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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.
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A client with depression appears lethargic and apathetic but agrees to participate in a leisure activity group. Which nursing intervention is most likely to help the client successfully participate?
- A. Allowing the client to direct her participation at her own pace.
- B. Giving the client several choices of projects, so she can choose her favorite.
- C. Staying away from the client during the session to encourage free expression.
- D. Structuring the activity to facilitate completion of one specific task.
Correct Answer: D
Rationale: Structuring the activity ensures success for a lethargic client, supporting engagement and achievement.
A client who has been discharged home on Celexa (citalopram) calls the nurse complaining that the medication causes her to feel too drowsy. The nurse should make which of the following suggestions?
- A. Make an appointment to change to a different medication.
- B. Take the medication at night.
- C. Be patient while this early side effect subsides.
- D. Skip a dose if drowsiness is excessive.
Correct Answer: B
Rationale: Taking citalopram at night minimizes daytime drowsiness, a common side effect, improving adherence.
A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm?
- A. Immediately after a family visit
- B. On the anniversary of significant life events in the client's life
- C. During the first few days after admission
- D. Approximately 2 weeks after starting antidepressant medication
Correct Answer: D
Rationale: The risk of self-harm increases about 2 weeks after starting antidepressants, as energy improves before mood stabilizes.
Which time periods during antidepressant therapy are persons most likely to commit suicide? Select all that apply.
- A. After starting antidepressant therapy but not having reached the therapeutic level
- B. After having reached the therapeutic level of antidepressants and maintained it for several years
- C. If the client has made a choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed
- D. If the client does not adhere to the medication regimen and takes antidepressant medications irregularly
- E. Prior to initiating antidepressant therapy but before the depression results in lack of energy
Correct Answer: A,C,D,E
Rationale: Suicide risk is highest when energy increases before mood stabilizes, or during untreated or poorly managed depression.
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.