse emphasize to ensure the client's safety? Answer Choices: A) "Avoid all dietary sodium to prevent rapid kidney damage." B) "Report any new skin rash immediately to your healthcare provider, as it could indicate a life-threatening reaction." C) "Expect to develop a mild, localized skin rash that will resolve on its own in 2 to 3 days." D) "Drink at least 1 glass of grapefruit juice daily with this medication to ensure absorption."

Option A is incorrect because sodium restriction is not indicated for lamotrigine [p. 1985 Table]. Option B is correct because lamotrigine can cause a serious, life-threatening skin rash known as Stevens-Johnson syndrome, and patients must be taught to report any rash immediately [p. 1985 Table]. Option C is incorrect because a skin rash is a medical emergency and must never be dismissed as normal or self-limiting [p. 1985 Table]. Option D is incorrect because grapefruit juice is interactive with carbamazepine, not lamotrigine, and is avoided [p. 1985 Table]. Correct Answer: B

Question: A client with bipolar mania is prescribed olanzapine (Zyprexa) orally disintegrating tablets. Which clinical rationale explains why this specific form of the medication was ordered? Answer Choices: A) Orally disintegrating tablets prevent "med cheeking," where patients hide tablets in their mouth to dispose of them later. B) This form is absorbed in the stomach much slower, preventing rapid weight gain. C) Orally disintegrating tablets bypass liver metabolism completely, reducing the risk of hepatotoxicity. D) This form does not cause any orthostatic hypotension or extrapyramidal side effects.

Option A is correct because the orally disintegrating form of olanzapine may be prescribed to reduce instances of "med cheeking," where patients hide the tablet in their mouth or cheek until they can dispose of it [p. 1986 Safety Alert]. Option B is incorrect because disintegrating tablets do not affect weight gain, which is a common side effect of olanzapine [p. 1985 Table]. Option C is incorrect because bypassing swallowing does not change hepatic metabolism [p. 1985 Table]. Option D is incorrect because olanzapine ODT still carries risks for orthostatic hypotension and EPS [p. 1985 Table, 1986]. Correct Answer: A

Question: A client taking haloperidol develops acute, painful muscle spasms of the neck and jaw. The nurse recognizes this as an acute dystonic reaction. Which medication should the nurse expect the provider to prescribe to treat this extrapyramidal side effect (EPS)? Answer Choices: A) Lithium carbonate. B) Benztropine (Cogentin). C) Valproic acid (Depakote). D) Aripiprazole (Abilify).

Option A is incorrect because lithium is a mood stabilizer, not an anticholinergic used to treat EPS [p. 1985 Table]. Option B is correct because extrapyramidal symptoms are reported and usually treated by the administration of an anticholinergic medication such as benztropine (Cogentin), diphenhydramine (Benadryl), or trihexyphenidyl (Artane) [p. 1986]. Option C is incorrect because valproic acid is an antiseizure mood stabilizer and does not treat acute dystonic reactions [p. 1985 Table]. Option D is incorrect because aripiprazole is an atypical antipsychotic and is a cause of EPS rather than a treatment for it [p. 1985 Table]. Correct Answer: B

Question: A client with severe major depressive disorder has shown no response to multiple antidepressant medication trials. The interdisciplinary team discusses Electroconvulsive Therapy (ECT). Which statement regarding the efficacy and side effects of ECT is supported by evidence? Answer Choices: A) ECT has a low efficacy rate of less than 30% in depression with psychotic features. B) ECT is associated with permanent, severe language loss and irreversible speech deficits. C) ECT shows response rates of over 80% in treating depression, with transient short-term memory loss and mild confusion being expected side effects. D) ECT is a painful procedure performed without anesthesia or muscle relaxants.

Option A is incorrect because ECT is highly effective, showing response rates of over 80%, and the response is even higher in patients with psychotic features [p. 1967, 1976 Table]. Option B is incorrect because ECT does not cause permanent language loss or speech deficits [p. 1967]. Option C is correct because ECT has response rates of over 80% in treating depression, and expected side effects include mild confusion immediately following the procedure (postictal state) and transient, short-term memory loss [p. 1967, 1976 Table]. Option D is incorrect because ECT is performed under general anesthesia and muscle relaxants to ensure safety and comfort [p. 1967]. Correct Answer: C

Question: An inpatient psychiatric nurse is discussing treatment options with a client who is experiencing acute, severe suicidal ideation. Which statement regarding the clinical use of intravenous ketamine is correct? Answer Choices: A) Ketamine is an FDA-approved daily maintenance drug that can be taken safely at home. B) A single treatment of ketamine has been shown to reduce suicidal ideation in adults, with effects lasting up to 72 hours. C) Ketamine is only effective when combined with electroconvulsive therapy on the same day. D) Ketamine is contraindicated for any patient with unipolar depression.

Option A is incorrect because ketamine is not approved as a daily, self-administered maintenance drug at home due to safety and abuse risks [p. 2005]. Option B is correct because in a study of 572 participants, a single treatment of ketamine reduced suicidal ideation in adult psychiatric patients predominantly diagnosed with unipolar depression, with effects lasting up to 72 hours [p. 2005]. Option C is incorrect because ketamine can act independently of ECT, although combining therapies is researched [p. 2005]. Option D is incorrect because the study participants were predominantly diagnosed with unipolar depression and showed significant improvement [p. 2005]. Correct Answer: B

Question: A nurse is explaining Cognitive-Behavioral Therapy (CBT) to a client with depression. Which core aspect of this therapy should the nurse emphasize? Answer Choices: A) It focuses on exploring deep, unresolved childhood trauma and dream analysis. B) It uses skills training and problem-solving techniques to focus on current situations and change automatic negative thoughts. C) It requires the client to accept that they have no control over their environment or future. D) It is only used in combination with physical restraints and isolation.

Option A is incorrect because psychoanalysis, not CBT, focuses on childhood exploration and dream analysis [p. 1966, 1977]. Option B is correct because CBT features skills training and problem-solving techniques that focus on current situations and uses cognitive modification to assist patients with identifying and changing automatic negative thoughts [p. 1966, 1977]. Option C is incorrect because CBT empowers clients to gain control over their thoughts and behaviors, refuting helplessness [p. 1977]. Option D is incorrect because CBT is a non-invasive, collaborative talk therapy that does not use restraints or isolation [p. 1977]. Correct Answer: B

Question: A clinical nurse is discussing suicide prevention strategies with a group of nursing students. The nurse explains that Safety Plan Interventions (SPIs) are preferred over traditional "no-harm contracts" for which evidence-based reason? Answer Choices: A) No-harm contracts are legally binding in court, whereas SPIs are completely informal. B) Unlike no-harm contracts that focus on what the patient promises not to do, the SPI focuses on trigger identification, coping strategies, and what the patient will do during a crisis. C) No-harm contracts require daily blood draws to monitor compliance. D) SPIs guarantee that a patient will never experience suicidal ideation again.

Option A is incorrect because neither document is a legally binding contract in court, and SPIs are structured, evidence-based tools [p. 2007 Box 28.5]. Option B is correct because there is a lack of evidence to support the use of no-harm contracts, and many practice guidelines recommend SPIs. Unlike the no-harm contract that focuses on what a patient promises not to do, the SPI emphasizes planning for what the patient will do during a suicidal crisis, guiding them through trigger identification, coping, and support [p. 2007 Box 28.5]. Option C is incorrect because no-harm contracts do not involve blood testing [p. 2007]. Option D is incorrect because no plan can guarantee a complete absence of future suicidal ideation, but SPIs provide a effective crisis-management framework [p. 2007 Box 28.5]. Correct Answer: B

Question: A nurse is assessing a client's affect. Which statements accurately describe the characteristics of normal euthymic affect and its variations? Select all that apply. Answer Choices: A) Broad affect is considered normal and means the client is able to convey many different feelings using verbal and nonverbal responses. B) A stable affect remains consistent when there is no provocation in the environment. C) Flat affect is a normal developmental variation commonly observed in healthy toddlers. D) Labile affect is characterized by rapidly changing emotions that are out of proportion to the stimulus or situation and suggests an underlying disorder. E) Restricted affect is demonstrated when an individual displays the same limited range of feelings across highly varied situations.

Option A is correct because broad (or full) affect is considered normal, meaning a person is able to convey many different feelings using verbal and nonverbal responses [p. 1953]. Option B is correct because stability refers to how often and how rapidly an individual's affect fluctuates, and a stable affect remains consistent when there is no provocation in the environment [p. 1953]. Option C is incorrect because flat affect is an absence of emotional cues and is abnormal in any age group, not a normal toddler variation [p. 1953, 1978]. Option D is correct because a labile or rapidly changing affect that is out of proportion to the stimulus or situation is considered abnormal and is often suggestive of a disease or disorder [p. 1953]. Option E is correct because restricted affect involves expressing only a limited range of feelings across varied situations (such as weeping for illness but showing no joy for birth) [p. 1953]. Correct Answer: A, B, D, E

Question: A nurse is reviewing the pathophysiology and predisposing factors associated with Bipolar Spectrum Disorders. Which statements are supported by clinical evidence? Select all that apply. Answer Choices: A) Bipolar disorders are thought to arise from a complex combination of genetic, physiologic, environmental, and psychosocial factors. B) Bipolar disorder is localized to one specific area of the prefrontal cortex with 100% certainty. C) Genetic factors are a strong predisposing factor, and children of parents with bipolar disorders have an increased risk. D) Studies have found a connection between bipolar disorder and cerebellar and basal ganglia dysfunctions in motor and emotional processing. E) Bipolar disorders, schizophrenia, and major depressive disorders share biological susceptibility and inheritance patterns.

Option A is correct because bipolar spectrum disorders are thought to arise from a complex combination of genetic, physiologic, environmental, and psychosocial factors [p. 1983]. Option B is incorrect because studies have not found significant evidence proving that bipolar disorder is localized to a specific area of the brain [p. 1983]. Option C is correct because genetics is a strong predisposing factor, and children of parents with bipolar disorders have an increased risk [p. 1983]. Option D is correct because studies have found a connection between bipolar disorder and cerebellar and basal ganglia dysfunctions in emotion and motor processing regions [p. 1983]. Option E is correct because bipolar disorders, schizophrenia, and major depressive disorders share biological susceptibility and inheritance patterns [p. 1983]. Correct Answer: A, C, D, E

Question: A nurse is teaching students about the pathophysiology of major depressive disorder. Which biological mechanisms are associated with this disorder? Select all that apply. Answer Choices: A) Decreased metabolic activity and decreased gray-matter volume in the medial prefrontal cortex (MPFC). B) Hyperactivity of the limbic system due to poor regulatory control by the prefrontal cortex. C) Alterations in neurotransmitter activity and neuronal receptivity, including serotonin (5-HT), norepinephrine (NE), dopamine (DA), and GABA. D) Increased levels of inflammatory biomarkers called cytokines. E) Elevated levels of cortisol and corticotropin-releasing hormone, indicating HPA axis hyperactivity.

Option A is correct because individuals with depression often have decreased gray-matter volume and lower metabolic activity in the MPFC [p. 1953, 1971]. Option B is correct because decreased MPFC activity prevents it from properly controlling and regulating the limbic system, leading to limbic system hyperactivity [p. 1953, 1971]. Option C is correct because the working neurochemical theory involves alterations in neurotransmitter activity and/or neuronal receptivity to neurotransmitters like 5-HT, NE, DA, ACh, GABA, and glutamate [p. 1971]. Option D is correct because recent studies have focused on a connection between depression and inflammation, based on the fact that many depressed individuals have increased levels of inflammatory biomarkers called cytokines [p. 1971]. Option E is correct because depressed individuals tend to have increased levels of cortisol and corticotropin-releasing hormone, which indicate HPA and limbic system hyperactivity [p. 1971]. Correct Answer: A, B, C, D, E

Question: According to Joiner's Interpersonal Theory of Suicide, which clinical elements must be present for an individual to die by suicide? Select all that apply. Answer Choices: A) A perception of being a burden to others. B) Social alienation and isolation leading to a low sense of belongingness. C) Possessing the acquired capability for lethal self-injury. D) An absolute genetic guarantee of suicidal behavior. E) Having young children at home to care for and provide for.

Option A is correct because Joiner's theory suggests that suicide results from the perception of burdening others, which leads to the misperception that "if I die, it will make it easier for my family and friends" [p. 2001]. Option B is correct because social alienation and isolation leading to a low sense of belongingness is a core element of Joiner's theory [p. 2001]. Option C is correct because Joiner concluded that the element of "acquired ability for lethal self-injury" (accumulated over time with repeated exposure to painful experiences) must be present to attempt suicide [p. 2001]. Option D is incorrect because while there is a genetic risk factor, there is no absolute genetic guarantee of suicidal behavior [p. 2000, 2001]. Option E is incorrect because having young children to care for is a protective factor against suicide, not an element that leads to suicide [p. 2002]. Correct Answer: A, B, C

Question: A nurse is assessing a client in an acute manic state. Which manifestations support a diagnosis of a manic episode according to the DSM-5? Select all that apply. Answer Choices: A) Decreased need for sleep, such as feeling rested after only 2 to 3 hours of sleep. B) Pressured, rapid speech that is difficult to interrupt. C) Flight of ideas, characterized by rapidly changing, fragmented thoughts. D) Psychomotor retardation, with noticeably slowed speech and physical movements. E) Excessive involvement in pleasurable activities that carry a high risk of painful consequences.

Option A is correct because a decreased need for sleep is a classic manifestation of mania [p. 1983 Table, 1984]. Option B is correct because pressured speech is a common symptom category in manic episodes [p. 1983 Table, 1984]. Option C is correct because flight of ideas (rapidly changing, fragmented thoughts) is a manic manifestation [p. 1983 Table, 1984]. Option D is incorrect because psychomotor retardation is a characteristic of major depression, whereas mania features psychomotor agitation [p. 1973, 1983 Table]. Option E is correct because excessive involvement in pleasurable activities with high risk of painful consequences (such as reckless spending or inappropriate sexual relationships) is a diagnostic criterion for mania [p. 1983 Table, 1984]. Correct Answer: A, B, C, E

Question: A school nurse is developing a suicide awareness program for adolescents. Which risk factors should the nurse identify as contributing to suicidal cognition and behavior in teenagers? Select all that apply. Answer Choices: A) The "collision" of depression, anxiety, drug use, and conduct disorders. B) Exposure to the suicidal behavior of role-model celebrities or peers (contagion). C) Bullying and harassment via text messaging and social media. D) Conflict with parents or a lack of meaningful relationships. E) Active participation in family-based cognitive-behavioral therapy.

Option A is correct because suicidal cognition increases dramatically in adolescents due to the collision of depression, anxiety, drug use, and conduct disorders in the teenage years [p. 2005]. Option B is correct because exposure to the dramatic suicides of role-model celebrities or peers plays a role, as adolescents are highly susceptible to imitative behavior and "contagion" [p. 2005]. Option C is correct because bullying and harassment via text messaging and social media have been linked to a rise in suicide attempts [p. 2005]. Option D is correct because adolescents may attempt suicide due to a lack of meaningful relationships, sexual problems, and/or acute problems with parents [p. 2005]. Option E is incorrect because family-based CBT is a primary prevention and protective factor, not a risk factor [p. 1959, 1972]. Correct Answer: A, B, C, D

Question: A community nurse is reviewing demographic and social risk factors associated with depression. Which populations are at an elevated risk for developing this disorder? Select all that apply. Answer Choices: A) Individuals living below the federal poverty level. B) Individuals with a family history of depression or other mental illnesses. C) Individuals who have experienced child abuse or trauma. D) Individuals with a high level of education and robust social support networks. E) Non-Hispanic Black adults, who experience depression at higher rates than other populations.

Option A is correct because adults living below the federal poverty level experience depression at almost five times the rate of those whose incomes are at or above 400% of the poverty level [p. 1972]. Option B is correct because a family history of depression or other mental illness is a major risk factor [p. 1972]. Option C is correct because a history of child abuse or trauma is a major environmental risk factor [p. 1972]. Option D is incorrect because higher education and robust social support networks are protective factors, not risk factors [p. 1972]. Option E is correct because non-Hispanic Black adults experience depression at greater rates (9.2%) than other populations [p. 1972]. Correct Answer: A, B, C, E

Question: A wellness nurse is educating clients on health promotion and primary prevention strategies that support optimal mood and affect. Which interventions should the nurse include? Select all that apply. Answer Choices: A) Encouraging clients to eat a healthy diet, exercise regularly, obtain adequate sleep, and avoid smoking. B) Educating patients about stress management and healthy coping skills. C) Encouraging patients to participate in meaningful social relationships. D) Using family-based cognitive-behavioral interventions to reduce depression in children of depressed parents. E) Prophylactically prescribing low-dose lithium carbonate to all clients with a family history of mental illness.

Option A is correct because encouraging clients to eat a healthy diet, exercise regularly, obtain adequate sleep, and avoid smoking are key health promotion and primary prevention strategies [p. 1972]. Option B is correct because educating patients about stress management and healthy coping is a recommended primary prevention approach [p. 1972]. Option C is correct because encouraging patients to participate in meaningful social relationships helps prevent mood alterations [p. 1972]. Option D is correct because research supports using family-based cognitive-behavioral interventions to reduce the likelihood of depression in children of depressed parents [p. 1972]. Option E is incorrect because prophylactic lithium is not a primary prevention strategy and is unsafe without a clinical diagnosis [p. 1985 Table, 1986]. Correct Answer: A, B, C, D

Question: A nurse is assessing a client for suicidal intent. The nurse understands that the mnemonic IS PATH WARM represents short-term indications of suicidal intent. Which terms are correctly identified by the letters in this mnemonic? Select all that apply. Answer Choices: A) I - Ideation. B) S - Substance abuse. C) P - Purposelessness. D) A - Anxiety. E) T - Tinnitus.

Option A is correct because 'I' stands for Ideation in the IS PATH WARM mnemonic [p. 2004 Table]. Option B is correct because 'S' stands for Substance abuse [p. 2004 Table]. Option C is correct because 'P' stands for Purposelessness [p. 2004 Table]. Option D is correct because 'A' stands for Anxiety [p. 2004 Table]. Option E is incorrect because 'T' stands for Trapped, not Tinnitus [p. 2004 Table]. Correct Answer: A, B, C, D

Question: A nurse is differentiating depression from grief in a client who recently experienced a loss. According to clinical guidelines, which characteristics are associated with grief rather than depression? Select all that apply. Answer Choices: A) The onset of symptoms is gradual with no specific trigger. B) General feelings of emptiness that tend to come in waves. C) Intact self-worth, with no persistent feelings of worthlessness. D) Preservation of the capacity to experience positive feelings, such as during visits from loved ones. E) An absolute requirement for clinical psychotropic intervention to achieve recovery.

Option A is incorrect because grief is characterized by an onset that follows one or more losses, whereas depression onset may be gradual unless triggered [p. 1975 Table 28.2]. Option B is correct because grief affect involves general feelings of emptiness that come in waves [p. 1975 Table 28.2]. Option C is correct because in grief, self-worth is typically preserved, unlike depression which features sustained loss of self-worth [p. 1975 Table 28.2]. Option D is correct because in grief, the capacity to experience positive feelings remains [p. 1975 Table 28.2]. Option E is incorrect because grief recovery occurs over time as the individual mourns, and does not absolutely require clinical psychotropic drug intervention to improve [p. 1975 Table 28.2]. Correct Answer: B, C, D

Question: A nurse is preparing discharge teaching for a client prescribed lithium carbonate. Which instructions must the nurse include to ensure safe therapy? Select all that apply. Answer Choices: A) "Keep all scheduled laboratory appointments to monitor your blood lithium levels." B) "Do not make sudden changes to your dietary sodium intake, as this can affect lithium levels." C) "Ensure you restrict your fluid intake to less than 1 liter a day to avoid diluting the medication." D) "Do not take over-the-counter NSAIDs like ibuprofen, as they can cause lithium toxicity." E) "Avoid strenuous exercise and excessive sweating, which can lead to dehydration and lithium toxicity."

Option A is correct because the nurse must emphasize the importance of adhering to blood work to check lithium levels [p. 1985 Table, 1986]. Option B is correct because patients must be educated to avoid any change in their sodium intake, as this can cause lithium levels to fluctuate [p. 1985 Table]. Option C is incorrect because patients must maintain adequate fluid intake, and restricting fluids can cause severe lithium toxicity [p. 1985 Table, 1986]. Option D is correct because concurrent use of NSAIDs can increase absorption of lithium and cause toxicity, and is avoided [p. 1985 Table]. Option E is correct because strenuous, constant exercise and sweating can lead to dehydration and subsequent lithium toxicity [p. 1985 Table]. Correct Answer: A, B, D, E

Question: Prior to initiating lithium carbonate therapy, which baseline laboratory and diagnostic tests must the nurse verify have been ordered? Select all that apply. Answer Choices: A) Renal function tests (BUN and creatinine). B) Thyroid function tests (TSH, free T4). C) Electrocardiogram (ECG). D) Pregnancy test (for women of childbearing age). E) Baseline computed tomography (CT) scan of the liver.

Option A is correct because renal function must be assessed prior to treatment as lithium is excreted by the kidneys [p. 1985 Table]. Option B is correct because thyroid function must be assessed baseline and monitored, as lithium can affect thyroid function [p. 1985 Table]. Option C is correct because a baseline ECG is required prior to lithium initiation to assess cardiovascular safety [p. 1985 Table]. Option D is correct because a pregnancy test is required for women as lithium is associated with fetal heart defects [p. 1985 Table, 1988]. Option E is incorrect because a liver CT scan is not a standard pre-lithium diagnostic requirement [p. 1985 Table]. Correct Answer: A, B, C, D

Question: A nurse is assessing a client for potential lithium toxicity. Which findings are indicative of severe lithium toxicity? Select all that apply. Answer Choices: A) Extreme polyuria and blurred vision. B) Tinnitus and ataxia. C) Seizures and severe hypotension. D) Fine hand tremors and mild thirst. E) Coma, which may lead to death.

Option A is correct because extreme polyuria and blurred vision are classic signs of severe lithium toxicity [p. 1985 Table]. Option B is correct because tinnitus and ataxia (loss of coordination) indicate severe toxicity [p. 1985 Table]. Option C is correct because seizures and severe hypotension are manifestations of severe, life-threatening toxicity [p. 1985 Table]. Option D is incorrect because fine hand tremors, mild GI upset, and thirst are signs of mild lithium toxicity, not severe toxicity [p. 1985 Table]. Option E is correct because severe toxicity can lead to coma and possible death [p. 1985 Table]. Correct Answer: A, B, C, E

Question: A nurse is monitoring a client taking antiseizure medications for mood stabilization. Which clinical alerts are associated with these drugs? Select all that apply. Answer Choices: A) Lamotrigine can cause a serious, life-threatening skin rash (Stevens-Johnson syndrome) that must be reported immediately. B) Carbamazepine and valproic acid can cause leukopenia, thrombocytopenia, and/or anemia, requiring baseline bloodwork. C) Valproic acid can cause hepatotoxicity, and the client must report signs of anorexia, abdominal pain, or jaundice. D) Carbamazepine can decrease the effects of oral contraceptives, requiring education on alternative forms. E) Clients taking carbamazepine must drink at least 1 glass of grapefruit juice daily with their dose.

Option A is correct because lamotrigine can cause a serious skin rash (Stevens-Johnson syndrome) [p. 1985 Table]. Option B is correct because carbamazepine, lamotrigine, and valproic acid can cause leukopenia, thrombocytopenia, and/or anemia, requiring baseline and periodic bloodwork [p. 1985 Table]. Option C is correct because valproic acid can cause hepatotoxicity, and clients must report signs of anorexia, fatigue, abdominal pain, and jaundice [p. 1985 Table]. Option D is correct because carbamazepine can decrease the effects of oral contraceptives, and alternative forms of contraception should be advised [p. 1985 Table]. Option E is incorrect because clients must avoid drinking grapefruit juice with carbamazepine as it can cause drug toxicity [p. 1985 Table]. Correct Answer: A, B, C, D

Question: A nurse is monitoring a client taking an atypical antipsychotic. Which manifestations represent extrapyramidal side effects (EPS) that must be reported? Select all that apply. Answer Choices: A) Parkinson-like symptoms, including rigidity, tremors, or "pill-rolling" hand movements. B) Dystonia, characterized by abnormal tonic contractions of muscles, such as severe muscle spasms. C) Akathisia, defined as a subjective need to move or feeling like "jumping out of my skin." D) Hypertensive crisis triggered by eating aged cheese. E) Severe weight gain of 50 to 100 pounds.

Option A is correct because Parkinson-like symptoms (rigidity, tremor, pill-rolling) are recognized extrapyramidal side effects [p. 1986]. Option B is correct because dystonia (abnormal tonic contractions of muscles or muscle spasms) is a severe EPS [p. 1986]. Option C is correct because akathisia (subjective need to move, "jumping out of my skin") is a common extrapyramidal symptom [p. 1986]. Option D is incorrect because hypertensive crisis from tyramine-containing foods is an interaction associated with MAOIs, not an extrapyramidal side effect of antipsychotics [p. 1976 Table, 1986]. Option E is incorrect because while weight gain is an adverse effect of atypical antipsychotics (especially olanzapine), it is a metabolic side effect, not an extrapyramidal side effect [p. 1985 Table, 1986]. Correct Answer: A, B, C

Question: A nurse is implementing safety precautions for a client admitted with acute suicidal ideation on an inpatient psychiatric unit. Which nursing interventions are indicated? Select all that apply. Answer Choices: A) Ensure that the patient does not have access to any sharp objects, weapons, or modes of self-harm. B) Ensure that the patient is never left alone, with a healthcare worker present at all times. C) Instruct guests as to what objects they cannot have while visiting the patient, including knives, razor blades, and large quantities of pills. D) Place the client in a private room at the end of a long, quiet hallway to promote rest. E) Restrict the client to their room with no communication allowed with other patients or staff.

Option A is correct because the nurse must ensure that patients actively experiencing suicidal ideation do not have access to any sharp objects, weapons, or modes that could be used to harm themselves [p. 2008]. Option B is correct because the patient at high risk for suicide must never be left alone; a healthcare worker should be with them at all times [p. 2008]. Option C is correct because within the healthcare setting, the nurse must instruct guests as to what objects they cannot have while visiting, including knives, razor blades, and large quantities of pills [p. 2008]. Option D is incorrect because placing a suicidal patient in a private room at the end of a long hallway provides opportunities for unobserved self-harm and is unsafe [p. 1989, 2008]. Option E is incorrect because isolating suicidal clients completely is not therapeutically recommended and does not promote safety or a therapeutic alliance [p. 2005, 2008]. Correct Answer: A, B, C

Question: A nurse is interacting with a manic client who is experiencing persecutory delusions and altered thought processes. Which communication strategies should the nurse utilize? Select all that apply. Answer Choices: A) Avoid engaging in direct arguments with the patient regarding their delusional beliefs. B) Agree with the delusion completely to avoid making the client angry. C) Use phrases that can lead to instilling reasonable doubts, such as "I find that difficult to believe." D) Orient the patient to reality by identifying yourself and stating the date, time, and location. E) Keep conversations grounded in concrete subjects, such as local events or the weather.

Option A is correct because the nurse must not engage in arguments with the patient who is experiencing delusions, as this is not therapeutic and often leads to the patient holding more firmly to the delusion [p. 1990 Working Phase]. Option B is incorrect because agreeing with a delusion validates an altered reality, which is non-therapeutic and hinders reality orientation [p. 1990]. Option C is correct because instead of arguing, the nurse can use phrases that can lead to instilling reasonable doubts, such as "That sounds very unlikely" or "I find that difficult to believe" [p. 1990 Working Phase]. Option D is correct because the nurse should orient the patient to reality by stating their identity, the date, time, and location [p. 1990]. Option E is correct because spending time with the patient and keeping conversations grounded in concrete subjects (such as local events and the weather) can help present reality [p. 1990]. Correct Answer: A, C, D, E

Question: A nurse is implementing a care plan to improve self-esteem in a client hospitalized with major depressive disorder. Which interventions should the nurse perform? Select all that apply. Answer Choices: A) Make positive, general observations, such as "I notice you got out of bed and showered today." B) Provide highly energetic, enthusiastic compliments like "You look absolutely gorgeous today!" C) Encourage the client to participate in social and recreational activities appropriate to their abilities. D) Allow the patient to express negative emotions but set limits on the amount of time they dwell on negativity. E) Teach assertiveness techniques and allow the client to practice them in communication.

Option A is correct because the nurse should make positive, general observations while interacting, such as "I notice that you got out of bed and showered today" to promote self-esteem [p. 1980]. Option B is incorrect because the nurse should avoid excessive praise, enthusiasm, or overly energetic compliments (like "You look great today!"), as these comments can be perceived as infantizing or insincere [p. 1980]. Option C is correct because encouraging patient participation in appropriate social and recreational activities can interrupt negative thoughts and promote success [p. 1980]. Option D is correct because the nurse should allow the patient to express negative emotions but set limits on the amount of time they dwell on and discuss negativity, redirecting thoughts to neutral ones [p. 1980]. Option E is correct because teaching assertiveness techniques helps patients with low self-esteem advocate for themselves, feel empowered, and improve self-esteem [p. 1980]. Correct Answer: A, C, D, E

Question: A nurse is differentiating between Mania and Hypomania in a client admitted with bipolar disorder. Which characteristics are associated with a hypomanic episode rather than a manic episode? Select all that apply. Answer Choices: A) The mood state is elevated, expansive, or irritable, but is less extreme than mania. B) The behavioral changes are severe enough to cause major social or occupational impairment. C) The episode does not necessitate hospitalization. D) There is a complete absence of any psychotic symptoms, such as delusions or hallucinations. E) The symptoms must persist for at least 1 week (7 days) continuously.

Option A is correct because hypomania refers to a mood that is "hypo" or under mania, meaning the mood state is less extreme than mania [p. 1983 Table, 1984]. Option B is incorrect because hypomania does not cause severe social or occupational impairment, which is a key differentiator of mania [p. 1983 Table, 1984]. Option C is correct because the behaviors in hypomania are not severe enough to require hospitalization [p. 1984]. Option D is correct because individuals with hypomania do not have any psychotic symptoms [p. 1984]. Option E is incorrect because hypomania symptoms must last at least four consecutive days, whereas manic episodes must last at least 1 week [p. 1983, 1984]. Correct Answer: A, C, D

Question: A nurse is planning sleep-promotion interventions for a client in an acute manic state. Which evidence-based nursing actions should the nurse include? Select all that apply. Answer Choices: A) Provide a consistent schedule that promotes good sleep hygiene and limit daytime naps. B) Administer prescribed sleep medications that do not suppress REM sleep, such as zolpidem tartrate (Ambien). C) Encourage bedtime rituals, such as decreasing light and noise, listening to soothing music, or taking a warm bath. D) Place the client in a private room with low lighting and reduced noise to minimize stimuli. E) If the client cannot sleep, engage them in excessive, stimulating conversation to wear them out.

Option A is correct because the nurse should provide a schedule that promotes good sleep hygiene and limit daytime naps to help promote nighttime sleeping [p. 1990]. Option B is correct because the nurse should administer prescribed medications that do not suppress REM sleep, such as zolpidem tartrate (Ambien) [p. 1990-1991]. Option C is correct because encouraging good bedtime rituals that promote relaxation (decreasing light, noise, soothing music, warm bath) helps resolve mania [p. 1990]. Option D is correct because a private room with low lighting and reduced noise may be necessary to reduce stimuli for hyperactive patients [p. 1989]. Option E is incorrect because the nurse should avoid engaging manic patients in excessive conversations or overly stimulating activities, as this increases wakefulness [p. 1991]. Correct Answer: A, B, C, D

Question: A pediatric nurse is reviewing depressive manifestations across childhood and adolescence. Which developmental pairings are correct? Select all that apply. Answer Choices: A) Toddlers: May regress from independence to dependence in some activities, such as toileting. B) Preschoolers: Whining, increased irritability, and destructive play themes. C) School-age children: Decreased academic performance, somatic complaints, and talk of running away. D) Adolescents: Changes in peer groups, poor school performance, and decreased self-care. E) Toddlers: Talk of running away and severe academic decline.

Option A is correct because toddlers experiencing depression may regress from independence to dependence in some activities, such as toileting [p. 1978]. Option B is correct because preschoolers may present with increased irritability, whining, destructive play themes, and a lack of interest/confidence [p. 1978]. Option C is correct because school-age children with depression commonly present with decreased academic performance, changes in physical activity, somatic complaints, boredom, and talk of running away [p. 1978]. Option D is correct because adolescents with depression frequently display changes in peer groups, decreased self-care, poor school performance, and conflict with parents/teachers [p. 1978]. Option E is incorrect because toddlers do not have academic performance to decline, nor do they speak of running away in this developmental manner, which is characteristic of school-age children [p. 1978]. Correct Answer: A, B, C, D

Question: A nurse is monitoring a client prescribed an atypical antipsychotic for bipolar disorder. Which clinical indicators require immediate notification and intervention? Select all that apply. Answer Choices: A) Severe muscle rigidity, high fever, and altered consciousness (suspected Neuroleptic Malignant Syndrome). B) An acute, painful tonic contraction of neck and jaw muscles (acute dystonic reaction). C) A sudden, massive weight loss of 20 pounds within 3 days. D) Risperidone-induced lactation or menstrual changes (elevated prolactin levels). E) Prolonged QT interval on an electrocardiogram (ECG) for a client taking risperidone or quetiapine.

Option A is correct because Neuroleptic Malignant Syndrome (NMS) is a life-threatening, emergency reaction characterized by muscle rigidity, high fever, and altered consciousness, requiring immediate intervention [p. 1976 Table, 1986]. Option B is correct because acute dystonic reactions are severe and require immediate medical intervention with an anticholinergic [p. 1986]. Option C is incorrect because atypical antipsychotics cause significant weight gain (up to 50-100 lbs), not sudden massive weight loss [p. 1985 Table]. Option D is correct because risperidone can significantly increase prolactin levels, which can cause clinical lactation (galactorrhea) or endocrine changes [p. 1985 Table]. Option E is correct because risperidone and quetiapine can cause QT prolongation, requiring a baseline and follow-up ECG to monitor for dangerous cardiac arrhythmias [p. 1985 Table]. Correct Answer: A, B, D, E

Question: A nurse is developing a Safety Plan Intervention (SPI) in collaboration with a suicidal client. Which components must be integrated into this emergency plan? Select all that apply. Answer Choices: A) Identification of personal triggers that precipitate a suicidal crisis. B) Internal coping strategies the patient can use independently, such as relaxation techniques. C) Redirection activities and identifying individuals or social settings that can provide distraction. D) Specific support groups, mental health professionals, and emergency contact numbers (such as the National Suicide Lifeline). E) Plans to secure or remove access to lethal means, such as firearms or large quantities of pills.

Option A is correct because SPIs guide patients through trigger identification [p. 2007 Box 28.5]. Option B is correct because SPIs emphasize self-care and coping strategies the patient can use independently [p. 2007 Box 28.5]. Option C is correct because SPIs include redirection activities and using support groups or distracting environments [p. 2007 Box 28.5]. Option D is correct because reaching out for professional help and securing emergency contacts is a core part of the SPI [p. 2007 Box 28.5]. Option E is correct because securing lethal means (such as locking up firearms or removing pills) is a critical component of the SPI [p. 2007 Box 28.5]. Correct Answer: A, B, C, D, E

Question: A nurse is completing a comprehensive suicide risk assessment using the SAFE-T framework. Which factors must the nurse evaluate? Select all that apply. Answer Choices: A) The presence of clinical risk factors, including mental disorders, substance abuse, and chronic pain. B) The presence of protective factors, such as strong family connections and access to mental health care. C) Direct questioning about suicidal thoughts, plans, behaviors, and active intent. D) Determination of the patient's risk level (low, moderate, or high) based on clinical judgment. E) Obtaining a signed no-harm contract as a replacement for documenting a safety plan.

Option A is correct because step 1 of SAFE-T is to assess risk factors, including depression, substance use, pain, and history of trauma [p. 2008]. Option B is correct because step 2 is to assess protective factors, such as family connections, community support, and access to care [p. 2002, 2008]. Option C is correct because step 3 is to directly ask the patient about intent, thoughts, plans, behaviors, and access to means [p. 2008]. Option D is correct because step 4 is to determine the patient's risk level (low, moderate, or high) and select interventions [p. 2008]. Option E is incorrect because no-harm contracts lack clinical evidence and should never replace the documentation of a thorough safety plan and risk level [p. 2007 Box 28.5, 2008]. Correct Answer: A, B, C, D

Question: A nurse is caring for an adolescent client displaying nonsuicidal self-injury (NSSI) behaviors. Which statements regarding NSSI are supported by evidence? Select all that apply. Answer Choices: A) NSSI consists of intentional self-inflicted acts of harm to body tissue with the active intent to die by suicide. B) Examples of NSSI include cutting, bruising, burning of the skin, and interfering with wound healing. C) NSSI generally occurs during periods of painful moods, including guilt, sorrow, flashbacks, or depersonalization. D) Reasons for NSSI can include self-punishment, attention seeking, imposing guilt, or adaptation to peers. E) Unlike suicidal behavior, patients demonstrating NSSI may be asked to sign a no-harm contract as an intervention.

Option A is incorrect because NSSI consists of intentional self-inflicted acts of harm to body tissue without the intent of suicide [p. 2008]. Option B is correct because examples of NSSI include cutting, bruising, burning of the skin, interfering with wound healing, and extreme nail biting or hair pulling [p. 2008]. Option C is correct because NSSI generally occurs during periods of painful moods, including guilt, sorrow, flashbacks, and depersonalization to physical pain [p. 2008]. Option D is correct because reasons attributed to NSSI include self-punishment, attention seeking, imposing guilt, and adaptation to peers who also participate in NSSI [p. 2008]. Option E is correct because patients demonstrating NSSI will need to be monitored closely and may be asked to sign a no-harm contract (which is used in this specific population) [p. 2008]. Correct Answer: B, C, D, E