Disorders
This disorder includes at least one manic episode.
Bipolar 1 disorder
Which condition is contraindicated for st john's wort herbal therapy?
A anxiety
B seizures
C dementia
D cardiac disease
Dementia
St John's wort is contraindicated for dementia; this herbal therapy is used to treat anxiety. Bupropion therapy is contraindicated for seizures. Valerian is contraindicated for cardiac disease.
Term for legal exception to confidentiality.
Duty to warn
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
ANS: A
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.
This combination is known as a chemical restraint.
B52 (Benadryl + Haldol + Ativan)
A client is diagnosed with persistent depressive disorder (dysthymia). Which symptom is most characteristic of this disorder?
A. Short periods of elevated mood alternating with depression
B. Chronic low mood lasting at least 2 years in adults
C. Sudden onset of intense sadness triggered by a specific event
D. Psychotic features with hallucinations and delusions
B – Dysthymia is characterized by chronic low-grade depression lasting ≥2 years.
This medication is safest for anxiety in patients with liver disease or alcohol withdrawal.
Lorazepam (ativan)
A client refuses to accept their diabetes diagnosis and says, “I don’t have diabetes; the doctor is wrong.” This is an example of:
A. Projection
B. Denial
C. Regression
D. Compensation
B – Denial = refusing to acknowledge reality.
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.”
ANS: A
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.
Legal term describes inability to care for basic needs.
Grave disability (GD)
Which are risk factors for developing mood disorders?
A. Family history of depression or bipolar disorder
B. Chronic medical illness
C. High resilience and strong social support
D. Recent traumatic life events
E. Substance abuse
A, B, D, E – Protective factors like resilience and social support decrease risk.
A patient taking benzodiazepines becomes very drowsy with a respiratory rate of 8.
What is the nurse’s FIRST action?
Administer flumazenil (antidote)
A client with low self-esteem works extra shifts to gain approval from the supervisor. This defense mechanism is:
A. Compensation
B. Regression
C. Splitting
D. Projection
A – Compensation = overachieving to cover perceived deficiencies.
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.
A client with social anxiety disorder expresses fear of attending a work party. The nurse recognizes that the client’s fear is an example of:
A. Agoraphobia
B. Specific phobia
C. Avoidant behavior
D. Obsessive-compulsive behavior
C – Avoidance is a hallmark of social anxiety disorder.
Which are appropriate nursing interventions for a manic patient? (Select all that apply)
A, C, D
Which antidepressant medication is a selective monoamine oxidase-B inhibitor?
A. Selegiline
B. Phenelzine
C. Isocarboxazid
D. Tranylcypromine
Selegiline is a selective monoamine oxidase-B inhibitor. Phenelzine, isocarboxazid, and tranylcypromine are nonselective monoamine oxidase-A and monoamine oxidase-B inhibitors.
A nurse is counseling a 70-year-old client who expresses regret about life choices and fears death. According to Erikson, this client is likely experiencing which stage?
A. Integrity vs. Despair
B. Generativity vs. Stagnation
C. Identity vs. Role Confusion
D. Autonomy vs. Shame and Doub
A – In later adulthood, the challenge is integrity vs. despair.
Key teaching points for SSRIs:
✓ 4–6 weeks for effect
✓ Avoid abrupt discontinuation
✓ Monitor for serotonin syndrome
A child with ASD is nonverbal and avoids eye contact. Which nursing intervention promotes communication?
A. Force the child to make eye contact while speaking.
B. Use visual aids and gestures to communicate needs.
C. Ignore the child until they attempt verbal communication.
D. Limit interactions to avoid overstimulation.
B – Visual supports and gestures are effective communication strategies for nonverbal children with ASD.
Which are common characteristics of autism spectrum disorder? Select all that apply
A. Difficulty with social interaction
B. Repetitive behaviors or routines
C. Strong preference for change and novelty
D. Delayed or atypical speech development
E. Heightened sensitivity to sensory stimuli
A, B, D, E – Children with ASD often prefer routines rather than change.
A patient on MAOIs reports a severe headache and high BP after eating pizza and wine.
What is the priority action?
Recognize hypertensive crisis and notify provider immediately
A client who is angry at their spouse punches a pillow instead of their spouse. Freud would identify this as:
A. Projection
B. Displacement
C. Reaction formation
D. Rationalization
B – The emotion is redirected to a safer object.
A nurse is planning care for an older adult with depression, poor appetite, and social isolation. Which intervention takes priority according to Maslow and Erikson?
A. Provide meals and monitor nutritional intake
B. Encourage participation in a social group
C. Support the client in life review and reflection
D. Assign journaling for self-expression
A – Physiological needs (Maslow) take priority, then psychosocial tasks like reflection (Erikson).
A client has social anxiety disorder and fears speaking in front of the class. The most appropriate nursing intervention:
A. Encourage exposure therapy gradually
B. Avoid any public speaking opportunities
C. Assign them to present immediately
D. Teach deep breathing after the class
A – Gradual exposure reduces anxiety safely.