Chapter 12: Mood Disorders: Depression, Bipolar, and Adjustment Disorders ALL ANSWERS 100% CORRECT SPRING -FALL 2022 LATEST GUARANTEED GRADE A+

1. The nurse learns at report that a newly admitted manic patient is demonstrating grandiosity. Which statement would be most consistent with this symptom? a. “I can’t do anything anymore.” b. “I’m the world’s most astute financier.” c. “I can understand why my wife is upset that I overspend.” d. “I can’t understand where all the money in our family goes.” ANS: B An individual who is demonstrating grandiosity has an exaggerated view of his abilities. The other options are more moderate statements and lack that element of exaggeration. DIF: Cognitive Level: Application REF: Page 233 | Page 235 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 2. The nurse will base a discussion of dysthymia on the fact that the condition: b. Involves delusional thinking c. Is chronic low-level depression d. Does not include suicidal ideation ANS: C Dysthymia is identified as a chronic low-level depression frequently lasting over a period of several years without remitting. Dysthymia has a slow, insidious onset. Delusional thinking is not a common manifestation of dysthymia. Suicidal thoughts are seen among dysthymic patients. DIF: Cognitive Level: Comprehension REF: Pages 232-233 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 3. What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include exaggerated physical activity, agitation, insomnia, and anorexia? a. Risk for injury b. Chronic low self-esteem c. Noncompliance d. Insomnia Risk for injury is the priority diagnosis. Possible injuries include dehydration, which may result from not drinking and trauma, which may result from bumping into objects or from physical altercations. The other options are valid diagnoses, but not of highest priority. DIF: Cognitive Level: Analysis REF: Page 242 TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity 4. A patient has been admitted with a diagnosis of atypical depression. In planning interventions, the nurse would expect to consider the characteristic symptom of: a. Seasonal episodes b. Leaden paralysis c. Psychomotor agitation d. Increased depression in the morning ANS: B Behavioral characteristics of atypical depression include the feeling that one’s limbs are so heavy they cannot be lifted or moved (leaden paralysis). Seasonal mood changes are characteristic of seasonal affective disorder. Psychomotor agitation and depression that is greater in the morning than in the evening are characteristics more likely to be observed in patients with melancholic depression. DIF: Cognitive Level: Application REF: Page 237 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 5. An inappropriately dressed patient has not slept for 3 days while making excessive, expensive long-distance phone calls. When the patient can be heard singing loudly in the examining room, the nurse makes initial plans to focus on: b. Setting strict limits on dress and behavior c. Conducting an in-depth suicide assessment d. Obtaining a complete psychosocial assessment ANS: A Patients with mania frequently ignore their basic physiologic needs, as evidenced by not sleeping for 3 days, thus making these assessments the priority. Limits, although appropriate to consider, are not the priority. The manic state precludes a thorough assessment initially. Suicide assessment is not a priority at this time but reckless behavior could result in personal injury. DIF: Cognitive Level: Application REF: Page 245 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 6. Which statement by the patient would indicate the need for additional education regarding the prescribed lithium treatment regimen? a. “I will restrict my daily salt intake.” b. “I will take my medications with food.” c. “I will have my blood drawn on schedule.” d. “I will drink 8 to 12 glasses of liquids daily.” Patients taking lithium must maintain a normal sodium intake or risk symptoms of lithium toxicity. The patient should have 2 to 3 liters of fluid daily. Taking lithium with food minimizes gastrointestinal side effects. Regular monitoring of lithium levels is important to prevent toxicity. DIF: Cognitive Level: Application REF: Page 246 | Page 250 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 7. The nurse would evaluate that patient education regarding lithium therapy for an individual with bipolar disorder as effective if the patient states: a. “I can stop my lithium when I feel better.” b. “I can continue with my diuretic and cardiac medications.” c. “I will probably need to take the lithium for the rest of my life.” d. “I will taper my lithium when a therapeutic serum level is achieved.” ANS: C Most patients with bipolar disorder require long-term maintenance on lithium or other antimanic medication. Patients should never stop medication without consulting the physician. When a therapeutic level is achieved, the patient will continue on maintenance doses of lithium. Diuretics are contraindicated for the patient on lithium. DIF: Cognitive Level: Application REF: Page 246 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 8. A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department with a list of medications he is taking. Which of the medications on the list would require re-evaluation of lithium dosage? b. Navane bid c. Ativan at bedtime d. Cefobid daily ANS: A Diuretics alter fluid and electrolyte balance, increasing risk for lithium toxicity; therefore HydroDIURIL is correct. Antipsychotic medications are frequently prescribed concurrently with lithium to manage acute symptoms of mania, so no re-evaluation of lithium dose is necessary for Navane. Antianxiety drugs are not contraindicated with concurrent lithium use, so no lithium dose re-evaluation is necessary for Ativan. Antibiotics do not alter fluid and electrolyte balance, so readjustment of lithium dosage is not required for Cefobid. DIF: Cognitive Level: Analysis REF: Page 246 | Page 250 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 9. Which outcomes would be appropriate to determine early favorable response to antidepressant medication? a. The patient will complete own self-care activities. b. The patient will demonstrate assertive communication skills. c. The patient will describe signs and symptoms of major depression. d. The patient will make plans to attend one community social activity a week. Ability to manage basic ADLs demonstrates improvement in major depression. Understanding the disorder may occur later when patient cognition has improved enough to be able to process information. Initiation of community social activity occurs when the patient has increased energy. Assertive communication is learned and practiced after the depression lifts. DIF: Cognitive Level: Application REF: Page 253 TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity 10. Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patient’s: a. Mood and affect b. Activity level c. Cognitive ability to understand information about the medication d. Support network and its members’ willingness to participate in treatment ANS: C Phenelzine (Nardil) administration requires strict adherence to a restricted diet. The patient must have the cognitive ability to understand the food and medication interactions that may cause a serious reaction. DIF: Cognitive Level: Application REF: Page 248 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 11. A patient who has a history of bipolar disorder recently underwent orthopedic surgery and was discharged to return home. When visited by the home care nurse, the nurse documented the following: slow and soft speech; sad facial expression; and patient crying when describing extreme fatigue, low mood, and the feeling that he will never get well. He has refused to bathe and perform ADLs for several days. Which nursing diagnosis would be appropriate? b. Situational low self-esteem related to immobility c. Deficient knowledge related to depression and surgery d. Disturbed thought processes related to bipolar disorder ANS: A Refusal to perform tasks of bathing, grooming, and other ADLs provides evidence of a self-care deficit. The other symptoms documented by the nurse are characteristic of depression. No data are present to suggest the diagnoses given in the other options. DIF: Cognitive Level: Application REF: Page 245 TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity 12. The nurse caring for an extremely withdrawn patient with depression wants to assist her to become more interactive. The best approach would be to say: a. “I know you’ll feel better if you leave your room.” b. “You look so gloomy sitting here all by yourself.” c. “Let’s explore how it feels to sit alone here all day and feel sad.” d. “I need another person for a card game and I’d like you to be my partner.” This direct approach invites the patient to participate in a kind, but firm manner. The patient is not given an option to simply say “yes” or “no.” It is not therapeutic to give false reassurance. The remaining options focus too intensively on negative thoughts and feelings. DIF: Cognitive Level: Application REF: Page 245 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 13. Which nursing diagnosis would relate to the primary nursing concern related to a recently written prescription for amitriptyline (Elavil) 50 mg tid? a. Anxiety b. Ineffective coping c. Risk for self-injury d. Chronic low self-esteem ANS: C Patients with depression are at increased risk for suicide when they have been on antidepressant medication for 2 weeks, because they are regaining some energy but may not have achieved full therapeutic effect with mood improvement. Poor coping is important but it is not the priority. Evidence of noncompliance is lacking. The medication is not prescribed for anxiety disorders. DIF: Cognitive Level: Analysis REF: Page 246 TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. What information concerning amitriptyline (Elavil) 50 mg tid would the nurse give the patient regarding the expected outcome of this medication therapy? b. “This medication is expected to improve brain chemical imbalance.” c. “Amitriptyline will help re-establish your ability to think clearly again.” d. “Elavil will be particularly effective at assisting you in regaining your independence.”