A nurse is assessing a client who has been diagnosed with persistent depressive disorder (dysthymia). Which of the following findings should the nurse expect?

Correct Answer: C

Rationale: The correct finding the nurse should expect in a client diagnosed with persistent depressive disorder (dysthymia) is a lack of interest in activities. This disorder is characterized by a chronic depressive mood lasting for at least two years, alongside symptoms such as changes in appetite, fatigue, low self-esteem, and difficulty concentrating. Clients with dysthymia do not typically experience hypomania, periods of elevated mood, or feelings of detachment from one's body, which are more commonly associated with other mood disorders. Therefore, options A, B, and D are incorrect findings for a client with persistent depressive disorder.

Correct Answer: B

Rationale: The most appropriate response is **B: "I don't see any FBI agents, but it sounds like you're feeling frightened."** **Rationale for Correct Answer (B):** This response validates the patient's emotional experience without reinforcing the delusion, which is crucial in therapeutic communication for paranoid schizophrenia. By acknowledging the patient’s fear ("it sounds like you're feeling frightened"), the nurse demonstrates empathy and builds trust. Simultaneously, the nurse avoids reinforcing the delusion by stating, "I don’t see any FBI agents," which gently introduces reality without confrontation. This approach aligns with evidence-based psychiatric nursing practices, which emphasize reducing distress while avoiding arguments that could escalate paranoia or damage rapport. **Rationale for Incorrect Answers:** **A: "You shouldn't worry about that. It's not real."** This response dismisses the patient's experience, which can increase distress and reinforce feelings of isolation. Telling a delusional patient that their beliefs "aren’t real" is counterproductive—it doesn’t address the underlying fear and may provoke defensiveness. Effective psychiatric care focuses on managing distress, not challenging delusions outright. **C: "Let's talk about something else to take your mind off of it."** While distraction can sometimes be useful, this response avoids addressing the patient’s immediate emotional state. Ignoring the delusion may leave the patient feeling unheard, worsening their anxiety. Therapeutic communication requires engagement with the patient’s concerns, even if the content of the delusion isn’t validated. **D: "Why do you think the FBI is watching you?"** Asking for justification of a delusion can reinforce paranoid ideation by encouraging the patient to elaborate on false beliefs. Probing questions may also increase agitation, as the patient might perceive the nurse as doubting or investigating them. This approach risks deepening the delusion rather than alleviating distress. The correct response (B) balances empathy with gentle reality orientation, which is essential in managing paranoid schizophrenia. The incorrect choices either dismiss emotions, avoid the issue, or inadvertently worsen delusional thinking. Understanding these distinctions is critical for effective mental health nursing interventions.

Correct Answer: B

Rationale: Anhedonia is the inability to experience pleasure from activities usually found enjoyable. The statement 'I don't enjoy the things I used to love' directly reflects this symptom as the client is expressing a lack of pleasure from previously enjoyable activities. Choices A, C, and D do not specifically relate to anhedonia but rather indicate symptoms of anxiety, concentration difficulties, and sleep disturbances, respectively.

Correct Answer: B

Rationale: In a manic episode, 'Flight of ideas' is characterized by rapid speech, where the individual moves quickly between topics without a clear connection. This symptom reflects the racing thoughts and impulsivity often seen in manic episodes. Circumstantiality refers to unnecessary detail and delay in getting to the point, tangentiality involves going off on a tangent or unrelated topics, and perseveration is the persistent repetition of a response or behavior. Therefore, 'Flight of ideas' best describes the symptom of rapidly changing topics during a manic episode.

Correct Answer: B

Rationale: Allowing the client to perform rituals in the early stages of treatment is a common therapeutic approach for obsessive-compulsive disorder (OCD). Allowing the client to engage in rituals can help reduce anxiety by providing temporary relief. It is a part of exposure therapy, where the individual is gradually exposed to anxiety-provoking situations. As treatment progresses, the focus shifts to gradually reducing the frequency and intensity of rituals through interventions like exposure and response prevention therapy. Discouraging the client from performing rituals (Choice A) is not recommended as it may increase anxiety and resistance to treatment. Encouraging the client to focus on their compulsions (Choice C) may reinforce the behavior rather than helping to decrease it. Isolating the client (Choice D) is not therapeutic and can lead to feelings of abandonment and worsen symptoms.