Depression

Thought to be increased by ECT?

Norepinephrine and Serotonin

Which position should the nurse place the client in immediately after ECT? A. On his or her side to prevent aspiration B. In semi-Fowler's position to promote oxygenation C. In Trendelenburg's position to promote blood flow to vital organs D. In prone position to prevent airway blockage

A. On his or her side to prevent aspiration

The nurse should frequently assess a client with a depressive disorder for lethality risk related to suicidal ideation. Which questions should the nurse include? Select all that apply. A. "Are you thinking about hurting yourself or someone else?" B. "Can you tell me your feelings about dying?" C. "Where do you keep your gun?" D. "Have you told your psychiatrist you feel like dying?" E. "Have you thought about how you would hurt yourself?"

A. "Are you thinking about hurting yourself or someone else?" C. "Where do you keep your gun?" E. "Have you thought about how you would hurt yourself?"

A client taking fluvoxamine (Luvox) without significant improvement asks if a MAOI might be added?" What is the most appropriate reply? A. "This combination of drugs can lead to delirium tremens." B. "A combination of an MAOI and fluvoxamine can lead to a life-threatening hypertensive crisis." C. "That's a good idea. There have been good results combining these two drugs." D. "The only disadvantage would be the exorbitant cost of the MAOI."

B. "A combination of an MAOI and fluvoxamine can lead to a life-threatening hypertensive crisis."

Select all adverse effects of VAGUS NERVE STIMULATION (VNS): A. Disorientation B. Dysphagia C. Neck pain D. Seizure activity E. Voice changes

B. Dysphagia C. Neck pain E. Voice changes

Which patient statement indicates an understanding of ECT? A. "I can have my depression cured if I receive a series of ECT treatments." B. "I will have seizures lasting 1 ½ to 2 minutes during ECT." C. "I will receive a muscle relaxant to protect me from injury during ECT." D. "It is common to treat depression with ECT before trying medications."

C. "I will receive a muscle relaxant to protect me from injury during ECT."

The nurse helps clients alter their mood by learning how to change the way they think. The nurse is functioning under which theoretical framework? A. Psychoanalytic theory B. Interpersonal theory C. Cognitive theory D. Behavioral theory

C. Cognitive theory

What is the highest priority in admitting a patient with comorbid MDD and anxiety disorder? A. Assisting patient to perform ADLs B. Encouraging patient to participate in counseling C. Placing patient on one to one observation D. Teaching patient about medication adverse effects

C. Placing patient on one to one observation

Chest X-ray, EKG, H&P (ECT)?

Complete physical workup

Most common side effect of ECT?

Confusion; temporary memory loss

6 to 12 treatments over a 2 to 3 week period (ECT)

Course of treatment

What is an "affective symptom" of Persistent Depressive Disorder (PDD) (dysthymia)? A. Social isolation with a focus on self B. Low energy level C. Difficulty concentrating D. Gloomy and pessimistic outlook on life

D. Gloomy and pessimistic outlook on life

Anticholinergic to decrease secretions and increase heart rate (avoid bradycardia) (ECT)?

Glycopyrrolate

Required before (ECT) treatment can be initiated?

Informed constent

Major indication for ECT?

Major depression

Administered as short-acting anesthetic (ECT)?

Methohexital

Contraindication (ECT)

Recent myocardial infarction

Should last 30-60 seconds

Seizure

Muscle relaxant to prevent fractures (ECT)

Succinylcholine

Monitor prior to, during, and after ECT?

Vital signs

A client strongly denies ever having suicidal ideations. Which is the nurse's best response? A. "Have you ever had thoughts of overdosing." B. "So I hear you say you have never had a suicidal ideation." C. "I will document that you never had a suicidal ideation." D. "Everyone has suicidal ideations."

A. "Have you ever had thoughts of overdosing."

Which client statement describes a symptom consistent with the diagnosis of PDD? A. "I am sad most of the time and I've felt this way for the last several years." B. "I find myself preoccupied with death." C. "Sometimes I hear voices telling me to kill myself." D. "I'm afraid to leave the house."

A. "I am sad most of the time and I've felt this way for the last several years."

A client is prescribed phenelzine. Which statements should indicate to the nurse that discharge teaching about this medication has been successful? Select all that apply. A. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." B. "Guess I will have to give up my glass of red wine with dinner." C. "I'll have to be very careful about reading food and medication labels." D. "I'm going to miss my caffeinated coffee in the morning." E. "I can stop this medication abruptly."

A. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." B. "Guess I will have to give up my glass of red wine with dinner." C. "I'll have to be very careful about reading food and medication labels." D. "I'm going to miss my caffeinated coffee in the morning."

What is the best motivational statement to get a depressed, newly admitted patient with MDD to attend a group held in the milieu? A. "I'll walk with you to the day room. Group is about to start." B. "It must be difficult for you to attend a group when you feel so bad." C. "Let me tell you about the benefits of attending groups." D. "We'll go to the day room when you are ready for group."

A. "I'll walk with you to the day room. Group is about to start."

MAOIs Question: Further instruction is needed if patient states: A. "I'm so glad I can have a salad with blue cheese dressing." B. "I will be able to eat cottage cheese without worrying." C. "I will have to avoid drinking nonalcoholic beer." D. "I can eat green beans on this diet."

A. "I'm so glad I can have a salad with blue cheese dressing."

A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which response is best? A. "Medications are one way to address chemical imbalances. Environmental and interpersonal factors can also have an impact on biological factors." B. "Biological factors are the sole cause of depression, so medications will improve your mood." C. "Environmental factors exert the most influence in development of depression." D. "Researchers are unable to demonstrate a link between biology and genetics."

A. "Medications are one way to address chemical imbalances. Environmental and interpersonal factors can also have an impact on biological factors."

A client was admitted 4 days ago with a diagnosis of MDD. Which nursing statement would best motivate this isolated client to attend a therapeutic group being held in the milieu? A."We'll go to the day room when you are ready for group." B."I'll walk with you to the day room. Group is about to start." C."It must be difficult for you to attend group when you feel so bad." D."Let me tell you about the benefits of attending this group."

A. "We'll go to the day room when you are ready for group."

Which teaching is appropriate for a patient taking fluoxetine? A. "You may have a decreased desire for intimacy while taking this medication." B. "You should take this medication at bedtime to help promote sleep." C. "You will have fewer urinary adverse effects if you urinate just before taking this medication." D. "You will need to wear sunglasses when outdoors for light sensitivity."

A. "You may have a decreased desire for intimacy while taking this medication."

Based on current risk factors, which client is most likely to die by suicide? A. 85-year-old white male B. 60-year-old African American male C. 17-year-old Hispanic male D. 17-year-old Asian female

A. 85-year-old white male

Immediately after an initial ECT procedure, a client states, "I'm not hungry and just want to stay in bed and sleep." Based on this information, which is the most appropriate nursing intervention? A. Allow the client to remain in bed. B. Encourage the client to join the milieu to promote socialization. C. Obtain a physician's order for parenteral nutrition. D. Involve the client in physical activities to stimulate circulation.

A. Allow the client to remain in bed.

Which strategy should the nurse implement first with a suicidal client? A. Ask a direct question such as, "Do you ever think about killing yourself?" B. Ask the client to rate his or her mood on a scale from 1 to 10. C. Establish a trusting nurse-client relationship. D. Apply the nursing process to the planning of client care.

A. Ask a direct question such as, "Do you ever think about killing yourself?"

Which statements are applicable for teaching when a patient has a new prescription of amitriptyline? Select all that apply. A. Change positions slowly to minimize dizziness. B. Chew sugarless gum to prevent dry mouth. C. Decrease dietary fiber to control diarrhea. D. Discontinue the medication after a week of improved mood. E. Expect therapeutic effects in 24 to 48 hours.

A. Change positions slowly to minimize dizziness. B. Chew sugarless gum to prevent dry mouth.

While reviewing laboratory results of a newly admitted client, the nurse discovers that the client's thyroid-stimulating hormone (TSH) levels are elevated. The nurse anticipates the client will exhibit which symptoms? Select all that apply. A. Depression B. Fatigue C. Increased libido D. Mania E. Hyperexcitability

A. Depression B. Fatigue

What questions are appropriate to ask a suicidal patient? Select all that apply. A. Do you have a plan? B. Do you feel that life is not worth living? C. Have you experienced a recent change in your mood? D. Have you thought about hurting yourself? E. Why do you want to commit suicide?

A. Do you have a plan? B. Do you feel that life is not worth living? C. Have you experienced a recent change in your mood? D. Have you thought about hurting yourself?

A client diagnosed with MDD was raised in a strongly religious family where bad behavior was equated with sins against God. Which nursing intervention is most appropriate to help the client address spirituality as it relates to his illness? A. Encourage client to bring into awareness underlying sources of guilt. B. Teach client how to put religious beliefs into perspective throughout the life span. C. Confront client with the irrational nature of the belief system. D. Assist client to modify his or her belief system to improve coping skills.

A. Encourage client to bring into awareness underlying sources of guilt.

Which client condition can best be explained using the psychoanalytical theory of depression? A. Experiencing depression after the sudden death of a loved one B. Is depressed after failing an examination even after multiple attempts C. Becoming depressed after thinking about negative expectations about the future D. Becoming depressed after separation from the mother for an extended period of time

A. Experiencing depression after the sudden death of a loved one

What should be reported before the patient receives ECT? A. Hypertension B. Diabetes mellitus C. Renal calculi D. Osteoarthritis

A. Hypertension

What behavior is expected in an older adult with depression? A. Insomnia B. Sundowning C. Rambling speech D. Rapid mood swings

A. Insomnia

What is the priority assessment if a patient says, "I plan to commit suicide." A. Lethality of the method and availability of means B. Patient's educational and economic background C. Patient's insight into the reasons for the decision D. Quality of patient's social support

A. Lethality of the method and availability of means

Which foods should the nurse teach the client to avoid if a MAOI is prescribed? A. Pepperoni pizza and red wine B. Bagels with cream cheese and tea C. Apple pie and coffee D. Potato chips and diet cola

A. Pepperoni pizza and red wine

What teaching is appropriate for a client taking doxepin? A. Sit on side of bed before standing. B. Avoid OTC magnesium. C. Decrease dose by half when mood improves. D. Eat a snack before bedtime.

A. Sit on side of bed before standing.

What is true about "no suicide contracts?" Select all that apply. A. They are inappropriate for use in emergency departments. B. They set boundaries for patients who are under the influence of drugs or alcohol. C. They can yield a false sense of security among clinicians. D. Nurses should encourage the use of "no suicide" contracts on units. E. These contracts are especially useful with patients with borderline personality disorders.

A. They are inappropriate for use in emergency departments. C. They can yield a false sense of security among clinicians.

The nurse reviews the laboratory data of a 29-year-old client suspected of having MDD. Which laboratory value would potentially rule out this diagnosis? A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL (normal 0.4 to 4.2) B. Potassium (K+) level of 4.2 mEq/L C. Sodium (Na+) level of 140 mEq/L D. Calcium (Ca2+) level of 9.5 mg/dL

A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL (normal 0.4 to 4.2)

When does a suicide prevention plan need to be re-evaluated? Select all that apply. A. When there is a change in the client's clinical presentation or worsening of symptoms B. When medications or treatments are changed C. When significant others identify an increase in concern D. When a client stops treatment E. Every six months

A. When there is a change in the client's clinical presentation or worsening of symptoms B. When medications or treatments are changed C. When significant others identify an increase in concern D. When a client stops treatment

The nurse is implementing a one-on-one suicide observation level with a client diagnosed MDD. The client states, "I'm feeling a lot better, so you can stop watching me. I have taken up too much of your time already." Which is the best nursing reply? A. "I really appreciate your concern but I've been ordered to continue to watch you." B. "Because we are concerned about your safety, we will continue to observe you." C. "I am glad you are feeling better. The treatment team will consider your request." D. "I will forward you request to your psychiatrist because it is his decision."

B. "Because we are concerned about your safety, we will continue to observe you."

A newly admitted client with MDD states, "I never considered suicide." Later, the client confides plans to end it all by medication overdose. Which is the most helpful nursing reply? A. "There is nothing to worry about. We will handle it together." B. "Bringing this up is a very positive action on your part." C. "We need to talk about the things you have to live for." D. "I think you should consider all of your options prior to taking this action."

B. "Bringing this up is a very positive action on your part."

A client recently admitted to the inpatient unit after a suicide attempt has not responded to SSRIs or TCAs. The client says, "I heard about MAOIs. Why can't they be added to what I'm on now?" What is the most appropriate nursing response? A. "Electroconvulsive therapy (ECT) is your best option at this point." B. "Combined use can lead to a life-threatening hypertensive crisis." C. "There is no reason why an MAOI couldn't be added to your therapy." D. "They can't be used together as their mechanisms of action are very different."

B. "Combined use can lead to a life-threatening hypertensive crisis."

After years of dialysis, an 84-year-old states, "I'm exhausted, depressed, and done with these attempts to keep me alive." Which question should the nurse ask the spouse when preparing a discharge plan of care? A. "Have there been any changes in your spouse's appetite or sleep?" B. "How often is your spouse left alone?" C. "Has your spouse been following a diet and exercise program consistently?" D. "How would you characterize your relationship with your spouse?"

B. "How often is your spouse left alone?"

Which statements by the nurse about TMS are correct? Select all that apply. A. "I will provide post-anesthesia care following TMS." B. "I will schedule the patient for daily TMS treatments for the first several weeks." C. "TMS is indicated for patients whose depression is not relieved by medication." D. "TMS is usually performed as an outpatient procedure."

B. "I will schedule the patient for daily TMS treatments for the first several weeks." C. "TMS is indicated for patients whose depression is not relieved by medication." D. "TMS is usually performed as an outpatient procedure."

A client who is diagnosed with MDD asks the nurse what causes depression. Which is the nurse's most accurate response? A. "Depression is caused by a deficiency in neurotransmitters, including serotonin and norepinephrine." B. "The exact cause is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role." C. "Depression is a learned state of helplessness caused by ineffective parenting." D. "Depression is caused by intrapersonal conflict between the id and the ego."

B. "The exact cause is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role."

What should be included in the plan of care for a client with MDD who can' concentrate? A. A simple, structured daily schedule with limited choices of activities B. A daily schedule filled with activities to promote socialization C. A flexible schedule that allows the client opportunities for decision-making D. A schedule that includes mandatory activities to decrease social isolation

B. A daily schedule filled with activities to promote socialization

A newly admitted client is diagnosed with MDD with suicidal ideations. Which is the priority nursing intervention for this client? A. Teach about the effect of suicide on family dynamics. B. Carefully and unobtrusively observe on the basis of assessed data at varied intervals around the clock. C. Encourage the client to spend a portion of each day interacting within the milieu. D. Set realistic achievable goals to increase self-esteem.

B. Carefully and unobtrusively observe on the basis of assessed data at varied intervals around the clock.

What is the priority reason for the nurse to perform a full physical health assessment on a client admitted with a diagnosis of MDD? A. The attention during the assessment is beneficial in decreasing social isolation B. Depression is a symptom of several medical conditions C. Physical health complications are likely to arise from antidepressant therapy D. Depressed clients avoid addressing physical health and ignore medical problems

B. Depression is a symptom of several medical conditions

An individual experiences sadness and melancholia in September continuing through November. Which factors are most likely to contribute to these symptoms? Select all that apply. A. Gender differences in social opportunities that occur with age B. Drastic temperature and barometric pressure changes C. Increased levels of melatonin D. Variations in serotonergic functioning E. Inaccessibility of resources for dealing with life stressors

B. Drastic temperature and barometric pressure changes C. Increased levels of melatonin D. Variations in serotonergic functioning

Which behavioral symptoms should the nurse expect to assess in MDD? A. Anxiety and unconscious anger B. Lack of attention to grooming and hygiene C. Guilt and indecisiveness D. Low self-esteem

B. Lack of attention to grooming and hygiene

What is a concern upon discharge of a patient prescribed TCAs for 2 weeks? A. The patient may need a prescription for diphenhydramine to use for side effects. B. The nurse will evaluate risk for suicide by overdose of the TCA. C. The nurse will need to include teaching the signs of neuroleptic malignant syndrome. D. The patient will need regular lab work to monitor therapeutic drug levels.

B. The nurse will evaluate risk for suicide by overdose of the TCA.

What interventions should the nurse implement while applying a selegiline transdermal patch? Select all that apply. A. Wet the skin before applying B. Wash hands after applying C. Avoid exposing the site of application to direct heat D. Apply a new patch to a new site if the patch falls off E. Apply approximately at the same time each day to the same spot on the skin.

B. Wash hands after applying C. Avoid exposing the site of application to direct heat D. Apply a new patch to a new site if the patch falls off

After undergoing two of nine ECT procedures, a client states, "I can't even remember eating breakfast, so I want to stop the ECT." Which is the most appropriate nursing reply? A. "After you begin the course of treatments, you must complete all of them." B. "You'll need to talk with your doctor about what you're thinking." C. "It is your right to discontinue treatments, but let's talk about your concerns." D. "Memory loss is a rare side effect of ECT. I don't think it should be a concern."

C. "It is your right to discontinue treatments, but let's talk about your concerns."

A client who is on antidepressant therapy visits the hospital after a week and complains, "Ever since I started taking the medication I am dizzy, and I can see no improvement in my condition." What information provided by the nurse is beneficial to the client? A. "Stop taking the drug until dizziness subsides and resume the course later." B. "Avoid consuming red wine and aged cheese because they increase depression." C. "Rest when you feel dizzy. It may take some time for your medication to work." D. "Never stop therapy. Take over-the-counter medications if a headache accompanies dizziness."

C. "Rest when you feel dizzy. It may take some time for your medication to work."

A client who is learning about ECT asks a nurse, "Isn't this treatment dangerous?" What is the most appropriate nursing reply? A. "ECT is not dangerous because there are no side effects. B. "There can be temporary paralysis, but full functioning returns within 3 hours of treatment." C. "You will have a thorough examination beforehand to ensure you can safely undergo ECT." D. "Transient ischemic attacks can occur but are rare."

C. "You will have a thorough examination beforehand to ensure you can safely undergo ECT."

Which assessment alerts the nurse to development of serotonin syndrome in a patient taking sertraline? A. Bradycardia B. Bruising C. Hyperpyrexia D. Paresthesia

C. Hyperpyrexia

A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, is much more communicative, and rates mood at 9/10. Which action should be the nurse's priority at this time? A. Give the client off-unit privileges as positive reinforcement. B. Encourage the client to share mood improvement in group. C. Increase frequency of client observation. D. Request that the psychiatrist reevaluate the current medication protocol.

C. Increase frequency of client observation.

A client recently admitted to the inpatient unit after a suicide attempt has been placed on a TCA. Which action should the nurse implement to maintain the client's safety when he is discharged? A. Provide education on foods that contain tyramine B. Provide a pill dispenser as a memory aide to remind him when it is time to have medication refilled. C. Provide a one-week supply with refills contingent on follow-up appointments. D. Provide a 6-month supply to ensure long-term compliance.

C. Provide a one-week supply with refills contingent on follow-up appointments.

Which client information does the nurse assess prior to initiating therapy with phenelzine? A. The client's understanding of the need for regular bloodwork B. The client's mood and affect score, according to the facility's mood scale C. The client's cognitive ability to understand information about the medication D. The client's access to a support network willing to participate in treatment

C. The client's cognitive ability to understand information about the medication

A nurse administers pure oxygen to a client during and after electroconvulsive therapy (ECT). What is the nurse's rationale for this procedure? A. To prevent increased intracranial pressure resulting from anoxia B. To prevent hypotension, bradycardia, and bradypnea due to electrical stimulation C. To prevent anoxia due to medication-induced paralysis of respiratory muscles D. To prevent blocked airway resulting from seizure activity

C. To prevent anoxia due to medication-induced paralysis of respiratory muscles

The nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status examination? A. To rule out bipolar disorder B. To rule out schizophrenia C. To rule out neurocognitive disorder (NCD) D. To rule out a personality disorder

C. To rule out neurocognitive disorder (NCD)

A client diagnosed with MDD states, "I've been feeling 'down' for 3 months. Will I ever feel like myself again?" Which statement best assesses this client's affective symptoms? A."Have you been diagnosed with any physical disorder within the last 3 months?" B."Have you ever felt this way before? C."People who have mood changes often feel better when spring comes." D. "Help me understand what you mean when you say, 'feeling down'?"

D. "Help me understand what you mean when you say, 'feeling down'?"

Which client statement expresses typical underlying feelings of clients diagnosed with MDD? A. "It's just a matter of time and I will be well." B. "If I ignore these feelings, they will go away." C. "I can fight these feelings and overcome this disorder." D. "Nothing will help me feel better."

D. "Nothing will help me feel better."

Electroconvulsive therapy (ECT) is considered the treatment of choice for which client? A. 39-year-old man experiencing recurrent suicidal ideation B. 23-year-old woman experiencing postpartum depression C. 41-year-old woman describing a suicide plan D. 67-year-old man explaining a recent suicide attempt

D. 67-year-old man explaining a recent suicide attempt

A geriatric client who is tolerant to antidepressants was brought to the hospital after attempting suicide. What would be the best treatment approach for such a client? A. Group therapy B. Family therapy C. Interpersonal therapy D. Electroconvulsive therapy (ECT)

D. Electroconvulsive therapy (ECT)

A client reports dry mouth, blurred vision, constipation and urinary retention after taking an antidepressant. Which med does the nurse find in the client's prescription? A. Duloxetine B. Bupropion C. Venlafaxine D. Imipramine

D. Imipramine

A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to a client's ECT procedure. What is the rationale for administering this medication? A. It decreases anxiety during the ECT procedure. B. It induces an unconscious state to prevent pain during the ECT procedure. C. It prevents severe muscle contractions during the ECT procedure. D. It decreases secretions to prevent aspiration during the ECT procedure.

D. It decreases secretions to prevent aspiration during the ECT procedure.

The psychiatric nurse is administering medication to a client experiencing a severe depression. The nurse understands that the mechanism of action for some psychoactive medications is related to which process? A. Glutamate inactivation B. Impulse transmission C. Neuropeptide signaling D. Neurotransmitter reuptake

D. Neurotransmitter reuptake

What is the highest priority if a client is taking a TCA and a diuretic? A. Risk for ineffective thermoregulation R/T inability to sweat B. Risk for constipation R/T excessive fluid loss C. Risk for infection R/T suppressed WBC D. Risk for injury R/T orthostatic hypotension

D. Risk for injury R/T orthostatic hypotension

The nurse orders a special diet for the client receiving which medication? A. Imipramine B. Doxepine C. Ziprasidone D. Tranylcypromine

D. Tranylcypromine