NURSING DIAGNOSIS
A patient diagnosed with major depressive disorder states, "I feel hopeless and everyone would be better off without me." The patient is withdrawing from family and has stopped engaging in activities they previously enjoyed. What is the nursing diagnosis?
Risk for Suicide related to feelings of hopelessness and worthlessness, evidenced by verbalization of self-harm and withdrawal from social activities
A patient with social anxiety disorder avoids interacting with others and reports feeling inferior and unworthy of friendship. The patient consistently isolates themselves during group activities. What is the nursing diagnosis?
Impaired Social Interaction related to social anxiety, evidenced by avoidance of social interactions and self-reported feelings of inferiority
This subtype of schizophrenia is characterized by unresponsiveness and motor immobility, with patients potentially remaining in a fixed position for extended periods. What is this type called?
Catatonic Type
This mood stabilizer is considered the gold standard for Bipolar I Disorder.
What is Lithium?
A patient with schizophrenia reports hearing voices. What is the most therapeutic initial nursing response?
What is “I don’t hear anything, but I understand that you do. That must be frightening.”
A patient with a history of paranoid delusions states, "People are out to get me, and I will defend myself if they try anything." The patient appears agitated and is pacing the room. What is the nursing diagnosis?
Risk for Violence (Self or Others) related to impaired impulse control and paranoid delusions, evidenced by agitation and verbal threats
A patient with a history of emotional abuse states, "I’m not good enough for anyone to love." The patient avoids eye contact and rarely engages in social activities. What is the nursing diagnosis?
Chronic Low Self-Esteem related to history of emotional abuse, evidenced by negative self-talk, low self-worth, and social withdrawal
A patient with this subtype exhibits disorganized speech and behavior, with inappropriate emotional reactions. The patient does not show catatonia. What subtype is this?
Disorganized Type
This form of therapy is the gold standard for Generalized Anxiety Disorder, often used alongside SSRIs.
What is Cognitive Behavioral Therapy (CBT)?
A manic patient is pacing, yelling, and becoming agitated. What’s the nurse’s priority action?
What is “Use calm, non-threatening communication and offer PRN medication if ordered”?
A patient with chronic anxiety says, "I don’t know how to handle my life anymore. I rely on alcohol to calm myself down when things get too overwhelming." What is the nursing diagnosis?
Ineffective Coping related to reliance on alcohol as a maladaptive coping mechanism, evidenced by verbalization of inability to manage stress without substance use
A patient experiences rapid heartbeat, shortness of breath, and an overwhelming sense of dread in response to an upcoming medical procedure. They state, "I feel like I’m going to die." What is the nursing diagnosis?
Anxiety (Panic) related to situational stress, evidenced by physical symptoms such as rapid heartbeat, shortness of breath, and overwhelming fear
This subtype is characterized by delusions of persecution or grandiosity, often accompanied by auditory hallucinations, but with functional thought patterns. What is this subtype called?
Paranoid Type
This non-pharmacologic treatment is used for treatment-resistant depression and involves applying an electrical current to the brain.
What is Electroconvulsive Therapy (ECT)?
A patient with severe anxiety begins hyperventilating and states, “I feel like I’m going to die.” What should the nurse do first?
What is “Stay with the patient and guide slow, deep breathing”?
A patient diagnosed with schizophrenia believes that they are being monitored by the government and that people around them are part of a conspiracy. What is the nursing diagnosis?
Disturbed Thought Processes related to delusions of persecution, evidenced by belief of being watched and part of a conspiracy
A patient with depression expresses, "I don’t want to be around anyone. I feel like no one would care if I disappeared." The patient has been withdrawing from social activities for weeks. What is the nursing diagnosis?
Social Isolation related to feelings of worthlessness, evidenced by self-reported withdrawal and lack of social engagement
A patient displays a mixture of symptoms from various categories, which do not fit neatly into one specific subtype of schizophrenia. What subtype does this patient likely have?
Undifferentiated Type
For patients with schizophrenia who are non-adherent to oral medications, this formulation of antipsychotics is the gold standard.
What is long-acting injectable (LAI) antipsychotics?
When a patient with antisocial personality disorder tries to charm staff into bending rules, what is the most important staff intervention?
What is “Maintain firm boundaries and consistent rules across all staff”?
A patient with schizophrenia reports hearing voices telling them to hurt themselves. The patient seems increasingly agitated and unable to distinguish the voices from reality. What is the nursing diagnosis?
Disturbed Sensory Perception related to auditory hallucinations, evidenced by patient’s report of hearing voices instructing self-harm
A patient with post-traumatic stress disorder reports nightmares and difficulty falling asleep. They have been averaging only two to three hours of sleep each night and appear fatigued during the day. What is the nursing diagnosis?
Insomnia related to hyperarousal and nightmares, evidenced by difficulty falling asleep and excessive daytime fatigue
A patient with this subtype of schizophrenia may demonstrate repetitive and purposeless movements or echolalia, where they mimic another person’s speech. What is this subtype?
Catatonic Type
The gold standard pharmacologic treatment for OCD often involves higher doses of this class of antidepressants.
What are SSRIs (like fluoxetine, fluvoxamine, sertraline)?
A patient with MDD refuses to attend group therapy, saying, “I’m too tired, it won’t help.” What is the most therapeutic nursing intervention?
What is “Acknowledge their feelings and encourage participation as part of recovery”?