Videbeck Chap 17 Mood disorders and Suicide Practice Questions

1 The client has been diagnosed with depression. He asks the nurse what imbalances influence depression. Which of the following best explains the neurochemical processes responsible for depression?

A. Increased activity of dopamine

B. Decreased glucocorticoid activity

C. Decreased serotonin and norepinephrine activity

D. Potentiating of the kindling process

C. Decreased serotonin and norepinephrine activity

The client's family is questioning the nurse about bipolar disorder. Which statements aboutthe etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply.

A. Norepinephrine levels may be increased in mania.

B. Manic episodes are a "defense" against underlying depression.

C. Acetylcholine seems to be implicated in mania.

D. The id takes over the ego and acts as an undisciplined hedonistic being (child).

B. Manic episodes are a "defense" against underlying depression.

D. The id takes over the ego and acts as an undisciplined hedonistic being (child).

4 The client presents to the Emergency Department with a flat affect. The family is concerned about the lack of family involvement with the client. Which variables represent the highest risk for developing major depressive disorder? Select all that apply.

A. Male gender

B. Mood disorder in first-degree relatives

C. Substance abuse

D. Divorced

E. Older adult age group

B. Mood disorder in first-degree relatives

C. Substance abuse

D. Divorced

5 A concerned family member tells the nurse, "I am concerned about my brother. He has been acting very different lately." Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the brother has bipolar disorder?

A. Taking unnecessary risks

B. Sleeping more

C. Intense focus

D. Showing low self-esteem

A. Taking unnecessary risks

6 A client is admitted for major depression. The client has stated that nothing seems to bring him pleasure anymore. What should the nurse expect to find during assessment?

A) Anhedonia, feelings of worthlessness, and difficulty focusing

B) Depressed mood, guilt, and pressured speech

C) Changes in sleep pattern, fatigue, and grandiose mood

D) Difficulty focusing, feelings of helplessness, and flight of ideas

A) Anhedonia, feelings of worthlessness, and difficulty focusing

7 A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm?

A) Immediately after a family visit

B) On the anniversary of significant life events in the client's life

C) During the first few days after admission

D) Approximately 2 weeks after starting antidepressant medication

D) Approximately 2 weeks after starting antidepressant medication

8 The nurse is planning care for a client with major depression. Which is an appropriate expected outcome?

A) The client will avoid causing harm to others.

B) The client will be free from stress.

C) The client will independently carry out activities of daily living.

D) The client will not experience agitation.

C) The client will independently carry out activities of daily living.

9 A client who is depressed begins to cry and states, "I'm just really sick of feeling this way. Nothing ever seems to go right in my life." Which would be the most appropriate response by the nurse?

A) "Don't cry. Try to look at the positive side of things."

B) "You are feeling really sad right now. It's a hard time."

C) "Hang in there. Your medication will start helping in a few days."

D) "Nothing ever goes right?"

B) "You are feeling really sad right now. It's a hard time."

10 A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior?

A) Administering a sedative that has been prescribed to be used PRN.

B) Insisting the client take a "time-out" in his room

C) Clearing the area of all other clients

D) Setting limits on aggressive and intimidating behavior

D) Setting limits on aggressive and intimidating behavior

11 Which meal would the nurse provide to best meet the nutritional needs of a client who is manic?

A) Peanut butter sandwich, chips, cola

B) Fried chicken, mashed potatoes, milk

C) Ham sandwich, cheese slices, milk

D) Spaghetti, garlic bread, salad, tea

C) Ham sandwich, cheese slices, milk

12 A client who is manic states, "What time is it? I have to see the doctor. Is breakfast here yet? I've got to see the doctor first. Can I get my cereal out of the kitchen?" Which would be the most appropriate response by the nurse?

A) "Please slow down. I'm not sure what you need first."

B) "You will have to be quiet and have breakfast after the doctor comes."

C) "Are you hungry?"

D) "Your thoughts seem to be racing this morning."

A) "Please slow down. I'm not sure what you need first."

13 A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time?

A) Accompany the client to his or her room to get dressed.

B) Put the client in seclusion for his or her own protection.

C) Tell other clients to ignore the behavior because it is harmless.

D) Tell the client that the behaviors have to stop right now.

A) Accompany the client to his or her room to get dressed.

14 The client with mania attempts to hit the nurse. Which is the best response by the nurse?

A) "Do not swing at me again. If you cannot control yourself, we will help you."

B) "If you do that one more time, you will be put in seclusion immediately."

C) "Stop that. I didn't do anything to provoke an attack."

D) "Why do you continue that kind of behavior? You know I won't let you do it."

A) "Do not swing at me again. If you cannot control yourself, we will help you."

15 During report, the nurse learns that a client with mania has not slept since admission 2 days ago. On entering the day room, the nurse finds this client dancing to loud music. Which would be the most appropriate statement by the nurse?

A) "Do you think you could sit still for a few minutes so we can talk?"

B) "How are you ever going to get any rest if you keep that music on?"

C) "Let's go to the conference room and talk for a while."

D) "Turn the radio down so we can hear ourselves talk."

C) "Let's go to the conference room and talk for a while."

At 1 AM, the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. What would be the nurse's most therapeutic response?

A) "Go to the day room and wait while I call your psychiatrist."

B) "Don't be unreasonable. I can't call the psychiatrist at this time of night."

C) "I can't call the psychiatrist now, but you and I can talk about your request for a pass."

D) "You must really be upset to want a pass immediately; I'll give you some medication."

C) "I can't call the psychiatrist now, but you and I can talk about your request for a pass."

17 A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale?

A) As soon as lunch is over, the client will calm down.

B) Other clients need to be protected from the intrusive behavior.

C) The client's behavior is not an imminent threat to anyone's physical safety.

D) The client needs food and fluids in any way possible.

B) Other clients need to be protected from the intrusive behavior.

18 A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first?

A) Decrease the client's environmental stimuli.

B) Give the client feedback about his behavior.

C) Introduce the client to other staff on the unit.

D) Tell the client about hospital rules and policies.

A) Decrease the client's environmental stimuli.

19 The nurse observes a client sitting alone at a table, looking sad and preoccupied. The nurse sits down and says, "I saw you sitting alone and thought I might keep you company." The client turns away from the nurse. Which would be the most therapeutic nursing intervention?

A) Move to another chair closer to the client and say, "The staff is here to help you."

B) Move to a chair a little further away and say, "We can just sit together quietly."

C) Remain in place and say, "How are you feeling today?"

D) Say, "I'll visit with you a little later," and leave the client alone for a while.

B) Move to a chair a little further away and say, "We can just sit together quietly."

20 A client with depression appears lethargic and apathetic but agrees to participate in a leisure activity group. Which nursing intervention is most likely to help the client successfully participate?

A) Allowing the client to direct her participation at her own pace

B) Giving the client several choices of projects, so she can choose her favorite

C) Staying away from the client during the session to encourage free expression

D) Structuring the activity to facilitate completion of one specific task

D) Structuring the activity to facilitate completion of one specific task

21 A client asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. Which would be the most therapeutic nursing intervention?

A) Stating, "The effects of medications will not last forever. You will need to eventually learn to function without them."

B) Stating, "Medications help your brain function better, but the therapy helps you achieve lasting behavior change."

C) Stating, "Both are recommended. Since your insurance covers both that is the best plan for you."

D) Asking, "Do you have reservations about going to therapy?"

B) Stating, "Medications help your brain function better, but the therapy helps you achieve lasting behavior change."

22 A client who has been discharged home on citalopram calls the nurse complaining that the medication causes her to feel too drowsy. The nurse should make which of the following suggestions?

A) Make an appointment to change to a different medication.

B) Take the medication at night.

C) Be patient while this early side effect subsides.

D) Skip a dose if drowsiness is excessive.

B) Take the medication at night.

23 The wife of a client with bipolar disorder calls the nurse expressing distress about recent spending patterns of her husband. The nurse suggests the wife implement the limit-setting skills she has learned in family therapy. In this instance, the nurse's action would be considered...

A) inappropriate; the nurse should not give advice to the wife.

B) inappropriate; the husband has the legal right to spend personal money.

C) appropriate; the wife is responsible for the husband's actions since he has a mental illness.

D) appropriate; the wife needs support in setting boundaries.

D) appropriate; the wife needs support in setting boundaries.

24 A client is being discharged on lithium. The nurse encourages the client to follow which health maintenance recommendations? Select all that apply.

A) Weigh self weekly at the same time of day.

B) Drink a 2-L bottle of decaffeinated fluid daily.

C) Do not alter dietary salt intake.

D) See the doctor if you get the flu.

E) Restrict involvement in intense exercise.

B) Drink a 2-L bottle of decaffeinated fluid daily.

C) Do not alter dietary salt intake.

D) See the doctor if you get the flu.

27 Which is a possible explanation for the increased risk of suicide in persons who have had a relative who committed suicide?

A) The relative's suicide offers a sense of "permission" or acceptance of suicide as a method of escaping a difficult situation.

B) Many people with depression who have suicidal ideation lack the energy to implement suicide plans, but antidepressant treatment can actually give clients with depression the energy to act on suicidal ideation.

C) Suicide is more likely to occur in April when natural energy from increased sunlight may give the client the energy to act on suicidal ideation.

D) The relative's suicide caused the family members to realize that suicide is emotionally harmful to the ones left behind and vow not to consider suicide.

A) The relative's suicide offers a sense of "permission" or acceptance of suicide as a method of escaping a difficult situation.

30 A client who is depressed states, "I think my family would be better off without me. They don't need to worry." Which would be the most appropriate response by the nurse?

A) "Are you planning to commit suicide?"

B) "What do you think they are worried about?"

C) "Where are you going?"

D) "You don't mean that. Your family loves you."

A) "Are you planning to commit suicide?"

31 A visitor comes to see a client who is suicidal. Upon entering the unit, the nurse notices that the visitor has brought the client a can of his favorite soda. Which action should the nurse take at this time?

A) Confiscate the soda can as a restricted item.

B) Pour the soda into a plastic cup.

C) Ask the visitor to place the soda can at the nurse's desk until he or she leaves.

D) Ask the visitor not to bring outside items on the unit in the future.

B) Pour the soda into a plastic cup.

32 A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has the highest priority?

A) Hopelessness related to recent divorce

B) Ineffective coping related to inadequate stress management

C) Spiritual distress related to conflicting thoughts about suicide and sin

D) Risk for suicide related to a highly lethal plan

D) Risk for suicide related to a highly lethal plan

33 The nursing instructor is conducting a preconference with a group of nursing students on a psychiatric unit. Which statement made by a student reflects the greatest barrier to being able to provide professional care to the client who is suicidal?

A) "I just don't understand why anyone would want to kill themselves."

B) "I think suicide is wrong and selfish."

C) "I get frustrated when my client negates all the positives I try to point out."

D) "I can see how much my client is hurting inside."

B) "I think suicide is wrong and selfish."

34 Which may contribute to a staff person being less effective in dealing with a person who is at increased risk for suicide? Select all that apply.

A) Negative societal view of suicide

B) Feeling inadequate and anxious about suicide and/or his or her own mortality

C) Having personally considered suicide but decided against it and not having dealt with the associated anxiety

D) Being unaware of his or her own feelings and beliefs about suicide

E) Implementing nursing interventions to decrease the risk of suicide

A) Negative societal view of suicide

B) Feeling inadequate and anxious about suicide and/or his or her own mortality

C) Having personally considered suicide but decided against it and not having dealt with the associated anxiety

D) Being unaware of his or her own feelings and beliefs about suicide

35 A client with depression has been taking an SSRI--fluoxetine--for the last 3 months and has noticed improvement of symptoms. The nurse inquires about any side effects. Which of the following would the nurse expect the client to report?

A) A headache after eating wine and cheese

B) A decrease in sexual pleasure during intimacy

C) An intense need to move about

D) Persistent runny nose

B) A decrease in sexual pleasure during intimacy

36 The client suffers from Bi-Polar disorder. The client is experiencing a downward spiral. For which one of the following drugs should the nurse expect the client to require serum level monitoring?

A) Anticonvulsants

B) Wellbutrin

C) Lithium

D) Prozac

C) Lithium

37 A client who is taking paroxetine reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially?

A) Instruct the client to stop the medication for a few days to see if the nausea goes away.

B) Reassure the client that this is an expected side effect that will improve with time.

C) Suggest that the client take the medication with food.

D) Tell the client to contact the physician for a change in medication.

C) Suggest that the client take the medication with food.

38 The client has been diagnosed with severe depression. During the assessment of the client, the nurse is aware of which of the following is the primary consideration with clients taking antidepressants?

A) Decreased mobility

B) Emotional changes

C) Suicide

D) Increased sleep

C) Suicide

39 A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see?

A) Constipation and postural hypotension

B) Fever, muscle rigidity, and disorientation

C) Nausea, diarrhea, and confusion

D) None; the serum level is in therapeutic range

C) Nausea, diarrhea, and confusion

40 A client with bipolar disorder takes lithium 300 mg three times daily. The nurse is educating on its use, side effects and need for compliance. The nurse evaluates that the dose is appropriate when the client reports which of the following?

A) feeling sleepy and less energetic

B) weight gain of 7 pounds in the last 6 months

C) minimal mood swings

D) increased feelings of self-worth

C) minimal mood swings

42 An inappropriately dressed client has not slept for 3 days and has been making excessive long-distance phone calls. When the client can be heard singing loudly in the examining room, the nurse makes initial plans to focus on which of the following?

A) setting strict limits on dress and behavior

B) assessing needs for food, liquids, and rest

C) conducting an in-depth suicide assessment

D) obtaining a complete psychosocial assessment

B) assessing needs for food, liquids, and rest

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

A) "I will take my medications with food."

B) "I will have my blood drawn on schedule."

C) "I will drink 8 to 12 glasses of liquids daily."

D) "I will restrict my intake of processed foods high in sodium."

D) "I will restrict my intake of processed foods high in sodium."

44 Which outcome would be appropriate to determine an early favorable response to antidepressant medication?

A) The client will establish a balance of rest, sleep, and activity.

B) The client will demonstrate assertive communication skills.

C) The client will describe signs and symptoms of major depression.

D) The client will make plans to attend one community social activity a week.

A) The client will establish a balance of rest, sleep, and activity.

45 What is the primary nursing concern related to a depressed client who has been taking amitriptyline 50 mg three times a day for the past 3 weeks?

A) anxiety

B) ineffective coping

C) risk for self-injury

D) chronic low self-esteem

C) risk for self-injury