Chapter 31: Mental Health Disorders and Substance Abuse
MULTIPLE CHOICE
1. A client with a history of bipolar disorder is called by the postpartum support nurse for
follow-up. Which symptoms would reassure the nurse that the client is not experiencing a
manic episode?
a. Psychomotor agitation and rapid speech patterns
b. Increased appetite and sleeping 8 hours a night
c. Hyperactivity and distractibility
d. Pressured speech and grandiosity
ANS: B
An increased appetite and a lack of interest would reassure the nurse that the client is not
experiencing an episode of mania. Clinical manifestations of a manic episode include at
least three of the following: grandiosity, decreased need for sleep, pressured speech, flight
of ideas, distractibility, psychomotor agitation, and excessive involvement in pleasurable
activities. The pregnant woman exhibiting symptoms of a manic episode will likely have a
decreased interest in eating and an increased level of interest in pleasurable activities
without regard for negative consequences. Psychomotor agitation and a lack of sleep,
hyperactivity and distractibility, and pressured speech and grandiosity are all clinical
manifestations of a manic episode.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: ImNpU
leR
mS onTB.MCSOCM
enItaNtiG : Client Needs: Physiologic Integrity
2. When a woman is diagnosed with postpartum depression (PPD) with psychotic features,
what is the nurse’s primary concern in planning the client’s care?
a. Displaying outbursts of anger
b. Neglecting her hygiene
c. Harming her infant
d. Losing interest in her husband
ANS: C
Thoughts of harm to herself or to the infant are among the most serious symptoms of PPD
and require immediate assessment and intervention. Although outbursts of anger and
neglecting personal hygiene are symptoms attributable to PPD, the major concern remains
the potential of harm to herself or her infant. Although this client is likely to lose interest in
her spouse, it is not the nurse’s primary concern.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
3. During an inpatient psychiatric hospitalization, what is the most important nursing
intervention?
a. Contacting the client’s significant other
b. Supervising and guiding visits with her infant
c. Allowing no contact with anyone who annoys her
, d. Having the infant with the mother the majority of the time
ANS: B
In the hospital setting, the reintroduction of the infant to the mother can and should occur at
the mother’s own pace. A schedule is set that increases the number of hours the mother
cares for her infant over several days, culminating in the infant staying overnight in the
mother’s room. These supervised and guided visits allow the mother to experience meeting
the infant’s needs and giving up sleep for the infant. Reintroducing the mother to her infant
while in a supervised setting is essential. Another important task for a mother under
psychiatric care is to reestablish positive interactions with others.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
4. Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit
drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)?
a. Respiratory conditions
b. Intellectual impairment
c. Neural development disorder
d. Alcohol-related birth defects (ARBDs)
ANS: A
Respiratory difficulties are not attributed to exposure to alcohol in utero. Other
abnormalities related to FAS include mental retardation, neurodevelopment disorders, and
ARBDs.
PTS: 1 DIF:N CRognIitivG
e LevB.
elC
: UnMderstand
TOP: Nursing Process: AssU SenN
essm t T MSOC: Client Needs: Psychosocial Integrity
5. As a powerful central nervous system (CNS) stimulant, which of these substances can lead
to miscarriage, preterm labor, placental separation (abruption), and stillbirth?
a. Heroin
b. Alcohol
c. Phencyclidine (1-phenylcyclohexylpiperidine; PCP)
d. Cocaine
ANS: D
Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use
include abruptio placentae, preterm labor, precipitous birth, and stillbirth. Heroin is an
opiate; its use in pregnancy is associated with preeclampsia, intrauterine growth restriction,
miscarriage, premature rupture of membranes, infections, breech presentation, and preterm
labor. The most serious effect of alcohol use in pregnancy is FAS. The major concern
regarding PCP use in pregnant women is its association with polydrug abuse and its
neurobehavioral effects on the neonate.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
6. According to research, which risk factor for postpartum depression (PPD) is likely to have
the greatest effect on the client postpartum?
, a. Prenatal depression
b. Single-mother status
c. Low socioeconomic status
d. Unplanned or unwanted pregnancy
ANS: A
Prenatal depression has been found to be a major risk factor for PPD. Single-mother status
and low socioeconomic status are both small-relationship predictors for PPD. Although an
unwanted pregnancy may contribute to the risk for PPD, it does not pose as great an effect
as prenatal depression.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
7. Which is the most accurate description of postpartum depression (PPD) without psychotic
features?
a. Postpartum baby blues requiring the woman to visit with a counselor or
psychologist
b. Condition that is more common among older Caucasian women because they have
higher expectations
c. Distinguishable by pervasive sadness along with mood swings
d. Condition that disappears without outside help
ANS: C
PPD is characterized by an intense pervasive sadness along with labile mood swings and is
more persistent than postpartum baby blues. PPD, even without psychotic features, is more
serious and persistent than postpartum baby blues. PPD is more common among younger
mothers and African-Americ NU
anRm INersGT
Soth B. wOomen need professional help to get through
. Most
PPD, including pharmacologic intervention.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
8. While providing care to the maternity client, the nurse should be aware that one of these
anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder
fits this criterion?
a. Phobias
b. Panic disorder
c. Posttraumatic stress disorder (PTSD)
d. Obsessive-compulsive disorder (OCD)
ANS: C
MULTIPLE CHOICE
1. A client with a history of bipolar disorder is called by the postpartum support nurse for
follow-up. Which symptoms would reassure the nurse that the client is not experiencing a
manic episode?
a. Psychomotor agitation and rapid speech patterns
b. Increased appetite and sleeping 8 hours a night
c. Hyperactivity and distractibility
d. Pressured speech and grandiosity
ANS: B
An increased appetite and a lack of interest would reassure the nurse that the client is not
experiencing an episode of mania. Clinical manifestations of a manic episode include at
least three of the following: grandiosity, decreased need for sleep, pressured speech, flight
of ideas, distractibility, psychomotor agitation, and excessive involvement in pleasurable
activities. The pregnant woman exhibiting symptoms of a manic episode will likely have a
decreased interest in eating and an increased level of interest in pleasurable activities
without regard for negative consequences. Psychomotor agitation and a lack of sleep,
hyperactivity and distractibility, and pressured speech and grandiosity are all clinical
manifestations of a manic episode.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: ImNpU
leR
mS onTB.MCSOCM
enItaNtiG : Client Needs: Physiologic Integrity
2. When a woman is diagnosed with postpartum depression (PPD) with psychotic features,
what is the nurse’s primary concern in planning the client’s care?
a. Displaying outbursts of anger
b. Neglecting her hygiene
c. Harming her infant
d. Losing interest in her husband
ANS: C
Thoughts of harm to herself or to the infant are among the most serious symptoms of PPD
and require immediate assessment and intervention. Although outbursts of anger and
neglecting personal hygiene are symptoms attributable to PPD, the major concern remains
the potential of harm to herself or her infant. Although this client is likely to lose interest in
her spouse, it is not the nurse’s primary concern.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
3. During an inpatient psychiatric hospitalization, what is the most important nursing
intervention?
a. Contacting the client’s significant other
b. Supervising and guiding visits with her infant
c. Allowing no contact with anyone who annoys her
, d. Having the infant with the mother the majority of the time
ANS: B
In the hospital setting, the reintroduction of the infant to the mother can and should occur at
the mother’s own pace. A schedule is set that increases the number of hours the mother
cares for her infant over several days, culminating in the infant staying overnight in the
mother’s room. These supervised and guided visits allow the mother to experience meeting
the infant’s needs and giving up sleep for the infant. Reintroducing the mother to her infant
while in a supervised setting is essential. Another important task for a mother under
psychiatric care is to reestablish positive interactions with others.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
4. Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit
drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)?
a. Respiratory conditions
b. Intellectual impairment
c. Neural development disorder
d. Alcohol-related birth defects (ARBDs)
ANS: A
Respiratory difficulties are not attributed to exposure to alcohol in utero. Other
abnormalities related to FAS include mental retardation, neurodevelopment disorders, and
ARBDs.
PTS: 1 DIF:N CRognIitivG
e LevB.
elC
: UnMderstand
TOP: Nursing Process: AssU SenN
essm t T MSOC: Client Needs: Psychosocial Integrity
5. As a powerful central nervous system (CNS) stimulant, which of these substances can lead
to miscarriage, preterm labor, placental separation (abruption), and stillbirth?
a. Heroin
b. Alcohol
c. Phencyclidine (1-phenylcyclohexylpiperidine; PCP)
d. Cocaine
ANS: D
Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use
include abruptio placentae, preterm labor, precipitous birth, and stillbirth. Heroin is an
opiate; its use in pregnancy is associated with preeclampsia, intrauterine growth restriction,
miscarriage, premature rupture of membranes, infections, breech presentation, and preterm
labor. The most serious effect of alcohol use in pregnancy is FAS. The major concern
regarding PCP use in pregnant women is its association with polydrug abuse and its
neurobehavioral effects on the neonate.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
6. According to research, which risk factor for postpartum depression (PPD) is likely to have
the greatest effect on the client postpartum?
, a. Prenatal depression
b. Single-mother status
c. Low socioeconomic status
d. Unplanned or unwanted pregnancy
ANS: A
Prenatal depression has been found to be a major risk factor for PPD. Single-mother status
and low socioeconomic status are both small-relationship predictors for PPD. Although an
unwanted pregnancy may contribute to the risk for PPD, it does not pose as great an effect
as prenatal depression.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
7. Which is the most accurate description of postpartum depression (PPD) without psychotic
features?
a. Postpartum baby blues requiring the woman to visit with a counselor or
psychologist
b. Condition that is more common among older Caucasian women because they have
higher expectations
c. Distinguishable by pervasive sadness along with mood swings
d. Condition that disappears without outside help
ANS: C
PPD is characterized by an intense pervasive sadness along with labile mood swings and is
more persistent than postpartum baby blues. PPD, even without psychotic features, is more
serious and persistent than postpartum baby blues. PPD is more common among younger
mothers and African-Americ NU
anRm INersGT
Soth B. wOomen need professional help to get through
. Most
PPD, including pharmacologic intervention.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
8. While providing care to the maternity client, the nurse should be aware that one of these
anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder
fits this criterion?
a. Phobias
b. Panic disorder
c. Posttraumatic stress disorder (PTSD)
d. Obsessive-compulsive disorder (OCD)
ANS: C
