Chapter 18: Emotional Responses and Mood Disorders My Nursing Test Banks

Chapter 18: Emotional Responses and Mood Disorders

Test Bank

MULTIPLE CHOICE

1. 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 cant believe Ill never hold my baby in my arms again.

b.

A patient whose spouse died 2 years ago, who states, Strong people dont mourn. Ive 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 fiance 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 fiance.

ANS: B

Suppression of emotions for a prolonged period is less adaptive than showing emotional responsiveness to loss.

DIF: Cognitive Level: Analysis REF: Text Page: 290

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

2. 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, Im 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.

ANS: C

Loss of ones job can precipitate a grief reaction. The steelworker is showing emotional responsiveness to the loss as evidenced by initial disbelief, anger, and pain.

DIF: Cognitive Level: Application REF: Text Pages: 290-291

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

3. 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

ANS: B

Mourning begins with introjection of the lost object. Denial, suppression, and dissociation are seen in delayed grief reactions.

DIF: Cognitive Level: Comprehension REF: Text Pages: 304-305

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

4. 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.

ANS: A

Inability to cry or express emotions and speaking of the deceased in the present tense suggest the use of denial.

DIF: Cognitive Level: Comprehension REF: Text Page: 302

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

5. A patients husband is distraught over his wifes 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 nurses most therapeutic response would be:

a.

I wonder why it is that you are so bothered by her crying.

b.

Im more concerned that you dont seem to be grieving.

c.

Ill spend some time with her to help her see that crying is counterproductive.

d.

Its hard to see her so upset, but crying is one way of expressing her feelings.

ANS: D

This reply is empathetic and allows the nurse to begin teaching the spouse the value of expressing feelings related to loss.

DIF: Cognitive Level: Application REF: Text Page: 308

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

6. While talking with a nurse, a patient remarks, My fathers 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.

Its 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?

ANS: C

It is appropriate to help the patient understand the grieving process, including the fact that normal grieving can take 1 year or more. The process is unique to the individual.

DIF: Cognitive Level: Application REF: Text Page: 302

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

7. A patient shares, My mood is really low, and even though I get plenty of sleep, Im 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.

ANS: D

Seasonal affective disorder is a fall and winter disorder thought to be associated with shortened hours of daylight and abnormal melatonin metabolism.

DIF: Cognitive Level: Comprehension REF: Text Pages: 294-295

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

8. 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.

ANS: D

The key element is change. In depression, patients and family see the depression as a change from their usual selves. In mania, others note major changes in usual patterns and responses while patients may indicate they are more creative or active. Present anxiety again must be compared to a baseline level of anxiety.

DIF: Cognitive Level: Application REF: Text Page: 291

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

9. 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).

ANS: B

Patients with severe depression may have suicidal ideation but lack the cognitive ability to plan an attempt and the energy to implement a plan. As depression lifts, the patient may be better able to plan a suicide attempt and may have sufficient energy to carry out a plan. Self-report of feeling less depressed does not mean the risk for self-injury is diminished. Vigilance continues to be necessary.

DIF: Cognitive Level: Application REF: Text Pages: 310-311

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

10. A patient paces continuously while repeatedly mumbling, Im worthless. Its 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 dont agree with your assessment of worthlessness.

ANS: C

Rapport is best established through shared time and supportive companionship, even if the patient talks little. The nurses presence indicates his or her belief that the patient has worth.

DIF: Cognitive Level: Application REF: Text Page: 310

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

11. 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.

Lets explore the origins of your pessimism.

c.

Its very likely that you will feel better as your treatment continues.

d.

You have to help yourself by getting rid of your negative thoughts.

ANS: C

Patients with depression need reassurance that their current pain and despair are not permanent. Nurses can convey a sense of hope that treatment will produce change, albeit slowly. Providing false reassurance that everything will work out is not therapeutic since the nurse cannot truly promise that outcome. The remaining options are negative and somewhat condescending.

DIF: Cognitive Level: Application REF: Text Page: 312

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

12. A patient with depression recently lost 8 pounds. After only a few bites the patient refuses to eat more, saying, Im full. All that food makes me sick just to look at it. The most effective way for the nurse to help increase the patients 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 patients family bring some favorite foods from home.

ANS: B

Patients with depression often say they feel too full to eat. Fullness may be related to slow stomach emptying. Seeing large portions and thinking one is expected to eat a large amount can be overwhelming. Serving six small, calorie-dense meals often helps the patient increase caloric intake while reducing the patients negative response to food.

DIF: Cognitive Level: Application REF: Text Page: 310

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

13. 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.

ANS: C

Cognitive therapy focuses on changing distortions and negative thinking patterns that affect the patients feelings and behaviors.

DIF: Cognitive Level: Application REF: Text Page: 306

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

14. 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.

ANS: C

The expected outcome for a patient with depression is that he or she will be emotionally responsive and return to a pre-illness level of functioning.

DIF: Cognitive Level: Application REF: Text Page: 314

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

15. 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 cant. 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.

ANS: B

When depression leads to inadequate hygiene, nurses must matter-of-factly assist the patient in bathing and dressing, explaining that the nurse is helping because the patient is unable to do it independently.

DIF: Cognitive Level: Application REF: Text Page: 313

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

16. 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.

ANS: A

Patients should be made aware that antidepressant medications work slowly, requiring 2 to 6 weeks for symptoms to be reduced. Patients without this knowledge may discontinue taking the medication, thinking it is not working. The remaining options are not relevant to administration of fluoxetine (Prozac).

DIF: Cognitive Level: Application REF: Text Pages: 310-311

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. When a nurse shares that caring for the manic client is less stressful than caring for a depressed one since they arent at risk for injury, the nurse manager responds:

a.

Every patient requires an assessment for injury risk.

b.

Lets consider the ways that acute mania can also cause injuries.

c.

Youre right that suicide potential always exists with depression.

d.

The potential for injury is high for all patients with an affective disorder.

ANS: B

Acute manic states are also a threatening factor for risk of injury. These patients show poor judgment, excessive risk taking, and an inability to evaluate realistic danger and the consequences of their actions. Extreme hyperactivity can lead to exhaustion and even death.

DIF: Cognitive Level: Analysis REF: Text Page: 309

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

18. 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

ANS: C

Hypomania is a state just below mania at which psychomotor activity and other symptoms are less pronounced than those observed when a patient is in the manic state.

DIF: Cognitive Level: Comprehension REF: Text Pages: 292-293

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

19. 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, Im 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.

ANS: A

Manic states are characterized by expansive, abnormally elevated, or irritable moods, impaired social or occupational functioning, increased motor activity, decreased sleep, grandiosity, and rapid, pressured speech.

DIF: Cognitive Level: Comprehension REF: Text Pages: 292-293

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

20. 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 nurses station

c.

A double room shared with a patient with depression

d.

A double room shared with a patient with schizophrenia

ANS: B

Patients with mania require reduced environmental stimuli; thus a single room is preferable to a double room. Patients with mania often require increased nursing supervision and limit setting to counteract impulsivity, so placing the patient near the nurses station is preferable to placement near the entrance, where leaving the unit would be easier.

DIF: Cognitive Level: Application REF: Text Page: 292

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

21. 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 cant frighten the other patients.

c.

escorting the patient out of the dayroom.

d.

distracting the patient with the television.

ANS: C

A less stimulating environment would be therapeutic for the patient but seclusion would not be the initial intervention. Verbal interventions would not be successful in providing the necessary structure; another approach to limit setting should be tried. When sufficient staff members are assembled, one nurse should set limits by saying, We are here to walk to your room with you. The presence of other staff members ensures that the limit setting can be safely implemented. The patients active state would not be distracted by the television.

DIF: Cognitive Level: Application REF: Text Page: 292

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

22. During discharge planning, a patient whose manic symptoms are remitting asks, Do I have to take lithium even though Im 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.

ANS: D

Patients with bipolar disorder are maintained on medication indefinitely to prevent recurrences. The earlier and the more thoroughly the patient understands this need, the more likely it is that he or she will comply with the long-term treatment plan.

DIF: Cognitive Level: Application REF: Text Page: 292

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

23. 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.

ANS: A

Inadequate nutrition, dehydration, weight loss, and sleep deprivation are frequent physiological consequences of manic episodes. It is easy for staff members to focus on the arresting affective, cognitive, and behavioral aspects while ignoring basic physical needs of patients.

DIF: Cognitive Level: Application REF: Text Page: 292 | Text Page: 295

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

24. 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 patients 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.

ANS: B

Remaining in the dining room does not ensure adequate intake. The patient may argue rather than eat. Providing calorie-dense foods that can be eaten or drunk on the run is a better strategy. Recording food and fluid intake and daily weights is appropriate for evaluation purposes.

DIF: Cognitive Level: Analysis REF: Text Page: 310

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

25. 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.

ANS: C

Patients with mania often have unattainable goals and grandiose self-appraisals. Identifying realistic goals and self-appraisals indicates appropriate emotional responsiveness.

DIF: Cognitive Level: Application REF: Text Page: 314

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

26. 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

ANS: C

Electroconvulsive therapy remains a viable treatment for patients with depression who do not respond to antidepressants. Light therapy is more useful for seasonal affective disorder than for severe depression. Antipsychotics and benzodiazepines are not therapies of choice for depression.

DIF: Cognitive Level: Comprehension REF: Text Page: 310

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

27. 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

ANS: A

Females are at greater risk for being diagnosed and treated for depression than males. The rate of depression among aging adults is lower than the rate in younger age groups.

DIF: Cognitive Level: Analysis REF: Text Page: 292

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

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