Personality, Mood Disorders, and Suicidal Behavior | NCLEX Quiz 210

1. Rendell is admitted in an acute psychiatric unit at the Medical Center. He suddenly tells Nurse Matt about his plans for suicide. The nurse's priority is to:

Allow the client time alone for reflection.

Encourage the client to use problem solving.

Follow agency protocol for suicide precautions.

Stimulate the client’s interest in activities.

The nurse must act to safeguard the client from danger, including self-harm implementing the specific agency protocol for suicidal precautions would best protect the client. Option A: A client with suicidal intent should not be left alone. One-to-one observations are generally part of suicide precautions. Options B and D: Encouraging the client to use problem solving and stimulating his interest in activities would be helpful for someone with depression. However, the nurse’s priority is to protect the client by initiating suicide precautions.

Explanation

The nurse must act to safeguard the client from danger, including self-harm implementing the specific agency protocol for suicidal precautions would best protect the client. Option A: A client with suicidal intent should not be left alone. One-to-one observations are generally part of suicide precautions. Options B and D: Encouraging the client to use problem solving and stimulating his interest in activities would be helpful for someone with depression. However, the nurse’s priority is to protect the client by initiating suicide precautions.

2. An individual with depression has a deficiency in which neurotransmitters, based on the biogenic amine theory?

Dopamine and thyroxin

GABA and acetylcholine

Cortisone and epinephrine

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. Options A, B and C are not right because according to current research, dopamine, thyroxin, GABA, acetylcholine, cortisone and epinephrine are not directly related to depression.

Explanation

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. Options A, B and C are not right because according to current research, dopamine, thyroxin, GABA, acetylcholine, cortisone and epinephrine are not directly related to depression.

3. Kyle is a client with an anxious, fearful personality who has difficulty accomplishing work assignments because of his fear of failure. He has been referred to the employee assistance program because of repeated absences from work and evidence of an alcohol problem. Which nursing diagnosis would be most appropriate?

Ineffective coping

Decisional conflict

Disturbed thought process

Risk for self-directed violence

"Ineffective Coping" would be the most appropriate nursing diagnosis for Kyle. His anxious and fearful personality, difficulty in completing tasks due to fear of failure, repeated absences from work, and evidence of an alcohol problem indicate an inability difficulty in occupational functioning and coping with stressors, which aligns with the "Ineffective Coping" diagnosis.

Explanation

"Ineffective Coping" would be the most appropriate nursing diagnosis for Kyle. His anxious and fearful personality, difficulty in completing tasks due to fear of failure, repeated absences from work, and evidence of an alcohol problem indicate an inability difficulty in occupational functioning and coping with stressors, which aligns with the "Ineffective Coping" diagnosis.

4. The community nurse is following up on Mrs. Jenner who was hospitalized at the Medical Center due to depressive disorder, not otherwise specified, following the death of her spouse. In reviewing the client's chart, the nurse notes that Mrs. Jenner has an Axis II diagnosis of dependent personality disorder. Which behavior would the nurse anticipate in this client?

Difficulty making decisions, lack of self-confidence

Grandiose thinking, attention-seeking behaviors

Odd mannerisms, speech and behaviors

Unstable moods and impulsive behaviors

The client with a dependent personality disorder typically demonstrates anxious and fearful behavior and is reluctant to make decisions. Lack of self-confidence is reflective of chronic low self-esteem. The behavior in option B is characteristic of someone with dramatic, emotional, erratic personality disorder, such as narcissistic personality. The behavior in option C is characteristic of schizoid or schizotypal personality disorder, in which odd, eccentric behavior is displayed. Option D characterizes borderline personality disorder.

Explanation

The client with a dependent personality disorder typically demonstrates anxious and fearful behavior and is reluctant to make decisions. Lack of self-confidence is reflective of chronic low self-esteem. The behavior in option B is characteristic of someone with dramatic, emotional, erratic personality disorder, such as narcissistic personality. The behavior in option C is characteristic of schizoid or schizotypal personality disorder, in which odd, eccentric behavior is displayed. Option D characterizes borderline personality disorder.

5. Ralph is admitted at the Medical Center with the diagnosis of bipolar disorder with single manic episode. Which of the following behaviors would the nurse expect to assess?

Apathy, poor insight and poverty of ideas

Anxiety, somatic complaints and insomnia

Elation hyperactivity and impaired judgment

Social isolation delusional thinking and clang associations

A client with bipolar disorder, manic episode, would demonstrate flight of ideas and hyperactivity as part of the increased psychomotor activity. The mood is one of elation, and the feeling is that one is invincible. Therefore, their judgment may be quite impaired. The symptoms in option A would be more characteristic of an individual with long-term schizophrenia. The symptoms in option B would be more characteristic of someone with an anxiety disorder, although a manic individual may also not sleep because of excessive energy. The symptoms in option D are more characteristic of schizophrenia.

Explanation

A client with bipolar disorder, manic episode, would demonstrate flight of ideas and hyperactivity as part of the increased psychomotor activity. The mood is one of elation, and the feeling is that one is invincible. Therefore, their judgment may be quite impaired. The symptoms in option A would be more characteristic of an individual with long-term schizophrenia. The symptoms in option B would be more characteristic of someone with an anxiety disorder, although a manic individual may also not sleep because of excessive energy. The symptoms in option D are more characteristic of schizophrenia.

6. 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?

Allow the peer group to intervene.

Describe acceptable behavior and set realistic limits with the client.

Recommend that the client is hospitalized for treatment.

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. Option A: The peer group is not responsible for monitoring the client’s behavior. Option C: The client’s behavior does not warrant hospitalization. Option D is inappropriate because the client is told only what is unacceptable and is not given any alternatives.

Explanation

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. Option A: The peer group is not responsible for monitoring the client’s behavior. Option C: The client’s behavior does not warrant hospitalization. Option D is inappropriate because the client is told only what is unacceptable and is not given any alternatives.

7. Clara is under evaluation for imminent suicide risk. Which information given by her would be most significant?

At least a 2-year history of feeling depressed more days than not

Divorced from spouse six (6) months ago

Feeling loss of energy and appetite

Reference to suicide as best solution to identified problems

An individual who talks about suicide as a solution to a problem is at high risk. This client’s suicidal threats need to be taken seriously because he does not see any other variable solutions to problems in living. Options A, B and C: All of the factors included in the other options would increase the client’s risk for depression. However, actual statements about suicidal intent are red flags indicating imminent danger.

Explanation

An individual who talks about suicide as a solution to a problem is at high risk. This client’s suicidal threats need to be taken seriously because he does not see any other variable solutions to problems in living. Options A, B and C: All of the factors included in the other options would increase the client’s risk for depression. However, actual statements about suicidal intent are red flags indicating imminent danger.

8. Nurse Rica 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?

Brain structure abnormalities

Chemical imbalance

Social environment

Recessive gene transmission

Chemical imbalance of neurotransmitters in the brain is the most significant factor in depression. However, the exact cause has not been established, so other factors may also be involved. Option C: A person’s social environment, including lack of support systems, may also increase the risk of depression. Option D: Although genetic transmission certainly may be a factor, no definite pattern of transmission has been identified.

Explanation

Chemical imbalance of neurotransmitters in the brain is the most significant factor in depression. However, the exact cause has not been established, so other factors may also be involved. Option C: A person’s social environment, including lack of support systems, may also increase the risk of depression. Option D: Although genetic transmission certainly may be a factor, no definite pattern of transmission has been identified.

9. Which mood disorder is characterized by the client feeling depressed most of the day for a 2-year period?

Cyclothymia

Dysthymia

Melancholic depressive disorder

Seasonal affective disorder

Dysthymia is characterized by at least a 2-year history of depression, occurring most of the day for more days than not. Option A: Cyclothymia is characterized by at least two years of several periods of hypomanic symptoms. Option C: Melancholic depressive disorder is characterized by either anhedonia in relation to all activities or lack of mood reactivity to usually pleasurable stimuli. Option D: Seasonal affective disorder is characterized by depressed feelings in fall and winter, associated with loss of sunlight.

Explanation

Dysthymia is characterized by at least a 2-year history of depression, occurring most of the day for more days than not. Option A: Cyclothymia is characterized by at least two years of several periods of hypomanic symptoms. Option C: Melancholic depressive disorder is characterized by either anhedonia in relation to all activities or lack of mood reactivity to usually pleasurable stimuli. Option D: Seasonal affective disorder is characterized by depressed feelings in fall and winter, associated with loss of sunlight.

10. Tekla is hospitalized at a Medical Center following a suicide attempt. His history reveals a previous diagnosis of schizoid personality disorder. Which of the following behaviors would be atypical of a client with this disorder?

Actions designed to please the nurse

Limited expressions of feelings and emotions

Odd ideas and mannerisms

Reluctance to join group activities

A client with schizoid personality disorder is typically detached, aloof and socially isolated. He has no interest in seeking the approval of others and would not behave in ways to please the nurse. The behaviors included in the remaining options are characteristic of someone with schizoid personality disorder.

Explanation

A client with schizoid personality disorder is typically detached, aloof and socially isolated. He has no interest in seeking the approval of others and would not behave in ways to please the nurse. The behaviors included in the remaining options are characteristic of someone with schizoid personality disorder.

Personality, Mood Disorders, And Suicidal Behavior | NCLEX Quiz 210