Mood Disorder

1. Nursing care of the depressed and the manic patient are similar in that both call for: a. Providing challenging group interactions. b. Limiting stimulation. c. Observation of intake and sleep pattern. d. Suicide and escape precautions. 2. Which of the following is a priority assessment for the patient with major depression? a. Nutritional status. b. Fluid and electrolyte balance. c. Suicidal ideation. d. Mood and affect. 3. A patient who has been diagnosed with seasonal affective disorder asks the nurse, "Will I ever feel better?" The best response, based on understanding of this psychopathology, is: a. "Your low mood will probably spontaneously improve in 6 months to a year." b. "Usually people who have seasonal mood swings feel better in the spring and summer when there is more light." c. "Unfortunately, the antidepressant medications are not particularly effective in treating this disorder." d. "Most people with this disorder feel better during the fall and winter as the experience the pleasure of the holiday season." 4. To plan effective care for a depressed patient, the nurse must be aware of what relationship between emotional pain and apathy? a. There is no relationship. b. Apathy produces emotional pain. c. Extreme emotional pain causes "shut down," resulting in apathy. d. Emotional pain produces anxiety, which, in turn, produces apathy. 5. To plan care for a patient with severe major depressive disorder, the nurse will make it a priority to: a. Avoid creating a stressful situation by asking for patient participation. b. Assess patient cognition and ability to participate in planning. c. Include teaching about the possibility of developing mania. d. Advise the patient the electroconvulsive therapy (ECT) may be indicated.

6. A patient with bipolar disorder is to be discharged on a maintenance dose of lithium. The nurse plans teaching to foster compliance. Which factor will be of least consequence in developing the teaching plan? a. Lithium side effects are unpleasant. b. The patient enjoys feeling energetic. c. The patient feels well and denies the possibility of relapse. d. Auditory hallucinations tell the patient he/she is being poisoned. 7. What can a nurse do to avoid feelings of frustration when establishing a relationship and working with a severely depressed patient? Expect the patient to: a. Be receptive to the plans for nursing care. b. Be withdrawn and disinterested in a relationship. c. Show signs of improvement after several scheduled dessions. d. Show gratitude for attention. 8. In planning care for a newly admitted patient with depression, the highest priority for the nurse is: a. Orienting the patient to the unit. b. Encouraging expression of feelings. c. Providing a safe environment. d. Meeting the patient at an appropriate affective level. 9. During the interview with a depressed person, it is important for the nurse to assess for impaired social interactions to determine: a. Disruptions in relationships with others. b. Need for diversional activities therapy. c. Patient ability to make decisions about care. d. Need for patient to participate in a "no-haem" contract with staff. 10. A principle of value when interacting with a patent who is experiencing a manic episode is: a. Use a calm, matter-of-fact approach. b. Avoid mentioning limits. c. Do not interrupt patient. d. Encourage joking. 11. A depressed patient who is receiving a tricyclic antidepressant tells the nurse, "My mood is a little better, but I'm so sleepy all the time that I can't do much of anything." The nurse should: a. Tell the patient that the sleepiness will probably wear off in about 6 weeks. b. Suggest to the physician that the medication be administered in one bedtime dose. c. Withhold the drug until the physician examines the patient. d. Perform a mental status examination on the patient.

12. A patient who lives at home and is on maintenance doses of lithium should be advised to maintain an adequate dietary intake of: a. Protein. b. Calcium. c. Glucose. d. Sodium. 13. A priority nursing intervention for a patient who underwent his first electroconvulsive therapy (ECT) treatment a half hour ago would be: a. Monitoring vital signs. b. Offering oral fluids. c. Encouraging group interaction. d. Evaluating ECT effectiveness. 14. What characteristic usually manifested by an individual during a manic episode can be used positively as a part of nursing intervention? a. Distractibility b. Clang association c. Flight of ideas d. Poor concentration 15. Based on the patient's behavior and ideation, which of the following personality types would the nurse interviewing a patient with major depression be most likely to identify? a. Egocentric b. Eccentric c. Narcissistic d. Dependent 16. Which symptom related to disordered communication is the nurse most likely to assess in a patient who is having a manic episode? a. Mutism b. Flight of ideas c. Loose associations d. Echolalia 17. The side effect of lithium the nurse can expect the patient to demonstrate when the serum lithium level is within the therapeutic range include: a. Extreme thirst and vomiting. b. Polyuria and fine hand tremor. c. Ataxia and orthostatic hypotension. d. Confusion, restlessness, and sleeplessness.

18. A parameter that should be observed when planning activities for a manic patient is: a. Promote group activities. b. Avoid competitive activities. c. Discourage solitary activities. d. Require attendance at the community meetings. 19. a 60-year-old man who cones to the health clinic for his annual flu shot tells the nurse he feels tired all the time, finds little pleasure in things anymore, and has difficulty sleeping. The best nursing intervention would be to: a. Have him remain in the clinic until evaluated by a mental health professional. b. Instruct him in how to manage these typical complaints associated with aging. c. Explore his psychiatric history and futher assess his current mental status. d. Explain that this is not a psychiatric clinic and provide a follow-up referral. 20. Information given to a depressed patient and his or her family when the patient id begun on tricyclic antidepressant therapy should include a. The need to avoid exposure to bright sunlight. b. The fact that mood improvement may take 7 to 28 days. c. Instructions to restrict sodium intake to 1 g daily. d. The need to maintain a tyramine-free diet. 21. The nurse who presents a psycho-education program to patients with bipolar disorder and their families mentions that the sighs of impending relapse include: a. Sleep disturbance and racing thoughts. b. Diarrhea, thirst, and gross tremor. c. Complacency with the status quo and agreeability. d. Sense of pleasure in feeling well, optimistic outlook. 22. What initial nursing intervention is appropriate to take in the immediate postelectroconvulsive therapy (ECT) treatment period? a. Place the patient in the lateral position. b. Repeatedly stimulate the patient to respond. c. Assist the patient to sit up, then ambulate. d. Begin forcing fluids.

23. A patient with depression is pacing and pulling at her clothing constantly. She wrings her hands and cannot sit for longer than 5 minutes, even at meals. The nurse would document this behavior as: a. Senility. b. Hypomanic activity. c. Psychomotor agitation. d. Catatonic excitement. 24. A depressed patient is admitted following a suicide attempt. She had taken an overdose of sedatives and was found by her husband. Presently she states that she is too tired to consider signing a no-harm contract and that she is angry that her spouse thwarted her attempt. What, if any, level of suicide precautions should the nurse recommend? a. No precautions. b. Routine observation appropriate for all patients. c. Every-15-minute observation by staff. d. One-to-one continuous supervision by staff. 25. A student nurse caring for a depressed patient reads the following in the patient's medical record: "This patient clearly shows the vegetative signs of depression." What can the student expect to observe? a. Suicidal ideation. b. Feelings of hopelessness, helplessness, and worthlessness. c. Constipation, anorexia, and sleep disturbance. d. Anxiety and psychomotor agitation. 26. Seclusion is being considered for a severely hyperactive, aggressive manic patient. Which rational explains the usefulness of this intervention? a. It permits uninterrupted nursing intervention time with other patients. b. It assists in limit setting, enabling the patient to learn to follow unit rules. c. It is an effective way of protecting the patient until medication can take effect. d. It provides reduction of environmental stimuli that impact negatively on the patient.