NURSING CARE OF CLIENTS WITH DISORDERS RELATED TO ANXIETY AND ALTERATIONS IN MOOD – Flashcards

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When the nurse is reviewing the record of a client who was recently admitted to a residential psychiatric facility, it indicates that the client was exhibiting akathisia. To determine whether this adaptation is still present, the nurse should assess whether the client: 1. Exhibits facial tics 2. Displays motor restlessness 3. Maintains a body position for hours 4. Repeats the movements of another person
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2. Displays motor restlessness With akathisia the client exhibits a constant state of movement; this is characterized by restlessness and difficulty sitting still, including constant jiggling of the arms and/or legs.
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The nurse recognizes that an excellent indicator of improvement in a client with the diagnosis of generalized anxiety disorder is when the client: 1. Learns to avoid anxiety 2. Participates in activities 3. Takes medication as prescribed 4. Identifies when anxiety is developing
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4. Identifies when anxiety is developing Recognition of anxiety or symptoms of increasing anxiety is an indication that the client is improving.
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The nurse is caring for a client with a generalized anxiety disorder. When the nurse assesses the client which is one of the best indicators of the client's present condition? 1. Memory 2. Behavior 3. Judgment 4. Responsiveness
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2. Behavior The client's current behavior is the best indicator of the client's current level of functioning; all behavior has meaning.
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An obviously distraught client arrives at the mental health clinic. The client is disheveled, is agitated, and demands that someone "do something to end this feeling." The nurse identifies that the client has: 1. A feeling of panic 2. Suicidal tendencies 3. Narcissistic ideation 4. A demanding personality
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1. A feeling of panic The client can no longer control or tolerate feelings and attempts to disregard reality as a mans of avoiding it.
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A client's severe anxiety and panic is often considered to be "contagious." When the nurse identifies that personal feelings of anxiety are increasing, the nurse should: 1. Refocus the conversation on some pleasant topics 2. Say to the client, "Calm down, you are making me anxious, too." 3. Say, " I have to leave for awhile. I'll send someone in and I'll be back." 4. Remain quiet so that personal feelings of anxiety do not become apparent to the client
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3. Say, "I have to leave for awhile. I'll send someone in and I'll be back." The nurse who is anxious should leave the situation after providing for continuity of care; the client will be aware of the nurse's anxiety, and the nurse's presence will be nonproductive and non therapeutic.
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The nurse understands that a phobic reaction rarely will occur unless the person: 1. Thinks about the feared object 2. Is in an unfamiliar environment 3. Is seeking attention from others 4. Comes into contact with the feared object
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4. Comes into contact with the feared object With phobias the individual transfers anxiety to a safer inanimate object or situation. Therefore the anxiety and resulting feelings will be precipitated only when in direct contact with the object or situation.
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The nurse has explored the modalities available for the treatment of phobias. Which treatment should the nurse tell the client has the highest success rate for people with phobias? 1. Systematic desensitization using relaxation 2. Insight therapy to determine the origin of the anxiety and fear 3. Psychotherapy aimed at rearranging psychotic through processes 4. Psychoanalytic exploration of repressed conflicts of an earlier developmental phase
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1. Systematic desensitization using relaxation The most successful therapy for clients with phobias involves behavior modification techniques using desensitization.
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When speaking with the client who has just experienced a panic attack, the nurse can best address the client's concerns most therapeutically by stating: 1. "I would have been upset too." 2. "Episodes like this can be upsetting, but they do end." 3. "You are concerned that this might happen again." 4. "Your family was concerned that you were having a heart attack."
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3. "You are concerned that this might happen again." Recurrence of attacks is a common concern.
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People who are involved in a bioterrorism attack exhibit immediate responses to the traumatic event. Which adaptions can the nurse expect in survivors during the immediate period after a traumatic event? Select all that apply. 1. Guilt 2. Denial 3. Altruism 4. Confusion 5. Helplessness
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2. Denial Shock and disbelief are the initial responses to a traumatic experience; a situational iris usually is unexpected and its impact causes disequilibrium 4. Confusion A crisi causes disequilibrium and the individual experience confusion, disorganization, and difficulty making decisions. 5. Helplessness When a person is unable to cope, helplessness and regression often emerge; a crisis occurs when a painful, frightening even occurs that is so overwhelming an individual's usual coping mechanisms are inadequate.
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The parents of a man who is experiencing post traumatic stress disorder has decided to care for their son at home. The priority intervention that the psychiatric home care nurse must include in the plan of care for the parents is to: 1. Help the parents keep the client within the home environment 2. Work to resolve the problems that cause the parents to be fearful 3. Discuss the parents' feelings of ambivalence about what the client is enduring 4. Assist the parents to understand that the client may avoid emotional attachments
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4. Assist the parents to understand that the client may avoid emotional attachments The client will tend to avoid emotional attachment to significant others because this is a common way to protect the self form the experience of potential future losses. The priority at this time is to have family members develop an understanding of what is happening to the client.
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A client with a general anxiety disorder says to the nurse, "What can I do to prevent over-responding to stress in the future?" What is the nurse's best response? 1. "Hone your problem-solving skills." 2. "Improve your time management skills." 3. "Ignore situations that you cannot change." 4. "Develop a wide variety of coping strategies."
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4. "Develop a wide variety of coping strategies." This increases the individual's ability to cope with stress; different defenses can be used in various situations.
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The nurse understands that it is unusual for an individual with an anxiety disorder to handle the anxiety disorder to handle the anxiety by: 1. Acting-out with antisocial behavior 2. Converting it into a physical symptom 3. Regressing to earlier levels of adjustment 4. Displacing it onto less-threatening objects
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1. Acting-out with antisocial behavior Acting-out anxiety with antisocial behavior is most commonly found in individuals with personality rather than anxiety disorders.
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How should the nurse expect a client's anxiety to be manifested physiologically? 1. Dilated pupil, dilated bronchioles, increased pulse rate, hyperglycemia, and peripheral vasoconstriction 2. Constricted pupils, dilated bronchioles, increased pulse rate, hypoglycemia, and peripheral vasodilation 3. Constricted pupils, constricted bronchioles, increased pulse rate, hypoglycemia, and peripheral vasodilation 4. Dilated pupils, constricted bronchioles, decreased pulse rate, hypoglycemia, and peripheral vasoconstriction.
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1. Dilated pupils, dilated bronchioles, increased pulse rate, hyperglycemia, and peripheral vasoconstriction The "fight or flight" responses of the autonomic nervous system are stimulated and result in these findings.
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The most appropriate way the nurse can decrease a client's anxiety is by helping the client: 1. Avoid unpleasant objects and events 2. Prolong exposure to fearful situations 3. Acquire skills with which to face stressful events 4. Introduce an element of pleasure into fearful situations
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3. Acquire skills with which to face stressful events Learning a variety of coping mechanisms helps reduce anxiety in stressful situations.
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A young client is admitted with a severe anxiety disorder. The client is crying, wringing the hands, and pacing. What should be the first nursing intervention? 1. Stay physically close to the client 2. Gently ask what is bothering the client 3. Tell the client to try to relax by sitting quietly 4. Get the client involved in a nonthreatening activity
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1. Stay physically close to the client By staying physically close, the nurse conveys the client the message that someone cares enough to be there and that the client is a person worthy of care.
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The nurse understands that in a conversion disorder pseudoneurologic symptoms such as paralysis or blindness: 1. Are unconscious methods for getting attention 2. Will subside if the client is helped to focus on getting healthy 3. Are generally necessary for the client to cope with a stressful situation 4. Will usually resolve when the client learns to deal with ongoing family conflicts
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3. Are generally necessary for the client to cope with a stressful situation The client is caught between two equally compelling needs, and movement or sight is impossible. Paralysis or blindness justifies to the client the inability to move in any direction.
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A client newly diagnosed with a conversion disorder is manifesting paralysis of the leg. The nurse can expect this client to: 1. Demonstrate a streak of paralysis to other body parts 2. Requires continuous psychiatric treatment to maintain individual functioning 3. Recover the use of the affected leg but, under stress, again develop similar symptoms 4. Follow a rather unpredictable emotional course in the future, depending on expires to stress
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3. Recover the use of the affected leg, but under stress, again develop similar symptoms The conversion type of defense tends to be a learned behavioral response that the individual will use when put under stress.
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The nurse is caring for client who has a diagnosis of conversion disorder with paralysis of the lower extremities. which is the most therapeutic intervention for the nurse to implement? 1. Encouraging the client to try to walk 2. Telling the client that there is nothing wrong 3. Avoiding focusing on the client's physical symptoms 4. Helping the client follow through with the physical therapy plan
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3. Avoiding focusing on the client's physical symptoms The physical symptoms are not the clients major problem and therefore should not be the focus for care. This is a psychologic problem, and the focus should be on this level.
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The nurse understands that for a client with a diagnosis of conversion disorder, anxiety is: 1. Diffuse and free floating 2. Consciously felt by the client 3. Projected onto the environment 4. Localized and relieved by the symptom
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4. Localized and relieved by the symptom The client's anxiety results form being unable to choose psychologically between conflicting actions. The conversion to a physical disability removes the choice and therefore reduces the anxiety.
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The nurse understands that the basic difference between psychophysiologic disorders and somatoform disorders is that in psychophysiologic disorders there is: 1. A feeling of illness 2. An emotional cause 3. An initial tissue change 4. A restriction of activities
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3. An initial tissue change The psychophysiologic response (hyper function or hypo function) creates actual tissue change. Somatoform disorders are unrelated to organic changes.
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A 20-year-old female believes that doorknobs are contaminated and refuses to touch them, except with a paper tissue. What nursing intervention is most therapeutic for this client? 1. Supply the client with paper tissues to help her function until her anxiety is reduced 2. Encourage the client to scrub the doorknobs with a strong antiseptic so that she does not need to use tissues 3. Explain to the client that her idea about doorknobs being contaminated is part of her illness and her precaution is not necessary 4. Encourage the client to touch doorknobs by removing all available paper tissue until learns to deal with the situation
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1. Supply the client with paper tissues to help her function until her anxiety is reduced The client is using this compulsive behavior to control anxiety and needs to continue with it until the anxiety is reduced and more acceptable methods are developed to handle it.
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The nurse understands that compulsive symptoms, such as using paper towels to open doors, develop because the clients are: 1. Unconsciously controlling unacceptable impulses or feelings 2. Consciously using this method to punish themselves 3. Listening to voices that tell them the doorknobs are unclean 4. Fulfilling a need to punish other by carrying out an annoying procedure
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1. Unconsciously controlling unacceptable impulses or feelings By carrying out the compulsive ritual, the client unconsciously tries to control the situation so that she will not act on unacceptable impulses and feelings.
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The nurse is developing a care plan for a client with an obsessive-compulsive behavior disorder. Which nursing intervention will dos likely increase the client's anxiety? 1. Permitting the client's ritualistic acts three times a day 2. Involving the client in establishing the therapeutic plan 3. Helping the client understand the nature of the anxiety 4. Providing the client with a nonjudgmental environment
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1. Permitting the client's ritualistic acts three times a day This sets an unrealistic limit that will increase anxiety by removing a defense the client needs.
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Why is the hospital or day-treatment center often indicated for the treatment of the client with an obsessive-compulsive disorder? This setting: 1. Prevents the client from completing symptomatic rituals 2. Allows the staff to exert control over the client's activities 3. Resolves the client's anxiety because decision making is minimal 4. Provides the neutral environment the client needs to work through conflicts
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4. Provides the neutral environment the client needs to work through conflicts These clients can work through their underlying conflicts more easily or productively when demands are reduced and the routine is simple.
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What should the nurse include in the initial nursing plan of care for a 40-year-old client with a longstanding, obsessive-compulsive behavior of hand and body washing? 1. Denying the client time for ritualistic behavior 2. Determining the purpose of the ritualistic behavior 3. Providing the client with a routine schedule of activities 4. Suggesting a symptom substitution technique to refocus the behavior
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3. Providing the client with a routine schedule of activities The initial action is to avoid hurrying the client because this increases anxiety and the performance of the ritual. Routines will also decrease anxiety and the need for the ritual.
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A client with a history of obsessive-compulsive behaviors has been attending a psychiatric day-treatment center. There has been a marked decrease in symptoms, and the client expresses a wish to obtain a part-time job. On the day of a job interview the client comes to the center fretful and displaying symptoms. Which is the nurse's best response in this situation? 1. "I know you're anxious, but make yourself got to the interview and conquer your fear." 2. "If going to an interview makes you this anxious, it seems like you're not ready to work." 3. "It must be that you really don't want that job after all. I think you should think more about it." 4. "Going for your interview triggered some feelings in you. Perhaps you could call a friend to drive you to your appointment."
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4. "Going for your interview triggered some feelings in you. Perhaps you could call a friend to drive you to your appointment." The symptoms are a defense against anxiety resulting form decision making, which triggers old fears; the client needs support.
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To give effective nursing care to a client who is using ritualistic behavior, the nurse must first understand that the client: 1. Should be prevented from performing the rituals 2. Needs to realize that the ritual serves no purpose 3. Must immediately be diverted when performing the ritual 4. Does not want to repeat the ritual, but feels compelled to do so
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4. Does not want to repeat the ritual, but feels compelled to do so The repeated thought or act defends the client against even higher, more severe levels of anxiety.
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What is the priority discharge criterion for a female client who is using ritualistic behaviors? The is client is able to: 1. Verbalize positive aspects about herself 2. Follow the rules of the therapeutic milieu 3. Recognize that her hallucinations occur at times of extreme anxiety and can be controlled 4. Verbalize signs and symptoms of increasing anxiety and intervene to maintain it at a manageable level
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4. Verbalize signs and symptoms of increasing anxiety and intervene to maintain it at a manageable level This outcome will result form teaching the client to recognize situations that provoke ritualistic behavior and from the client learning how to interrupt the pattern.
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A psychiatrist prescribes an anti obsessional agent for a client who is using ritualistic behavior. A common anti obsessional medication that the nurse can expect the practitioner to order for this client is: 1. Fluvoxamine (Luvox) 2. Benztropine (Cogentin) 3. Amantadine (Symmetrel) 4. Diphenhydramine (Benadryl)
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1. Fluvoxamine (Luvox) This drug blocks the uptake of serotonin, which leads to a decrease in obsessive-compulsive behaviors.
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A client is using ritualistic behaviors. Why does the nurse allow the client ample time for the performance of the ritual? 1. Denial of this activity may precipitate panic levels of anxiety 2. Anger turned inward on the self should be allowed to be expressed 3. Successful performance of independent activities enhances self-esteem 4. Provides an opportunity to point out that the behavior is inappropriate
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1. Denial of this activity may precipitate panic levels of anxiety The repeated act defends the client against severe anxiety; interruption of the ritual will result in increased anxiety.
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Although the nurse becomes tense as the client with an obsessive-compulsive personality disorder carries out a ritual, the nurse understands that a compulsive act is one that: 1. Has a purpose but is useless 2. Is performed after long urging 3. Appears to be performed willingly 4. Seems absurd but is necessary to the person
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4. Seems absurd but is necessary to the person The client's exact compliance in carrying out the compulsive ritual relieves anxiety, at least temporarily. Furthermore, it meets a need and is necessary to the client.
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The nurse understands that a therapeutic treatment of a female client with ritualistic behavior should be directed toward helping her to: 1. Redirect her energy into activities to help others 2. Learn that her behavior is not serving a realistic purpose 3. Forget her fears by administering anti anxiety medications 4. Understand her behavior is caused by maladaptive coping to increased anxiety
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4. Understand her behavior is caused by maladaptive coping to increased anxiety Helping clients understand that a behavior is being used to control anxiety usually makes them more amenable to psychotherapy.
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Which is the best nursing intervention to meet the needs of individuals who demonstrate obsessive-compulsive behavior? 1. Restricting their movements 2. Calling attention to their behavior 3. Keeping them busy to distract them 4. Supporting but limiting their behavior
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4. Supporting but limiting their behavior Accepting these clients and their symptomatic behavior sets the foundation for the nurse-client relationship. Setting limits provides external controls and helps lower anxiety.
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A client with a somatoform disorder is well-known to the nurse from prior hospitalizations. When planning care for the client the nurse must be aware that this client is prone to: 1. Ask then nurse to make a recommendation for palliative care 2. Write down conversations in order to remember information 3. Monopolize conversations about the anxiety being experienced 4. Redirect the conversation with the nurse to physical symptoms
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4. Redirect the conversation with the nurse to physical symptoms Clients with a somatoform disorder are preoccupied with the symptoms that are being experienced and usually do not want to talk about their emotions or relate them to their present situation.
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A client is admitted to the mental health unit with the diagnosis of bipolar disorder, depressed. During the assessment interview when the client avoids eye contact, responds in a very low voice, and is tearful, it is most therapeutic for the nurse to state: 1. "You'll find that you'll get better faster is you try to help us to help you." 2. "Hold my hand; I known you are frightened. I will not allow anyone to harm you." 3. "I'm you nurse. I'll take you to the day room as soon as I get some information." 4. "I know this is difficult, but as soon as we are finished, I'll take you to your room."
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4. "I know this is difficult, but as soon as we are finished, I'll take you to your room." This recognizes feelings and tells what is expected.
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An older adult has not been eating well since admission. The client repeatedly states, "No one cares." What is the most appropriate response by the nurse? 1. "We all care about you; now please eat." 2. "You know you have to eat; it will keep you alive." 3. "I care about you. What foods do you especially like?" 4. "I care about you. Will you please eat some of this food for me?"
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3. "I care about you. What foods do you especially like?" This provides a direct response to the client's concern and allows some exploration of food choices.
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A client is admitted to the mental health unit because of a progressively increasing depression over the past month. During the initial assessment, the nurse should expect the client to display: 1. Elated affect related to reaction formation 2. Loose associations related to thought disorder 3. Physical exhaustion resulting from decreased physical activity 4. Paucity of verbal expression caused by slowed thought processes
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4. Paucity of verbal expression caused by slowed thought processes As depression increases, thought processes become more slowed and verbal expression decreases.
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When the nurse is developing a plan of care for a depressed client, which approach by the nurse is most therapeutic? 1. Allowing time for the client's slowness when planning activities 2. Helping the client focus on family strengths and support systems 3. Encouraging the client to perform menial tasks to meet the need for punishment 4. Telling the client repeatedly that the staff vies the client as worthwhile and important
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1. Allowing time for the client's slowness when planning activities Routines should be kept simple and no demands should be made that the client cannot meet. The client is depressed, and all reactions will be slow. Putting pressure on the client will only increase anxiety and feelings of worthlessness.
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Which statement is most appropriate for the nurse to use when interviewing an newly admitted 35-year-old depressed client whose thoughts focus on feelings of unworthiness and failure? 1. "Tell me how you feel about yourself." 2. "Tell me what has been bothering you." 3. "Why do you feel so bad about yourself." 4. "What can we do to help you during your stay with us?"
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1. "Tell me how you feel about yourself." Because major depression is due to the client's feelings of self-rejection, it is important for the nurse to have the client initially identify these feelings before a pan of action can be taken. Later discussion should be on other topics so as not to reinforce negative thoughts and feelings.
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A female client whose depression is beginning to lift remains aloof from the other clients on the psychiatric unit. The nurse with whom the client has developed a relationship may help her participate in some activities by: 1. Finding solitary pursuits that the client can enjoy 2. Speaking to the client about the importance of entering into activities 3. Asking the physician to speak to the client about participating in activities 4. Inviting another client to take part in a joint activity with the nurse and the client
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4. Inviting another client to take part in a joint activity with the nurse and the client Bringing another client into a set situation is the most therapeutic, least-threatening approach.
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Which activity is most appropriate of the nurse to introduce to a depressed client during the early part of hospitalization? 1. Game of Trivial Pursuit 2. Project involving drawing 3. Small aerobic exercise group 4. Card game with three other clients
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2. Project involving drawing An art-type project that may be worked on successfully at one's own pace is appropriate for a depressed client.
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A withdrawn client refuses to get out of bed and becomes upset. What action is most therapeutic for the nurse to take? 1. Require the client to get out of bed at once 2. Stay with the client until the client calms down 3. Give the client the PRN neuroleptic that is ordered 4. Allow the client to stay in bed for now without company
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2. Stay with the client until the client calms down This provides support and security without rejecting the client or placing value judgments on behavior.
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A female client with the diagnosis of bipolar disorder, depressive episode, has been hospitalized on a psychiatric unit for 1 week. When scheduling activities for this client, it is most appropriate to pan for the client to: 1. Complete a jigsaw puzzle by herself 2. Play a game of cards with several other clients 3. Talk with the nurse several times during the day 4. Engage in a game of Ping-Pong with another client
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3. Talk with the nurse several times during the day Involving the client in a one-on-one conversation provides individualized, low-anxiety-producing attention and gives the message that the client is important, which supports self-esteem.
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During a special meeting to discuss the unexpected suicide of one of the female clients while on a weekend pass, the nurse overhears another client moaning softly, "I'm next. Oh, my God, I'm next. They couldn't prevent hers and they can't protect me." What is the most therapeutic response by the nurse? 1. "You seem to be afraid you will hurt yourself." 2. "The other client was a lot sicker than you are." 3. "It's different. The other client was home; you are here." 4. "There is no need to worry. Passes will be canceled for a while."
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1. "You seem to be afraid you will hurt yourself." This statement identifies the importance of feelings and provides an opening so that the client may talk about them.
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An older depressed client is concerned about many fears that are upsetting and frightening and expresses a feeling of having committed the "unpardonable sin." The nurse can best reassure the client by stating: 1. "Your family loves you very much." 2. "You know that you are not a bad person." 3. "You know, those ideas of yours are in your imagination." 4. "Your ideas, which are part of your illness, will change as you improve."
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4. "Your ideas, which are part of your illness, will change as you improve." This statement points out reality while accepting the fact that the client believes the feelings and thoughts are real.
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A client who attempted suicide by slashing her wrists is transferred from the emergency department to the psychiatric unit of a community hospital. When the client arrives on the unit, the priority nursing intervention should be to: 1. Obtain the client's vital signs 2. Initiate a therapeutic relationship 3. Inspect the bandages for sings of bleeding 4. Institute continuous observation of the client
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4. Institute continuous observation of the client This action protects the client from acting on suicidal thoughts an provides a sense of security.
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After admission, the nurse needs to evaluate a depressed client's potential for suicide. The approach that best gains this information is for the nurse to ask: 1. The client about plans for the future 2. The client whether suicide is now being considered 3. Other clients about suicide while the client is in the group 4. Family members whether the client has ever attempted suicide
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2. The client whether suicide is now being considered Directness is the best approach at the first interview, because this sets the focus and concern and lets the nurse know what the client is feeling now.
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A middle-aged female client with major depression feels all her family members have been killed because she has been sinful and needs to be punished. The prime responsibility of the nurse caring of this client should be to: 1. Protect the client against any suicidal impulses 2. Keep up the client's interest in the outside world 3. Help the client handle her concern for family members 4. Reassure the client that past behaviors are not being punished
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1. Protect the client against any suicidal impulses Suicidal impulses take priority, and the client must be stopped from acting on them while treatment is in progress.
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A client is admitted to the mental health unit after attempting suicide. When the nurse approaches, the client is tearful and silent. Which is the nurse's best initial response? 1. Note the behavior, record it, an notify the attending physician 2. Sit quietly next to the client and wait until the clients begins to speak 3. Say, "You are crying; that means you feel badly about attempting suicide and really want to live." 4. Say, "I notice you are tearful and seem sad. Tell me what it's like for you and perhaps we can begin to work it out together."
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4. Say, "I notice you are tearful and seem sad. Tell me what it's like for you and perhaps we can begin to work it out together." This response recognizes feelings and behavior and encourages the client to share feelings; it also promotes trust, which is essential to a therapeutic relationship.
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A nurse has been assigned to work with a depressed client on a one-to-one basis. The next morning the client refuses to get out of bed, stating, "I'm too sick to be helped and I don't want to be bothered." What is the best response the nurse can make? 1. "You will not feel better unless you make the effort to get up and get dressed." 2. "I known you will feel better again in you only make the attempt to help yourself." 3. "Everyone feels this way in the beginning as they confront repressed feelings. I'll sit down with you." 4. "I known you don't feel like getting up, but you probably will feel better if you do. Let me help you get started."
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4. "I known you don't feel like getting up, but you probably will feel better if you do. Let me help you get started." This acknowledges the client's feelings, offers hope, and assists the client to a higher level of functioning.
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An older, depressed client frequently paces the halls, becoming physically tired from the activity. To help the client reduce this activity, the nurse should: 1. Supply the client with simple, monotonous tasks 2. Request a sedative order form the client's physician 3. Restrain the client in a chair, reducing the opportunity to pace 4. Place the client in a single room, thus limiting pacing to a smaller area
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1. Supply the client with simple, monotonous tasks These clients can usually be fairly easily distracted by planned involvement in repetitious, simple tasks.
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The nurse sits with an older depressed client twice a day, although there is little verbal communication. One afternoon, the client asks, "Do you think they'll ever let me out of here?" The nurse's best reply should be: 1. "Maybe you should ask your doctor." 2. "Everyone says you're doing just fine." 3. "Why, do you think you're ready to leave?" 4. "You have the feeling that you might not leave?"
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4. "You have the feeling that you might not leave?" The nurse's response urges the client to reflect on feelings and encourages communication.
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The nurse develops a long-term therapy goal for a female client hospitalized for a major depressive episode. The goal states that client will: 1. Talk openly about her depressed feelings 2. Identify and use new defense mechanisms 3. Discuss the unconscious source of her anger 4. Verbalize realistic perceptions of herself and others
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4. Verbalize realistic perceptions of herself and others A major part of depression involves an inability to accept the self as it is, which leads to making demands on others to meet unrealistic needs.
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A depressed client states, "I am no good. I'm better off dead." Which intervention by the nurse is a priority? 1. Stating, "I think you're good; you should think of living." 2. Alerting the staff to provide 24-hour observation of the client 3. Responding, "I will stay with you until you are less depressed." 4. Unobtrusively removing those articles that may be used in a suicide attempt
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2. Alerting the staff to provide 24-hour observation of the client This is the most therapeutic approach to prevent suicide. The staff member also provides special attention to help the client meet dependency needs and reduce a self-defeating attitude.
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What is a positive nursing action when caring for a middle-age, depressed client? 1. Play a game of chest with the client 2. Allow the client to make personal decisions 3. Sit down next to the client at frequent intervals 4. Provides the client with frequent periods of time for reflection
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3. Sit down next to the client at frequent intervals This gives the client the nonverbal message that someone cares and vies the client as being worthy of attention and concern.
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A teenage recently committed suicide. The school community was saddened by the even and grief counselors have been working with students. The school nurse understands that other students may attempt to copy the behavior. When observing the student body, the nurse should monitor for presuicide behavior, which includes: 1. Giving away prized possessions 2. Memorializing the dead teenager 3. Talking excessively about the event 4. Becoming involved in student activities
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1. Giving away prized possessions This behavior indicates that the student expects no future.
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A client with a diagnosis of major depression refuses to participate in the unit activities because of being "just too tired." What nursing approach best expresses an understanding of the client's needs? 1. Planning a rest period for the client during activity time 2. Explaining why the staff believes the activities are therapeutic 3. Helping the client express negative feelings about the activities 4. Accepting the client's behavior calmly while setting firm limits
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4. Accepting the client's behavior calmly while setting firm limits Fatigue and apathy are symptom of depression. If members of the staff criticize, it will only increase the client's negative feelings.
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The nurse stops by the room of a tearfully depressed newly admitted client and offers to wha the client to the evening meal. The client looks intently at the nurse, saying nothing. Which is the best response by the nurse? 1. "I will be at the desk if you need me." 2. "You must tell me what you are feeling now." 3. "It must be very difficult for you to be on a psychiatric unit." 4. "We will walk together to dinner when you pull yourself together.
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3. "It must be very difficult for you to be on a psychiatric unit." This statement lets the client know that nurse realizes the client is having difficulty without asking direct questions or focusing on specific behavior.
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A client is admitted to the psychiatric hospital after many self-inflicted nonlethal injuries over the last month. The nurse identifies that these injuries are documented on the admission history as suicidal: 1. Threats 2. Gestures 3. Attempts 4. Ideations
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2. Gestures Suicidal gestures involve superficial nonlethal injuries; the client has no intent to die as a result of the injuries.
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During individual sessions design dot help the depressed client with a history of suicide attempts explore alternative coping strategies, it is most appropriate of the nurse to ask: 1. "How have you managed your problem in the past?" 2. "What do you feel you have learned form this suicide attempt?" 3. "How will you manage the next time your problems start piling up?" 4. "Where there other things going on in your life that made you want to die?"
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3. "How will you manage the next time your problems start piling up?" This question focuses the interaction toward the future and invites the client to explore alternative coping strategies.
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The nurse is assigned to care for a middle-age depressed female client on a day when the client seems more withdrawn and depressed than usual. Which intervention by the nurse is most appropriate? 1. Remain visible to the client 2. Get the client involved in group activities 3. Ask the client if it would help to sit with her a while 4. Spend a few extra minutes with the client throughout the day
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4. Spend a few extra minutes with the client throughout the day Spending extra time with the client demonstrates that the client is worthy of the nurse's time and the nurse cares.
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The nurse is to discharge a client form the psychiatric unit who has been treated for major depression. Which statement by the nurse demonstrates the most understanding at this time? 1. "Call the unit night or day if you have problems." 2. "I am going miss you; we have become good friends." 3. "I known you are really going to be all right when you get home." 4. "This is my phone number; call me to let me know how you are doing."
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1. "Call the unit night or day if you have problems." This statement demonstrates an understanding the the newly discharged client needs to have the support to the therapeutic unit when discharged. The client needs to feel that in a crisis the staff will be there for support.
question
On the second day after admission, a suicidal client asks the nurse, "Why am I being observed around the clock, and why is my freedom to move around the unit being restricted?" Which reply by the nurse is most appropriate? 1. "Why do you think we are observing you?" 2. "What makes you think that we are observing you?" 3. "We are concerned that you might try to harm yourself." 4. "Your doctor has ordered it so the doctor is the one you should ask about it."
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3. "We are concerned that you might try to harm yourself." This statement is honest and helps establish trust. Also, the client may realize that the staff members care and feel that the client is worthy of care.
question
After 4 days on the inpatient psychiatric unit, a client on suicidal precautions tells the nurse, "Hey, look! I was feeling pretty depressed for a while, but I'm certainly not going to kill myself."The nurse's best response to this statement is: 1. "Kill yourself? I don't understand." 2. "You do seem to be feeling better." 3. "Suppose we talk some more about this." 4. "We have to observe you until your psychiatrist tells us to stop."
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3. "Suppose we talk some more about this." This encourages the client to talk about feelings without the nurse setting the focus for the discussion.
question
During a group discussion, it is learned that a female group member masked her depression and suicidal urges and indeed committed suicide several days ago. The nurse leading the group should be prepared primary to deal with the: 1. Guilt that group members feel because they could not prevent another's suicide 2. Lack off concern over the member's act of suicide expressed by some of the group 3. Guilt, and anger of the co-leaders that they failed to anticipate and prevent the suicide 4. Anxiety and fear by some members of the group that hate down suicidal urges may go unnoticed and unprotected
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4. Anxiety and fear by some members of the group that hate down suicidal urges may go unnoticed and unprotected Ambivalence about life and death plus the introspection commonly found in clients with emotional problems can lead to increased anxiety and fear in the group members.
question
The nurse should anticipate that the treatment plan for a lent admitted with a severe, persistent, intractable depression and suicidal ideation will probably include: 1. Electroconvulsive therapy 2. Short-term psychoanalysis 3. Nondirective psychotherapy 4. High doses of anxiolytic drugs
answer
1. Electroconvulsive therapy Electroconvulsive therapy, which interrupts established patterns of behavior, helps relieve symptoms and limits possible suicide attempts in clients with severe, intractable depressions that do not respond to antidepressant medication.
question
A severely depressed client is to have electroconvulsive therapy. When discussing the therapy, what should the nurse tell the client? 1. Sleep will be induced and treatment will not cause pain 2. With new methods of administration, treatment is totally safe 3. It is better not to talk about it, but you can ask any question you like 4. There may be some permanent memory loss as a result of the treatment
answer
1. Sleep will be induced and treatment will not cause pain Clients fear this therapy because of the expected pain. If they are reassured that they will be asleep and have no pain, there will be less anxiety and more cooperation.
question
An extremely depressed client is to begin electroconvulsive therapy and expresses anxiety about the procedure. When explaining this procedure, the nurse should emphasize that: 1. Answers to any questions will be provided 2. Periods of amnesia will follow the treatment 3. The treatments will make the client feel better 4. The client will not be alone during the treatment
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4. The client will not be alone during the treatment The staff's presence provides continued emotional support and helps relieve anxiety.
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The nurse understands that a side effect of electroconvulsive therapy that a client may experience is: 1. Loss of appetite 2. Postural hypotension 3. Complete loss of memory for a time 4. Confusion immediately after the treatment
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4. Confusion immediately after the treatment The electrical energy passing through the cerebral cortex during ECT results in a temporary state of confusion after treatment.
question
When the nurse sits next to a depressed client and begins to talk, the client says to the nurse, "I'm stupid and useless. Talk with the other people who are more important." Which response by the nurse is most therapeutic? 1. "Everyone is important." 2. "Do you feel that you are not important?" 3. "Why do you feel you are not important?" 4. "I want to talk with you because you are important to me."
answer
4. "I want to talk with you because you are important to me." This statement expresses the nurse's positive thoughts about the client while letting the client know that the nurse is concerned.
question
A client is admitted to a mental health facility for depression. In an effort to promote a positive self-regard, the nurse should: 1. Set limites on the client's negative behaviors 2. Praise the client's efforts at every opportunity 3. Involve the client in activities that promote success 4. Encourage the client to participate in activities with other clients
answer
3. Involve the client in activities that promote success Self-esteem and feelings of competence are increased when a person experiences success.
question
During an interaction, a depressed client says, "I want to die." What is the most therapeutic response by the nurse? 1. "You would rather not live." 2. "You are not alone in feeling this way." 3. "When was the last time you felt this way?" 4. "Do you believe that there is life after death?"
answer
1. "You would rather not live." This response uses paraphrasing to demonstrate to the client that it is all right to talk about these feelings; it recognizes the client's sense of hopelessness without intensifying the feeling while providing an opportunity to verbalize further.
question
A hyperactive client exhibiting manic behavior is admitted to the hospital. In view of the client's elated state, the nurse should arrange of the client to be in a room: 1. That has basic simple furnishings 2. With another client who is very quiet 3. That will provide a great deal of stimuli 4. With another client exhibiting similar behavior
answer
1. That has basic simple furnishings Overactive individuals are stimulated by environmental factors. A responsibility of the nurse is to simplify their surroundings as much as possible.
question
During the orientation tour for three new staff members, a young, hyperactive manic client greets them by saying, "Welcome to the funny farm. I'm Jo-Jo, the head yo-yo." Which meaning can the nurse assign to the client's statement? The client is: 1. Trying to fill the "life-of-the-party" role 2. Looking for attention from the new staff 3. Unable to distinguish fantasy from reality 4. Anxious over the arrival of the new staff members
answer
4. Anxious over the arrival of the new staff members The client's behavior demonstrates increased anxiety. Since it was directed towards the new staff, it was probably precipitated by their arrival.
question
When the language of a client in the manic phase of a bipolar disorder becomes vulgar and profane, what is the best intervention by the nurse? 1. State, "We do not like that kind of talk around here." 2. Ignore it, since the client is using it only to get attention 3. Recognize the language as part of the illness, but set limits on it 4. State, "When you can talk in an acceptable way, we will talk to you."
answer
3. Recognize the language as part of the illness, but set limits on it Recognizing the language as part of the illness makes it easier to tolerate, but limits must be set for the benefit of the staff and other clients. Setting limits also shows the client that the nurse cares enough to stop the behavior.
question
A client with the diagnosis of bipolar I disorder, manic episode, has a superior, authoritative manner and is consistently instructing the other clients on the unit about how to dress, what to eat, and where to sit. The nurse intervenes in these behaviors because they will eventually make the other clients feel: 1. Angry 2. Dependent 3. Inadequate 4. Ambivalent
answer
1. Angry A person with a condescending, bossy attitude frequently evokes feelings of anger in others as a means to decrease their anxiety.
question
A client with the diagnosis of bipolar disorder, manic epidote, is extremely active, talks constantly, and tends to badger other clients, some of whom are now becoming agitated. What is the best strategy for the nurse to use with this client? 1. Humor 2. Sympathy 3. Distraction 4. Confrontation
answer
3. Distraction During periods of hyperactivity, the client has a short attention span and can be distracted easily; this is a therapeutic intervention for all the clients.
question
What nursing intervention may redirect a hyperactive manic client therapeutically? 1. Asking the client to guide other clients as they clean their rooms 2. Suggesting the client initiate social activities on the unit for the client group 3. Encouraging the client to tear pictures out of magazines for a scrap book 4. Providing a pencil and paper to encourage the client to write a short story
answer
3. Encouraging the client to tear pictures out of magazines for a scrap book Physical activity will help with some of the excess energy without requiring the client to make decisions or forcing other clients to deal with the behavior.
question
The nurse is assigned to care for a 39-year-old, hyperactive, manic client who exhibits flight of ideas. The client is not eating. The nurse recognizes this may be because the client: 1. Feels undeserving of the food 2. Is too busy to take the time to eat 3. Wishes ro avoid the clients in the dining room 4. Believes that at this time there is no need for food
answer
2. Is too busy to take the time to eat Hyperactive clients frequently will not take the time to eat because they are over involved with everything in their environment.
question
A physician has been a client of the psychiatric nurse for the past 3 days. The client has questioned the authority of the treatment team, has advised other clients that their treatment plans are wrong, and has been generally disruptive in group therapy. The nurse's most appropriate response should be to: 1. Ignore the client and hope the disruptive behavior will stop 2. Restrict the client's contact with other clients until the disruptive behavior ceases 3. Tell the other client that they should not pay attention to what the client says 4. Understand that the client is unable to control this behavior and that limits must be set
answer
4. Understand that the client is unable to control this behavior and that limits must be set Clients who are out of control need controls set of them. The staff must understand that the client is not deliberately try to disrupt the unit.
question
During a client's periods of extreme mania and hyperactivity, how should the nursing staff provide of the client's nutritional needs? 1. Accept the fact that the client will eat if hungry 2. Follow the client around the dining room with a tray 3. Allow the client to prepare own meals to eat when desired 4. Provide the client with frequent, high-calorie feedings that can be hand-held
answer
4. Provide the client with frequent, high-calorie feedings that can be hand-held Hyperactive clients burn up large quantities of calories, which must be replenished. Since these clients will not take the time to sit down and eat, providing them with food they can carry with them sometimes helps.
question
A 23-year-old client has been admitted to a psychiatric hospital after a month of unusual behavior that included eating and sleeping very little, talking and singing constantly, and going on frequent shopping sprees. In the hospital, the client is demanding, bossy, and sarcastic. The nurse understands that the adaptations the client is exhibiting usually are found in clients with the diagnosis of: 1. Major depression 2. Bipolar disorder, manic phase 3. Antisocial personality disorder 4. Chronic undifferentiated schizophrenia
answer
2. Bipolar disorder, manic phase Hyperactive behavior in individuals, such as this is typical of manic flight into reality associated with mood disorders.
question
When approaching a client during a period of great over activity, it is essential for the nurse to: 1. Use a firm and warm, consistent approach 2. Allow the client to choose the activities in which to participate 3. Anticipate and physically control the client's hyperactivity 4. Let the client know the staff will not tolerate destructive behavior
answer
1. Use a firm and warm, consistent approach This will help reduce the client's anxiety, thereby reducing hyperactivity.
question
When developing a plan of care for client in the main phase of bipolar disorder, the nurse should plan to: 1. Focus the client's interest in reality 2. Encourage the client to talk as much as needed 3. Persuade the client to complete any task that has been started 4. Provide constructive channels for redirecting the client's excess energy
answer
4. Provide constructive channels for redirecting the client's excess energy The hyperactive client is usually rather easily distracted, so the excess energy can be redirected into constructive channels.
question
Clients with a diagnosis of bipolar disorder, manic episode, most likely will exhibit signs of: 1. Passivity 2. Dysphoria 3. Anhedonia 4. Grandiosity
answer
4. Grandiosity Grandiosity is manifested by extravagant, pompous, flamboyant beliefs about the self. It frequently occurs during manic phases of bipolar disorder.
question
Depressed clients often have the primary characteristic of early morning awakening. Which nursing intervention in the day time is best for the staff to implement for this client? 1. Restrict the client's access to the bedroom 2. Offer the client a series of relaxation tapes 3. Reschedule the client's bedtime to an earlier hour 4. Suggest that the client exercise before going to bed
answer
1. Restrict the client's access to the bedroom The goal is 6 to 8 hours of rest at night; too much time spent sleeping in the day time will defeat the goal of adequate rest at night.
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