Community Mental Health EAQ

A client who was admitted to the psychiatric unit because of a major depressive disorder is exhibiting increasingly withdrawn behavior. The nurse understands that eventually the client will experience what feelings?

Isolation In an attempt to control anxiety, the client continues to retreat from people and the activities within the environment; this will eventually precipitate feelings of loneliness and isolation. Depressed clients exhibit a decreased interest in pleasurable activities (anhedonia) rather than an excessive interest in pleasurable activities (hedonia). Paranoia may be a cause, not a result, of withdrawal. Ambivalence, or experiencing conflicting emotions at the same time, is not precipitated by depression.

A client with recurrent episodes of depression comes to the mental health clinic for a routine follow-up visit. The nurse suspects that the client is at increased risk for suicide. What is a contributing factor to the client's risk for suicide?

Overwhelming feelings of guilt Overwhelming feelings of guilt contribute to the client's risk for suicide. The client may ruminate over past or current failings, and extreme guilt can assume psychotic proportions. Psychomotor retardation and decreased physical activity are clinical findings associated with depression and usually do not lead to suicide because the client does not have the energy for self-harm. Impulsive behaviors, not deliberate thoughtful behaviors, contribute to the client's risk for suicide.

A client is admitted to the hospital with a diagnosis of depression. What clinical manifestations of depression does the nurse expect when assessing this client?

Psychomotor retardation Both thought and motor activity, which require physical and psychic energy, are commonly slowed when someone is depressed. Flight of ideas is associated with manic behavior because it requires psychic energy. Suspicion is associated with paranoid ideation and is less common with depression. Intrusive social behaviors are associated with manic behavior.

A nurse is caring for a newly admitted client with obsessive-compulsive disorder. When should the nurse anticipate that the client's anxiety level will increase?

When limits are set on the performance of a ritual Setting limits on the performance of a ritual will increase the client's anxiety. The ritual is a defense that the client needs at this time to control anxiety. The client needs time to develop other defenses before the ritual can be limited. The precipitation of anxiety in a client with obsessive-compulsive disorder is usually unrelated to the time of day. Visits from family members may or may not precipitate anxiety. Researchers have implicated trauma to the basal ganglia or cortical connections or a genetic predisposition as the origin of obsessive-compulsive disorder. A physical assessment by the nurse may or may not precipitate anxiety. The presentation of a nonjudgmental, supportive attitude by the nurse should decrease, not increase, anxiety.

What should the nurse teach parents about childhood depression?

may appear as acting-out behavior Children have difficulty verbally expressing their feelings; acting-out behaviors, such as temper tantrums, may indicate an underlying depression. Many conventional therapies for adults with depression, including medication, are effective for children with depression. Adult and childhood depression may be manifested in different ways. Childhood depression is not necessarily short and requires treatment.

The nurse assesses a client with the diagnosis of bipolar disorder, manic episode. Which clinical findings support the diagnosis? Select all that apply.

Grandiosity Distractibility Talkativeness Grandiosity, manifested by extravagant, pompous, flamboyant beliefs about the self, frequently occurs during the manic phase of bipolar disorder. As mania increases, the client's rate of speech increases, and speech is delivered with urgency (pressured speech). Clients experiencing manic episodes have difficulty blocking out incoming stimuli, which results in distractibility and responses to irrelevant stimuli. Passiveness is exhibited when clients turn anger inward and show little emotion. It frequently occurs during the depressive stage of bipolar disorder. Dysphoria, a depressed, sad mood, is associated with the depressive stage of bipolar disorder. Anhedonia, an inability to feel pleasure, is associated with the depressive stage of bipolar disorder.

A nurse is assessing a client with major depression. Which clinical manifestation reflects a disturbance in affect related to depression?

Hopelessness Feelings of hopelessness are symptomatic of depression; the individual feels unable to find any solution to problems and therefore feels overwhelmed. Echolalia, the pathological meaningless repetition of another's words or phrases, is associated with schizophrenia, not with depression. Delusions are associated with psychotic disorders such as schizophrenia, not depression. Confusion is not common because these individuals are in contact with reality.

A client who has been found to have bipolar disorder, manic episode, has been sleeping very little and had not eaten in the 2 weeks preceding hospitalization. What does the nurse conclude is a frequent cause of feeding problems in the overactive client?

Inability to take the time to eat During a manic episode the affected individual tries to keep active to prevent the feeling of depression from overtaking him or her; avoidance of feelings, not food, is the priority, and manic people do not take the time to eat. Feelings of grandeur have replaced unconscious feelings of unworthiness at this phase of the illness. The manic phase is not characterized by a desire for punishment. Manic clients are usually not aware of unconscious feelings. Clients in the manic phase do not control anxiety by the use of ritualistic behavior; ritualistic behavior is common in clients with an obsessive-compulsive disorder.

A client who is to begin a physical therapy regimen after orthopedic surgery expresses anxiety about starting this new therapy. Why does the nurse respond that some of this apprehension can be an asset?

Increase alertness to the environment Mild and moderate levels of anxiety can be beneficial because they focus attention on the environment by attempting to ward off additional anxiety. Initially anxiety amplifies physiological function; function decreases after prolonged anxiety because of exhaustion. Automatic behavioral responses and ego defense mechanisms may hinder, rather than increase, an individual's awareness.

An executive assistant experiences an overwhelming impulse to count and arrange the rubber bands and paper clips in his desk. The client feels that something dreadful will occur if the ritual is not carried out. Considering the client's symptoms, what does the nurse conclude about the rituals?

They serve to control anxiety resulting from unconscious impulses Serving to control anxiety resulting from unconscious impulses is the psychoanalytical explanation for the development of obsessive-compulsive symptomatology. Compulsive rituals commonly result in interference with activities of daily living, and the individual becomes dysfunctional; the need to perform rituals cannot be controlled. A displacement of general anxiety onto an unrelated specific fear is the general description of phobias. The client is unable to consciously stop the behavior because anxiety will become overwhelming if the ritualistic defense is not used. The behavior is not overwhelming because it limits anxiety.