Quiz 4: Nursing care Of The Client With Anxiety And Depression
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This is a multiple choice, multiple response and True/False answer quiz. Avoid memorizing answers as questions on future exams will be worded differently.
- 1.
A client who was recently paroled as a sex offender is in therapy for pedophilia. The client says, "I’ve served my sentence and I’m still in therapy, so why does this group have posters of me all over the neighborhood? It has my picture on it and tells all about me." Which of the following would be the therapeutic response by the nurse?
- A.
"Try to realize how fortunate you are that our society doesn't let the group escalate to more punitive measures after your crimes against children."
- B.
"Are you saying that you understand people are afraid for their children but that you feel you are being unfairly treated?"
- C.
"It's sad for you, but when children are hurt as you hurt them, people want you identified and isolated"
- D.
"You seem angry, but you must understand that your neighbors are frightened because of your serious crimes against children."
Correct Answer
B. "Are you saying that you understand people are afraid for their children but that you feel you are being unfairly treated?"Explanation
Focusing and verbalizing are therapeutic communication techniques that help relook at what the client is really saying. The correct option (2) is the only one that reflects the use of this therapeutic communication technique.Rate this question:
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- 2.
A nurse is having a conversation with a depressed client in an inpatient psychiatric unit. The client says to the nurse, “Things would be so much better for everyone if I just weren’t around.” Which response by the nurse would be appropriate at this time?
- A.
“Those feelings will go away once your medication really takes effect.”
- B.
“I know what you mean; everyone gets that way when they are depressed.”
- C.
“Have you talked to anyone specifically about what is bothering you?”
- D.
“You sound very unhappy. Are you thinking of harming yourself?”
Correct Answer
D. “You sound very unhappy. Are you thinking of harming yourself?”Explanation
Clients who are depressed may be at higher risk for suicide. When clients make statements that suggest extreme despair, the best action for the nurse is to ask the client directly about whether a specific plan for suicide has been formed.Rate this question:
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- 3.
A nurse is caring for an elderly client whose husband died approximately 6 weeks ago. The client says, "There’s no one left to care about me. Everyone that I have loved is now gone." The nurse would make which appropriate response?
- A.
“I don't believe that, and I really don’t think you do either.”
- B.
“I’m sure you have someone if you think hard enough.”
- C.
“It sounds as though you are feeling all alone right now.”
- D.
“That doesn’t sound like the real you talking!”
Correct Answer
C. “It sounds as though you are feeling all alone right now.”Explanation
The client is experiencing loss due to the recent death of her husband and is expressing feelings of hopelessness. The best therapeutic response by the nurse (3) is one that attempts to translate words into feelings.Rate this question:
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- 4.
A client who attempted suicide by overdosing with a very large number of antidepressant pills has been admitted to the psychiatric unit. The nurse, being most concerned with the client’s safety, would take which immediate action?
- A.
Have the client put on a hospital gown and remove the client’s clothing from the room.
- B.
Request that a friend of the client remain with the client at all times.
- C.
Suggest placing the client in a seclusion room where all potentially dangerous articles are removed.
- D.
Stay with the client at all times.
Correct Answer
D. Stay with the client at all times.Explanation
The plan of care for a client with a suicide attempt must reflect action by the nurse that will promote the client’s safety. Constant observation status (one on one) is the best immediate intervention.Rate this question:
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- 5.
A client has been brought to the emergency department after attempting to commit suicide by hanging. The nurse should take which nursing action first?
- A.
Examine the neck area and assess the airway
- B.
Encourage the client to talk about the experience
- C.
Administer an anxiolytic medication as prescribed at once.
- D.
Obtain a detailed history of events leading to the attempt
Correct Answer
A. Examine the neck area and assess the airwayExplanation
Following Malow's hierarchy of needs, the nurse should first assess the airway and prepare to treat injuries to the neck area. Failure to do so could be life threatening. Other interventions may follow after the client has received medical intervention for physical injuries.Rate this question:
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- 6.
A nurse working in an urgent care center is interviewing a woman with vague somatic complaints. When the nurse is alone with the client, the client states that she was raped a few weeks ago but still feels “as if it just happened to me.” The nurse should make which therapeutic response to the client?
- A.
"It is very, very hard to get over these types of feelings after being raped."
- B.
"It’s hard, but try to keep a sense of perspective. After all, it’s been a while since the rape occurred.”
- C.
"What do you think you should do to reduce the likelihood that you will be raped again?"
- D.
"Tell me more about what happened, which causes you to feel like the rape just occurred."
Correct Answer
D. "Tell me more about what happened, which causes you to feel like the rape just occurred."Explanation
The correct option (4) explores the client’s thoughts and feelings directly. Using a nonjudgmental and supportive attitude, the nurse reassures the client that her feelings are normal and may be expressed in this safe care environment. Option 1 places the client’s feelings on hold, and option 2 blocks further communication. Option 3 is likely to increase the client’s fear.Rate this question:
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- 7.
An anxious client reports to the nurse that she feels weak and dizzy. The nurse should respond by:
- A.
Helping the client relax
- B.
Giving the client something to drink
- C.
Giving the client oxygen by nasal cannula
- D.
Taking the client's vital signs
Correct Answer
D. Taking the client's vital signsExplanation
Assessment of the client's statement requires validation that the client's physical condition is stable by taking vital signs. Giving fluids may also be required, but the nursing assessment should precede any intervention. Oxygen therapy requires a physician's order.Rate this question:
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- 8.
A client is preoccupied with persistent intrusive thoughts and ideas and uses ritualistic behavior to decrease anxiety associated with the unwelcome thoughts. The most therapeutic treatment options for this client would include:
- A.
Identifying situations that precipitate compulsive behavior and encourage the client to verbalize his concerns and feelings.
- B.
Allow the client to perform the ritualistic behavior, but set limits on behaviors that might interfere with the client's physical well-being.
- C.
Recognize and reinforce positive, nonritualistic behaviors
- D.
Administer tranquilizers such as diazepam to sedate the client when the client's actions jeopardize the safety of others.
Correct Answer(s)
A. Identifying situations that precipitate compulsive behavior and encourage the client to verbalize his concerns and feelings.
B. Allow the client to perform the ritualistic behavior, but set limits on behaviors that might interfere with the client's physical well-being.
C. Recognize and reinforce positive, nonritualistic behaviorsExplanation
The description of this client's behavior matches Obsessive-Compulsive Disorder (OCD), an anxiety disorder. Anxiety disorders can be effectively treated with behaviorally-based treatments (1,2&3) and antianxiety medication. Although diazepam (Valium) is an antianxiety medication, it's used as a tranquilizer as described above is limited to emergency situations and would not be considered the best treatment option for the general management of OCD.Rate this question:
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- 9.
A 52-yr old male is brought by ambulance to the emergency department. His general appearance is unkempt and he smells of urine. He complains of inability to sleep, loss of appetite, and lack of energy. He also expresses a lack of confidence in the ability of the staff to help him with his problems and he refuses to answer questions, asking to be left alone so he can get some sleep. Which interpretation of the client's behavior is most likely?
- A.
He is unhappy about his family's request for emergency medical care. The nurse should tell the client his family only wants what's best for him.
- B.
He needs encouragement and the nurse should provide reassurance that the client has been brought to a very good health care facility and that the doctors will soon be able to make him feel better.
- C.
The client is depressed and at risk for suicide, the nurse should stay with him.
- D.
The client has the right to refuse medical treatment and the nurse should leave the room.
Correct Answer
C. The client is depressed and at risk for suicide, the nurse should stay with him.Explanation
This client's behavior could be interpreted as unhappy or resistant (choices 1, 2, or 4), but in doing so, the nurse is making a value judgment and fails to recognize the symptoms of depression and potential risk for suicide. The nurse should stay with the client until the assessment is complete and potentially life-threatening conditions have been identified and addressed.Rate this question:
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- 10.
A nurse enters the room of a middle-aged executive who is on the telephone arguing with his business partner. He abruptly hangs up the phone and becomes angry with the nurse. This client is using which coping mechanism?
- A.
Diffusion
- B.
Displacement
- C.
Denial
- D.
Decompensation
Correct Answer
B. DisplacementExplanation
Displacement is the transfer of feelings or reactions from one object to another, usually, one that is safer, such as a person who is angry with a spouse but yells at the dog instead of dealing with the anger. Diffusion and decompensation are not recognized as coping mechanisms. Denial is the refusal to acknowledge the reality of threatening situations despite factual evidence.Rate this question:
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- 11.
A nurse is caring for a client with a diagnosis of depression. The nurse monitors for signs of constipation and urinary retention, knowing that these problems are likely caused by:
- A.
Poor dietary choices
- B.
Lack of exercise and poor diet
- C.
Inadequate dietary intake and dehydration
- D.
Psychomotor retardation and side effects of medication
Correct Answer
D. Psychomotor retardation and side effects of medicationExplanation
Constipation can be related to inadequate food intake, lack of exercise and dehydration. In this case, urinary retention is most likely due to medication; therefore option (4) is the best response as it addresses side effects of antidepressant medication.Rate this question:
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- 12.
A mother of a teenage daughter with an anxiety disorder is concerned about her daughter's progress on discharge. She states that her daughter "stashes food, eats all the wrong things that make her hyperactive," and "hangs out with the wrong crowd." In helping the mother prepare for her daughter's discharge, the nurse suggests that the mother:
- A.
Restrict the daughter's socializing time with her friends
- B.
Restrict the amount of chocolate and caffeine products in the home
- C.
Keep her daughter out of school until she can adjust to the school environment
- D.
Consider taking time from work to help her daughter readjust to being at home
Correct Answer
B. Restrict the amount of chocolate and caffeine products in the homeExplanation
Clients with anxiety disorder should abstain from or limit their intake of caffeine, chocolate, or alcohol as these products have the potential of increasing anxiety. Options 1, 3, & 4 are similar as they are concerned with monitoring or limiting physical activity. Option (2) best focuses on the concern expressed by the mother than the daughter stashes food and eats things that worsen anxious behavior.Rate this question:
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- 13.
A client is unwilling to go out of the house for fear of "doing something crazy in public." Because of this, the client remains homebound, except when accompanied outside by a trusted adult. The nurse determines that the client has:
- A.
Agoraphobia
- B.
Hematophobia
- C.
Claustrophobia
- D.
Hypochondriasis
Correct Answer
A. AgoraphobiaExplanation
Agoraphobia is the fear of being alone in open or public places where escape might be difficult. The phobia includes a sense of fear, helplessness, or embarrassment if a phobic attack occurs. Avoidance of such situations usually results in reduced social interaction. Two other conditions are phobias concerned with the fear of blood and close-in places. Hypochondriasis is a condition where the client is preoccupied with their health.Rate this question:
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- 14.
A nurse collects data on a client with a diagnosis of bipolar affective disorder mania. The finding that requires the nurse's immediate intervention is:
- A.
The client's outlandish behavior and inappropriate dress
- B.
The client's grandiose delusions of being a royal descendent of King Arthur
- C.
The client's constant incessant talking that includes sexual innuendoes and teasing the staff
- D.
The client's nonstop activity and poor nutritional intake
Correct Answer
D. The client's nonstop activity and poor nutritional intakeExplanation
Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. The mood may be elevated, expansive, or irritable. Using Maslow's hierarchy of needs, nonstop activity and poor nutritional intake are physiologic needs requiring immediate intervention.Rate this question:
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- 15.
A client in a manic state emerges from her room. She is topless and is making sexual remarks and gestures toward staff and peers. The appropriate nursing action is to:
- A.
Approach the client in the hallway and insist that she go into the room
- B.
Confront the client on the inappropriateness of her behavior and offer her a time out.
- C.
Quietly approach the client, escort her to her room and assist her in getting dressed
- D.
Ask the other clients to ignore her behavior: she will eventually return to her room.
Correct Answer
C. Quietly approach the client, escort her to her room and assist her in getting dressedExplanation
The person experiencing mania lacks insight and judgment, has poor impulse control, and is highly excitable. A quiet, firm approach while distracting the client by walking to her room, achieves the goal of preserving her psychological integrity and having her be appropriately dressed. The subject of the question is the client's inappropriate dress, and recognizing this makes option (3) preferable to insisting on different behaviors or confronting the client with an option that may have no meaning for her.Rate this question:
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- 16.
A nurse reviews the activity schedule for the day and determines that the best activity that the manic client could participate in is:
- A.
A paint-by-number activity
- B.
A brown bag lunch and book review
- C.
Deep breathing and progressive relaxation exercises
- D.
Ping-pong
Correct Answer
D. Ping-pongExplanation
The person experiencing mania is overactive, full of energy, lacks concentration, and has poor impulse control. The client needs an activity that allows the use of excess energy but not endanger others in the process, making ping-pong a good choice for the manic client. The other options require concentration and are passive, which could lead to increased frustration for this client.Rate this question:
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- 17.
A woman comes into the emergency department in a severe state of anxiety following a car accident. The most important nursing intervention is to:
- A.
Put the client in a quiet room
- B.
Remain with the client
- C.
Teach the client deep breathing
- D.
Encourage the client to talk about her feelings and concerns.
Correct Answer
B. Remain with the clientExplanation
If a client is left alone with severe anxiety after a traumatic experience, he or she may feel abandoned and become overwhelmed. Putting the client in a quiet room may be indicated, but the nurse must also stay with the client. It is not possible to teach the client or encourage conversation until the client's anxiety level has decreased. Noting that the client's condition involves "severe" anxiety will direct you to the most important intervention which is to stay with the client.Rate this question:
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- 18.
Choose all nursing interventions for a hospitalized client with mania who is exhibiting manipulative behavior (Select all that apply)
- A.
Communicate expected behaviors to the client
- B.
Ensure that the client knows that he or she is not in charge of the nursing unit.
- C.
Assist the client in developing means of setting limits on personal behaviors.
- D.
Follow through about the consequences of behavior in a nonpunitive manner.
- E.
Be clear with the client about the consequences of exceeding limits set regarding behavior.
Correct Answer(s)
A. Communicate expected behaviors to the client
C. Assist the client in developing means of setting limits on personal behaviors.
D. Follow through about the consequences of behavior in a nonpunitive manner.
E. Be clear with the client about the consequences of exceeding limits set regarding behavior.Explanation
Interventions for the client with manipulative behavior includes setting clear, consistent, and enforceable limits on manipulative behavior. The client should be made aware of the consequences of exceeding the limits set in a nonpunitive manner. By focusing on the subject of the client's manipulative behavior and recalling that power struggles need to be avoided, you can determine which interventions are correct.Rate this question:
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- 19.
Nursing diagnoses for the client with bipolar disorder include all of the following, except:
- A.
Disturbed sleep pattern related to inability to sleep and sensitivity to environmental noise
- B.
Noncompliance with medication and treatment regimen related to health beliefs
- C.
Imbalanced nutrition: Less than body requirements related to constant activity and increased metabolic demand
- D.
Risk for Electrolyte Imbalance related to inadequate fluid intake and lithium therapy for bipolar disorder
- E.
Hopelessness related to feelings of loss of control and need for lifelong treatment with mood stabilizing medications
- F.
Anxiety related to inability to recall important information
Correct Answer
F. Anxiety related to inability to recall important informationExplanation
All diagnoses (1 - 5) are acceptable as the client with bipolar disorder may intensely experience both manic and depressive stages of the disorder.Rate this question:
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- 20.
The best way for a nurse to determine whether domestic violence abuse is occurring is:
- A.
Notice unusual behavior patterns, such as a father bringing children in for medical care without the mother being present.
- B.
Assess all members of the family unit, especially the children, for signs of physical injury.
- C.
The nurse should ask directly if abuse is occurring
- D.
The nurse should schedule a follow-up appointment to validate concerns
Correct Answer
C. The nurse should ask directly if abuse is occurringExplanation
Making assumptions about behavior patterns is inappropriate. Delaying or avoiding discussion about concerns puts the needs of the provider ahead of the client. The best way to determine if domestic violence and abuse are occurring is to ask directly.Rate this question:
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- 21.
A nurse answering a hotline at a rape crisis center should instruct a victim to bathe and shower before going to the Emergency department of the local hospital.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
It is important to instruct the victim NOT to bathe and shower before going to the Emergency department of the local hospital.Rate this question:
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- 22.
If a client admits that domestic violence and abuse are occurring, the most beneficial nursing intervention would be to identify resources for shelter and safety of the victim.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The most beneficial nursing intervention in the case of a client admitting to domestic violence and abuse is to identify resources for shelter and safety of the victim. This is because the priority in such situations is to ensure the safety and well-being of the victim. By providing information about resources for shelter, the nurse can help the victim find a safe place to go and escape the abusive situation. This intervention can potentially save the victim from further harm and provide them with the support they need to address the abuse.Rate this question:
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- 23.
A depressed client who is scheduled for a series of ECT treatments is most likely to experience headache and short-term memory loss in the immediate post-procedure period.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
A depressed client who undergoes a series of electroconvulsive therapy (ECT) treatments is likely to experience headache and short-term memory loss immediately after the procedure. ECT involves passing electrical currents through the brain to induce controlled seizures, which can cause side effects such as headache due to the stimulation of brain tissue. Additionally, the procedure can affect memory temporarily, leading to short-term memory loss.Rate this question:
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- 24.
A client with a specific phobia like claustrophobia typically uses avoidance as a coping mechanism to deal with fear.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Individuals with specific phobias, such as claustrophobia, often resort to avoidance as a coping mechanism to manage their fear. Avoidance involves staying away from situations or objects that trigger anxiety or distress. In the case of claustrophobia, individuals may avoid enclosed spaces, such as elevators or small rooms, to prevent feeling trapped or panicked. This behavior allows them to temporarily alleviate their fear and maintain a sense of control. Therefore, the statement is true.Rate this question:
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- 25.
Frequent panic attacks should be treated as soon as possible to decrease likelihood that the client may fear venturing from home and become reclusive.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Frequent panic attacks can significantly impact a person's daily life and mental well-being. If left untreated, these panic attacks can lead to the development of agoraphobia, which is a fear of leaving one's home or safe environment. By treating panic attacks as soon as possible, the likelihood of the client developing such fears and becoming reclusive is decreased. Therefore, it is important to address and manage panic attacks promptly to prevent further negative consequences.Rate this question:
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