Mary Rose S.

Gargar
BSN-III

NCM 105 - CARE OF CLIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR

MARCH 24, 2020 ACTIVITY #2 MOOD DISORDER BIPOLAR DISORDER

INSTRUCTION: Please choose the correct answer. Color RED your chosen answer. Add rationalization to your chosen
answer and color it BLUE.

Situation: Two days ago, Maggie arrived on the psychiatric unit, exhibiting extreme excitement, disorientation,
incoherent speech, agitation, frantic, aimless physical activity, and grandiose delusions. Maggie is in a manic episode.
1. Which assessment finding is most characteristic of this stage of mania?
A. mild elation
B. hypomania
C. acute elation
D. delirium
A lowered sate of mania that does a little to impair function or decrease quality of life. Increase productivity and
creativity.

2. Which nursing diagnostic category would hold the highest priority for Maggie at this time?
A. ineffective individual coping
B. hopelessness
C. potential for injury
D. personal identity disturbance
In mania, the risk are generally related to heightened risk taking behaviour, but periods of severe depression ca
arise during manic episode and carry risk of self-injury or injury to others.

3. Maggie is assigned to a private room that is somewhat remote from the nurse's station. The primary reason for
this room assignment is to:
A. decrease environmental stimuli
B. prevent the patient's excessive activity from disturbing others
C. deter the patient from interrupting the nurses
D. provide the patient with a quiet environment for thinking about his problems
Baseline functioning behaviours decrease while disruptive behaviours increase, reflecting a decreased ability to
adapt and understand stimuli. Interventions that decrease environmental stimuli and individual stressors will
reduce stress and promote appropriate behaviour.

4. When the nurse is caring for a depressed patient, the problem that should receive the highest nursing priority is:
A. powerlessness.
B. suicidal ideation.
C. inability to cope effectively.
D. anorexia and weight loss.
One key development is the ideation-to-action framework, which stipulates that (a) the development of suicidal
ideation and (b) the progression from ideation to suicide attempts are distinct phenomena with distinct
explanations and predictors. A second key development is a growing body of research distinguishing factors that
predict ideation from those that predict suicide attempts.

5. Which response to a patient experiencing depression would be helpful from the nurse?
A. “Don’t worry, we all get down once in a while.”
 B. “Don ’t consider suicide. It’s an unacceptable option.”
C. “Try to cheer up. Things always look darkest before the dawn.”
D. “I can see you’re feeling down. I’ll sit here with you for a while.”
Presence is important when you see patient is feeling down. Be there to listen always.

6. The nurse is assigned to care for a 39-year-old, hyperactive, elated client who exhibits flight of ideas. The client
is not eating. The nurse recognizes this maybe because the client:
A. Feels undeserving of the food
B. Is too busy to take the time to eat
C. Wishes to avoid the clients in the dining room
D. Believes that at this time there is no need for food
Flight of ideas describes excessive speech at a rapid rate that involves fragmented or unrelated iseas. It is common
in mania.

7. A client is receiving lithium carbonate. While this medication is being administered, it is important that the
nurse;
A. test the client’s urine weekly
B. restrict the client’s sodium intake
C. monitor the client’s blood level regularly
D. Withhold the client’s other medications for one week
Blood levels are often done five days after a dosage change as it takes some time for the levels to stabilize. Levels
should also be checked if any new medications that can impact lithium levels are added or discontinued, as many
medications interact with lithium.

8. A client with a diagnosis of major depression, recurrent with psychotic features is admitted to the mental health
unit. To create a safe environment for the client, the nurse most importantly devises a plan of care that deals
specifically with the clients:
A. Disturbed thought process
B. Self Care Deficit
C. Imbalanced Nutrition
D. Deficient Knowledge
Major depression, recurrent, with psychotic features alerts the nurse that in addition to the criteria that designate
the diagnosis of major depression, one also must deal with the client's psychosis. Psychosis is defined as a state in
which a person's mental capacity to recognize reality and to communicate and relate to others is impaired, thus
interfering with the person's capacity to deal with the demands of life. Altered thought processes generally
indicate a state of increased anxiety in which hallucinations and delusions prevail.

9. An individual with depression has a deficiency in which neurotransmitters, based on the biogenic amine theory?
A. Dopamine and thyroxin
B. GABA and acetylcholine
C. Cortisone and epinephrine
D. Serotonin and norepinephrine
The biogenic amine theory of depression describes deficiencies in the neurotransmitters serotonin and
norepinephrine. Antidepressants medications increase the levels of these neurotransmitters and therefore help to
relieve depressive symptoms.

10. In a day treatment program, a manic client is creating considerable chaos, behaving in a dominating and
manipulative way. Which nursing intervention is most appropriate?
A. Allow the peer group to intervene.
B. Describe acceptable behavior and set realistic limits with the client.
C. Recommend that the client be hospitalized for treatment.
D. Tell the client that his behavior is inappropriate.
In this situation, it would be appropriate for the nurse to suggest alternative behaviors in place of unacceptable
ones to help the client gain self-control.
11. Nurse Kim is teaching a client and her family about the causes of depression. Which of the following causative
factors should the nurse emphasize as the most significant?
A. Brain structure abnormalities
B. Chemical imbalance
C. Social environment
D. Recessive gene transmission
A chemical imbalance in the brain occurs when a person has either too little or too much of certain
neurotransmitters. Neurotransmitters are the chemical messengers that pass information between nerve cells.
Examples of neurotransmitters include serotonin, dopamine, and norepinephrine.

12. Which mood disorder is characterized by the client feeling depressed most of the day for a 2-year period?
A. Cyclothymia
B. Dysthymia
C. Melancholic depressive disorder
D. Seasonal affective disorder
Dysthymia is a type of low-grade depression that lasts for at least
two years. Dysthymia is less severe than major depression, but the chronic symptoms
often have negative effects on work, relationships, and family and social interactions

13. Using cognitive-behavioral therapy, which treatment would be appropriate for a client with depression?
A. Challenging negative thinking
B. Encouraging analysis of dreams
C. Prescribing antidepressant medications
D. Using ultraviolet light therapy
CBT focuses on challenging and changing unhelpful cognitive distortions and behaviours, improving emotional
regulation and the development of personal coping strategies that target solving current problems.

14. Nurse Janine is assessing James who is diagnosed with bipolar disorder. The nurse would expect to find a
history of:
A. a depressive episode followed by prolonged sadness.
B. a series of depressive episodes that recur periodically.
C. symptoms of mania that may or may not be followed by depression.
D. symptoms of mania that include delusional thoughts.

15. Nurse Mark teaches the family of a client with major depression disorder. Which of the following information
should be included in the teaching? Select all that apply.
A. Depression is characterized by sadness, feelings of hopelessness, and decreased self-worth
B. It is common for a depressed individual to have thoughts of suicide.
C. Attempts to cheer up a person with depression are often helpful.
D. Talk therapy, along with antidepressant medications, is usually the treatment.
E. Someone with depression may be preoccupied with spending money and too busy to sleep.
F. Encourage a person with depression to keep a regular routine of activity and rest.
These statements about major depressive disorders provide correct information and will be helpful to the client’s
family. Option C is incorrect; it is better to acknowledge the client’s sad mood and offer reassurance that his
mood will improve. Option E is more characteristic of someone in a manic phase of bipolar disorder.

16. The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and
using elaborate hand gestures. The nurse concludes that the client is demonstrating which of the following?
A. Aggression
B. Anger
C. Anxiety
D. Psychomotor agitation
Psychomotor agitation is a symptom related to a wide range of mood disorders. People with this condition engage
in movements that serve no purpose. Examples include pacing around the room, tapping your toes, or rapid
talking. Psychomotor agitation often occurs with mania or anxiety.
17. Which of the following typifies the speech of a person in the acute phase of mania?
A. Flight of ideas
B. Psychomotor retardation
C. Hesitant
D. Mutism
A flight of ideas occurs when a person rapidly shifts between conversation topics, making his or her speech
challenging or even impossible to follow.

18. What are the most common types of side effects from SSRIs?
A. Dizziness, drowsiness, and dry mouth
B. Convulsions and respiratory difficulties
C. Diarrhea and weight gain
D. Jaundice and agranulocytosis

19. Which of the serum lithium level is correct for maintenance and safety.
A. 0.1 to 1.0 mEq/L
B. 0.5 to 1.5 mEq/L
C. 10 to 50 mEq/L
D. 50 to 100 mEq/L
Patients with bipolar disorder on long-term treatment with lithium are typically maintained at serum lithium
concentrations between 0.6 and 1.0 mEq/L. Although there are individual exceptions, serum lithium levels below
0.6 mEq/L have been shown in controlled clinical trials to be less effective in preventing relapses than levels
within this range, whereas levels much above 1.2 mEq/L can lead to toxicity.

20. In Bipolar II Disorder, major depressive episodes alternate with periods of:
A. Hyperventilation.
B. Hypomania.
C. Hypothermia.
D. Hypoxia.
Hypomania: Mild episodes of mania.

21. In Major Depression, which of the following is a significant neurotransmitter?

A. Serotonin.
B. Dopamine.
C. Beta-carotene.
D. Acetylcholine.
Serotonin: An important brain neurotransmitter.

22. Which of the following neurotransmitters is associated specifically with Bipolar Disorder:
A. Serotonin.
B. Norepinephrine.
C. Dopamine.
D. Acetylcholine.
Norepinephrine: An adrenal hormone which functions as a neurotransmitter and is also used as a drug to raise
blood pressure.

23. In psychoanalytic theories of depression, introjection is a problem because?

A. Not everyone experiences anger.
B. Not everyone who experiences depression has lost a loved one.
C. Not everyone believes in Freud's stages of development.
D. Not everyone who loses a loved one develops depression.
Introjection: A response to a loss where the individual regresses to the oral stage of development, and this allows
them to integrate the identity of the person they have lost with their own.

24. Which of the following is a behavioral symptom exhibited by individuals suffering unipolar depression?
A. Unpredictable and erratic behavior.
 B. Compulsive checking.
C. Stay in bed for long periods.
D. Ritualized behavior.
Unipolar Depression: A psychological disorder characterised by relatively extended periods of clinical depression
which cause significant distress to the individual and impairment in social or occupational functioning.

25. Seligman's theory of depression proposed that life experiences could give rise to a cognitive set termed:
A. Introjection.
B. Learned Helplessness.
C. Negative triad.
D. Attribution theory.
Learned Helplessness: A theory of depression that argues that people become depressed following unavoidable
negative life events because these events give rise to a cognitive set that makes individuals learn to become
'helpless', lethargic and depressed.

26. Beck's Cognitive Theory proposes that individuals suffering from depression have developed:
A. Negative schema.
B. Lowered levels of Serotonin.
C. Introjected loss.
D. Negative social behavior.
Negative Schema: A set of beliefs that tends individuals toward viewing the world and themselves in a negative
way.

27. Which method would a nurse use to determine a client’s potential risk for suicide?
A. Wait for the client to bring up the subject of suicide.
B. Observe the client’s behavior for cues of suicide ideation.
C. Question the client directly about suicidal thoughts.
D. Question the client about future plans.
Question the client directly about suicidal thoughts. -directly questioning a client about suicide is important to
determine suicide risk. the client may not bring up this subject for several reasons, including guilt regarding
suicide, wishing not to be discovered, and his lack of trust in staff. behavioral cues are important, but direct
questioning is essential to determine suicide risk. indirect questions convey to the client that the nurse is not
comfortable with the subject of suicide and, therefore, the client may be reluctant to discuss the topic.

28. The nurse correctly teaches a client taking the Benzodiazepine Oxazepam (Serax) to avoid excessive intake of:
A. Cheese
B. Coffee
C. Sugar
D. Shellfish
Coffee contains caffeine which has a stimulating effect on the central nervous system that will counteract the
effect of the antianxiety medication oxazepam.
29. A client taking the Monoamine Oxidase Inhibitor (MAOI) Antidepressant Isocarboxazid (Marplan) is
instructed by the nurse to avoid which foods and beverages?
A. Aged cheese and red wine
B. Milk and green, leafy vegetables
C. Carbonated beverages and tomato products
D. Lean red meats and fruit juices
Aged cheese and red wines contain the substance tyramine which, when taken with an MAOI, can precipitate a
hypertensive crisis. The other foods and beverages do not contain significant amounts of tyramine and, therefore,
are not restricted.

30. The nurse is teaching a group of clients about the Mood-Stabilizing-medication Lithium Carbonate. Which
medications should she instruct the clients to avoid because of the increased risk of Lithium toxicity?
A. Antacids
B. Antibiotics
C. Diuretics
 D. Hypoglycemic agents
The use of diuretics would cause sodium and water excretion, which would increase the risk of lithium toxicity.
Clients taking lithium carbonate should be taught to increase their fluid intake and to maintain normal intake of
sodium. Concurrent use of any of the remaining medications will not increase the risk of lithium toxicity.

This portion don’t require rationalization:

a. ASSESSMENT OF DEPRESSION:

b. ASSESSMENT FOR MANIA: 

c. ASSESSMENT FOR SUICIDE: