Deck 18: Emotional Responses and Mood Disorders

Question 1

A patient with depression recently lost 8 pounds.After only a few bites the patient refuses to eat more,saying,"I'm full.All that food makes me sick just to look at it." The most effective way for the nurse to help increase the patient's dietary intake would be to:

A) provide a high-calorie liquid diet.
B) serve six small, calorie-dense meals daily.
C) take the patient to the hospital cafeteria for meals.
D) have the patient's family bring some favorite foods from home.

Answer 1

serve six small, calorie-dense meals daily.

Question 2

A patient diagnosed with severe depression exhibits psychomotor retardation and a sense of worthlessness manifested in poor personal hygiene.The patient refuses to shower,stating,"I can't." The nurse should:

A) not force the issue before a nurse-patient relationship has been established.
B) matter-of-factly assist the patient to shower and dress in clean clothes.
C) state that the patient will be required to shower the following morning.
D) explain that others respond negatively to those with poor hygiene.

Answer 2

matter-of-factly assist the patient to shower and dress in clean clothes.

Question 3

The nurse can expect to find which assessment findings in a patient who is hypomanic?

A) Psychomotor symptoms more severe than mania
B) Some motor hyperactivity but depressive affect
C) Clinical symptoms less severe than those of a manic state
D) Grandiosity, distractibility, flight of ideas, and excessive psychomotor activity

Answer 3

Clinical symptoms less severe than those of a manic state

Question 4

The critical element a nurse must consider when completing a behavioral assessment of a patient with a mood disturbance is:

A) the level of anxiety present.
B) the degree of agitation noted.
C) the depth of depression reported.
D) a change in usual patterns and responses.

Question 5

The emergency department calls to say a patient experiencing symptoms of mania is being admitted.Which room placement should a nurse choose for the patient?

A) A single room near the unit entrance
B) A single room near the nurse's station
C) A double room shared with a patient with depression
D) A double room shared with a patient with schizophrenia

Question 6

A patient shares,"My mood is really low,and even though I get plenty of sleep,I'm tired all the time.It seems like it happens every fall and winter." This patient is most likely experiencing:

A) poor REM sleep.
B) acute depression.
C) chronic depression.
D) seasonal affective disorder.

Question 7

Which coping mechanism should a nurse expect to see a patient initially use to mourn the death of a spouse?

A) Denial
B) Introjection
C) Suppression
D) Dissociation

Question 8

A patient hospitalized for depression demonstrates dysfunctional thinking as evidenced by persistent pessimism and predictions of disastrous outcomes.A nurse using cognitive therapy will focus on:

A) uncovering unconscious conflicts that affect the "here and now" behavior.
B) finding an area of mutual understanding to serve as a basis for therapy.
C) patient recognition and replacement of automatic negative evaluations.
D) analyzing and enhancing relationships with significant others.

Question 9

A person was arrested for writing thousands of dollars of worthless checks.After acting out sexually in court,the patient explained in rapid-fire speech to the judge,"I'm going to expand my outlook,shape-up,sail away,and be a bird in paradise." These behaviors are consistent with a diagnosis of:

A) mania.
B) dysthymia.
C) depression.
D) delayed grief reaction.

Question 10

According to the Stuart Stress Adaptation Model,which person can be assessed as being the closest to the maladaptive responses end of the continuum of emotional responses?

A) A patient whose child died of sudden infant death syndrome (SIDS) 2 weeks ago, who states, "I can't believe I'll never hold my baby in my arms again."
B) A patient whose spouse died 2 years ago, who states, "Strong people don't mourn. I've kept busy and focused on supporting the kids."
C) A patient whose spouse died 6 months ago, who states, "I hate the fact that my spouse died and left me alone after all the years we shared."
D) A patient whose fiancée died 6 weeks ago, who tells the nurse, "My life will never be the same. I find myself crying every day when I think of my fiancée."

Question 11

A patient was widowed 8 months ago.The patient has never cried and speaks of the spouse as if they were still together.The prominent defense mechanism exhibited by the patient is:

A) denial.
B) projection.
C) introjection.
D) sublimation.

Question 12

Select the most appropriate goal for a patient with depression.The patient will be:

A) experiencing less severe signs of being depressed.
B) physically recovered and able to take on new responsibilities.
C) emotionally responsive and functioning at the pre-illness level.
D) able to tolerate high levels of stress and exceeding pre-illness hardiness.

Question 13

A patient paces continuously while repeatedly mumbling,"I'm worthless.It's all hopeless." Which nursing measure would be most helpful in establishing a relationship with this patient?

A) Greet the patient with a cheerful smile.
B) Insist that the patient go to a room to talk with the nurse.
C) Walk with the patient, and make occasional empathic observations.
D) Tell the patient, "I don't agree with your assessment of worthlessness."

Question 14

The initial response of a steelworker who was fired from a job was disbelief.At home the steelworker told family members about the firing but retreated to the bedroom,saying,"I'm too choked up to talk about it right now." These behaviors are characteristic of:

A) disbelief.
B) depression.
C) normal grief reaction.
D) delayed grief reaction.

Question 15

A patient hospitalized 3 weeks ago with major depressive disorder presented with suicidal ideations but no suicide plan.Sertraline (Zoloft) was prescribed,and the patient now reports that the feelings of depression have somewhat lessened.The guiding factor the nurse considers when planning care is that there is:

A) little risk for injury if the patient has no plan.
B) an increased risk for suicide as the depression lifts.
C) little suicide risk after 3 weeks on an antidepressant.
D) an increase in patient compliance with sertraline (Zoloft).

Question 16

A patient being treated for severe depression shows resistance to involvement in the nurse-patient relationship by being withdrawn and unresponsive.There is also preoccupation with guilt and hopelessness.When interacting with the patient,which response would have the greatest therapeutic impact?

A) "Everything will work out."
B) "Let's explore the origins of your pessimism."
C) "It's very likely that you will feel better as your treatment continues."
D) "You have to help yourself by getting rid of your negative thoughts."

Question 17

A patient's husband is distraught over his wife's behavior since their child died in a car accident 1 month ago.He says,"She still cries herself to sleep each night.Help my wife control herself." The nurse's most therapeutic response would be:

A) "I wonder why it is that you are so bothered by her crying."
B) "I'm more concerned that you don't seem to be grieving."
C) "I'll spend some time with her to help her see that crying is counterproductive."
D) "It's hard to see her so upset, but crying is one way of expressing her feelings."

Question 18

When a nurse shares that "caring for the manic client is less stressful than caring for a depressed one since they aren't at risk for injury," the nurse manager responds:

A) "Every patient requires an assessment for injury risk."
B) "Let's consider the ways that acute mania can also cause injuries."
C) "You're right that suicide potential always exists with depression."
D) "The potential for injury is high for all patients with an affective disorder."

Question 19

When a patient begins fluoxetine (Prozac),what information should be included in the plan for patient education?

A) The onset of action is 2 to 6 weeks.
B) Foods containing tyramine should be restricted.
C) Intake of salt and salty foods should be restricted.
D) The patient should be alert for symptoms of hypomania.

Question 20

While talking with a nurse,a patient remarks,"My father's been dead for months.I think Mom needs to get on with her life." The most appropriate response by the nurse is:

A) "Giving her support will be more helpful than being critical."
B) "Have you thought of ways you might help her find more pleasure in her life?"
C) "It's possible that she still needs more time. Grieving often takes 1 year or more."
D) "A death is usually a crisis for the whole family. How has his death affected you?"

Question 21

Based on current sociocultural risk factors for mental illness,a nurse assesses that which patient is at highest risk for depression?

A) A 26-year-old female
B) A 33-year-old male
C) A 57-year-old male
D) A 72-year-old female

Question 22

A patient is extremely hyperactive,distractible,and rarely sleeps.The patient eats little,resulting in a loss of 6 pounds since admission 3 days ago.Which measure is a priority when developing a plan for the patient's care?

A) Require that the patient remain in the dining room for at least 15 minutes per meal.
B) Offer high-calorie "portable" finger foods and nutritionally fortified fluids hourly.
C) Document all food and fluid intake.
D) Weigh the patient daily.

Question 23

Which findings indicate that the goal of returning to appropriate emotional responsiveness has been attained by a patient with mania?

A) The patient interacts superficially with staff but refuses involvement in a therapeutic alliance.
B) The patient manipulates another patient to create a disturbance and laughs at the outcome.
C) The patient identifies two attainable personal goals and offers a realistic (nongrandiose) self-appraisal.
D) The patient maintains aloof relationships with other patients and advises others based on personal preferences.

Question 24

A patient with mania is displaying elation,hyperactivity,grandiosity,verbosity,disturbed sleep pattern,and poor judgment.The plan of care should take into consideration the need to:

A) maintain physiological equilibrium.
B) provide a permissive, unstructured environment.
C) show good humor when interacting with the patient.
D) provide large amounts of appropriate sensory stimulation.

Question 25

A patient with severe depression and suicidal ideation has not improved after trials with selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants.Which treatment option can a nurse expect the health care provider will now consider?

A) Light therapy
B) Benzodiazepines
C) Electroconvulsive therapy
D) Antipsychotic medication

Question 26

A patient displaying symptoms of mania has spent the entire morning pacing in the dayroom and now has begun verbally intimidating other patients.The nurse manages the milieu by:

A) obtaining a telephone order to seclude the patient.
B) stating, "You can't frighten the other patients."
C) escorting the patient out of the dayroom.
D) distracting the patient with the television.

Question 27

During discharge planning,a patient whose manic symptoms are remitting asks,"Do I have to take lithium even though I'm not high any longer?" The most appropriate response is:

A) "You can stop the medication 1 week after discharge."
B) "You will need to take medication for about 12 weeks."
C) "Usually patients take medication for 6 months after discharge."
D) "Taking the medication daily will help you avoid relapses and recurrences."