Question: A patient diagnosed with major depressive disorder will begin electroconvulsive therapy tomorrow. Which interventions are routinely implemented before the treatment? (Select all that apply.)
Answer Choices: a. Administer pretreatment medication 30 to 45 minutes before treatment. b. Withhold food and fluids for a minimum of 6 hours before treatment. c. Remove dentures, glasses, contact lenses, and hearing aids. d. Restrain the patient in bed with padded limb restraints. e. Assist the patient to prepare an advance directive.
Answer: a. Administer pretreatment medication 30 to 45 minutes before treatment. b. Withhold food and fluids for a minimum of 6 hours before treatment. c. Remove dentures, glasses, contact lenses, and hearing aids.
Question: A patient diagnosed with major depressive disorder shows vegetative signs of depression. Which nursing actions should be implemented? (Select all that apply.)
Answer Choices: a. Offer laxatives, if needed. b. Monitor food and fluid intake. c. Provide a quiet sleep environment. d. Eliminate all daily caffeine intake. e. Restrict the intake of processed foods.
Answer: a. Offer laxatives, if needed. b. Monitor food and fluid intake. c. Provide a quiet sleep environment.
Question: A patient being treated with paroxetine 50 mg/day orally for major depressive disorder reports to the clinic nurse, “I took a few extra tablets earlier in the day and now I feel bad.” Which aspects of the nursing assessment are most critical? (Select all that apply.)
Answer Choices: a. Vital signs b. Urinary frequency c. Increased suicidal ideation d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness
Answer: a. Vital signs d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness
Question: A person is directing traffic on a busy street while shouting and making obscene gestures at passing cars. The person has not slept or eaten for 3 days. What features of mania are evident?
Answer Choices: a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficit and sad mood
Answer: c. Poor judgment and hyperactivity
Question: A patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves. The patient cusses while twirling and shadowboxing. Then the patient says gaily, “Do you like my scarves? Here… they are my gift to you.” How should the nurse document the patient’s mood?
Answer Choices: a. Labile and euphoric b. Irritable and belligerent c. Highly suspicious and arrogant d. Excessively happy and confident
Answer: a. Labile and euphoric
Question: A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has priority?
Answer Choices: a. Risk for injury b. Ineffective coping c. Impaired social interaction d. Ineffective therapeutic regimen management
Answer: a. Risk for injury
Question: A patient diagnosed with bipolar disorder is hyperactive and manic after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate?
Answer Choices: a. “Stop that! No one did anything to provoke an attack by you.” b. “If you do that one more time, you will be secluded immediately.” c. “Do not hit anyone. If you are unable to control yourself, we will help you.” d. “You know we will not let you hit anyone. Why do you continue this behavior?”
Answer: c. “Do not hit anyone. If you are unable to control yourself, we will help you.”
Question: This nursing diagnosis applies to a patient experiencing mania: imbalanced nutrition: less than body requirements, related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. What is the most appropriate outcome related to patient behavior?
Answer Choices: a. Asking staff for assistance with feeding within 4 days b. Drinking six servings of a high-calorie, high-protein drink each day c. Consistently sitting with others for at least 30 minutes at mealtime within 1 week d. Wearing appropriate attire for age and gender within 1 week while in the psychiatric unit
Answer: b. Drinking six servings of a high-calorie, high-protein drink each day
Question: A patient develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily and begin olanzapine. This is the expected reaction to the addition of olanzapine to the medication regimen?
Answer Choices: a. Minimize the side effects of lithium. b. Bring hyperactivity under rapid control c. Enhance the antimanic actions of lithium. d. Provide long-term control of hyperactivity
Answer: b. Bring hyperactivity under rapid control
Question: A patient diagnosed with bipolar disorder has rapid cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed?
Answer Choices: a. Phenytoin b. Clonidine c. Carbamazepine d. Chlorpromazine
Answer: c. Carbamazepine
Question: This is the primary reason that the cause of bipolar disorder has not been determined?
Answer Choices: a. Several factors, including genetics, are implicated. b. Brain structures were altered by trauma early in life. c. Excess norepinephrine is probably a major factor. d. Excess sensitivity in dopamine receptors may exist.
Answer: a. Several factors, including genetics, are implicated.
Question: The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. What response supported by research should the nurse provide?
Answer Choices: a. “A high proportion of patients diagnosed with bipolar disorders are found among creative writers.” b. “A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder.” c. “Patients diagnosed with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stresses.” d. “More individuals diagnosed with bipolar disorder come from high socioeconomic and educational backgrounds.”
Answer: b. “A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder.”
Question: A patient diagnosed with bipolar disorder commands other patients, “Get me a book. Take this stuff out of here,” and other similar demands. What is the best initial approach by the nurse to interrupt this behavior without entering into a power struggle?
Answer Choices: a. Distraction: “Let’s go to the dining room for a snack.” b. Humor: “How much are you paying servants these days?” c. Limit setting: “You must stop ordering other patients around.” d. Honest feedback: “Your controlling behavior is annoying others.”
Answer: a. Distraction: “Let’s go to the dining room for a snack.”
Question: A nurse reviewing the laboratory results for a patient diagnosed with bipolar disorder notes the lithium level as 1 mEq/L. How will the nurse interpret this information about the medication level?
Answer Choices: a. It requires no additional nursing intervention. b. It is below recognized therapeutic serum limits. c. It is above recognized therapeutic serum limits. d. It indicates a need for immediate medical intervention.
Answer: a. It requires no additional nursing intervention.
Question: The nurse is monitoring a patient closely for signs and symptoms of Stevens-Johnson syndrome. Which medication is likely the trigger for such a syndrome?
Answer Choices: a. Clonazepam b. Risperidone c. Lamotrigine d. Aripiprazole
Answer: c. Lamotrigine
Question: When a hyperactive patient experiencing acute mania is hospitalized, what initial nursing intervention is a priority?
Answer Choices: a. Allowing the patient to act out his or her feelings b. Setting limits on the patient’s behavior as necessary c. Providing verbal instructions to the patient to remain calm d. Restraining the patient to reduce hyperactivity and aggression
Answer: b. Setting limits on the patient’s behavior as necessary
Question: At a unit meeting, staff members discuss the decor for a special room for patients experiencing mania. What selection is the best option?
Answer Choices: a. Extra-large windows with a view of the street b. Neutral walls with pale, simple accessories c. Brightly colored walls and print drapes d. Deep colors for walls and upholstery
Answer: b. Neutral walls with pale, simple accessories
Question: A patient experiencing acute mania has exhausted the staff members by noon. The patient has joked, manipulated, insulted, and been aggressive all morning. Staff members are feeling defensive and fatigued. Which is the best action?
Answer Choices: a. Confer with the health care provider regarding use of seclusion for this patient. b. Hold a staff meeting to discuss consistency and limit setting approaches. c. Conduct a meeting with all patients to discuss the behavior. d. Explain to the patient that the behavior is unacceptable.
Answer: b. Hold a staff meeting to discuss consistency and limit setting approaches.
Question: A patient experiencing acute mania undresses in the group room and dances. What should be the nurse’s first intervention?
Answer Choices: a. Quietly ask the patient, “Why don’t you put on your clothes?” b. Firmly tell the patient, “Stop dancing, and put on your clothing.” c. Put a blanket around the patient and walk with the patient to a quiet room. d. Allow the patient to stay in the group room while moving the other patients to a different area.
Answer: c. Put a blanket around the patient and walk with the patient to a quiet room.
Question: A patient experiencing acute mania waves a newspaper and says, “I must have my credit card and use the computer right now. A store is having a big sale and I need to order 10 dresses and four pairs of shoes.” What is the nurse’s most appropriate intervention?
Answer Choices: a. Suggesting to the patient to ask a friend to do the shopping and bring purchases to the unit b. Inviting the patient to sit with the nurse and look at new fashion magazines c. Telling the patient that computer use is not allowed until self-control improves d. Asking whether the patient has enough money to pay for the purchases
Answer: b. Inviting the patient to sit with the nurse and look at new fashion magazines