Mental Health (ch 14, 25, 2) Exam 3

Which statement factually describes the act of suicide?

A client diagnosed with schizophrenia is at great risk for attempting suicide.

Which is the greatest protective factor against the risk of suicide?

A sense of responsibility to family

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of which feeling?

Disbelief

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." How should the nurse respond to the client's concern?

"For your safety I can be no more than an arm's length away."

A 38-year-old patient is admitted with major depression. Which statement made by the patient alerts the nurse to a common accompaniment to depression?

"I still feel bad about my sister dying of cancer. I should have done more for her!"

Which statement, made by a patient admitted with a diagnosis of depression, indicates the need for further assessment?

"I think things will be better soon."

Consider both Sullivan's term security operations and Freud's term defense mechanisms. Which statement suggests that the client's specialized treatment goal has been successfully met?

"I'm experiencing much less anxiety about school now."

When working with a client who may have made a covert reference to suicide, the nurse should base the response on what statement?

Asking the client directly if they are thinking of attempting suicide.

Using Maslow's model of needs, the nurse providing care for an anxious client identifies which intervention as being a priority?

Assessing the client for strengths upon which a nurse-client relationship can be based

A student nurse on the psychiatric unit expresses being uncomfortable about discussing possible suicidal ideations with clients because "It might put ideas in their head about suicide." What is the nurse's best response to this student's concern?

"Actually, it's a myth that asking about suicide puts ideas into someone's head."

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." How should the nurse respond to this statement?

"Depression is seen in people of all ages, from childhood to old age."

The nurse providing anticipatory operant conditioning guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by which intervention?

Ignoring the tantrum and giving attention when the child acts appropriately

Because the patient had a plan of overdose, the best course of action is to give

a small prescription of Tricyclic antidepressant (TCA) requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan.

The nurse is working with a client experiencing depression stemming from low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially what is the nurse's priority?

Making the client feel physically and emotionally safe

The nurse observes the meal tray about to serve a suicidal client. Which item should be removed from the tray?

Metal utensils

Role-playing is associated with which type of psychotherapy?

Modeling

Beck's cognitive theory suggests that the etiology of depression is related to what factor?

Negative processing of information

When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior?

No pleasure from previously enjoyed activities

Which suicide prevention intervention that has the greatest impact on a client's safety?

One-on-one observation by the staff.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching?

Onset of action is from 1 to 3 weeks or longer.

The nurse is planning care for a 14-year-old. The nurse demonstrates an understanding of the developmental task appropriate for this client by providing which experience?

Providing them with the opportunity to select which unit activities they will participate in to gain autonomy

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term?

Psychomotor agitation

Which of the following statements is true regarding culture and protective factors against suicide?

Religion and the importance of family are protective factors for Hispanic Americans.

Which nursing intervention demonstrates the theory behind operant conditioning?

Rewarding the client with a token for avoiding an argument with another client

A client states, "I will always be alone because nobody could ever love me." The nurse recognizes that the client is expressing what cognitive-behavioral concept?

Schema

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. Which is the most appropriate short-term goal for this diagnosis?

Seek help when feeling self-destructive.

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic?

Self-deprecatory ideation

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide?

Serotonin

Which theorist is associated with behavioral therapy?

Skinner B.F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" The nurse's response is based on what fact concerning hostility?

The client may be at high risk for self-harm.

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention?

Waiting quietly for the client to reply

What are the most important characteristics for staff members who work with suicidal clients?

Warm, consistent interaction

Monoamine oxidase inhibitors inhibit?

the breakdown of tyramine

Beck is a cognitive theorist who developed?

the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue.

What should you do when taking SSRI?

may take over-the-counter medications if sanctioned by the provider,

What is the major reason for the hospitalization of a depressed patient?

Suicidal ideation

This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication.

high fever, fast heartbeat, or abdominal pain patient should be wearing sunscreen to avoid sunburn,

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response?

"Let's look at what you just said, that you can 'never do anything right.'"

Amitriptyline is a tricyclic antidepressant (TCA); these drugs are Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only 1 week. Side effects are always a consideration but not the most important consideration with TCAs.

known to be lethal in smaller doses than other antidepressants.

Dysthymia is a

chronic condition by definition has to have existed for longer than 2 years

Learned helplessness results in

depression when the client feels no control over the outcome of a situation

increased thirst and urination is a side effect of

fluoxetine

Interpersonal therapy is considered to be effective in resolving problems of?

grief, role disputes, role transition, and interpersonal deficit.

A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement?

"I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away."

Which statement would best show acceptance of a depressed, mute client?

"I would like to sit with you for 15 minutes now and again this afternoon."

A cognitive therapist would help a client restructure the thought "I am stupid!" to which statement?

"What I did was stupid."

An assessment tool that is useful to nurses in rating suicide risk is the

SAFE-T.

Suicidal thoughts are a major reason for

hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm.

How does Harry Stack Sullivan's Interpersonal Theory view anxiety?

A painful emotion arising from social insecurity.

According to Freud, a client experiencing dysfunction of the conscious as part of the mind will have problems with which aspect of memory?

All memories

A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact?

Amitriptyline is lethal in overdose.

Dysthymia cannot be diagnosed unless it has existed for what period of time?

At least 2 years

What foods contain tyramine?

Avocados, fermented food such as sauerkraut, processed meat, and organ meat

What is the premise underlying behavioral therapy?

Behavior is learned and can be modified.

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted?

Constant 24-hour, one-to-one observation at arm's length

Freud believed that individuals cope with anxiety by implementing which mechanism?

Defense mechanisms

What statement about the comorbidity of depression is accurate? Depression most often exists in an individual as a single entity. Depression is commonly seen in individuals with medical disorders. Substance abuse and depression are seldom seen as comorbid disorders. Depression may coexist with other disorders but is rarely seen with schizophrenia.

Depression is commonly seen in individuals with medical disorders.

Which client problem would be most suited to the use of interpersonal therapy?

Dysfunctional grieving

A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. The nurse should provide the client with what information regarding this practice?

Explain the high possibility of an adverse reaction.

Unit practice requires inspection of all items being brought onto the unit by visitors. How can this be most effectively done?

Having a staff member sit at the door and check packages as visitors enter.

A client tells the nurse that he believes his situation is intolerable and is observed isolating socially. Which nursing diagnosis should be considered?

Hopelessness

What is the focus of the SAFE-T assessment tool?

Identify level of suicidal risk. Development of client focused treatment. Stress collaboration with the client

A nurse expresses an exclusive belief in the biological model for mental illness when stating "it's the only one I really believe." What conclusion should be drawn from this statement?

In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.

While intoxicated a client unsuccessfully attempted suicide by using a gun. This method of using a gun to attempt suicide should be described in what terms?

It is high risk, or a hard method.

The nurse is caring for an adult client who experienced severe physical abuse from the age of 2 through 12. What information should the nurse provide the client concerning the function of the "id" and the ability to function as an adult?

It is the source of one's survival instincts.

A nurse is providing care to a 28-year-old patient diagnosed with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, the nurse should identify which patient symptom as having priority?

Lack of sleep

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response?

Learned helplessness

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment?

Whether the plan has specific details Whether the method is one that could cause death Whether the client has the means to implement the plan

Serotonin malignant syndrome is

a possibility if St. John's wort is taken with other antidepressants

The break down of tyramine can lead to?

blood pressure, a hypertensive crisis, and eventually a cerebrovascular accident..

A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat

fruit and cottage cheese plate. do not contain tyramine