ST. TONIS COLLEGECollege Of NursingBulanao, Tabuk City, Kalinga

Nursing Care Management 105 : Mood Disorders

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IINSTRUCTIONS: Choose and encircle the best answer for the following items. No erasures, alterations, and unnecessary markings. Make your answer sheets as clean as possible.

1. 2. Which statement describes a major difference between a client diagnosed with major depressive disorder and a client diagnosed with dysthymic disorder?A. A client diagnosed with dysthymic disorder is at higher risk for suicide.B. A client diagnosed with dysthymic disorder may experience psychotic features.C. A client diagnosed with dysthymic disorder experiences excessive guilt.D. A client diagnosed with dysthymic disorder has symptoms for at least 2 years.3. A client expresses frustration and hostility toward the nursing staff regarding the lack of care his or her recently deceased parent received. According to Kubler-Ross, which stage of grief is this client experiencing?A. Anger.B. Disequilibrium.C. Developing awareness.D. Bargaining.4. A client plans and follows through with the wake and burial of a child lost in an automobile accident. Using Engels model of normal grief response, in which stage would this client fall?A. Resolution of the loss.B. Recovery.C. Restitution.D. Developing awareness.5. Which charting entry most accurately documents a clients mood?A. The client expresses an elevation in mood.B. The client appears euthymic and is interacting with others.C. The client isolates self and is tearful most of the day.D. The client rates mood at a 2 out of 10.6. Which client is at highest risk for the diagnosis of major depressive disorder?A. A 24-year-old married woman.B. A 64-year-old single woman.C. A 30-year-old single man.D. A 70-year-old married man.7. A client is admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder. Which of the following data would the nurse expect to assess? Select all that apply.A. Loss of interest in almost all activities and anhedonia.B. A change of more than 5% of body weight in 1 month.C. Fluctuation between increased energy and loss of energy.D. Psychomotor retardation or agitation.E. Insomnia or hypersomnia.8. A client is exhibiting behavioral symptoms of depression. Which charting entry would appropriately document these symptoms?A. Rates mood as 4/10.B. Expresses thoughts of poor self-esteem during group.C. Became irritable and agitated on waking.D. Rates anxiety as 2/10 after receiving lorazepam (Ativan).9. Which symptom is an example of physiological alterations exhibited by clients diagnosed with moderate depression?A. Decreased libido.B. Difficulty concentrating.C. Slumped posture.D. Helplessness.10. Which symptom is an example of an affective alteration exhibited by clients diagnosed with severe depression?A. Apathy.B. Somatic delusion.C. Difficulty falling asleep.D. Social isolation.11. Major depressive disorder would be most difficult to detect in which of the following clients?A. A 5-year-old girl.B. A 13-year-old boy.C. A 25-year-old woman.D. A 75-year-old man.12. Which is the key to understanding if a child or adolescent is experiencing an underlying depressive disorder?A. Irritability with authority.B. Being uninterested in school.C. A change in behaviors over a 2-week period.D. Feeling insecure at a social gathering.13. The nurse in the emergency department is assessing a client suspected of being suicidal. Number the following assessment questions, beginning with the most critical and ending with the least critical.___ Are you currently thinking about suicide?___ Do you have a gun in your possession?___ Do you have a plan to commit suicide?___ Do you live alone? Do you have local friends or family?14. Which nursing charting entry is documentation of a behavioral symptom of mania?A. Thoughts fragmented, flight of ideas noted.B. Mood euphoric and expansive. Rates mood a 10/10.C. Pacing halls throughout the day. Exhibits poor impulse control.D. Easily distracted, unable to focus on goals.A nurse on an in-patient psychiatric unit receives report at 1500 hours. Which client would need to be assessed first?A. A client on one-to-one status because of active suicidal ideations.B. A client pacing the hall and experiencing irritability and flight of ideas.C. A client diagnosed with hypomania monopolizing time in the milieu.D. A client with a history of mania who is to be discharged in the morning.15. A nurse is planning to teach about appropriate coping skills. The nurse would expect which client to be at the highest level of readiness to participate in this instruction?A. A newly admitted client with an anxiety level of 8/10 and racing thoughts.B. A client admitted 6 days ago for a manic episode refusing to take medications.C. A newly admitted client experiencing suicidal ideations with a plan to overdose.D. A client admitted 6 days ago for suicidal ideations following a depressive episode.16. A newly admitted client has been diagnosed with major depressive disorder. Which nursing diagnosis takes priority?A. Social isolation R / T poor mood AEB refusing visits from family.B. Self-care deficit R / T hopelessness AEB not taking a bath for 2 weeks.C. Anxiety R / T hospitalization AEB anxiety rating of an 8/10.D. Risk for self-directed violence R / T depressed mood.17. A clients outcome states, The client will make a plan to take control of one life situation by discharge. Which nursing diagnosis documents the clients problem that this outcome addresses?A. Impaired social interaction.B. Powerlessness.C. Knowledge deficit.D. Dysfunctional grieving.18. Which nursing diagnosis takes priority for a client immediately after electroconvulsive therapy (ECT)?A. Risk for injury R / T altered mental status.B. Impaired social interaction R / T confusion.C. Activity intolerance R / T weakness.D. Chronic confusion R / T side effect of ECT.19. A client diagnosed with major depressive disorder has been newly admitted to an inpatient psychiatric unit. The client has a history of two suicide attempts by hanging. Which nursing diagnosis takes priority?A. Risk for violence directed at others R / T anger turned outward.B. Social isolation R / T depressed mood.C. Risk for suicide R / T history of attempts.D. Hopelessness R / T multiple suicide attempts.20. A client diagnosed with cyclothymia is newly admitted to an in-patient psychiatric unit. The client has a history of irritability and grandiosity and is currently sleeping 2 hours a night. Which nursing diagnoses takes priority?A. Altered thought processes R / T biochemical alterations.B. Social isolation R / T grandiosity.C. Disturbed sleep patterns R / T agitation.D. Risk for violence: self-directed R / T depressive symptoms.21. A client diagnosed with bipolar I disorder and experiencing a manic episode is newly admitted to the in-patient psychiatric unit. Which nursing diagnosis is a priority at this time?A. Risk for violence: other-directed R / T poor impulse control.B. Altered thought process R / T hallucinations.C. Social isolation R / T manic excitement.D. Low self-esteem R / T guilt about promiscuity.22. A client admitted with major depressive disorder has a nursing diagnosis of ineffective sleep pattern R / T aches and pains. Which is an appropriate short-term outcome for this client?A. The client will express feeling rested on awakening.B. The client will rate pain level at or below a 4/10.C. The client will sleep 6 to 8 hours at night by day 5.D. The client will maintain a steady sleep pattern while hospitalized.23. Which client would the charge nurse assign to an agency nurse working on the inpatient psychiatric unit for the first time?A. A client experiencing passive suicidal ideations with a past history of an attempt.B. A client rating mood as 3/10 and attending but not participating in group therapy.C. A client lying in bed all day long in a fetal position and refusing all meals.D. A client admitted for the first time with a diagnosis of major depression.24. A client has a nursing diagnosis of risk for suicide R / T a past suicide attempt. Which outcome, based on this diagnosis, would the nurse prioritize?A. The client will remain free from injury throughout hospitalization.B. The client will set one realistic goal related to relationships by day 3.C. The client will verbalize one positive attribute about self by day 4.D. The client will be easily redirected when discussion about suicide occurs by day 5.25. A client diagnosed with bipolar I disorder has a nursing diagnosis of disturbed thought process R / T biochemical alterations. Based on this diagnosis, which outcome would be appropriate?A. The client will not experience injury throughout the shift.B. The client will interact appropriately with others by day 3.C. The client will be compliant with prescribed medications.D. The client will distinguish reality from delusions by day 6.26. The nurse is reviewing expected outcomes for a client diagnosed with bipolar I disorder. Number the outcomes presented in the order in which the nurse would address them.___ The client exhibits no evidence of physical injury.___ The client eats 70% of all finger foods offered.___ The client is able to access available out-patient resources.___ The client accepts responsibility for own behaviors.27. A client diagnosed with bipolar II disorder has a nursing diagnosis of impaired social interactions R / T egocentrism. Which short-term outcome is an appropriate expectation for this client problem?A. The client will have an appropriate one-on-one interaction with a peer by day 4.B. The client will exchange personal information with peers at lunchtime.C. The client will verbalize the desire to interact with peers by day 2.D. The client will initiate an appropriate social relationship with a peer.28. A suicidal Jewish-American client is admitted to an in-patient psychiatric unit 2 days after the death of a parent. Which intervention must the nurse include in the care of this client?A. Allow the client time to mourn the loss during this time of shiva.B. To distract the client from the loss, encourage participation in unit groups.C. Teach the client alternative coping skills to deal with grief.D. Discuss positive aspects the client has in his or her life to build on strengths.29. A client denying suicidal ideations comes into the emergency department complaining about insomnia, irritability, anorexia, and depressed mood. Which intervention would the nurse implement first?A. Request a psychiatric consultation.B. Complete a thorough physical assessment including lab tests.C. Remove all hazardous materials from the environment.D. Place the client on a one-to-one observation.30. A client diagnosed with major depressive disorder has a nursing diagnosis of low self-esteem R / T negative view of self. Which cognitive intervention by the nurse would be appropriate to deal with this clients problem?A. Promote attendance in group therapy to assist client to socialize.B. Teach assertiveness skills by role-playing situations.C. Encourage the client to journal to uncover underlying feelings.D. Focus on strengths and accomplishments to minimize failures.31. A newly admitted client diagnosed with major depressive disorder isolates self in room and stares out the window. Which nursing intervention would be the most appropriate to implement initially, when establishing a nurse-client relationship?A. Sit with the client and offer self frequently.B. Notify the client of group therapy schedule.C. Introduce the client to others on the unit.D. Help the client to identify stressors of life that precipitate life crises.32. A client diagnosed with major depressive disorder is being considered for electroconvulsive therapy (ECT). Which client teaching should the nurse prioritize?A. Empathize with the client about fears regarding ECT.B. Monitor for any cardiac alterations to avoid possible negative outcomes.C. Discuss with the client and family expected short-term memory loss.D. Inform the client that injury related to induced seizure commonly occurs.33. Which intervention takes priority when working with newly admitted clients experiencing suicidal ideations?A. Monitor the client at close, but irregular, intervals.B. Encourage the client to participate in group therapy.C. Enlist friends and family to assist the client to remain safe after discharge.D. Remind the client that it takes 4 to 6 weeks for antidepressants to be fully effective.34. A client notifies a staff member of current suicidal ideations. Which intervention by the nurse would take priority?A. Place the client on a one-to-one observation.B. Determine if the client has a specific plan to commit suicide.C. Assess for past history of suicide attempts.D. Notify all staff members and place the client on suicide precautions.35. A client seen in the emergency department is experiencing irritability, pressured speech, and increased levels of anxiety. Which would be the nurses priority intervention?A. Place the client on a one-to-one to avoid injury.B. Ask the physician for a psychiatric consultation.C. Assess vital signs, and complete physical assessment.D. Reinforce relaxation techniques to decrease anxiety.36. A client experiencing mania states, Everything I do is great. Using a cognitive approach, which nursing response would be most appropriate?A. Is there a time in your life when things didnt go as planned?B. Everything you do is great.C. What are some other things you do well?D. Lets talk about the feelings you have about your childhood.37. A client newly admitted to an in-patient psychiatric unit who is experiencing a manic episode. The clients a nursing diagnosis is imbalanced nutrition, less than body requirements. Which meal is most appropriate for this client?A. Chicken fingers and French fries.B. Grilled chicken and a baked potato.C. Spaghetti and meatballs.D. Chili and crackers.38. A provocatively dressed client diagnosed with bipolar I disorder is observed laughing loudly with peers in the milieu. Which nursing action is a priority in this situation?A. Join the milieu to assess the appropriateness of the laughter.B. Redirect clients in the milieu to structured social activities, such as cards.C. Privately discuss with the client the inappropriateness of provocative dress during hospitalization.D. Administer PRN antianxiety medication to calm the client.39. A client diagnosed with bipolar I disorder in the manic phase is yelling at another peer in the milieu. Which nursing intervention takes priority?A. Calmly redirect and remove the client from the milieu.B. Administer prescribed PRN intramuscular injection for agitation.C. Notify the client to lower voice.D. Obtain an order for seclusion to help decrease external stimuli.40. A client newly admitted with bipolar I disorder has a nursing diagnosis of risk for injury R/ T extreme hyperactivity. Which nursing intervention is appropriate?A. Place the client in a room with another client experiencing similar symptoms.B. Use PRN antipsychotic medications as ordered by the physician.C. Discuss consequences of the clients behaviors with the client daily.D. Reinforce previously learned coping skills to decrease agitation.41. A client diagnosed with bipolar I disorder experienced an acute manic episode and was admitted to the in-patient psychiatric unit. The client is now ready for discharge. Which of the following resource services should be included in discharge teaching? Select all that apply.A. Financial and legal assistance.B. Crisis hotline.C. Individual psychotherapy.D. Support groups.E. Family education groups.42. A nursing student is studying major depressive disorder. Which student statement indicates that learning has occurred?A. 1% of the population is affected by depression yearly.B. 2% to 5% of women experience depression during their lifetimes.C. 1% to 3% of men become clinically depressed.D. Major depression is a leading cause of disability in the United States.43. A client has a nursing diagnosis of dysfunctional grieving R / T loss of a job AEB inability to seek employment because of sad mood. Which would support a resolution of this clients problem?A. The client reports an anxiety level of 2 out of 10 and denies suicidal ideations.B. The client exhibits trusting behaviors toward the treatment team.C. The client is noted to be in the denial stage of the grief process.D. The client recognizes and accepts the role he or she played in the loss of the job.44. A nursing instructor is teaching about the cause of mood disorders. Which statement by a nursing student best indicates an understanding of the etiology of mood disorders?A. When clients experience loss, they learn that it is inevitable and become hopeless and helpless.B. There are alterations in the neurochemicals, such as serotonin, which cause the clients symptoms.C. Evidence continues to support multiple causations related to an individuals susceptibility to mood symptoms.D. There is a genetic component affecting the development of mood disorders.45. A nursing instructor is presenting statistics regarding suicide. Which student statement indicates that learning has occurred?A. Approximately 10,000 individuals in the United States commit suicide each year.B. Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder.C. Suicide is the eighth leading cause of death among young Americans 15 to 24 years old.D. Depressive disorders account for 70% of all individuals who commit or attempt suicide.46. A client diagnosed with major depressive disorder has an outcome that states, The client will verbalize a measure of hope about future by day 3. Which client statement indicates this outcome was successful?A. I dont want to die because it would hurt my family.B. I need to go to group and get out of this room.C. I think I am going to talk to my boss about conflicts at work.D. I thank you for your compassionate care.47. A nursing instructor is teaching about the psychosocial theory related to the development of bipolar disorder. Which student statement would indicate that learning has occurred?A. The credibility of psychosocial theories in the etiology of bipolar disorder has strengthened in recent years.B. Bipolar disorder is viewed as a purely genetic disorder.C. Following steroid, antidepressant, or amphetamine use, individuals can experience manic episodes.D. The etiology of bipolar disorder is unclear, but it is possible that biological and psychosocial factors are influential.48. A nurse working with a client diagnosed with bipolar I disorder attempts to recognize the motivation behind the clients use of grandiosity. Which is the rationale for this nurses action?A. Understanding the reason behind a behavior would assist the nurse to accept and relate to the client, not the behavior.B. Change cannot occur until the client can accept responsibility for behaviors.C. As self-esteem is increased, the client will meet needs without the use of manipulation.D. Positive reinforcement would enhance self-esteem and promote desirable behaviors.49. A nursing instructor is teaching about the criteria for the diagnosis of bipolar II disorder. Which student statement indicates that learning has occurred?A. Clients diagnosed with bipolar II disorder experience a full syndrome of mania and have a history of symptoms of depression.B. Clients diagnosed with bipolar II disorder experience numerous episodes of hypomania and dysthymia for at least 2 years.C. Clients diagnosed with bipolar II disorder have mood disturbances that are directly associated with the physiological effects of a substance.D. Clients diagnosed with bipolar II disorder experience recurrent bouts of depression with episodic occurrences of hypomania.50. Which of the following medications may be administered before electroconvulsive therapy? Select all that apply.A. Glycopyrrolate (Robinul).B. Thiopental sodium (Pentothal).C. Succinylcholine chloride (Anectine).D. Lorazepam (Ativan).E. Divalproex sodium (Depakote).51. A client diagnosed with major depressive disorder is prescribed phenelzine (Nardil). Which teaching should the nurse prioritize?A. Remind the client that the medication takes 4 to 6 weeks to take full effect.B. Instruct the client and family about the many food-drug and drug-drug interactions.C. Teach the client about the possible sexual side effects and insomnia that can occur.D. Educate the client about the need to take the medication even after symptoms have improved.52. A client diagnosed with bipolar I disorder is experiencing auditory hallucinations and flight of ideas. Which medication combination would the nurse expect to be prescribed to treat these symptoms?A. Amitriptyline (Elavil) and divalproex sodium (Depakote).B. Verapamil (Calan) and topiramate (Topamax).C. Lithium carbonate (Eskalith) and clonazepam (Klonopin).D. Risperidone (Risperdal) and lamotrigine (Lamictal).53. A client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of dilute urine, tremors, and muscular irritability. These symptoms would lead the nurse to expect that the clients lithium serum level would be which of the following?A. 0.6 mEq/L.B. 1.5 mEq/L.C. 2.6 mEq/L.D. 3.5 mEq/L.54. A client diagnosed with major depressive disorder is newly prescribed sertraline (Zoloft). Which of the following teaching points would the nurse review with the client? Select all that apply.A. Monitor the client for suicidal ideations related to depressed mood.B. Discuss the need to take medications, even when symptoms improve.C. Instruct the client about the risks of abruptly stopping the medication.D. Alert the client to the risks of dry mouth, sedation, nausea, and sexual side effects.E. Remind the client that the medications full effect does not occur for 4 to 6 weeks.55. Which symptoms would the nurse expect to assess in a client suspected to have serotonin syndrome?A. Alterations in mental status, restlessness, tachycardia, labile blood pressure, and diaphoresis.B. Hypomania, akathisia, cardiac arrhythmias, and panic attacks.C. Dizziness, lethargy, headache, and nausea.D. Orthostatic hypotension, urinary retention, constipation, and blurred vision.56. Which medication would be classified as a tricyclic antidepressant?A. Bupropion (Wellbutrin).B. Mirtazapine (Remeron).C. Citalopram (Celexa).D. Nortriptyline (Pamelor).

-===== Good luck & God bless =====-

Prepared by:

Lucky P. Roaquin, RN, MANSTCI-CON Faculty