Chapter 12: Mood Disorders: Depression, Bipolar, and Adjustment Disorders My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 12: Mood Disorders: Depression, Bipolar, and Adjustment Disorders

Test Bank

MULTIPLE CHOICE

1. The nurse learns at report that a newly admitted manic patient is demonstrating grandiosity. Which statement would be most consistent with this symptom?

a.

I cant do anything anymore.

b.

Im the worlds most astute financier.

c.

I can understand why my wife is upset that I overspend.

d.

I cant understand where all the money in our family goes.

ANS: B

An individual who is demonstrating grandiosity has an exaggerated view of his abilities. The other options are more moderate statements and lack that element of exaggeration.

DIF: Cognitive Level: Application REF: Page 233 | Page 235

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. The nurse will base a discussion of dysthymia on the fact that the condition:

a.

Typically has an acute onset

b.

Involves delusional thinking

c.

Is chronic low-level depression

d.

Does not include suicidal ideation

ANS: C

Dysthymia is identified as a chronic low-level depression frequently lasting over a period of several years without remitting. Dysthymia has a slow, insidious onset. Delusional thinking is not a common manifestation of dysthymia. Suicidal thoughts are seen among dysthymic patients.

DIF: Cognitive Level: Comprehension REF: Pages 232-233

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

3. What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include exaggerated physical activity, agitation, insomnia, and anorexia?

a.

Risk for injury

b.

Chronic low self-esteem

c.

Noncompliance

d.

Insomnia

ANS: A

Risk for injury is the priority diagnosis. Possible injuries include dehydration, which may result from not drinking and trauma, which may result from bumping into objects or from physical altercations. The other options are valid diagnoses, but not of highest priority.

DIF: Cognitive Level: Analysis REF: Page 242 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

4. A patient has been admitted with a diagnosis of atypical depression. In planning interventions, the nurse would expect to consider the characteristic symptom of:

a.

Seasonal episodes

b.

Leaden paralysis

c.

Psychomotor agitation

d.

Increased depression in the morning

ANS: B

Behavioral characteristics of atypical depression include the feeling that ones limbs are so heavy they cannot be lifted or moved (leaden paralysis). Seasonal mood changes are characteristic of seasonal affective disorder. Psychomotor agitation and depression that is greater in the morning than in the evening are characteristics more likely to be observed in patients with melancholic depression.

DIF: Cognitive Level: Application REF: Page 237 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

5. An inappropriately dressed patient has not slept for 3 days while making excessive, expensive long-distance phone calls. When the patient can be heard singing loudly in the examining room, the nurse makes initial plans to focus on:

a.

Assessing needs for food, liquids, and rest

b.

Setting strict limits on dress and behavior

c.

Conducting an in-depth suicide assessment

d.

Obtaining a complete psychosocial assessment

ANS: A

Patients with mania frequently ignore their basic physiologic needs, as evidenced by not sleeping for 3 days, thus making these assessments the priority. Limits, although appropriate to consider, are not the priority. The manic state precludes a thorough assessment initially. Suicide assessment is not a priority at this time but reckless behavior could result in personal injury.

DIF: Cognitive Level: Application REF: Page 245 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

6. Which statement by the patient would indicate the need for additional education regarding the prescribed lithium treatment regimen?

a.

I will restrict my daily salt intake.

b.

I will take my medications with food.

c.

I will have my blood drawn on schedule.

d.

I will drink 8 to 12 glasses of liquids daily.

ANS: A

Patients taking lithium must maintain a normal sodium intake or risk symptoms of lithium toxicity. The patient should have 2 to 3 liters of fluid daily. Taking lithium with food minimizes gastrointestinal side effects. Regular monitoring of lithium levels is important to prevent toxicity.

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7. The nurse would evaluate that patient education regarding lithium therapy for an individual with bipolar disorder as effective if the patient states:

a.

I can stop my lithium when I feel better.

b.

I can continue with my diuretic and cardiac medications.

c.

I will probably need to take the lithium for the rest of my life.

d.

I will taper my lithium when a therapeutic serum level is achieved.

ANS: C

Most patients with bipolar disorder require long-term maintenance on lithium or other antimanic medication. Patients should never stop medication without consulting the physician. When a therapeutic level is achieved, the patient will continue on maintenance doses of lithium. Diuretics are contraindicated for the patient on lithium.

DIF: Cognitive Level: Application REF: Page 246 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

8. A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department with a list of medications he is taking. Which of the medications on the list would require re-evaluation of lithium dosage?

a.

HydroDIURIL daily

b.

Navane bid

c.

Ativan at bedtime

d.

Cefobid daily

ANS: A

Diuretics alter fluid and electrolyte balance, increasing risk for lithium toxicity; therefore HydroDIURIL is correct. Antipsychotic medications are frequently prescribed concurrently with lithium to manage acute symptoms of mania, so no re-evaluation of lithium dose is necessary for Navane. Antianxiety drugs are not contraindicated with concurrent lithium use, so no lithium dose re-evaluation is necessary for Ativan. Antibiotics do not alter fluid and electrolyte balance, so readjustment of lithium dosage is not required for Cefobid.

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9. Which outcomes would be appropriate to determine early favorable response to antidepressant medication?

a.

The patient will complete own self-care activities.

b.

The patient will demonstrate assertive communication skills.

c.

The patient will describe signs and symptoms of major depression.

d.

The patient will make plans to attend one community social activity a week.

ANS: A

Ability to manage basic ADLs demonstrates improvement in major depression. Understanding the disorder may occur later when patient cognition has improved enough to be able to process information. Initiation of community social activity occurs when the patient has increased energy. Assertive communication is learned and practiced after the depression lifts.

DIF: Cognitive Level: Application REF: Page 253 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

10. Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patients:

a.

Mood and affect

b.

Activity level

c.

Cognitive ability to understand information about the medication

d.

Support network and its members willingness to participate in treatment

ANS: C

Phenelzine (Nardil) administration requires strict adherence to a restricted diet. The patient must have the cognitive ability to understand the food and medication interactions that may cause a serious reaction.

DIF: Cognitive Level: Application REF: Page 248 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

11. A patient who has a history of bipolar disorder recently underwent orthopedic surgery and was discharged to return home. When visited by the home care nurse, the nurse documented the following: slow and soft speech; sad facial expression; and patient crying when describing extreme fatigue, low mood, and the feeling that he will never get well. He has refused to bathe and perform ADLs for several days. Which nursing diagnosis would be appropriate?

a.

Self-care deficit secondary to possible depression

b.

Situational low self-esteem related to immobility

c.

Deficient knowledge related to depression and surgery

d.

Disturbed thought processes related to bipolar disorder

ANS: A

Refusal to perform tasks of bathing, grooming, and other ADLs provides evidence of a self-care deficit. The other symptoms documented by the nurse are characteristic of depression. No data are present to suggest the diagnoses given in the other options.

DIF: Cognitive Level: Application REF: Page 245 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

12. The nurse caring for an extremely withdrawn patient with depression wants to assist her to become more interactive. The best approach would be to say:

a.

I know youll feel better if you leave your room.

b.

You look so gloomy sitting here all by yourself.

c.

Lets explore how it feels to sit alone here all day and feel sad.

d.

I need another person for a card game and Id like you to be my partner.

ANS: D

This direct approach invites the patient to participate in a kind, but firm manner. The patient is not given an option to simply say yes or no. It is not therapeutic to give false reassurance. The remaining options focus too intensively on negative thoughts and feelings.

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13. Which nursing diagnosis would relate to the primary nursing concern related to a recently written prescription for amitriptyline (Elavil) 50 mg tid?

a.

Anxiety

b.

Ineffective coping

c.

Risk for self-injury

d.

Chronic low self-esteem

ANS: C

Patients with depression are at increased risk for suicide when they have been on antidepressant medication for 2 weeks, because they are regaining some energy but may not have achieved full therapeutic effect with mood improvement. Poor coping is important but it is not the priority. Evidence of noncompliance is lacking. The medication is not prescribed for anxiety disorders.

DIF: Cognitive Level: Analysis REF: Page 246 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. What information concerning amitriptyline (Elavil) 50 mg tid would the nurse give the patient regarding the expected outcome of this medication therapy?

a.

Complying with this therapy will cure your depression.

b.

This medication is expected to improve brain chemical imbalance.

c.

Amitriptyline will help re-establish your ability to think clearly again.

d.

Elavil will be particularly effective at assisting you in regaining your independence.

ANS: B

Antidepressant medication works by re-establishing the balance of neurotransmitters in the brain, particularly serotonin and norepinephrine. Antidepressants do not promise a cure for depression. Cognitive therapy, rather than antidepressants, addresses thinking issues. Learned helplessness is addressed by cognitive therapy.

DIF: Cognitive Level: Application REF: Page 246

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. Which principle should the nurse apply when planning nursing care for a patient who was voluntarily admitted after a suicide attempt?

a.

Patients who attempt suicide and fail will not try again.

b.

The more specific the plan, the greater the risk for suicide.

c.

Patients who talk about suicide are less likely to attempt it.

d.

Patients who attempt suicide and fail do not really want to die.

ANS: B

Patients whose suicidal ideation includes a vague, diffuse plan or no plan at all are not at as high a risk for attempting suicide as an individual who has a well-developed plan and the means to carry it out. The nurse will need to continually reassess the patient. None of the remaining options are true statements concerning suicide attempts.

DIF: Cognitive Level: Application REF: Page 244 TOP: Nursing Process: Planning

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16. An appropriate nursing strategy to assist a patient who was involuntarily admitted after a suicide attempt is::

a.

Avoiding any focus on the topic of suicide

b.

Encouraging patient to verbalize personal feelings

c.

Supporting patient focus on others rather than self

d.

Discussing the impact of suicidal thoughts on the family

ANS: B

Verbalization helps relieve pent-up feelings and emotional pain. Avoidance of the topic is nontherapeutic for a suicidal patient. The remaining options may serve to increase the patients feelings of guilt.

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17. Which principle should the nurse apply when planning care for a patient who is diagnosed with bipolar disorder and currently in the manic phase?

a.

Manic patients respond well to peer pressure.

b.

Decreasing stimulation tends to diminish symptoms.

c.

Increasing stimulation tends to encourage the patient to focus.

d.

Detailed activities will facilitate the patients ability to self control behavior.

ANS: D

The only statement that is a valid principle is the option related to activity and its impact on controlling behavior. The other statements are inaccurate.

DIF: Cognitive Level: Application REF: Page 246 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

18. Which nursing intervention is most therapeutic when the nurse is managing the aggressive, disruptive behaviors of a manic patient whose attempts to control the milieu has been rejected by the other patients?

a.

Advising that the patient to accept the wishes of the group

b.

Suggesting that the patient either quiet down or leave the room

c.

Accompanying the patient to a quieter part of the unit

d.

Ignoring the patients outbursts because they are surly related to the mania

ANS: C

Escorting the patient to a less stimulating environment will assist the patient to remain in control of behavior. It is unlikely that the patient would respond to verbal suggestions to leave the area unaccompanied or accept the groups wishes and would likely see the suggestions as a threat that would further escalate the impending loss of control. The behavior cannot be ignored since it will likely lead to an acceleration of the mania.

DIF: Cognitive Level: Application REF: Page 246

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19. What information would serve as the basis for the nurses reply when asked whether the cycling of moods from depressed to manic is a constant pattern seen in bipolar disorders?

a.

Clinical observation tells us that mood disorders tend to remit and recur.

b.

Most cyclic behavior can be managed with the appropriate forms of therapy.

c.

Mood disorders generally see a decrease in cyclic affecting within 5 years of onset.

d.

Persons with higher cognitive abilities will generally exhibit fewer cyclic episodes.

ANS: A

Mood disorders tend to remit and recur throughout the patients lifetime. There is no current research to support the other options.

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20. The individual who displays the history and symptoms most consistent with a medical diagnosis of seasonal affective disorder (SAD) is:

a.

26 years of age and complains of 3 consecutive years of depressed mood beginning in November and remitting in April

b.

64 years of age and complains of anhedonia, early morning awakening, psychomotor retardation, weight loss, and excessive feelings of guilt

c.

46 years of age and complains of dysphoric mood for 3 years, poor concentration, loss of interest in social activities, indecision, low energy, and low self-esteem

d.

38 years of age and complains of sadness, loss of ability to react to positive stimuli, weight gain, hypersomnia, leaden paralysis of limbs, and sensitivity to interpersonal rejection

ANS: A

Marked seasonal changes in mood typify seasonal affective disorder. Depression begins in October or November and lifts in March or April and must occur for at least 2 consecutive years. The other options are lacking in the identifying period of time when the symptoms are exhibited.

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21. A patient with suspected seasonal affective disorder asks the nurse, Ive been feeling down for 3 months. Will I ever feel like myself again? The response that builds on an understanding of this disorder is:

a.

Spontaneous improvement usually comes in 6 months to a year.

b.

Can you tell me what you mean when you say feel like myself?

c.

People who have seasonal mood changes often feel better when spring comes.

d.

Usually patients with this disorder see improvement during the fall and winter.

ANS: C

Seasonal affective disorder is a condition in which the patient experiences depression beginning in the fall, lasting throughout the winter, and remitting in spring in the northern hemisphere. Fall and winter is not reflective of any diagnostic category of mood disorder. Spontaneous improvement occurs only with the change of seasons and available sunlight. Questioning is a response that does not address the point of understanding SAD.

DIF: Cognitive Level: Application REF: Pages 230 | Page 237

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22. A Chinese-American patient comes to the mental health clinic after referral by her primary care physician. She complains of nervousness, headaches, fatigue, and vague GI symptoms for which no organic basis has been established. The symptoms began about 9 months ago when her favorite aunt died. The most appropriate independent nursing action would be to:

a.

Prescribe a trial course of antianxiety medication.

b.

Plan strategies for cognitive behavioral therapy.

c.

Arrange admission to the inpatient unit for a complete workup and psychologic testing.

d.

Confer with the psychiatrist about the cultural association between depression and somatic symptoms.

ANS: D

Expression of symptoms is influenced by ethnicity and culture. When depressed, Asian and Asian-American patients describe somatic symptoms, whereas patients of Western cultures may focus on mood and cognitive symptoms. Option d is an appropriate independent intervention the nurse should take. Options a, b, and c would be considered collaborative, rather than independent, interventions.

DIF: Cognitive Level: Application REF: Page 228

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23. A patient with melancholic depression paces and wrings her hands for hours at a time while repeating, Im a bad person. Staff members have been unsuccessful in their attempts to promote rest. Which intervention is most appropriate in promoting rest?

a.

Instructing the patient to lie down for 15 minutes of every hour

b.

Asking the patient to fold and stack bath towels and washcloths

c.

Making the patient aware of the negative effects of fatigue on mood

d.

Reassuring the patient that she is accepted and not considered a bad person

ANS: B

The psychomotor energy of agitation must be expended; it may be channeled into simple, repetitive activity. Standing in one place to fold towels is an improvement over pacing. This patient will be unable to comply with the request to lie down. A severely depressed patient will not be able to cognitively process this sort of information. Reassurance will not appreciably affect the need for psychomotor activity.

DIF: Cognitive Level: Application REF: Page 246

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24. What measure will facilitate communication with a patient who is depressed and evidencing psychomotor retardation and withdrawal?

a.

Ask the patient to indicate yes or no with finger signals.

b.

Arrange to spend time with the patient at prearranged intervals.

c.

Give concrete and concise directions rather than asking questions.

d.

Speak loudly and rapidly to the patient to focus his or her attention.

ANS: B

This measure will promote the establishment of rapport and demonstrate respect and acceptance of the patient. It will facilitate patient willingness to communicate thoughts and feelings without making unnecessary demands on the patient; a headshake or nod would work as well. Patients should not simply be ordered about; they should be asked to respond without placing excessive demands. Patients with psychomotor retardation have the ability to hear, but their ability to process information may be slowed, requiring well-paced simple communication.

DIF: Cognitive Level: Application REF: Page 244

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25. Which measure consistent with the use of cognitive therapy could the nurse incorporate into the treatment plan of a chronically depressed patient?

a.

Approach the patient with cheerful affect and optimistic remarks.

b.

Ignore the patients pessimistic statements; give attention for positive thinking.

c.

Identify negative evaluations and challenge pessimistic beliefs.

d.

Seek to uncover unconscious conflicts about significant relationships.

ANS: C

Cognitive therapy addresses symptom removal by identifying and correcting distorted negative thinking. An overly cheerful mannerism is an insensitive nontherapeutic approach that will reinforce patient negative thinking about self. To ignore negative statements while reinforcing positive thinking is considered a behavioral approach. Seeking to uncover unconscious conflicts is a psychodynamic approach.

DIF: Cognitive Level: Application REF: Page 251 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

26. Which symptom related to thought-flow disturbance is the nurse most likely to assess in a newly admitted patient who is diagnosed with bipolar disorder, manic episode?

a.

Slow, halting speech

b.

Flight of ideas

c.

Schemata

d.

Anhedonia

ANS: B

Flight of ideas is a continuous rapid flow of speech marked by jumping from topic to topic. It is a manifestation of thought disorder associated with inability to filter stimuli causing increased distractibility. Slow speech would be seen in depression. Neither schemata or anhedonia are symptoms of a thought-flow disorder.

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27. Therapeutic interactions between the nurse and a manic patient will be facilitated when the nurse:

a.

Uses a calm, matter-of-fact approach to structuring

b.

Focuses primarily on enforcing rigid limits on behaviors

c.

Implements a laissez-faire approach to the patients symptoms

d.

Encourages the patient to use humor and wit to redirect energy

ANS: A

A calm, matter-of-fact approach minimizes patient need for defensiveness and minimizes power struggles. The use of rigid limit setting leads to power struggles and escalation of patient hyperactive, aggressive behavior. Structure and judicious limit setting are more therapeutic. A laissez-faire approach is nontherapeutic; manic patients usually need structure. Encouraging humor and wit is generally ineffective since patients with mania cannot maintain control of emotions and may shift from witty to angry in seconds.

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28. A patient who is experiencing a manic episode approaches the nurse and with pressured speech states, I hate oatmeal. Lets get everybody together to do exercises. Im thirsty and Im burning up. Get out of my way; I have to see that guy. The priority nursing action is to:

a.

Measure the patients temperature and pulse.

b.

Offer to have the dietitian visit to discuss his diet.

c.

Tell the patient he can lead exercises at the community meeting.

d.

Show relief when the patient ends the interaction and walks away.

ANS: A

During a manic episode, the patient may be inattentive to physical needs or illness. The brief remark about burning up could suggest fever. Thirst may accompany fever, be a sign of dehydration, or be related to lithium administration. More information is needed. Because hyperactive patients have difficulty remaining still, taking the temperature and pulse will give priority information. If necessary, BP can be taken later. A nutritional consult is not a priority intervention. It is not appropriate to foster increased hyperactivity. To show relief would be disrespectful on the part of the nurse.

DIF: Cognitive Level: Application REF: Page 242

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

29. A patient with bipolar disorder reveals to the clinic nurse that she may be 4 weeks pregnant. Which action will the nurse take?

a.

Confer with the physician about ordering a pregnancy test and discontinuing lithium.

b.

Educate the patient to the risk to the fetus as a result of exposure to the lithium in her blood.

c.

Suggest to the physician that the lithium dose should be increased for better symptom control.

d.

Remind the patient that barrier birth control methods should be used to prevent pregnancy during lithium therapy.

ANS: A

The first need is to learn whether the patient is pregnant. Lithium ingestion by the mother can cause fetal damage. Lithium should be discontinued, not increased, if pregnancy is confirmed. It is premature to discuss fetal malformations before the pregnancy is confirmed. Options b and c are inappropriate and harmful. Birth control information has no value unless the pregnancy test is negative.

DIF: Cognitive Level: Application REF: Page 250

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

30. Which nursing measure would be relevant to protecting the physiologic integrity of a patient during a manic episode when marked hyperactivity is present?

a.

Provide appropriate attire for patient to wear.

b.

Set firm limits on behavior injurious to others.

c.

Monitor the patients weight at the same time daily.

d.

Use genuineness to develop a therapeutic alliance with the patient.

ANS: C

Hyperactivity expends huge amounts of calories and interferes with caloric intake, thus resulting in rapid weight loss. Monitoring weight daily protects the patients physiologic integrity. The other options are concerned with psychosocial integrity.

DIF: Cognitive Level: Analysis REF: Page 245

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

31. Care planned for a patient with adjustment disorder will be most effective if the nurse knows adjustment disorders are a group of disorders that:

a.

Involve psychotic thinking in adolescents

b.

Address issues of anxiety and depression

c.

Include behaviors that are seen primarily in the child and adolescent population

d.

Manifest as transient episodes of dysfunction in response to specific stressors

ANS: D

Adjustment disorders are short-term disturbances in mood or behavior resulting from identifiable stressors. Psychotic features are not present. Adjustment disorders can occur in any age group. Anxiety and depression may be present, but emphasis is on identifying and resolving the specific issue.

DIF: Cognitive Level: Comprehension REF: Page 238 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

32. The nurse manager, teaching a class to new staff members about working with patients with adjustment disorders, will specify that the intervention most helpful in working with patients with this diagnosis is:

a.

Entering pertinent data in the patients medical record

b.

Including family members in the interdisciplinary treatment plan

c.

Identifying the precipitating stressful event and current problems

d.

Reducing the patients level of anxiety to prevent behavioral escalation

ANS: C

Identification of the precipitating stressful event and interpretation of the existing problem are fundamental to working with the patient to reduce symptoms. Including family in treatment planning is secondary to identification of the stressor and the problem. Anxiety will remain high until the problem and the stressor are identified. Data entry is not directly related to the question posed.

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33. When a father states, I dont understand what the doctor means by saying my daughter has an adjustment disorder. The nurse explains that this disorder often results from:

a.

Failure of existing coping skills

b.

Lack of stable emotional support

c.

Denial that a problem truly exists

d.

Overcompensation to present a controlled appearance

ANS: A

When existing coping skills are not adequate to deal with a stressor, and new coping skills have not been developed, symptoms appear. These symptoms may fit the DSM-IV-TR criteria for adjustment disorder. The lack of emotional support is not applicable to the situation. The disorder does not result from use of denial since patients usually recognize that a problem exists. Overcompensation is not related to the onset of adjustment disorder.

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34. Which question would be most effective in helping a patient with an adjustment disorder identify the event that triggered the maladaptive response?

a.

Can you tell me about your support system?

b.

Have you ever been in psychotherapy before?

c.

Did you experience any stressful events recently?

d.

How do you usually handle problems in your life?

ANS: C

This question will determine whether the patient is able to identify a particular stressor that has affected her life recently. Asking about support systems will help gain information about important persons in the patients life. History of psychotherapy will provide information about mental health. Previous methods will provide information about use of coping strategies.

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35. A teenager is admitted to the adolescent unit with a diagnosis of adjustment disorder with depression. Which information collected from the assessment interview will be given highest priority when planning the patients care?

a.

Patient frequently disregards curfew.

b.

Patients parents were divorced 8 years ago.

c.

Patient states she finds no pleasure in living.

d.

Patient is failing most of her high school classes.

ANS: C

Finding no pleasure in living should suggest the need for further assessment of suicide potential. Safety needs take priority over problems suggested by other data collected.

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36. The nurse has been working with a patient who has adjustment disorder with depressed mood. Which finding would permit the nurse to accurately evaluate that the crisis has been resolved?

a.

Absence of presenting symptoms

b.

Decreased need for medications

c.

Increased socialization with peers

d.

Significant increase in the patients appetite

ANS: A

When the presenting symptoms are absent, the nurse can evaluate the problems as resolved. Most patients with adjustment disorders do not require medication, so this is not a good indicator. Data do not substantiate that the patient is experiencing problem socializing. This could indicate the patient is overeating as a means of dealing with stress.

DIF: Cognitive Level: Application REF: Page 253 TOP: Nursing Process: Evaluation

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37. Which of the following statements would correctly serve as a basis for teaching a family the usual outcome of an adjustment disorder?

a.

The symptoms will likely resolve completely.

b.

The patient may continue to be in danger of self-harm.

c.

Medications are frequently used to mask the symptoms.

d.

Relaxation is an effective tool to decrease and manage stress.

ANS: A

The prognosis for most patients with adjustment disorders is good. In the majority of cases, identification of the stressor and use of effective coping strategies result in resolution. Continued self-harm is not a usual outcome for an adjustment disorder. Medications are not used routinely to treat adjustment disorders. Relaxation techniques are interventions rather than outcomes.

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38. Which activity would be a constructive outlet for tension and anxiety while enhancing self-esteem for a patient with adjustment disorder with anxious mood?

a.

Knitting scarves for a homeless shelter

b.

Painting a paint-by-number scenic picture

c.

Working on a large, colorful picture puzzle

d.

Engaging in regular, age-appropriate physical exercise

ANS: D

Physical exercise may assist in relieving tension and promoting feelings of well-being. Knitting is tedious and requires steadiness, which the patient may not have if symptoms of anxiety include jitteriness. Painting requires fine motor coordination, not always present if a patient is anxious. Some patients find puzzles frustrating and become even more tense while working on one.

DIF: Cognitive Level: Application REF: Page 246 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

39. The major rationale for careful ongoing assessment of a patient with adjustment disorder is:

a.

Characteristic symptoms abate but take at least 6 months to do so.

b.

The disorder may be a precursor to a more serious mental health problem.

c.

Practitioners become less discerning as they become more familiar with the patient.

d.

Patients with adjustment disorders have a high risk for self-harm, especially suicide.

ANS: B

Adjustment disorders usually improve with identification of the stressor and development of coping strategies to relieve stress. If symptoms worsen, new treatment strategies must be developed to treat the more serious mental health disorder that has become apparent. There is no research to support the remaining options.

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MULTIPLE RESPONSE

1. When assessing a patient diagnosed with a mood disorder, which abnormal diagnostic tests would be considered a possible factor in the manifestation of the disorder? Select all that apply

a.

RBC (red blood cell)

b.

ECG (electrocardiogram)

c.

BUN ( blood urea nitrogen)

d.

TSH (thyroid stimulating hormone)

e.

Blood glucose

ANS: A, D, E

Anemia, hyper- or hyperthyroidism, and diabetes mellitus are all medical conditions that can occur simultaneously with mood disorders. There is no research to support a strong connection between renal or cardiac disorders with mood disorders.

DIF: Cognitive Level: Analysis REF: Page 236

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. Which statements regarding a hypomanic episode are true? Select all that apply.

a.

Behavior has been observed in the patient for at least 4 days.

b.

Patient appears unaware of potentially dangerous situations.

c.

Hospitalization is generally required to stabilize the behavior.

d.

Patient is engaging in behaviors that are normally uncharacteristic of them.

e.

Primary difference between mania and hypomania is the nature of the activity.

ANS: A, B, D

Manic and hypomanic episodes share symptom criteria, and they differ primarily with regard to their severity and duration but not the nature of the activity. Hypomanic episodes are not severe enough to cause significant impairment in social and occupational functioning or to require hospitalization. However, for diagnosis, it must be evident that the mood and behavioral disturbances of hypomania represent a definite change in the persons usual functioning that lasts for at least 4 days. As judgment declines, patients sometimes fail to recognize the consequences of their actions and the presence of possible danger.

DIF: Cognitive Level: Application REF: Page 236

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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