Nurse Marge teaches the family of a client with major depression disorder. Which of the following information should be included in the teaching? Select all that apply.
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Solution
Answer: A, B, D, F
These statements about major depressive disorders provide correct information and will be helpful to the client’s family.
Option C is incorrect; it is better to acknowledge the client’s sad mood and offer reassurance that his mood will improve.
Option E is more characteristic of someone in a manic phase of bipolar disorder.
The community nurse is speaking to a group of new mothers as part of a primary prevention program. Which self-measures would be most helpful as a strategy to decrease the occurrence of mood disorders?
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Solution
Verbalizing rather than internalizing feelings
Individuals who develop mood disorders often have difficulty expressing feelings, especially feelings of anger toward significant others. Internalizing those feelings can contribute to loss of self-esteem and guilt, and therefore negative cognitions and depression.
Option A: Ignoring problems is not a helpful strategy. Recognizing problems and using problem-solving methods will contribute to mental health.
Option B: Antidepressants are certainly necessary in the treatment of the mood disorder of depression; however, they are not used in primary prevention.
Option C: Crisis intervention would be a useful strategy in handling the immediate needs of someone experiencing a crisis; it is not a tool of primary prevention.
A client completing requirements for student teaching reports to the nurse an incident in which a student was rude and disrespectful. The client states, “None of the students respects my teaching ability.” The nurse identifies this as an example of which common negative cognition?
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Solution
Overgeneralization
The client in this situation is overgeneralizing the response of one particular student, inferring that the entire class has this attitude and blowing the incident but of proportion.
Option A: Labeling is the application of negative labels to oneself or others.
Option B: Fortune telling is the conviction that things will not turn out right, despite evidence to the contrary.
Option D: “Should” statements refer to statements establishing standards for self and others.
Nurse Nadine is assessing James who is diagnosed with bipolar disorder. The nurse would expect to find a history of:
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Solution
symptoms of mania that may or may not be followed by depression.
The definition of bipolar disorder is a mood disturbance in which the symptoms of mania have occurred at least one time. Depression may or may not occur as a separate episode in bipolar disorder. None of the other options indicate a correct understanding of bipolar disorder.
Using cognitive-behavioral therapy, which treatment would be appropriate for a client with depression?
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Solution
Challenging negative thinking
Cognitive-behavioral therapy includes identifying and challenging a client’s negative cognitions. The belief is that these negative thoughts influence the feelings and behaviors of depression.
Option B: Dream analysis would be used in psychoanalytic psychotherapy.
Option C: Antidepressant medication could be part of a treatment program for an individual with depression; however, this would not be considered cognitive-behavioral therapy.
Option D: Ultraviolet light therapy would be a somatic approach to treatment for the seasonal affective disorder.
Which mood disorder is characterized by the client feeling depressed most of the day for a 2-year period?
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Solution
Dysthymia
Dysthymia is characterized by at least a 2-year history of depression, occurring most of the day for more days than not.
Option A: Cyclothymia is characterized by at least two (2) years of several periods of hypomanic symptoms.
Option C: Melancholic depressive disorder is characterized by either anhedonia in relation to all activities or lack of mood reactivity to usually pleasurable stimuli.
Option D: Seasonal affective disorder is characterized by depressed feelings in fall and winter, associated with loss of sunlight.
Rendell is admitted in an acute psychiatric unit at Nurseslabs Medical Center. He suddenly tells Nurse Matt about his plans for suicide. The nurse’s priority is to:
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Solution
Follow agency protocol for suicide precautions.
The nurse must act to safeguard the client from danger, including self-harm implementing the specific agency protocol for suicidal precautions would best protect the client.
Option A: A client with suicidal intent should not be left alone. One-to-one observations are generally part of suicide precautions.
Options B and D: Encouraging the client to use problem solving and stimulating his interest in activities would be helpful for someone with depression; however, the nurse’s priority is to protect the client by initiating suicide precautions.
Clara is under evaluation for imminent suicide risk, which information given by her would be most significant?
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Solution
Reference to suicide as best solution to identified problems
An individual who talks about suicide as a solution to a problem is at high risk. This client’s suicidal threats need to be taken seriously because he does not see any other variable solutions to problems in living.
Options A, B, and C: All of the factors included in the other options would increase the client’s risk for depression; however, actual statements about suicidal intent are red flags indicating imminent danger.
Nurse Rica is teaching a client and her family about the causes of depression. Which of the following causative factors should the nurse emphasize as the most significant?
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Solution
Chemical imbalance
Chemical imbalance of neurotransmitters in the brain is the most significant factor in depression. However, the exact cause has not been established, so other factors may also be involved.
Option C: A person’s social environment, including lack of support systems, may also increase the risk of depression.
Option D: Although genetic transmission certainly may be a factor, no definite pattern of transmission has been identified.
An individual with depression has a deficiency in which neurotransmitters, based on the biogenic amine theory?
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Solution
Serotonin and norepinephrine
The biogenic amine theory of depression describes deficiencies in the neurotransmitters serotonin and norepinephrine. Antidepressants medications increase the levels of these neurotransmitters and therefore help to relieve depressive symptoms.
Options A, B, and C: According to current research, dopamine, thyroxin, GABA, acetylcholine, cortisone, and epinephrine are not directly related to depression.
In a day treatment program, a manic client is creating considerable chaos, behaving in a dominating and manipulative way. Which nursing intervention is most appropriate?
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Solution
Describe acceptable behavior and set realistic limits with the client.
In this situation, it would be appropriate for the nurse to suggest alternative behaviors in place of unacceptable ones to help the client gain self-control.
Option A: The peer group is not responsible for monitoring the client’s behavior.
Option C: The client’s behavior does not warrant hospitalization.
Option D is inappropriate because the client is told only what is unacceptable and is not given any alternatives.
Ralph is admitted at Nurseslabs Medical Center with the diagnosis of bipolar disorder, single manic episode. Which of the following behaviors would the nurse expect to assess?
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Solution
Elation, hyperactivity, and impaired judgment
A client with bipolar disorder, manic episode, would demonstrate flight of ideas and hyperactivity as part of the increased psychomotor activity. The mood is one of elation, and the feeling is that one is invincible; therefore, judgment may be quite impaired.
The symptoms in option A would be more characteristic of an individual with long-term schizophrenia.
The symptoms in option B would be more characteristic of someone with an anxiety disorder, although a manic individual may also not sleep because of excessive energy.
The symptoms in option D are more characteristic of schizophrenia.
The community nurse is following up on Mrs. Jenner who was hospitalized at Nurseslabs Medical Center due to depressive disorder, not otherwise specified, following the death of her spouse. In reviewing the client’s chart, the nurse notes that Mrs. Jenner has an Axis II diagnosis of dependent personality disorder. Which behavior would the nurse anticipate in this client?
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Solution
Difficulty making decisions, lack of self-confidence
The client with a dependent personality disorder typically demonstrates anxious and fearful behavior and is reluctant to make decisions. Lack of self-confidence is reflective of chronic low self-esteem.
The behavior in option B is characteristic of someone with dramatic, emotional, erratic personality disorder, such as narcissistic personality.
The behavior in option C is characteristic of schizoid or schizotypal personality disorder, in which odd, eccentric behavior is displayed.
Option D characterizes borderline personality disorder.
Tekla is hospitalized at Nurseslabs Medical Center following a suicide attempt. His history reveals a previous diagnosis of schizoid personality disorder. Which of the following behaviors would be atypical of a client with this disorder?
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Solution
Actions designed to please the nurse
A client with schizoid personality disorder is typically detached, aloof, and socially isolated. He has no interest in seeking the approval of others and would not behave in ways to please the nurse. The behaviors included in the remaining options are characteristic of someone with schizoid personality disorder.
Kyle is a client with an anxious, fearful personality who has difficulty accomplishing work assignments because of his fear of failure. He has been referred to the employee assistance program because of repeated absences from work and evidence of an alcohol problem. Which nursing diagnosis would be most appropriate?
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Solution
Ineffective coping
The client is experiencing difficulty in occupational functioning as well as problems with alcohol; therefore, she meets criteria for the diagnosis of Ineffective coping.