Unit 4: Bipolar, Depression, + Personality Disorders NCLEX-RN questions

Unit 4: Bipolar, Depression, + Personality Disorders

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cait A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." How should the nurse interpret this behavior as a cue to modify the treatment plan?

1.Suggesting a reduction of medication 2.Allowing increased "in-room" activities 3.Increasing the level of suicide precautions 4.Allowing the client off-unit privileges as needed 3 A client who is moderately depressed and has only been in the hospital 2 days is unlikely to have such a dramatic cure. When a depression suddenly lifts, it is likely that the client may have made the decision to harm himself or herself. Suicide precautions are necessary to keep the client safe. The remaining options are therefore incorrect interpretations Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply.

1.Communicate expected behaviors to the client.

2.Ensure that the client knows that they are not in charge of the nursing unit.

3.Assist the client in identifying ways of setting limits on personal behaviors.

4.Follow through about the consequences of behavior in a nonpunitive manner.

5.Enforce rules by informing the client that he/she will not be allowed to attend therapy groups.

6.Have the client state the consequences for behaving in ways that are viewed as unacceptable

1,3,4,6

Interventions for dealing with the client exhibiting manipulative behavior include setting clear, consistent, and enforceable limits on manipulative behaviors; being clear with the client regarding the consequences of exceeding the limits set; following through with the consequences in a nonpunitive manner; and assisting the client in identifying a means of setting limits on personal behaviors. Ensuring that the client knows that she or he is not in charge of the nursing unit is inappropriate; power struggles need to be avoided. Enforcing rules and informing the client that she or he will not be allowed to attend therapy groups is a violation of a client's rights.

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client?

1.Chess 2.Writing 3.Board games 4.Group exercise 2 Solitary activities that require a short attention span with mild physical exertion are the most appropriate activities for a client who is exhibiting aggressive behavior.Writing (journaling), walks with staff, and finger painting are activities that minimize stimuli and provide a constructive release for tension. The remaining options have a competitive element to them or are group activities and should be avoided because they can stimulate aggression and increase psychomotor activity.The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. Which client symptoms require the nurse's immediate action?

1.Incessant talking and sexual innuendoes 2.Grandiose delusions and poor concentration 3.Outlandish behaviors and inappropriate dress 4.Nonstop physical activity and poor nutritional intake 4 Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. The client's mood is predominantly elevated, expansive, or irritable. All of the options reflect a client's possible symptoms.However, the correct option clearly presents a problem that compromises physiological integrity and needs to be addressed immediately.The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement?

1.Setting limits on the client's behavior 2.Asking the client to leave the group session 3.Asking another nurse to escort the client out of the group session 4.Telling the client that he or she will not be able to attend any future group sessions 1 Manic clients may be talkative and can dominate group meetings or therapy sessions by their excessive talking. If this occurs, the nurse initially would set limits on the client's behavior. Initially, asking the client to leave the session or asking another person to escort the client out of the session is inappropriate. This may agitate the client and escalate the client's behavior further. Barring the client from group sessions is also an inappropriate action because it violates the client's right to receive treatment and is a threatening action.Which activity should the nurse include in the plan of care for a client with mania who is experiencing psychomotor agitation?

1.Playing checkers with members of the staff 2.Reading in a quiet, low-stimulus environment 3.Engaging in a card game with other clients on the unit 4.Attending a clay-molding class that is scheduled for today 4 When a client is experiencing psychomotor agitation, it is best to provide activities that involve the use of hands and gross motor movements. Such activities can include volleyball, finger painting, drawing, and working with clay. These activities provide an appropriate way for the client to discharge motor tension. Reading and simple card games are sedentary activities. Playing checkers requires concentration and more intensive use of thought processes.A client recently admitted to the hospital in the manic phase of bipolar disorder is unkempt, taking antipsychotic medications, and complaining of abdominal fullness and discomfort. Which intervention addresses the priority sign/symptom?

1.Teach self-grooming skills.

2.Reward cleanliness with unit privileges.

3.Monitor the adequacy of the antipsychotic dosage.

4.Encourage frequent fluid intake and a high-fiber diet.4 Constipation is a common elimination problem with clients in a manic phase of bipolar disorder. Constipation may occur as the result of a combination of factors, including taking antipsychotic medications, suppressing the urge to defecate, and a decreased fluid intake as a result of the manic activity level. The symptoms listed in the question in combination with antipsychotic medications are indicators of constipation. A high-fiber diet and increased fluids can reduce constipation.

A client in a manic state presents to the dayroom only partially dressed and is making sexual remarks and gestures toward the staff and other clients. Which is the initial nursing action?

1.Instruct the client to go back to his room.

2.Inform the client that such behavior will not be accepted.

3.Instruct the other clients to go to their rooms immediately.

4.Escort the client to his room to get appropriately dressed.4 A person who is experiencing mania lacks insight and judgment, has poor impulse control, and is highly excitable. The nurse must take control without creating increased stress or anxiety in the client. Use of a quiet, firm approach and distracting the client (walking to his room and assisting him in getting dressed) will achieve the goal of having him dressed appropriately while preserving his psychosocial integrity. While restating boundaries is appropriate, the initial task relates to controlling inappropriate behaviors while protecting the client. Telling the other clients to go to their rooms immediately is inappropriate and does not address the client's behavior.When planning discharge care for a client diagnosed with bipolar disorder, the nurse determines the need for further teaching when the client makes which statement?

1."I hope I am going to like my new counselor." 2."I sure hope I will still be productive at work." 3."I am going to keep a close check on any stress I have in my life." 4."I will take the medicine until I am sure I can handle my own problems.4 The client does not demonstrate an understanding of the continued need for medication and suggests that the illness can be controlled by decreasing stress.The remaining options are common concerns of a client on discharge but do not indicate the need for further teaching.In formulating a discharge teaching plan, the nurse should include which precaution for a client with bipolar disorder who is prescribed lithium carbonate therapy?

1.Avoid soy sauce, wine, and aged cheese.

2.Have the blood lithium level checked every 2 weeks.

3.Take the medication only as prescribed to avoid becoming addicted. 4.Check with the psychiatrist before using any over-the-counter medications.4 Lithium is a mood stabilizer and a medication to treat bipolar disorder. Its exact mechanism of action remains speculative; however, equilibrium of sodium and potassium must be maintained at the intracellular membrane to maintain therapeutic effects. Lithium competes with sodium in the cell. Many over-the- counter medications contain sodium, and often prescription medications (diuretics) change the sodium-potassium ratios of the cell, thereby affecting lithium concentrations so that it is more difficult to achieve therapeutic levels of the medication. Food restriction (tyramine-restricted diet) is associated with monoamine oxidase inhibitors. Lithium blood levels are recommended for the client taking lithium, but these tests generally are prescribed every 3 to 4 months.Lithium is not addictive.A client with depression verbalizes feelings of low self- esteem and self-worth typified by statements such as, "I'm such a failure. I can't do anything right." Which is the best nursing response?

1.Tell the client that this is not true, that we all have a purpose in life. 2.Identify recent behaviors or accomplishments that demonstrate the client's skills.

3.Reassure the client that the nurse knows how the client is feeling and that things will get better.

4.Remain with the client and sit in silence. This will encourage the client to verbalize feelings.2 Feelings of low self-esteem and worthlessness are common symptoms of a depressed client. An effective plan of care to enhance the client's personal self- esteem is to provide experiences for the client that are challenging but that will not be met with failure. Reminders of the client's accomplishments or personal successes are ways to interrupt the client's negative self-talk and distorted cognitive view of self. Silence may be interpreted as agreement. Avoid options that give advice and devalue the client's feelings.

Which statement made by a severely depressed client requires the nurse's immediate attention?

1."Feeling better really isn't important to me anymore." 2."No one can really understand what I've had to deal with." 3."I really don't like the way that new depression pill makes me feel." 4."I've not been the least bit interested in socializing since my divorce." 1 The suicidal client may subtly express the intention to harm oneself in the form of a covert suicidal threat. The statement in option 1 should receive the nurse's priority attention because it is directly related to the client's safety. The remaining options are not related to safety as directly.The nurse is creating a discharge plan for the family of a client diagnosed with a mood disorder. The nurse should plan to provide which priority information to the family?

1.Brain anomalies that are responsible for this disorder 2.Signs that indicate the client may be considering suicide 3.The importance benzodiazepines play in the management of this disorder 4.The possibility that the client will experience medication-induced tinnitus 2 Suicide is the most serious concern for clients with mood disorders. Early identification of behaviors that reflect the client's suicidal mind-set is vital to minimizing the risk of self-injury and/or death. Mood disorders are not typically a result of brain anomalies. Benzodiazepines are not the medication classification of choice for treating mood disorders. Tinnitus is not a typical side effect of antidepressant medication therapy.A client admitted 72 hours ago with a diagnosis of depression presents for breakfast today appropriately dressed and well groomed, and appears to be calm and relaxed, yet more energetic than before. Which initial action should the nurse take after noting this client's behavior?

1.Institute the unit's suicide precaution protocol.

2.Alert the client's psychiatrist of these changes immediately.

3.Notify the staff of these observations at today's team meeting.

4.Ask the client directly about the presence of any suicide-related thoughts.4 A sudden improvement in a depressed client's mood may indicate that the client has decided to commit suicide. The most direct way to validate the nurse's impression is to ask the client directly about suicidal ideation or plans. The other options are not the most appropriate initial nursing intervention.The nurse suspects that the client hospitalized with a diagnosis of depression could benefit from further development of coping strategies. Which client statement supports this suspicion?

1."I know now that I can't be all things to all people all the time." 2."It is important for me to take my medications just as prescribed." 3."It's been good to learn better ways to deal with the stresses in my life." 4."I know that I won't become depressed again as long as I reduce my stressors." 4 Depression is a mood disorder that can be a recurrent illness. While stress reduction is a factor, managing stress is not the only strategy for avoiding depression. The client must learn to recognize symptoms of the disorder and to know who and when to call to resume more active treatment. Each of the incorrect options indicates a successful coping mechanism or health-promoting behavior