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Which of the following interventions should a nurse include in the care plan for a client with major depressive disorder? Select one that is not appropriate.
- A. Encourage participation in activities
- B. Promote adequate nutrition and hydration
- C. Discourage verbalization of feelings
- D. Monitor for suicidal ideation
Correct Answer: C
Rationale: Interventions for a client with major depressive disorder should focus on encouraging participation in activities, promoting adequate nutrition and hydration, monitoring for suicidal ideation, and providing a structured daily schedule. Discouraging verbalization of feelings goes against the therapeutic approach as expressing and discussing feelings is crucial in the treatment of major depressive disorder. Clients with major depressive disorder often benefit from talking about their emotions and experiences, as it can help in processing their feelings and promoting recovery. Therefore, discouraging verbalization of feelings would hinder the client's progress and is not an appropriate intervention.
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When developing a care plan for a client with generalized anxiety disorder (GAD), which of the following interventions should not be included?
- A. Encourage the client to avoid anxiety-provoking situations.
- B. Teach the client relaxation techniques.
- C. Encourage the client to express their feelings.
- D. Provide a structured daily routine.
Correct Answer: A
Rationale: Avoiding anxiety-provoking situations is not a recommended intervention in caring for a client with generalized anxiety disorder (GAD) as it can reinforce the client's anxiety. Exposing the client gradually to feared situations can help reduce anxiety in the long term through techniques like cognitive-behavioral therapy. Teaching relaxation techniques helps the client manage stress and anxiety effectively. Encouraging the client to express their feelings promotes emotional processing and reduces internal tension. Providing a structured daily routine can offer predictability and stability, which are beneficial for individuals with GAD.
When under stress, a client routinely uses an excessive amount of alcohol. Finding her drunk, her husband yells at her about the chronic alcohol abuse. Which reaction should the nurse recognize as the use of the defense mechanism of denial?
- A. Hiding liquor bottles in a closet
- B. Yelling at their son for slouching in his chair
- C. Burning dinner on purpose
- D. Saying to the spouse, 'I don't drink too much!'
Correct Answer: D
Rationale: The nurse should recognize the client's statement 'I don't drink too much!' as the use of the defense mechanism of denial. This response indicates the client's refusal to acknowledge the reality of excessive alcohol consumption, which is a key characteristic of denial. By denying the problem, the client avoids facing the negative consequences and feelings associated with their alcohol abuse. Choices A, B, and C do not exhibit denial but rather represent different defense mechanisms. Hiding liquor bottles in a closet might indicate the defense mechanism of concealment, yelling at their son for slouching in his chair could reflect displacement, and burning dinner on purpose might suggest passive-aggressive behavior.
A client with bipolar disorder is experiencing a depressive episode. Which of the following interventions should the nurse not implement?
- A. Agree with the client's delusions to avoid confrontation.
- B. Monitor for signs of suicidal ideation
- C. Promote a regular sleep schedule
- D. Discourage the expression of negative feelings
Correct Answer: A
Rationale: During a depressive episode in bipolar disorder, it is crucial not to agree with the client's delusions to avoid reinforcing false beliefs. Monitoring for signs of suicidal ideation is essential for safety. Promoting a regular sleep schedule can help stabilize mood. Discouraging the expression of negative feelings is not recommended as it is important to allow clients to express their emotions and feel heard.
How do psychiatrists determine which diagnosis to give a patient?
- A. Psychiatrists use pre-established criteria from the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
- B. Hospital policy dictates how psychiatrists diagnose mental disorders.
- C. Psychiatrists assess the patient and identify diagnoses based on the patient's unhealthy responses and contributing factors.
- D. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choose from.
Correct Answer: A
Rationale: The correct answer is A. Psychiatrists use the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association (APA) to determine diagnoses. The DSM-5 provides standardized criteria for the classification of mental disorders, ensuring accurate and reliable diagnosis and treatment. Choices B and D are inaccurate as hospital policy does not dictate psychiatric diagnoses, and the American Medical Association is not responsible for psychiatric diagnostic criteria. Choice C describes a more general approach to assessment and does not specifically address the standardized criteria used in psychiatric diagnosis.
An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem-solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention?
- A. Encourage the graduate to use alternative coping mechanisms such as relaxation exercises.
- B. Complete the problem-solving process for the graduate.
- C. Work through the problem-solving process with the graduate.
- D. Encourage the graduate to keep a journal.
Correct Answer: C
Rationale: In situations where a client is experiencing severe anxiety and struggles with independent problem-solving, it is essential for the nurse to work through the problem-solving process together with the client. By doing so, the nurse can provide support and guidance to help the client navigate through their challenges effectively. Choice A is not the most appropriate as just encouraging alternative coping mechanisms may not address the root of the problem. Choice B of completing the problem-solving process for the graduate does not promote independence or skill development. Choice D of encouraging the graduate to keep a journal may be helpful but does not directly address the need for assistance in problem-solving during heightened anxiety.