1. affect
    outwardly bodily expression of emotions
  2. Mood
    • a feeling state reported by the client that can
    • vary with internal and external changes
  3. Manic episode
    • an elevated, expansive or irritable mood accompanied
    • by hyperactivity, grandiosity, and loss of reality.
  4. Hypomanic edpisode
    • clients may appear happy, agreeable, humorous, and
    • agreeable; not severe enough to cause significant impairment
  5. Flight of ideas
    shifting from one idea to another quickly
  6. Learned hopelessness / helplessness theory
  7. Kindling
    • the creation of electro stress in the brain from
    • stress that results in alteration of neural functioning
  8. Comorbidity
    co-occurrence, a drespressive syndrome frequently acommpanies other psychiatric disorders

    • schizophrenia
    • eating disorder
    • anxiery disorder
    • substance abuse
    • personality disorder
  9. Anhedonia
    loss of interest and pleasure in activities
  10. Dysthymia
    chronic low level depression
  11. Cyclothymia
    chronic mood d/o of at least 2 yrs hypomania
  12. Serotonin Syndrome
    idiosyncratic medication reaction d/t accumulation of serotonin- SNS: MS changes, fever, elevated Bp, severe could result in death. Nurse intervention d/c med and notify prescribing authority
  13. Apathy
  14. 2 major neurotransmitters associated with depression and mania
    Norepinephrine and serotonin
  15. 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?
    Sudden change in mood or behavior.
  16. 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?
    • Amount of sleep, nutritional status, history of
    • aggression, a/v hallucinations, etc…
  17. 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?
    Depression develops when a person believes he or she is powerless to effect change in a situation.
  18. Which response to a patient experiencing depression would be helpful from the nurse?
    “I can see you’re feeling down. I’ll sit here with you for a while.”
  19. 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
    1. Sleep disturbance
  20. 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.
    Repetitive negative thinking is noted.
  21. 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.
    suicidal ideation
  22. 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.
    use a calm firm approach
  23. 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.
    2. adhere to medication regimen.
  24. 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
    1. The importance of periodic monitoring of renal and thyroid function
  25. 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
    2. Verbosity
  26. 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
    2. Cardiac
  27. 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.
    1. GABA.
  28. Fluoxetine (an SSRI) exerts its antidepressant effect by blocking the reuptake of:

    1. GABA.
    2. dopamine.
    3. serotonin.
    4. norepinephrine.
    3. serotonin.
  29. 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.
    1. lithium.
  30. 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
    2. DRAs
  31. 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
    • 1. Reduction of positive symptoms of schizophrenia
    • 2. Reduction of negative symptoms of schizophrenia
    • 4. Possible improvement in cognitive function
  32. 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) neural dysfunction.
  33. 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

    B) "I understand that the voices are very real to you, but I do not hear them."
  34. A client with disorganized schizophrenia would have greatest difficulty with the nurse

    D) giving multistep directions.
  35. 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.
    teach the client and family about behaviors associated with relapse.
  36. 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.
    a neologism.
  37. 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

    D) "I do not believe I understand the word volmers. Tell me more about them."

    This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option 1 gives global reassurance. Option 2 encourages elaboration about the delusion. Option 3 asks for information that the client will likely be unable to answer.
  38. 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

    C) ask for validation of reality
  39. 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.
    social, vocational, and self-care skills.

    During the stable plateau phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community.Text page: 321
  40. 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.
    arrange for the client to have blood drawn for a white blood cell count.

    Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.
  41. 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.
    ardive dyskinesia

    An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia.
  42. Schizophrenia is best characterized as
    A) split personality.
    B) multiple personalities.
    C) ambivalent personality.
    D) deteriorating personality.
    .D) deteriorating personality.
  43. A descriptor for a subtype of schizophrenia is

    C) disorganized
  44. Which of the following would be assessed as a negative symptom of schizophrenia?
    A) Anhedonia
    B) Hostility
    C) Agitation
    D) Hallucinations
  45. The type of altered perception most commonly experienced by clients with schizophrenia is
    A) delusions.
    B) illusions.
    C) tactile hallucinations.
    D) auditory hallucinations.
    auditory hallucinations
  46. 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.
    recurrent acute exacerbations and deterioration

    Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis an increase in residual dysfunction and deterioration occurs.
  47. 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.
    a combination of inherited and nongenetic factors.
  48. 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
    Affective flattening
  49. 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.
    disturbed thought processes
  50. 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.
    is a projection of the client's own feelings
  51. Which side effect of antipsychotic medication has no known treatment?
    A) Anticholinergic effects
    B) Pseudoparkinsonism
    C) Dystonic reaction
    D) Tardive dyskinesia
    is a projection of the client's own feelings

    Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. Options 1, 2, and 3 often appear early in therapy and can be minimized with treatment.Text page: 331
  52. The first-line drug used to treat mania is

    D) lithium.
  53. A person who has numerous hypomanic and dysthymic episodes can be assessed as having

    B) cyclothymia.
  54. 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.

    Exaggerated belief in one's own importance, identity, or capabilities, is seen with grandiosity
  55. Which behavior would be most characteristic of a client during a manic episode?

    A) Going rapidly from one activity to another
  56. 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.
    colorful and outlandish.
  57. 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.
    .B) is free of injury.
  58. 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.
    D) ignores food and fluid.
  59. Which room placement would be best for a client experiencing a manic episode?

    C) A single room near the nurse's station
  60. 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.
    verbal limit setting.
  61. What intervention can the nurse suggest when a client reports that lithium gives him an upset stomach?

    D) Take it with meals
  62. 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
    rapid cycling
  63. 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

    B) "Depression is seen in people of all ages, from childhood to old age."
  64. 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.
    Depression is commonly seen among individuals with medical disorders
  65. Beck suggests that the etiology of depression is related t
    A) sleep abnormalities.
    B) serotonin circuit dysfunction.
    C) negative processing of information.
    D) a belief that one has no control over outcomes.
    negative processing of information.
  66. 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.
    obtains no pleasure from previously enjoyed activities.
  67. 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.
    self-deprecatory ideation.
  68. 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.
    D) explain the high possibility of an adverse reaction.
  69. 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

    .D) client statement of appetite.
    C) weekly weights.
  70. It is likely that a client with seasonal affective disorder will begin to feel better in theA) fall.B) winter.C) spring.D) summer.
  71. A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with

    C) psychomotor agitation.
  72. 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.
    D) at least 2 years.
  73. Which nursing diagnosis would be least useful for a depressed client who shows psychomotor retardation?

    B) Death anxiety
  74. 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

    C) wait quietly for the client to reply.
  75. 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."
    B) "I would like to sit with you for 15 minutes now and again this afternoon."
  76. Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with postpartum depression.

    B) Health-seeking behaviors
  77. 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.
    C) learned helplessness.
  78. 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) suggesting "Let's look at what you just said, that you can 'never do anything right.'"
  79. 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) to reduce depressive symptoms
  80. 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.
    .B) fruit and cottage cheese plate.
  81. 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

    B) rest.
  82. 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.
    A) Onset of action is from 1 to 6 weeks.
  83. 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.
  84. 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.
  85. Selective inattention is first noted when experiencing anxiety that is:A) mild.B) moderate.C) severe.D) panic.
  86. Delusionary thinking is a characteristic of:A) chronic anxiety.B) acute anxiety.C) severe anxiety.D) panic level anxiety
  87. 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.
  88. 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.
  89. 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.
  90. Which behavior would be characteristic of an individual who is displacing anger?A) LyingB) StealingC) SlappingD) Procrastinating
  91. 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.
  92. 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.
  93. 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.
  94. 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.
  95. 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
  96. 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.
  97. A symptom associated with panic attacks isA) obsessions.B) apathy.C) feverD) fear of impending doom.
  98. 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.
  99. 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?"
Card Set
mental questions