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A nurse is creating a plan of care for a client who has major depressive disorder. Which of the following interventions should the nurse include in the plan?
- A. Discourage the client from expressing feelings of anger
- B. Identify and schedule alternative group activities for the client
- C. Encourage physical activity for the client during the day
- D. Keep a bright light on in the clients room at night
Correct Answer: C
Rationale: The correct answer is C: Encourage physical activity for the client during the day. Physical activity has been shown to improve mood and reduce symptoms of depression by increasing endorphins. This intervention can help the client combat feelings of sadness and hopelessness.
A: Discouraging the client from expressing feelings of anger is not therapeutic and may further suppress emotions, worsening depression.
B: Identifying and scheduling alternative group activities can be helpful, but it may not directly address the physical aspect of depression.
D: Keeping a bright light on in the client's room at night may disrupt sleep patterns and is not a targeted intervention for major depressive disorder.
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A nurse in a psychiatric unit is caring for a client who has obsessive-compulsive disorder. Which of the following actions should the nurse take?
- A. Allow the client to perform compulsive rituals
- B. Discourage discussion about the compulsions
- C. Encourage the client to use thought-stopping techniques
- D. Limit the client’s decision-making opportunities
Correct Answer: C
Rationale: The correct answer is C: Encourage the client to use thought-stopping techniques. This is because thought-stopping techniques are a common cognitive-behavioral intervention used to help individuals with obsessive-compulsive disorder interrupt and replace their distressing thoughts or compulsive behaviors with healthier alternatives. By encouraging the client to use these techniques, the nurse can help the client develop coping strategies to manage their symptoms effectively.
Choices A, B, and D are incorrect because they do not address the core issue of obsessive-compulsive disorder and may even exacerbate the client's symptoms. Allowing the client to perform compulsive rituals reinforces maladaptive behaviors, discouraging discussion about the compulsions limits the client's ability to seek support and understanding, and limiting decision-making opportunities may increase the client's anxiety and feelings of lack of control.
A nurse is caring for a client who is involuntarily admitted for major depressive disorder and refuses to take prescribed antianxiety medication. Which of the following actions should the nurse take?
- A. Inform the client that he does not have the right to refuse medication
- B. Administer the medication to the client via IM injection
- C. Offer the client the medication at the next scheduled dose time
- D. Implement consequences until the client takes the medication
Correct Answer: D
Rationale: Correct Answer: D
Rationale: Implementing consequences until the client takes the medication is the most appropriate action as the client is involuntarily admitted. This approach ensures the client's safety and well-being by addressing the refusal to take prescribed medication. Administering medication via IM injection (B) may escalate the situation and violate the client's rights. Informing the client that he does not have the right to refuse medication (A) is inaccurate and may lead to resistance. Offering the medication at the next scheduled dose time (C) does not address the client's refusal.
A nurse is giving a presentation about intimate partner abuse for a community group. Which of the following statements by a group member indicates understanding of the teaching?
- A. Survivors of abuse often feel guilty
- B. Abusers often have high self-esteem
- C. The honeymoon stage of violence usually gets longer over time
- D. As abuse continues, victims become more determined to be independent
Correct Answer: A
Rationale: Correct Answer: A: Survivors of abuse often feel guilty
Rationale: This statement indicates understanding of the psychological impact of intimate partner abuse. Guilt is a common emotion experienced by survivors due to manipulation and blame from the abuser. It reflects the internalized self-blame and shame that many survivors struggle with.
Summary of other choices:
B: Abusers often have high self-esteem - Incorrect. Abusers typically have low self-esteem and use abuse as a way to exert power and control.
C: The honeymoon stage of violence usually gets longer over time - Incorrect. The honeymoon phase tends to decrease over time as abuse cycles escalate.
D: As abuse continues, victims become more determined to be independent - Incorrect. Victims often experience increased isolation and dependency on the abuser.
A nurse in a mental health facility is assessing a client who has schizophrenia. The nurse should document which of the following as a positive symptom?
- A. Social withdrawal
- B. Flat affect
- C. Delusions
- D. Lack of motivation
Correct Answer: C
Rationale: The correct answer is C: Delusions. Positive symptoms are behaviors or experiences that are added to a person's personality, such as hallucinations or delusions. Delusions are false beliefs that are not based on reality. In the context of schizophrenia, delusions are considered positive symptoms because they represent an addition to a person's usual behavior or mental state. Social withdrawal (A), flat affect (B), and lack of motivation (D) are considered negative symptoms of schizophrenia, as they involve a decrease or absence of normal behaviors or emotions. Therefore, the nurse should document delusions as a positive symptom in the assessment of the client with schizophrenia.
A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect?
- A. Increased energy
- B. Restlessness
- C. Euphoric mood
- D. Depersonalization
Correct Answer: B
Rationale: The correct answer is B: Restlessness. In generalized anxiety disorder, individuals often experience restlessness due to persistent worry and fear. This can manifest as physical agitation and an inability to relax. Increased energy (A) is not typically associated with generalized anxiety disorder, as individuals may feel fatigued due to constant worrying. Euphoric mood (C) is more characteristic of conditions like bipolar disorder, not generalized anxiety disorder. Depersonalization (D) involves feeling detached from oneself and is more commonly associated with conditions like dissociative disorders, not generalized anxiety disorder.