ANXIETY AND MOOD DISORDERS
1 . The client reports becoming involved with legislation that promotes gun
safety after the death of the child by accidental shooting. Which defense
mechanism is the client exhibiting?
A. Denial
B. Sublimation
C. Identification
D. Intellectualization
ANSWER: B
A. Denial is the refusal to accept a painful reality by pretending that it did not happen.
B. Sublimation involves redirecting unacceptable feelings or drives into an acceptable
channel.
C. Identification involves taking on attributes and characteristics of someone admired.
D. Intellectualization involves excessive focus on reasoning to avoid feelings associated
with a situation.
2. The client reports becoming physically ill with frequent crying episodes,
intense feelings of worthlessness, and loss of appetite on the anniversary of
the death of the client’s spouse. The client reports that this has occurred for the
last 5 years- What should be the nurse’s focus when counseling the client?
A. Anticipatory grief
B. Uncomplicated grief
C. Delayed grief reaction
D. Distorted grief reaction
ANSWER: D
A. Anticipatory grief is grief before a loss occurs.
B. In uncomplicated grief, the client’s self-esteem remains intact with symptom resolution.
C. Delayed grief reaction is the absence of the expression of grief during situations when a
grief reaction is expected.
, D. The nurse’s focus for counseling should be directed toward the client’s distorted grief
reaction. The symptoms reported by the client are exaggerated and prolonged.
3. The client is being discharged after hospitalization for a suicide attempt.
Which question asked by the nurse assesses the learned prevention and future
coping strategies of the client?
A. “How did you try to kill yourself?”
B. “Why did you think life wasn’t worth living?”
C. “What skills can you utilize if you experience problems again?”
D. “Do you have the phone number of the suicide prevention center?”
ANSWER: C
A. How suicide was initially attempted would have been addressed during the initial
assessment and does not determine future coping.
B. Asking the client a “why” question is not helpful and conveys a judgmental attitude.
C. Asking the client directly regarding what skills he or she could utilize if similar problems
occurred in the future provides the client with an opportunity to reflect on learned
behaviors and to determine a plan for future prevention.
D. Although asking the client if the suicide prevention center number is known would be
helpful, the question does not determine learned coping strategies.
4. The nurse is caring for the client with a major depressive disorder. Which
nursing problem should be priority?
A. Powerlessness
B. Attempted suicide
C. Anticipatory grieving
D. Disturbed sleep pattern
ANSWER: B
1. The presence of powerlessness is concerning but does not take priority over the suicide.
2. The potential for suicidal behavior is priority for the client with a major depressive disorder
who previously attempted suicide.
3. Anticipatory grieving is concerning because it may be the cause of the major depressive
disorder, but it is not the priority.
,4. The presence of a disturbed sleep pattern is concerning and should be addressed, but it is not
the priority.
5. The nurse is interviewing the client at a mental health clinic who recently
attempted suicide and continues to report active suicidal ideation. Which care
setting is most appropriate for this client?
A. An acute care hospital unit
B. An inpatient mental health unit
C. An outpatient mental health clinic
D. A community detoxification center
ANSWER: B
A. There is no indication that the client sustained injuries that require
hospitalization on an acute care unit.
B. The client with a history of suicidal behavior with current suicidal ideation is at
risk and in need of hospitalization. The most appropriate setting is an inpatient
mental health unit that is equipped to handle the safety issues of risky behaviors.
C. An outpatient mental health clinic does not provide the level of safety required
for the client reporting suicidal ideation.
D. There is no indication that the client’s attempted suicide was due to drug or
alcohol intoxication.
6. The nurse is discharging the client who was hospitalized on the mental
health unit for suicidal ideation. The nurse should advise the client to seek help
by contacting the mental health professional or the national suicide prevention
hotline if experiencing which warning signs for suicide? Select all that apply.
A. Feeling sad
B. Hopelessness
C. Feelings of being trapped
D. Severe anxiety and agitation
E. Increasing alcohol or drug use
ANSWER: B, C, D, E
A. Feeling sad can be a normal mood variation and is not considered a warning sign
, of suicide.
B. Hopelessness is a warning sign for suicide. Statements about problems never
resolving or about feelings of giving up indicate hopelessness.
C. Feeling trapped as if there is no way out is a warning sign of suicide.
D. Severe anxiety or agitation as well as recklessness can be an indication of
suicide risk.
E. Increasing drug or alcohol use can be indicative of suicide risk.
7. The nurse is planning care for the client diagnosed with acute mania. What
situation must occur prior to initiating treatment with lithium carbonate?
A. The client must have been fasting for the past 12 hours.
B. The client’s kidney function should be within normal parameters.
C. The client’s behavior has not been controlled with room seclusion.
D. Benzodiazepine use has been discontinued in the client’s treatment.
ANSWER: B
A. Having the client fast is unnecessary prior to initiating treatment with lithium
carbonate.
B. Because lithium carbonate (Lithobid) is excreted by the kidneys, a baseline
evaluation of normal kidney function should be completed before treatment
begins.
C. Room seclusion is used as a last resort and is unrelated to medication
administration.
D. Benzodiazepines are often used in treatment during the initiation phase to aid in
controlling mania, as it can take up to a week for lithium to become effective.
8. The client with a bipolar disorder presents to the ED with impaired
consciousness, nystagmus, and seizures. The nurse determines that which
result(s) on the client’s serum laboratory report illustrated explains the client’s
symptoms?
1 . The client reports becoming involved with legislation that promotes gun
safety after the death of the child by accidental shooting. Which defense
mechanism is the client exhibiting?
A. Denial
B. Sublimation
C. Identification
D. Intellectualization
ANSWER: B
A. Denial is the refusal to accept a painful reality by pretending that it did not happen.
B. Sublimation involves redirecting unacceptable feelings or drives into an acceptable
channel.
C. Identification involves taking on attributes and characteristics of someone admired.
D. Intellectualization involves excessive focus on reasoning to avoid feelings associated
with a situation.
2. The client reports becoming physically ill with frequent crying episodes,
intense feelings of worthlessness, and loss of appetite on the anniversary of
the death of the client’s spouse. The client reports that this has occurred for the
last 5 years- What should be the nurse’s focus when counseling the client?
A. Anticipatory grief
B. Uncomplicated grief
C. Delayed grief reaction
D. Distorted grief reaction
ANSWER: D
A. Anticipatory grief is grief before a loss occurs.
B. In uncomplicated grief, the client’s self-esteem remains intact with symptom resolution.
C. Delayed grief reaction is the absence of the expression of grief during situations when a
grief reaction is expected.
, D. The nurse’s focus for counseling should be directed toward the client’s distorted grief
reaction. The symptoms reported by the client are exaggerated and prolonged.
3. The client is being discharged after hospitalization for a suicide attempt.
Which question asked by the nurse assesses the learned prevention and future
coping strategies of the client?
A. “How did you try to kill yourself?”
B. “Why did you think life wasn’t worth living?”
C. “What skills can you utilize if you experience problems again?”
D. “Do you have the phone number of the suicide prevention center?”
ANSWER: C
A. How suicide was initially attempted would have been addressed during the initial
assessment and does not determine future coping.
B. Asking the client a “why” question is not helpful and conveys a judgmental attitude.
C. Asking the client directly regarding what skills he or she could utilize if similar problems
occurred in the future provides the client with an opportunity to reflect on learned
behaviors and to determine a plan for future prevention.
D. Although asking the client if the suicide prevention center number is known would be
helpful, the question does not determine learned coping strategies.
4. The nurse is caring for the client with a major depressive disorder. Which
nursing problem should be priority?
A. Powerlessness
B. Attempted suicide
C. Anticipatory grieving
D. Disturbed sleep pattern
ANSWER: B
1. The presence of powerlessness is concerning but does not take priority over the suicide.
2. The potential for suicidal behavior is priority for the client with a major depressive disorder
who previously attempted suicide.
3. Anticipatory grieving is concerning because it may be the cause of the major depressive
disorder, but it is not the priority.
,4. The presence of a disturbed sleep pattern is concerning and should be addressed, but it is not
the priority.
5. The nurse is interviewing the client at a mental health clinic who recently
attempted suicide and continues to report active suicidal ideation. Which care
setting is most appropriate for this client?
A. An acute care hospital unit
B. An inpatient mental health unit
C. An outpatient mental health clinic
D. A community detoxification center
ANSWER: B
A. There is no indication that the client sustained injuries that require
hospitalization on an acute care unit.
B. The client with a history of suicidal behavior with current suicidal ideation is at
risk and in need of hospitalization. The most appropriate setting is an inpatient
mental health unit that is equipped to handle the safety issues of risky behaviors.
C. An outpatient mental health clinic does not provide the level of safety required
for the client reporting suicidal ideation.
D. There is no indication that the client’s attempted suicide was due to drug or
alcohol intoxication.
6. The nurse is discharging the client who was hospitalized on the mental
health unit for suicidal ideation. The nurse should advise the client to seek help
by contacting the mental health professional or the national suicide prevention
hotline if experiencing which warning signs for suicide? Select all that apply.
A. Feeling sad
B. Hopelessness
C. Feelings of being trapped
D. Severe anxiety and agitation
E. Increasing alcohol or drug use
ANSWER: B, C, D, E
A. Feeling sad can be a normal mood variation and is not considered a warning sign
, of suicide.
B. Hopelessness is a warning sign for suicide. Statements about problems never
resolving or about feelings of giving up indicate hopelessness.
C. Feeling trapped as if there is no way out is a warning sign of suicide.
D. Severe anxiety or agitation as well as recklessness can be an indication of
suicide risk.
E. Increasing drug or alcohol use can be indicative of suicide risk.
7. The nurse is planning care for the client diagnosed with acute mania. What
situation must occur prior to initiating treatment with lithium carbonate?
A. The client must have been fasting for the past 12 hours.
B. The client’s kidney function should be within normal parameters.
C. The client’s behavior has not been controlled with room seclusion.
D. Benzodiazepine use has been discontinued in the client’s treatment.
ANSWER: B
A. Having the client fast is unnecessary prior to initiating treatment with lithium
carbonate.
B. Because lithium carbonate (Lithobid) is excreted by the kidneys, a baseline
evaluation of normal kidney function should be completed before treatment
begins.
C. Room seclusion is used as a last resort and is unrelated to medication
administration.
D. Benzodiazepines are often used in treatment during the initiation phase to aid in
controlling mania, as it can take up to a week for lithium to become effective.
8. The client with a bipolar disorder presents to the ED with impaired
consciousness, nystagmus, and seizures. The nurse determines that which
result(s) on the client’s serum laboratory report illustrated explains the client’s
symptoms?
