Deck 12: Mood Disorders: Depression, Bipolar, and Adjustment Disorders

Question 1

The nurse caring for an extremely withdrawn patient with depression wants to assist her to become more interactive.The best approach would be to say:

A) "I know you'll feel better if you leave your room."
B) "You look so gloomy sitting here all by yourself."
C) "Let's explore how it feels to sit alone here all day and feel sad."
D) "I need another person for a card game and I'd like you to be my partner."

Answer 1

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

Question 2

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

A) Risk for injury
B) Chronic low self-esteem
C) Noncompliance
D) Insomnia

Answer 2

Risk for injury

Question 3

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

A) "I will restrict my daily salt intake."
B) "I will take my medications with food."
C) "I will have my blood drawn on schedule."
D) "I will drink 8 to 12 glasses of liquids daily."

Answer 3

"I will restrict my daily salt intake."

Question 4

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

A) Anxiety
B) Ineffective coping
C) Risk for self-injury
D) Chronic low self-esteem

Question 5

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

A) Patients who attempt suicide and fail will not try again.
B) The more specific the plan, the greater the risk for suicide.
C) Patients who talk about suicide are less likely to attempt it.
D) Patients who attempt suicide and fail do not really want to die.

Question 6

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

A) Avoiding any focus on the topic of suicide
B) Encouraging patient to verbalize personal feelings
C) Supporting patient focus on others rather than self
D) Discussing the impact of suicidal thoughts on the family

Question 7

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

A) 26 years of age and complains of 3 consecutive years of depressed mood beginning in November and remitting in April
B) 64 years of age and complains of anhedonia, early morning awakening, psychomotor retardation, weight loss, and excessive feelings of guilt
C) 46 years of age and complains of dysphoric mood for 3 years, poor concentration, loss of interest in social activities, indecision, low energy, and low self-esteem
D) 38 years of age and complains of sadness, loss of ability to react to positive stimuli, weight gain, hypersomnia, leaden paralysis of limbs, and sensitivity to interpersonal rejection

Question 8

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

A) Manic patients respond well to peer pressure.
B) Decreasing stimulation tends to diminish symptoms.
C) Increasing stimulation tends to encourage the patient to focus.
D) Detailed activities will facilitate the patient's ability to self control behavior.

Question 9

A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department with a list of medications he is taking.Which of the medications on the list would require re-evaluation of lithium dosage?

A) HydroDIURIL daily
B) Navane bid
C) Ativan at bedtime
D) Cefobid daily

Question 10

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

A) The patient will complete own self-care activities.
B) The patient will demonstrate assertive communication skills.
C) The patient will describe signs and symptoms of major depression.
D) The patient will make plans to attend one community social activity a week.

Question 11

A patient who has a history of bipolar disorder recently underwent orthopedic surgery and was discharged to return home.When visited by the home care nurse,the nurse documented the following: slow and soft speech; sad facial expression; and patient crying when describing extreme fatigue,low mood,and the feeling that he will never get well.He has refused to bathe and perform ADLs for several days.Which nursing diagnosis would be appropriate?

A) Self-care deficit secondary to possible depression
B) Situational low self-esteem related to immobility
C) Deficient knowledge related to depression and surgery
D) Disturbed thought processes related to bipolar disorder

Question 12

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

A) Mood and affect
B) Activity level
C) Cognitive ability to understand information about the medication
D) Support network and its members' willingness to participate in treatment

Question 13

Which nursing intervention is most therapeutic when the nurse is managing the aggressive,disruptive behaviors of a manic patient whose attempts to control the milieu has been rejected by the other patients?

A) Advising that the patient to accept the wishes of the group
B) Suggesting that the patient either quiet down or leave the room
C) Accompanying the patient to a quieter part of the unit
D) Ignoring the patient's outbursts because they are surly related to the mania

Question 14

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

A) "I can't do anything anymore."
B) "I'm the world's most astute financier."
C) "I can understand why my wife is upset that I overspend."
D) "I can't understand where all the money in our family goes."

Question 15

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

A) Typically has an acute onset
B) Involves delusional thinking
C) Is chronic low-level depression
D) Does not include suicidal ideation

Question 16

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

A) "I can stop my lithium when I feel better."
B) "I can continue with my diuretic and cardiac medications."
C) "I will probably need to take the lithium for the rest of my life."
D) "I will taper my lithium when a therapeutic serum level is achieved."

Question 17

An inappropriately dressed patient has not slept for 3 days while making excessive,expensive long-distance phone calls.When the patient can be heard singing loudly in the examining room,the nurse makes initial plans to focus on:

A) Assessing needs for food, liquids, and rest
B) Setting strict limits on dress and behavior
C) Conducting an in-depth suicide assessment
D) Obtaining a complete psychosocial assessment

Question 18

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

A) "Complying with this therapy will cure your depression."
B) "This medication is expected to improve brain chemical imbalance."
C) "Amitriptyline will help re-establish your ability to think clearly again."
D) "Elavil will be particularly effective at assisting you in regaining your independence."

Question 19

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

A) Seasonal episodes
B) Leaden paralysis
C) Psychomotor agitation
D) Increased depression in the morning

Question 20

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

A) Clinical observation tells us that mood disorders tend to remit and recur.
B) Most cyclic behavior can be managed with the appropriate forms of therapy.
C) Mood disorders generally see a decrease in cyclic affecting within 5 years of onset.
D) Persons with higher cognitive abilities will generally exhibit fewer cyclic episodes.

Question 21

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

A) Patient frequently disregards curfew.
B) Patient's parents were divorced 8 years ago.
C) Patient states she finds no pleasure in living.
D) Patient is failing most of her high school classes.

Question 22

When a father states,"I don't understand what the doctor means by saying my daughter has an adjustment disorder." The nurse explains that this disorder often results from:

A) Failure of existing coping skills
B) Lack of stable emotional support
C) Denial that a problem truly exists
D) Overcompensation to present a controlled appearance

Question 23

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

A) Absence of presenting symptoms
B) Decreased need for medications
C) Increased socialization with peers
D) Significant increase in the patient's appetite

Question 24

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

A) Ask the patient to indicate yes or no with finger signals.
B) Arrange to spend time with the patient at prearranged intervals.
C) Give concrete and concise directions rather than asking questions.
D) Speak loudly and rapidly to the patient to focus his or her attention.

Question 25

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

A) "Can you tell me about your support system?"
B) "Have you ever been in psychotherapy before?"
C) "Did you experience any stressful events recently?"
D) "How do you usually handle problems in your life?"

Question 26

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

A) Approach the patient with cheerful affect and optimistic remarks.
B) Ignore the patient's pessimistic statements; give attention for positive thinking.
C) Identify negative evaluations and challenge pessimistic beliefs.
D) Seek to uncover unconscious conflicts about significant relationships.

Question 27

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

A) Slow, halting speech
B) Flight of ideas
C) Schemata
D) Anhedonia

Question 28

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

A) Entering pertinent data in the patient's medical record
B) Including family members in the interdisciplinary treatment plan
C) Identifying the precipitating stressful event and current problems
D) Reducing the patient's level of anxiety to prevent behavioral escalation

Question 29

When assessing a patient diagnosed with a mood disorder,which abnormal diagnostic tests would be considered a possible factor in the manifestation of the disorder? Select all that apply

A) RBC (red blood cell)
B) ECG (electrocardiogram)
C) BUN ( blood urea nitrogen)
D) TSH (thyroid stimulating hormone)
E) Blood glucose

Question 30

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

A) "Spontaneous improvement usually comes in 6 months to a year."
B) "Can you tell me what you mean when you say 'feel like myself'?"
C) "People who have seasonal mood changes often feel better when spring comes."
D) "Usually patients with this disorder see improvement during the fall and winter."

Question 31

A Chinese-American patient comes to the mental health clinic after referral by her primary care physician.She complains of nervousness,headaches,fatigue,and vague GI symptoms for which no organic basis has been established.The symptoms began about 9 months ago when her favorite aunt died.The most appropriate independent nursing action would be to:

A) Prescribe a trial course of antianxiety medication.
B) Plan strategies for cognitive behavioral therapy.
C) Arrange admission to the inpatient unit for a complete workup and psychologic testing.
D) Confer with the psychiatrist about the cultural association between depression and somatic symptoms.

Question 32

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

A) The symptoms will likely resolve completely.
B) The patient may continue to be in danger of self-harm.
C) Medications are frequently used to mask the symptoms.
D) Relaxation is an effective tool to decrease and manage stress.

Question 33

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

A) Provide appropriate attire for patient to wear.
B) Set firm limits on behavior injurious to others.
C) Monitor the patient's weight at the same time daily.
D) Use genuineness to develop a therapeutic alliance with the patient.

Question 34

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

A) Instructing the patient to lie down for 15 minutes of every hour
B) Asking the patient to fold and stack bath towels and washcloths
C) Making the patient aware of the negative effects of fatigue on mood
D) Reassuring the patient that she is accepted and not considered a "bad" person

Question 35

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

A) Uses a calm, matter-of-fact approach to structuring
B) Focuses primarily on enforcing rigid limits on behaviors
C) Implements a laissez-faire approach to the patient's symptoms
D) Encourages the patient to use humor and wit to redirect energy

Question 36

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

A) Characteristic symptoms abate but take at least 6 months to do so.
B) The disorder may be a precursor to a more serious mental health problem.
C) Practitioners become less discerning as they become more familiar with the patient.
D) Patients with adjustment disorders have a high risk for self-harm, especially suicide.

Question 37

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

A) Knitting scarves for a homeless shelter
B) Painting a "paint-by-number" scenic picture
C) Working on a large, colorful picture puzzle
D) Engaging in regular, age-appropriate physical exercise

Question 38

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

A) Involve psychotic thinking in adolescents
B) Address issues of anxiety and depression
C) Include behaviors that are seen primarily in the child and adolescent population
D) Manifest as transient episodes of dysfunction in response to specific stressors

Question 39

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

A) Measure the patient's temperature and pulse.
B) Offer to have the dietitian visit to discuss his diet.
C) Tell the patient he can lead exercises at the community meeting.
D) Show relief when the patient ends the interaction and walks away.

Question 40

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

A) Confer with the physician about ordering a pregnancy test and discontinuing lithium.
B) Educate the patient to the risk to the fetus as a result of exposure to the lithium in her blood.
C) Suggest to the physician that the lithium dose should be increased for better symptom control.
D) Remind the patient that barrier birth control methods should be used to prevent pregnancy during lithium therapy.

Question 41

Which statements regarding a hypomanic episode are true? Select all that apply.

A) Behavior has been observed in the patient for at least 4 days.
B) Patient appears unaware of potentially dangerous situations.
C) Hospitalization is generally required to stabilize the behavior.
D) Patient is engaging in behaviors that are normally uncharacteristic of them.
E) Primary difference between mania and hypomania is the nature of the activity.