Mind Games!
This disorder involves recurrent, unpredictable panic attacks often accompanied by a sense of impending doom and physiological symptoms like increased heart rate, respiratory rate, and blood pressure.
What is Panic Disorder
Rationale:
Panic disorder is defined by recurrent and unexpected panic attacks with intense fear or discomfort. Clients experience at least four physiological symptoms (e.g., sweating, trembling, chest pain, dizziness) and often report feeling like they are “dying” or “going crazy.”
This acute cognitive disturbance is characterized by sudden onset of confusion, disorientation, and clouded consciousness — often reversible once the underlying cause is treated.
What is Delirium
💡 Rationale:
Delirium has an abrupt onset and fluctuating course, with disorganized thinking, agitation, and altered attention. Unlike dementia, it’s typically short-term and reversible once the cause (like infection, hypoxia, or medications) is resolved.
This clinician-administered tool rates 17 symptoms of depression, including mood, guilt, sleep, and psychomotor changes, to determine the severity of depressive illness.
What is the Hamilton Depression Rating Scale (HAM-D)?
💡 Rationale:
The HAM-D is used by clinicians to assess depression severity. Scores help determine if depression is mild (7–17), moderate (18–24), or severe (>24). It evaluates emotional, cognitive, and physical symptoms like insomnia and psychomotor changes.
A nurse is assessing a client who reports a sudden sense of doom, heart palpitations, trembling, and shortness of breath. Which nursing action should take priority?
A. Encourage the client to identify triggers for the panic attack
B. Stay with the client and speak in a calm, reassuring voice
C. Administer prescribed benzodiazepine
D. Instruct the client to take slow, deep breaths in a paper bag
✅ Correct Answer: B. Stay with the client and speak in a calm, reassuring voice
💬 Rationale: During a panic attack, the priority is to reduce fear and ensure safety by remaining with the client and using calm communication. Deep breathing is helpful, but reassurance and presence come first before techniques or medications.
A client with major depressive disorder suddenly becomes talkative, energetic, and starts giving away personal items.
👉 What should the nurse do first, and why?
Increase observation and assess for suicide risk.
💬 Rationale:
A sudden lift in mood after deep depression may mean the client has decided to end their life and now has the energy to carry it out. Safety is the top priority
This disorder is characterized by chronic, excessive worry occurring more days than not for at least six months and causes functional impairment.
What is Generalized Anxiety Disorder
💡 Rationale:
GAD involves persistent, unrealistic worry about everyday events. To meet diagnostic criteria, anxiety must persist for 6+ months and cause distress or impairment in social, occupational, or other important areas of life.
During assessment, a client with Alzheimer’s disease fabricates details about recent events to cover memory loss.
→ What is this behavior called, and how should the nurse respond?
What is Confabulation – Respond gently without confronting the false statements.
💡 Rationale: Confabulation is an unconscious attempt to maintain self-esteem; confrontation can increase anxiety and confusion.
A client on fluoxetine reports agitation, sweating, tremors, and confusion after starting St. John’s Wort. The nurse suspects this potentially fatal complication.
What is Serotonin Syndrome?
💡 Rationale:
Combining SSRIs with other serotonergic agents like MAOIs or herbal supplements (St. John’s Wort) can cause dangerously high serotonin levels. Symptoms include agitation, hyperthermia, muscle rigidity, and altered mental status.
A client with delirium is admitted with a urinary tract infection. Which nursing intervention is most effective in promoting orientation and safety?
A. Keep the room dark to minimize overstimulation
B. Frequently reorient the client to time and place using clocks and calendars
C. Assign multiple staff members for frequent care interactions
D. Use restraints if the client attempts to leave the bed
✅ Correct Answer: B. Frequently reorient the client to time and place using clocks and calendars
💬 Rationale: Delirium involves fluctuating consciousness and disorientation. Frequent reorientation and environmental cues (clocks, calendars) help reduce confusion and promote safety. Darkness and restraints increase fear and agitation.
A patient taking an SSRI for two weeks reports having “a lot more energy but still feeling hopeless.”
👉 Why is this combination of symptoms concerning, and what action should the nurse take?
It signals increased suicide risk; the nurse should immediately assess for suicidal thoughts or a plan.
💬 Rationale:
Antidepressants can restore energy before improving mood, giving the client means to act on suicidal impulses.
An imbalance in neurotransmitters—specifically increased norepinephrine and decreased serotonin and GABA—is associated with these two anxiety disorder
What are Panic Disorder and Generalized Anxiety Disorder
💡 Rationale:
Biological factors in both disorders include neurotransmitter dysregulation: high norepinephrine increases the “fight-or-flight” response, while low serotonin and GABA reduce the brain’s ability to calm itself, leading to heightened anxiety and panic.
In this stage of Alzheimer’s disease, a client may forget major personal events, deny problems, and create imaginary events (confabulation) to fill memory gaps.
What is Stage 4 of Alzheimer’s Disease?
💡 Rationale:
Stage 4 (“Mild-to-Moderate Cognitive Decline”) involves noticeable memory gaps and denial of deficits. Confabulation is a coping mechanism used to protect self-esteem as memory impairment worsens.
This therapy involves sitting in front of a 10,000-lux light box for 30–45 minutes daily to reduce melatonin and boost serotonin during winter months.
What is Light Therapy?
💡 Rationale:
Light therapy treats Seasonal Affective Disorder (SAD) by regulating biological rhythms and increasing serotonin through retinal stimulation. It helps improve mood and energy levels associated with reduced daylight exposure.
A nurse is providing education to a client newly prescribed an SSRI for major depressive disorder. Which statement by the client indicates further teaching is needed?
A. “I might not feel better for a few weeks.”
B. “I’ll call my provider if I start to feel like hurting myself.”
C. “I can stop taking the medication when I start to feel better.”
D. “I should avoid taking this with St. John’s Wort.”
✅ Correct Answer: C. “I can stop taking the medication when I start to feel better.”
💬 Rationale: SSRIs must not be discontinued abruptly due to risk of withdrawal (discontinuation syndrome). Clients must be taught to taper slowly under provider guidance.
During assessment, a depressed patient says, “I just can’t keep doing this.”
👉 What is the nurse’s most therapeutic response?
✅ Answer:
Ask directly, “Are you thinking about hurting or killing yourself?”
💬 Rationale:
Open, direct questioning about suicide shows concern and allows accurate risk assessment. Avoiding the topic increases danger.
This type of phobia involves an intense fear of being in situations or places where escape might be difficult or help unavailable if panic symptoms occur.
What is Agoraphobia
💡 Rationale:
Agoraphobia often develops as a complication of panic disorder. Clients avoid open or crowded spaces due to fear they won’t be able to escape or receive help if panic symptoms arise. Avoidance behaviors reinforce anxiety.
This classification of neurocognitive disorder is caused by or related to another disease or condition, such as HIV infection or cerebral trauma.
What is a Secondary Neurocognitive Disorder (NCD)?
💡 Rationale:
Primary NCDs (like Alzheimer’s) arise independently, while secondary NCDs occur due to another medical condition. Identifying the cause is crucial since treatment may differ or partially reverse symptoms.
To diagnose this disorder, a client must experience a depressed mood or loss of interest/pleasure in usual activities for at least two weeks, with no history of mania.
What is Major Depressive Disorder (MDD)?
💡 Rationale:
MDD involves a persistent, clinically significant decline in mood or interest, impaired functioning, and symptoms like sleep disturbance, fatigue, and poor concentration. Duration of at least two weeks differentiates it from transient sadness.
A client presents with multiple unexplained physical symptoms and frequent hospital visits with no clear medical findings. The nurse suspects a factitious disorder. Which approach is most therapeutic?
A. Confront the client directly about fabricating symptoms
B. Avoid discussing symptoms to prevent reinforcement
C. Maintain a neutral approach and treat reported symptoms as real until ruled out
D. Encourage family members to monitor the client for deceptive behavior
✅ Correct Answer: C. Maintain a neutral approach and treat reported symptoms as real until ruled out
💬 Rationale: Clients with factitious disorder intentionally produce symptoms for attention. The nurse should treat complaints as legitimate until confirmed otherwise, using nonjudgmental communication and focusing on emotional needs.
You are planning care for a newly admitted client with severe depression.
👉 List two priority nursing interventions for the first 24 hours.
✅ Answer:
Continuous suicide assessment and close observation.
Maintain a safe environment (remove sharp objects, secure belongings).
💬 Rationale:
Early hospitalization carries the highest suicide risk; nurses must ensure physical safety while beginning therapeutic rapport.
In this disorder, psychological stress converts into physical symptoms such as paralysis or pseudoseizures, yet the patient shows little concern about these symptoms.
What is Conversion Disorder
💡 Rationale:
Conversion disorder, also called functional neurological symptom disorder, involves unexplained neurological symptoms triggered by stress. The hallmark is la belle indifférence—the patient’s lack of concern about serious symptoms like paralysis or blindness.
Clients with this type of dementia often experience visual hallucinations, parkinsonian features, and rapid cognitive decline. They are also extremely sensitive to antipsychotic medications.
What is Lewy Body Dementia?
💡 Rationale:
Lewy Body Dementia is the second most common dementia after Alzheimer’s. It’s marked by the presence of Lewy bodies in the cerebral cortex and brainstem, leading to visual hallucinations, rigidity, and heightened medication sensitivity.
A nurse caring for a suicidal client removes sharp objects, uses unpredictable safety rounds, and provides one-to-one monitoring. These are examples of this nursing priority.
What are Suicide Precautions?
💡 Rationale:
Suicide precautions prioritize environmental safety, observation, and therapeutic engagement. Removing hazards and ensuring supervision prevents self-harm and supports crisis stabilization.
A client admitted for major depressive disorder states, “I finally have the energy to get things done.” The nurse notices an improved mood and affect. Which action is the priority?
A. Encourage participation in unit activities
B. Increase observation and assess for suicide risk
C. Praise the client for showing improvement
D. Review medication side effects with the client
✅ Correct Answer: B. Increase observation and assess for suicide risk
💬 Rationale: A sudden lift in mood after severe depression may indicate the client has decided to commit suicide and now has the energy to act. Priority is safety and close observation.
A client with depression says, “I finally have everything figured out. Things will be over soon.”
👉 What immediate steps should the nurse take?
Stay with the client, assess for suicidal intent and plan, notify the provider, and implement one-to-one observation.
💬 Rationale:
Vague statements suggesting finality require urgent safety measures and communication with the healthcare team.