question

affect

Mood

Manic episode

Hypomanic edpisode

Flight of ideas

Learned hopelessness / helplessness theory

Kindling

Comorbidity

Anhedonia

Dysthymia

Cyclothymia

Serotonin Syndrome

Apathy

2 major neurotransmitters associated with depression and mania

In your assessment of a patient who is severely depressed and just started on antidepressants, what would be
behavior that would concern you and require further assessment?

A patient suffering from Bipolar I Disorder is admitted in a manic episode to the Mental Health Inpatient Unit. What should be included in your assessment in addition to suicide?

If a nurse subscribes to the theory that learned helplessness is a major factor in the development of depression, which statement best represents her belief?

Which response to a patient experiencing depression would be helpful from the nurse?

Which of the following is considered a vegetative symptom of depression?

1. Sleep disturbance
2. Trouble concentrating
3. Neglected grooming and hygiene
4. Negative expectations for the future

For a person with severe depression, which statement about cognitive functioning is true?

1. Reality testing remains intact.
2. Concentration is unimpaired.
3. Repetitive negative thinking is noted.
4. The ability to make decisions is improved.

When the nurse is caring for a depressed patient, the problem that should receive the highest nursing priority is:

1. powerlessness.
2. suicidal ideation.
3. inability to cope effectively.
4. anorexia and weight loss.

In communicating with a patient who is experiencing elated mood, which of the following interventions is appropriate by the nurse?


1. Use a calm, firm approach.
2. Give expanded explanations.
3. Make use of abstract concepts.
4. Encourage lighthearted optimism.

For a person in the “continuation of treatment” phase of bipolar disorder, which of the following is an appropriate nursing outcome? Patient will:


1. avoid involvement in self-help groups.
2. adhere to medication regimen.
3. demonstrate euphoric mood.
4. maintain normal weight.

When a patient has been prescribed lithium, the medication teaching plan should include which information?


1. The importance of periodic monitoring of renal and thyroid function
2. Dietary teaching to restrict daily sodium intake
3. The importance of blood draws to monitor serum potassium level
4. Discontinuing the drug if weight gain and fine hand tremors are noticed

For a patient with mania, which symptom related to communication is likely to be present?


1. Mutism
2. Verbosity
3. Poverty of ideas
4. Confabulation

When a patient is experiencing a severe manic episode, which bodily system is most at risk for decompensation?


1. Renal
2. Cardiac
3. Endocrine
4. Pulmonary

A nurse administering a benzodiazepine should understand that the therapeutic effect results from the benzodiazepine binding to receptors adjacent to receptors for the neurotransmitter:
1. GABA.
2. dopamine.
3. serotonin.
4. acetylcholine.

Fluoxetine (an SSRI) exerts its antidepressant effect by blocking the reuptake of:

1. GABA.
2. dopamine.
3. serotonin.
4. norepinephrine.

A psychiatric nurse routinely administers the following drugs to patients in the community mental health center. The patients who should be most carefully assessed for untoward cardiac side effects are those receiving:
1. lithium.
2. clozapine.
3. diazepam.
4. sertraline.

Which of the following classes of psychotropic medications could trigger the development of parkinsonian movement disorders among individuals who take therapeutic doses?
1. SSRIs
2. DRAs
3. Benzodiazepines
4. Tricyclic antidepressants

Atypical antipsychotic medications have which of the following effects? Select all that apply.
1. Reduction of positive symptoms of schizophrenia
2. Reduction of negative symptoms of schizophrenia
3. Reduction of body mass
4. Possible improvement in cognitive function

A client with residual schizophrenia is uninterested in community activities. He lacks initiative, demonstrates both poverty of content of speech and poverty of speech, and seems unable to follow the schedule for taking his antipsychotic medication. The case manager continues to direct his care with the knowledge that his behavior is most likely prompted by
A) chronic uncooperativeness.
B) neural dysfunction.
C) personality conflict.
D) dependency needs.

A client with paranoid schizophrenia refuses food. He states the voices are telling him the food is contaminated and will change him from a male to a female. A therapeutic response for the nurse would be
A) "Other people are eating the food and nothing is happening to them."
B) "The voices are wrong about the hospital food. It is not contaminated."
C) "I understand that the voices are very real to you, but I do not hear them."
D) "You are safe here in the hospital, nothing bad will happen to you."

A client with disorganized schizophrenia would have greatest difficulty with the nurse
A) using concrete language.
B) providing nutritional supplements.
C) giving multistep directions.
D) interacting with a neutral attitude.

A nursing intervention designed to help a schizophrenic client manage relapse is to
A) schedule the client to attend group therapy
.B) teach the client and family about behaviors associated with relapse.
C) remind the client of the need to return for periodic blood draws.
D) help the client and family adapt to the stigma of chronic mental illness.

A client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed a
sA) a neologism.
B) clang association.
C) blocking.
D) a delusion.

When a client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be
A) "You are safe here. This is a locked unit and no one can get in."
B) "Why do you think someone or something is going to harm you?"
C) "It must be frightening to think something is going to harm you."
D) "I do not believe I understand the word volmers. Tell me more about them."

A desired outcome for a client with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will
A) describe content of hallucinations.
B) demonstrate a cool, aloof demeanor.
C) ask for validation of reality.
D) identify prodromal symptoms of disorder.

A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be
A) safety and crisis intervention.
B) acute symptom stabilization.
C) stress and vulnerability assessment.
D) social, vocational, and self-care skills.

A client has been receiving antipsychotic medication for 6 weeks. At her clinic appointment she tells the nurse that her hallucinations are nearly gone and that she can concentrate fairly well. She states her only problem is "the flu" that she's had for 2 days. She mentions having a fever and a very sore throat. The nurse should
A) suggest that the client take something for her fever and get extra rest.
B) advise the physician that the client should be admitted to the hospital.
C) arrange for the client to have blood drawn for a white blood cell count.
D) consider recommending a change of antipsychotic medication.

The purpose for a nurse periodically performing the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has schizophrenia is early detection of
A) acute dystonia.
B) tardive dyskinesia.
C) cholestatic jaundice.
D) pseudoparkinsonism.

Schizophrenia is best characterized as
A) split personality.
B) multiple personalities.
C) ambivalent personality.
D) deteriorating personality.

A descriptor for a subtype of schizophrenia is
A) delusional.
B) disorganized.
C) developmental.
D) dissociated.

Which of the following would be assessed as a negative symptom of schizophrenia?
A) Anhedonia
B) Hostility
C) Agitation
D) Hallucinations

The type of altered perception most commonly experienced by clients with schizophrenia is
A) delusions.
B) illusions.
C) tactile hallucinations.
D) auditory hallucinations.

What is the most common course of schizophrenia? Initial episode followed by
A) recurrent acute exacerbations and deterioration.
B) recurrent acute exacerbations.
C) continuous deterioration.
D) complete recovery.

The causation of schizophrenia is currently understood to be
A) a combination of inherited and nongenetic factors.
B) excessive amounts of the neurotransmitter dopamine.
C) excessive amounts of the neurotransmitter serotonin
D) stress related.

Which symptom would not be assessed as a positive symptom of schizophrenia?
A) Delusion of persecution
B) Auditory hallucinations
C) Affective flattening
D) Idea of reference

A withdrawn client is assessed as having distorted thinking that is not reality based. A nursing diagnosis that should be considered for her would be
A) impaired verbal communication.
B) disturbed thought processes.
C) disturbed self-esteem.
D) defensive coping.

When a client with schizophrenia hears hallucinated voices saying he is a vile human being, the nurse can correctly assume that the hallucination
A) is a projection of the client's own feelings.
B) derives from neuronal impulse misfiring.
C) is a retained memory fragment.
D) may signal seizure onset.

Which side effect of antipsychotic medication has no known treatment?
A) Anticholinergic effects
B) Pseudoparkinsonism
C) Dystonic reaction
D) Tardive dyskinesia

The first-line drug used to treat mania is
A) clonazepam.
B) lamotrigine
C) lithium.
D) carbamazepine.

A person who has numerous hypomanic and dysthymic episodes can be assessed as having
A) cyclothymia.
B) bipolar II disorder.
C) bipolar I disorder.
D) seasonal affective disorder.

A bipolar client tells the nurse "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying
A) grandiosity.
B) limit testing.
C) flight of ideas.
D) distractibility.

Which behavior would be most characteristic of a client during a manic episode?
A) Watching others intently and talking little
B) Going rapidly from one activity to another
C) Being unwilling to leave home to see other people
D) Taking frequent rest periods and naps during the day

The physician tells the nurse "Mrs. G's appearance is that of a typical manic client." The nurse can expect Mrs. G to be attired in clothing that is
A) dark colored and modest
.B) colorful and outlandish.
C) compulsively neat and clean.
D) ill-fitted and ragged.

An outcome for a manic client during the acute phase that would indicate that his treatment plan was successful would be that the client
A) reports racing thoughts
.B) is free of injury.
C) is highly distractible.
D) ignores food and fluid.

An outcome for a manic client during the acute phase that would indicate that his treatment plan was successful would be that the client
A) reports racing thoughts
.B) is free of injury.
C) is highly distractible.
D) ignores food and fluid.

Which room placement would be best for a client experiencing a manic episode?
A) A shared room with a client with dementia
B) A single room near the unit activities area
C) A shared room away from the unit entrance
D) A single room near the nurse's station

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention should be
A) questioning client motive.
B) verbal limit setting.
C) physical confrontation.
D) seclusion.

What intervention can the nurse suggest when a client reports that lithium gives him an upset stomach?
A) Take it with an antacid
B) Take it 30 minutes before meals
C) Take it 2 hours after meals
D) Take it with meals

When a client experiences 4 or more mood episodes in a 12 month period, the client is said to be:A) dysynchronous.B) incongruent.C) cyclothymic.D) rapid cycling

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." The reply by the nurse that clarifies prevalence is
A) "Depression is seen in people of all ages, from childhood to old age."
B) "The age of onset for most depressive episodes is given as 18 years."
C) "Depression is most often seen among the middle adult age group."
D) "That is a good observation. Depression does mostly strike people older than 50 years."

What statement about the comorbidity of depression is accurate?
A) Depression most often exists in an individual as a single entity.
B) Depression is commonly seen among individuals with medical disorders
.C) Substance abuse and depression are seldom seen as comorbid disorders.
D) Depression may coexist with other disorders but is rarely seen with schizophrenia.

Beck suggests that the etiology of depression is related t
o
A) sleep abnormalities.
B) serotonin circuit dysfunction.
C) negative processing of information.
D) a belief that one has no control over outcomes.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client
A) has poor retention of recent events.
B) has weight loss of 10 lb or more from anorexia.
C) obtains no pleasure from previously enjoyed activities.
D) has difficulty with tasks requiring fine motor skills.

Assessment of thought processes of a client with depression is most likely to reveal
A) good memory and concentration
.B) delusions of persecution.
C) self-deprecatory ideation.
D) sexual preoccupation.

A client who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The client mentions she will take the medication along with the St. John's wort she uses daily. The nurse should
A) agree that taking the drugs at the same time will help her remember them daily.
B) caution the client to drink several glasses of water daily
.C) suggest that the client also use a sun lamp daily.
D) explain the high possibility of an adverse reaction.

7.The nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client with severe depression. The most reliable evaluation of outcomes will be based on
A) energy level.
B) observed eating patterns
C) weekly weights.
.D) client statement of appetite.

It is likely that a client with seasonal affective disorder will begin to feel better in theA) fall.B) winter.C) spring.D) summer.

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with
A) senile dementia.
B) psychomotor agitation.
C) hypertensive crisis.
D) central serotonin syndrome.

Dysthymia cannot be diagnosed unless it has existed for
A) at least 3 months
.B) at least 6 months.
C) at least 1 year.
D) at least 2 years.

Which nursing diagnosis would be least useful for a depressed client who shows psychomotor retardation?
A) Death anxiety
B) Activity intolerance
C) Constipation
D) Self-care deficit: bathing/hygiene

When the nurse remarks to a depressed client "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to
A) repeat the question if the client does not answer promptly.
B) prompt the client if the reply is slow.
C) wait quietly for the client to reply.
D) seek information from the client's significant others.

A nurse caring for a nearly mute depressed client wishes to show acceptance of the client. An intervention that would meet this objective would be to sayA) "I will be spending time with you each day to try to improve your mood."
B) "I would like to sit with you for 15 minutes now and again this afternoon."
C) "Each day we will spend time together to talk about things that are bothering you."
D) "It is important for you to share your thoughts with someone who can help you evaluate whether your thinking is realistic."

Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with postpartum depression.
A) Risk for impaired parent/infant/child attachment
B) Ineffective role performance
C) Impaired parenting
D) Health-seeking behaviors

A depressed client tells the nurse "There is no sense in trying. I am never able do anything right!" The nurse can identify this cognitive distortion as an example o
fA) self-blame.
B) catatonia.
C) learned helplessness.
D) discounting positive attributes.

A depressed client tells the nurse "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion byA) suggesting "Let's look at what you just said, that you can 'never do anything right.'"
B) querying "Tell me what things you think you are not able to do correctly."
C) asking "Is this part of the reason you think no one likes you?"
D) saying "That is the most unrealistic thing I have ever heard."

A depressed client tells the nurse he is in the 'acute phase' of his treatment for depression. The nurse recognizes that the client has been in treatment:
A) for more than 4 months
B) to reduce depressive symptoms
C) that focuses on prevention of future depression
D) that is directed toward relapse prevention

A client with severe depression has been regulated on a monamine oxidase inhibitor because trials of other antidepressants proved unsuccessful. She has a pass to go out to lunch with her husband. Given a choice of the following entrees, which can she safely eat?
A) avocado salad plate
.B) fruit and cottage cheese plate.
C) kielbasa and sauerkraut.
D) liver and bacon plate.

A client has a severe sleep pattern disturbance and psychomotor retardation. The nurse has developed a plan for him to spend 20 minutes in the gym at 1 PM. The hour immediately after the exercise period should be scheduled for
A) individual therapy.
B) occupational therapy.
C) group therapy.
D) rest.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching?A) Onset of action is from 1 to 6 weeks.
B) They tend to be more effective for men.
C) They may cause recent memory impairment.
D) They often cause the client to have diurnal variation.

The major distinction between fear and anxiety is that fear:
A) is a universal experience; anxiety is neurotic.
B) enables constructive action; anxiety is dysfunctional.
C) is a psychological experience; anxiety is a physiological experience
.D) is a response to a specific danger; anxiety is a response to an unknown danger.

The initial nursing action for a newly admitted anxious client is to
A) assess the client's use of defense mechanisms.
B) assess the client's level of anxiety.
C) limit environmental stimuli.
D) provide antianxiety medication.

Selective inattention is first noted when experiencing anxiety that is:A) mild.B) moderate.C) severe.D) panic.

Delusionary thinking is a characteristic of:A) chronic anxiety.B) acute anxiety.C) severe anxiety.D) panic level anxiety

Generally, ego defense mechanisms:
A) often involve some degree of self-deception
.B) are rarely used by mentally healthy people.
C) seldom make the person more comfortable.
D) are usually effective in resolving conflicts.

A 20-year-old was sexually molested at age10 but he can no longer remember the incident. The ego defense mechanism in use isA) projection.B) repression.C) displacement.D) reaction formation.

The defense mechanisms that can only be used in healthy ways are
A) suppression and humor.
B) altruism and sublimation
.C) idealization and splitting.
D) reaction formation and denial.

Which behavior would be characteristic of an individual who is displacing anger?A) LyingB) StealingC) SlappingD) Procrastinating

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, "burns" money that could be better spent to feed the poor, and so forth is usingA) projection.B) rationalization.C) reaction formation.D) undoing.

A man keeps his wife's clothing in the closet and bureau of his bedroom although she has been dead for 3 years. This behavior suggests the use ofA) altruism.B) denial.C) undoing.D) suppression.

What can be said about the age of onset of most anxiety disorders? Onset is
A) before age 20 years.
B) before age 40 years.
C) after age 40 years.
D) scattered throughout the lifespan.

What can be said about the comorbidity of anxiety disorders?
A) Anxiety disorders exist alone.
B) A second anxiety disorder may coexist with the first.
C) Anxiety disorders virtually never coexist with mood disorders.
D) Substance abuse disorders rarely coexist with anxiety disorders.

Studies of clients with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal?A) BrainstemB) Hypothalamus-pituitary-adrenal systemC) Frontal lobeD) Limbic system

An obsession is defined as
A) thinking of an action and immediately taking the action.
B) a recurrent, persistent thought or impulse
.C) an intense irrational fear of an object or situation.
D) a recurrent behavior performed in the same manner.

A symptom associated with panic attacks isA) obsessions.B) apathy.C) feverD) fear of impending doom.

17.The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder isA) legal protection.B) to establish nursing diagnoses of priority.C) to provide information about client psychosocial background.D) to determine if the anxiety is of primary or secondary origin.

An important question to ask in the assessment of a client with anxiety disorder isA) "How often do you hear voices?"B) "Have you ever considered suicide?"C) "How long has your memory been bad?"D) "Do your thoughts always seem jumbled?"