Nokea
At 1 AM, the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. What would be the nurse's most therapeutic response?
- A. Go to the day room and wait while I call your psychiatrist.
- B. Don't be unreasonable. I can't call the psychiatrist at this time of night.
- C. I can't call the psychiatrist now, but you and I can talk about your request for a pass.
- D. You must really be upset to want a pass immediately; I'll give you some medication.
Correct Answer: C
Rationale: This response sets limits on an unreasonable demand while opening a dialogue to address the client's needs.
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Which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply.
- A. Norepinephrine levels may be increased in mania.
- B. Manic episodes are a defense against underlying depression.
- C. Acetylcholine seems to be implicated in mania.
- D. The id takes over the ego and acts as an undisciplined hedonistic being (child).
Correct Answer: B,D
Rationale: Psychoanalytical theories view mania as a defense against depression, with the id overriding the ego, acting impulsively.
A client is admitted for major depression. What should the nurse expect to find during assessment?
- A. Anhedonia, feelings of worthlessness, and difficulty focusing
- B. Depressed mood, guilt, and pressured speech
- C. Changes in sleep pattern, tired, and grandiose mood
- D. Difficulty focusing, feelings of helplessness, and flight of ideas
Correct Answer: A
Rationale: Major depression typically presents with anhedonia, worthlessness, and difficulty focusing, unlike symptoms of mania.
Which is a possible explanation for the increased risk of suicide in persons who have had a relative who committed suicide?
- A. The relative's suicide offers a sense of permission or acceptance of suicide as a method of escaping a difficult situation.
- B. Many people with depression who have suicidal ideation lack the energy to implement suicide plans, but antidepressant treatment can actually give clients with depression the energy to act on suicidal ideation.
- C. Suicide is more likely to occur in April when natural energy from increased sunlight may give the client the energy to act on suicidal ideation.
- D. The relative's suicide caused the family members to realize that suicide is emotionally harmful to the ones left behind and vow not to consider suicide.
Correct Answer: A
Rationale: A relative's suicide may normalize the act, increasing risk by providing a sense of acceptability.
A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first?
- A. Decrease the client's environmental stimuli.
- B. Give the client feedback about his behavior.
- C. Introduce the client to other staff on the unit.
- D. Tell the client about hospital rules and policies.
Correct Answer: A
Rationale: Reducing environmental stimuli is the priority to help calm an agitated client with bipolar disorder.
A client who is depressed begins to cry and states, 'I'm just really sick of feeling this way. Nothing ever seems to go right in my life.' Which would be the most appropriate response by the nurse?
- A. Don't cry. Try to look at the positive side of things.
- B. You are feeling really sad right now. It's a hard time.
- C. Hang in there. Your medication will start helping in a few days.
- D. Nothing ever goes right?
Correct Answer: B
Rationale: Acknowledging the client's sadness validates their feelings, fostering a therapeutic connection without dismissing emotions.