Prep U Psychiatric-Mental Health Nursing Chapter 17: Mood Disorders and Suicide

For which reason is depression in older adults often undiagnosed and untreated?

Older adult depression is often seen as "normal aging."

A client has been diagnosed with major depression and placed on amitriptyline. Which is a side effect of amitriptyline?

Orthostatic hypotension

While caring for a client in the hospital, the nurse becomes concerned that the client may be having thoughts of suicide. Which statement would be most therapeutic?

"I've noticed something is bothering you. Please share you thoughts with me."

The nurse is assessing a client with depression and a colleague suggests that the client be encouraged to sign a no-suicide contract. What is the nurse's best response to the colleague?

"There's no demonstrated benefit of no-suicide contracts, though they're not believed to be harmful."

A client has just been diagnosed with bipolar disorder and is upset with the diagnosis. The client tells the nurse, "It is probably my mother's fault, she has bipolar too." Which is the best response by the nurse?

"While bipolar disorders are genetic, there are other causes as well."

The police bring a client to the hospital. They found the client in a hospital gown, swimming in a local creek. The client states that the client was "being baptized by Mother Nature, who loves and worships me." How would the nurse describe the client's current alterations in mental status?

Grandiose delusions

Which would be a finding related to perceptual disturbances during the mental status exam in the client with mania?

Hallucinations Explanation: Perceptual disturbances include hallucinations and delusions, anxiety, and grandiose delusions involving power, wealth, fame, or knowledge. Increased motor activity is assessed in appearance and general behavior. Inappropriate affect is assessed in mood and affect. Limited insight is part of the judgment and insight assessment.

A client was abandoned by the parents at age 3, resulting in the client's perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of what?

A psychodynamic interpretation of the client's major depressive disorder.

Which characteristic is most common among suicidal clients?

Ambivalence Explanation: Suicide involves ambivalence. Many fatal accidents may be impulsive suicides. It is impossible to know, for example, whether the person who drove into a telephone pole did this intentionally.

The nurse is seeing a 26-year-old client and the client's family. The client's family describes the client as being "very, very different." The family describes a history of periods of unpredictable behavior and disregard for consequences occurring a few times each year. The client has recently been diagnosed with bipolar I disorder, a condition that is characterized by what?

An elevated mood that lasts for at least 1 week

A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder?

Anticonvulsants

A loss of pleasure or interest in a client diagnosed with depression would be documented as what?

Anhedonia

A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications?

Carbamazepine Explanation: Carbamazepine is an anticonvulsant with mood-stabilizing effects. Lithium is a mood stabilizer. Mannitol and methyldopa are not used in the treatment of bipolar disorder.

The major difference between bipolar I and bipolar II disorder is what?

Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances.

A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. The client's suicidal risk has lessened considerably, and the client currently denies having any desire to kill himself or herself. In addition, the client is able to identify reasons why the client wants to be alive. Which nursing intervention would be most appropriate at this time?

Developing a personal plan for managing suicidal thoughts when they occur

When teaching prevention to the parents of a 15-year-old client who recently attempted suicide by taking an overdose of alprazolam, the nurse describes which behavioral clue?

Giving away valued personal items Explanation: The suicidal individual may exhibit behaviors that provide clues to his or her intent, including the following: • Talking about death, suicide, and wanting to be dead • Talking or thinking about punishment, torture, and being persecuted • Hearing voices and suddenly seeming very happy after being very depressed for some time • Being very aggressive or very impulsive, and acting suddenly and unexpectedly • Showing an unusual amount of interest in getting his or her affairs in order • Giving away personal belongings

Before a client became depressed, the client was an active, involved parent with three children, often attending their school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals that the client feels like an unnecessary burden on the client's family. Which nursing diagnosis is most appropriate?

Situational low self-esteem

To confirm that a client is experiencing a manic episode, the nurse must eliminate the possibility that the client's symptoms are related to which problem?

Substance use

A 38-year-old client has been diagnosed with major depressive disorder. The client is being placed on an antidepressant and the nurse is providing medication teaching. Which would be appropriate information to provide to the client?

"You may not notice an improvement in your symptoms for 2 to 6 weeks."

A client has experienced a first episode of major depression and has received medication and treatment, which has led to a complete remission of the symptoms. The client asks the nurse, "How much longer will I need to take the medication?" Which response by the nurse would be most appropriate?

"You'll need to continue the medication for about 6 to 12 months to see how things go."

Women are how many times more likely than men to attempt suicide?

4 Explanation: Women are four times more likely to attempt suicide, although men commit 72% of suicides.

Which sleep pattern is suggestive of a manic episode?

A client stays awake for several days and nights before "crashing" and sleeping for a long period.

An elderly client is admitted to the hospital with fatigue and weight loss of 20 pounds in 1 month. Upon further assessment, the client is diagnosed with depression. What other thing should the nurse assess this client for based on the weight loss?

Dehydration

Which statement about bipolar disorders and gender is correct?

Bipolar I and II occur almost equally in men and women.

A nurse is preparing a presentation for family members of clients who have been diagnosed with depression. When describing the family response to depression, which would the nurse include?

Depression in one family member affects the entire family.

Which statement regarding depression and gender is correct?

Depressive disorders are more common in women than men. Explanation: Depressive disorders are more prevalent in women than in men. Genetics, sociocultural factors, hormones, and other elements may account for this disparity.

Which is an anticonvulsant used as a mood stabilizer?

Divalproex

A client with a diagnosis of bipolar disorder is described by a family member as "flip-flopping between being happy and loving to irritable and hostile." Which characteristic symptoms of this disorder is the family member referring to?

Emotional lability Explanation: Emotional lability is alterations in moods with little or no change in external events. It is a term used for the rapid shifts in moods that often occur in bipolar disorder.

The nurse is conducting an admission assessment with a 45-year-old client who has been demonstrating signs of bipolar disorder. While conducting the assessment, the client starts speaking in illogical rhymes and using word associations. What is the name for this thought pattern?

Flight of ideas Explanation: Rapid "flights of ideas" lead to excessive and illogical rhyming, punning, and word associations, along with pressured speech.

Which medication classification is considered first-line drug therapy for bipolar disorder?

Mood stabilizers

Which biogenic amines have been implicated in depression?

Norepinephrine and serotonin Explanation: The monoamines that have been implicated in depression are norepinephrine (NE), dopamine (DA), and serotonin (5-HT). Disturbances in mood may result when absolute concentrations of NE, 5-HT, or both are deficient.

Which is a true statement regarding depressive disorders?

Norepinephrine, dopamine, and serotonin have been implicated.

A newly admitted client's history includes multiple suicide attempts. How can the nurse on the psychiatric-mental health unit best protect the client's safety?

Performing vigilant assessment and close observation

A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client's feelings of sadness and hopelessness, the nurse would expect to assess what?

Psychomotor retardation Explanation: Associated signs and symptoms of depression include an inability to think or concentrate, increased complaints of pain, psychomotor retardation, and lack of energy and fatigue.

Which would be the priority diagnosis for the client in the manic phase of bipolar disorder who is exhibiting aggressive behavior?

Risk for other-directed violence

A nursing student is caring for an elderly client who is taking sertraline for depression. The instructor quizzes the student about the medication and its actions. To what classification of drugs should the student assign sertraline?

Selective serotonin reuptake inhibitor Explanation: Sertraline is a selective serotonin reuptake inhibitor.

A client with major depression is prescribed paroxetine. The nurse develops an education plan for the client based on the understanding that this drug belongs to which class of drugs?

Selective serotonin reuptake inhibitors Explanation: Paroxetine is a selective serotonin reuptake inhibitor. Serotonin norepinephrine reuptake inhibitors include venlafaxine, nefazodone, duloxetine, and desvenlafaxine. Amitriptyline is an example of a tricyclic antidepressant. Monoamine oxidase inhibitors include phenelzine, tranylcypromine, isocarboxazid, and selegiline.

A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what?

Side effect

A client who has just been prescribed lithium for bipolar disorder is being given education from the nurse about this medication. Which is important for the nurse to include in teaching?

The higher the sodium level, the lower the lithium level will be.

Which is an accurate statement regarding women and suicide?

They are less likely to complete suicide than men.

When completing a baseline assessment of a client with depression, which diagnostic tests would the nurse anticipate?

Thyroid function tests

Psychodynamic theory attributes the development of mood disorders to what?

Unexpressed and unconscious anger

A client taking lithium for bipolar disorder comes to the clinic and reports symptoms which the nurse interprets as consistent with moderate lithium toxicity. Which action should the nurse perform? Select all that apply.

Withhold additional doses of lithium. Obtain a blood sample for lithium level. Push fluids. Contact the physician.

Which mental health disorder has the most significant risk factor for suicide?

depression

A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the client will have to demonstrate specific symptoms. What are some of these symptoms? Select all that apply.

disruption in sleep disruption in appetite disruption in concentration excessive guilt

The nurse is planning the inpatient care of a client who has been admitted with major depression. The client's plan of care includes regular exercise, but the client is reluctant to participate due to a lack of energy and motivation. What is the nurse's best action?

Collaborate with the client to choose a manageable amount of exercise and acknowledge the client's subsequent effort

A 30-year-old woman has been brought to the emergency department after causing a disturbance. She is wearing a pair of tight, pink yoga pants, high heels, a sports bra, and a bright-colored hat. The woman's care providers would recognize that the woman's dress may suggest what?

Mania

When assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client?

Confusion

A nurse is preparing a client for discharge. As part of the discharge process, the nurse provides education to the client regarding safety from self-harm. Which intervention should the nurse employ?

Include family members to provide a better understanding of symptoms of the illness Explanation: In addition to trying to reduce the stigma that the client and family may associate with suicide, the nurse must educate them about depression, suicidal behavior, and treatments. When possible, the nurse should schedule educational sessions to include significant others so that they will better understand the client's illness and also learn what is necessary in providing outpatient care.

A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition?

Light therapy

The nurse is caring for a client with major depressive disorder who has been admitted to a psychiatric-mental health facility. After assessing the client, the nurse has developed a nursing diagnosis of "risk for violence toward others related to agitation and low tolerance level." Which would be an appropriate intervention for this client?

Remove all dangerous items from the client's room.

A client hospitalized for uncontrolled manic behavior constantly belittles other clients on the general ward and is demanding special favors from the nurses. Which is the most effective nursing intervention for this client?

Set limits with specific and consistent consequences for belittling or demanding behavior.

The nurse is working with an inpatient who has a history of suicide attempts. What action by the client should the nurse follow up on because it may constitute a suicide planning behavior?

The client has requested extra bedding despite the warm weather

A client with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation?

The client is experiencing catatonia. Explanation: Electroconvulsive therapy is an effective treatment for clients with severe depression. It is generally reserved for those whose disorder is refractory or intolerant to initial drug treatments and who are so severely ill that rapid treatment is required (e.g., clients with malnutrition, catatonia, or suicidality).

The nurse is assessing a client who has presented to the emergency department in emotional distress. What client data represents the greatest risk for suicide?

The client overdosed on pills 2 years earlier

A client admitted to the inpatient psychiatric unit changes clothes eight or nine times a day, wears heavy eye makeup, is intrusive with other clients, and makes inappropriate sexual advances toward staff members. Which goal would be most appropriate for this client?

The client will refrain from being intrusive with others and change clothing only twice per day.

A 50-year-old client who has recently been diagnosed with a chronic degenerative illness has announced to the nurse the intention to commit suicide in order to prevent future suffering. Which fact should underlie the nurse's response to this client?

The nurse is obliged to protect the client from self-harm.

A client with bipolar disorder is receiving lithium therapy. The nurse is reviewing the client's serum plasma drug levels and determines that the client's level is therapeutic based on what?

1.0 mEq/L

The mental health nurse appropriately provides education on light therapy to which client?

20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

A 46-year-old client comes to the community mental health center because the client thinks they might be suffering from depression. When assessing this client, which symptom would the nurse identify as being necessary for the diagnosis of major depressive disorder to be made?

A loss of interest or inability to derive pleasure for previously enjoyed activities

Which client is most likely to benefit from electroconvulsive therapy (ECT)?

A client whose major depression has not responded appreciably to antidepressants

A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis?

The client will reframe negative thoughts in a more positive way.

Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension?

Increase hydration

A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy?

Liver function

A nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the highest risk for a suicide attempt?

Man with major depressive disorder

Limit setting is most appropriate in which client population?

Manic

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what?

Middle insomnia

Which is a primary risk factor for suicide?

Social isolation

Trying to kill oneself and surviving the ordeal is identified as what?

Suicide attempt

The nurse is conducting an interview with an adult client who is being treated for major depression. What question should the nurse prioritize in an effort to determine the client's risk for suicide?

"Do you ever feel like your situation is hopeless?" Explanation: Hopelessness is a significant risk factor for suicide among persons who are depressed. For an adult client, relationships with parents are significant but not among the major risk factors for suicide. Similarly, the client's perception of medication effectiveness is important but not a key risk factor. It is common for depressed individuals to lack firm plans for their days, and a lack of planning does not necessarily indicate a heightened suicide risk.

The nurse is providing care for a client who deliberately overdosed on acetaminophen several days ago. The nurse should assess the current severity of the client's suicidal ideation by asking what question?

"How often are you having thoughts about suicide this morning?"

The nurse is interviewing a client with a diagnosis of depression and the client states, "Honestly, I know my family would be a lot better off if I wasn't around to be a burden on them. That's just between you and me, though, okay?" What is the nurse's best response?

"I'm obliged to share what we talk about with the other people on your care team." Explanation: The nurse has a binding obligation to communicate information suggesting a suicide risk to other members of the care team. The nurse should certainly assess the motivations for the client's desire for secrecy, but the priority is clearly communicating to the client that this is not possible. The nurse should avoid trite advice ("Nothing good ever comes ..."). The client's permission is not required to share this information, though the nurse should make efforts to preserve rapport and trust.

A client comes to the clinic for an evaluation of headache, fatigue, and an overall feeling of being "down." When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply.

"I've been drinking about three or four more beers every night." "I'm so tired that all I ever want to do is sleep all the time." "Most times, I feel like I'm trapped with no way out."

A client is to receive three treatments of electroconvulsive therapy (ECT) per week for 3 weeks. After the third treatment, the client is forgetful and confused. When the client's spouse arrives to take the client home, the nurse discusses the client's condition with the spouse. Which statement is best?

"Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer."

A psychiatric-mental health nurse is conducting an in-service education program about suicide for a group of nurses working at a community mental health center. The nurse determines that the teaching was successful based on which statement by the group?

"Suicide has profound effects on those connected to the individual."

A nurse is caring for a white, 30-year-old man whose wife has recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important?

Ask the client whether he is thinking about killing himself.

The policies and procedures at a community psychiatric-mental health center include an emphasis on case finding. How can a nurse at the center best perform case finding?

Assessing all clients carefully to identify those at risk for suicide

A 20-year-old client was admitted to the inpatient unit following a suicide attempt. The client is disheveled, disorganized, and dehydrated. The priority for the client's care during the first 24 hours of admission will be what?

Assessing the client's current suicidal ideation and putting the client on suicide precautions.

A client who suffers from bipolar disorder is admitted to a mental health unit for a manic episode. The nurse knows that which takes priority?

Client safety

A 35-year-old client with bipolar disorder has a history of discontinuing medication when feeling well and then becoming manic again. During the client's last episode of mania, the client lost several thousand dollars in risky investments. Which intervention will be most helpful in achieving medication adherence?

During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse.

A nurse is giving a presentation on mental health promotion at a community center. A participant states, "My friend tells me I'm depressed because I don't have a lot of energy and have trouble concentrating. I had to quit my full-time job because I don't seem to have the energy to manage it. But I don't want to kill myself or anything like that." Although more data are needed for diagnosis, the nurse suspects that the client may have what?

Dysthymic disorder Explanation: Dysthymia is a mild depressive illness in which symptoms, such as poor appetite or overeating, insomnia or excessive sleep, low energy, fatigue, low self-esteem, poor concentration, and difficulty making decisions, are chronic but less severe than with major depression. Diagnostic criteria include depressed or irritable mood most of the day, occurring more days than not for at least 2 years.

The nurse knows that the most dangerous time period following a previous suicide attempt is what?

First 3 months Explanation: The first 2 years after a suicide attempt represent the highest risk period, especially the first 3 months.

Following a change in job position, a minister asks a client how the client likes the new job. The client states, "Oh everything is great. I can really see myself going far in this new position." However, the client's voice is monotone and the client's face is nearly absent of affective expression. The minister is worried about this client and describes this facial expression as what?

Flat

The nurse is working with a 50-year-old client admitted for a major depressive episode. The client has remained isolated and withdrawn since admission and is reluctant to speak. Which therapeutic communication skill is most likely to encourage the client to verbalize the client's feelings?

Silence and active listening

When conducting a suicide risk assessment, the nurse understands that which method has the least lethality?

Wrist slashing

A client with a diagnosis of depression tells the nurse that the client's mood was especially bad this morning but that the client pushed through it to attend a support group. How can the nurse best validate the client?

"That shows an admirable level of perseverance on your part. Well done!"

A client has been successfully treated on the psychiatric mental health unit following a suicide attempt. In preparation for discharge, the nurse should prioritize what action?

Ensuring a plan is in place for the client's community-based care

A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which is the nurse's priority intervention for this client?

Ensuring that the client is not permitted to use anything that would be potentially dangerous.

A nurse is reviewing the medical record of a young client to determine the client's risk for suicide. Which factor would alert the nurse to an increased risk for this client?

experiencing unemployment that has lasted a year Explanation: Social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among the younger population. Internal distress, low self-esteem, and interpersonal distress have long been associated with suicide. Cognitive risk factors include problem-solving deficits, impulsivity, rumination, and hopelessness. Impulsivity, anger, and reduced inhibition increase the risk of suicide. Fear of growing older is not a common concern for this population. With the likelihood of a positive outcome, acute illness is not generally viewed as being hopeless. Chronic medical illnesses increase the likelihood of chronic depression, which in turn contributes to the increased suicide rate of those older than the age of 65 years. While starting a new business may create a degree of anxiety, it is usually viewed with hopefulness and enthusiasm.

A 29-year-old first-time mother has been diagnosed with postpartum psychosis after her partner reported the client was hearing voices and told the partner she "saw someone trying to steal the baby." In the planning of this client's care, which outcome should the nurse prioritize?

he client will demonstrate the ability to differentiate between perceptual disturbances and reality.

A client who is depressed tells the nurse, "If I'm honest, I really see suicide as the only way out." In order to challenge the client's belief, the nurse should ...

help the client to identify and explore other options.

A nurse is providing a presentation about suicide for a group of health professionals. Which would the nurse address as a major contributing factor to the rising suicide rate among men?

substance abuse