Psych Mood Disorders and Suicide
A client with panic disorder with agoraphobia is talking with the nurse about his treatment progress. Which statement indicates a positive client response? -"I went to the mall with my friend last Saturday" -"I'm hyperventilating only when I have a panic attack" -"Today, I decided I can stop taking my medication" -"Last night, I decided to eat more than one bowl of cereal"
"I went to the mall with my friend last Saturday" Clients with panic disorder tend to be socially withdrawn; therefore, going to the mall is a sign that he's working on avoidance behaviors. Hyperventilation is a key symptom of a panic disorder, indicating a need for teaching about breathing control. Clients taking medications for panic disorder, such as tricyclic antidepressants and benzodiazepines, must be weaned off the drugs. Most clients with panic disorder with agoraphobia don't have eating disorders.
A client admitted with severe depression has been prescribed fluoxetine (prozac) for 3 weeks. The client approaches the nurse complaining of a headache. Which of the following would be the nurse's best response? -"I'll withhold your next dose of Prozac" -"You need to a have a computed tomography (CT) scan of your head" -"Just lay down; you'll be fine" -"I'll see if you have an order for Tylenol"
"I'll see if you have an order for Tylenol" A common adverse effect of fluoxetine is headache. The headache associated with fluoxetine is relieved by acetaminophen (Tylenol). Skipping doses isn't advised. The client needs to maintain a therapeutic drug level for the medication to be effective. A CT scan of the head isn't the initial approach for a client with a headache. Instructing the client to lay down disregards the headache and wouldn't be a therapeutic response for a depressed client.
A client is admitted to the psychiatric unit for treatment of bipolar disorder. The client is exhibiting symptoms of pressured speech, racing thoughts, frequent pacing, and an inability to sleep more than 3 hours every 36 to 48 hours. Which client goal should the nurse address first? -Demonstrate a clear thinking pattern -Demonstrate nonpressured speech patterns -Reestablish sleep patterns -Examine reasons for pacing
Reestablish sleep patterns According to Abraham Maslow, the nurse should address the client's most basic physiological needs first, including sleep. The other goals are lower priorities based on Maslow's hierarchy of needs.
A client with antisocial personality disorder smokes where it is prohibited and doesn't follow other unit or facility rules. The client gets others to do the laundry and other personal chores, tries to divide the staff, and works only with certain nurses. The primary focus of this client's care plan should be: -consistently enforcing unit rules and facility policy -isolating the client to decrease contact with easily manipulated clients -engaging in power struggles with the client to decrease the incidence of manipulative behavior -using behavior modification to decrease the amount of negative behavior by using negative reinforcement
consistently enforcing unit rules and facility policy Firmness and consistency about rules are the hallmarks of a care plan for a client with personality disorder. Isolation is inappropriate and violates the client's rights. Power struggles should be avoided because the client may try to manipulate people through them. Behavior modification usually fails because of staff inconsistency and client manipulation.
To prevent lithium toxicity in a client with bipolar disorder who is receiving 300 mg of lithium citrate P.O. t.i.d., the nurse should: -assess him for decrease urine output -give a nonsteroidal anti-inflammatory drug (NSAID) for mild pain -regularly monitor his lithium level -maintain the lithium level between 1.5 and 2 mEq/L
regularly monitor his lithium level The client's lithium level must be regularly monitored to prevent toxicity. Urine output increases with higher lithium levels. NSAIDs inhibit lithium excretion. A lithium level above 1.5 mEq/L is considered toxic
During a private conversation, a client with borderline personality disorder asks the nurse to "keep my secret" and then displays multiple, self-inflicted, superficial lacerations on his forearms. What is the nurse's best response? -"This type of behavior requires you to be on suicide precautions." -"I'm going to tell your physician. Do you want to tell me why you did that?" -"Tell me what type of instrument you used. I'm concerned about infection." -"Whenever something important occurs, the team needs to know about it. I'll have to tell the others, but let's talk about it first."
"Whenever something important occurs, the team needs to know about it. I'll have to tell the others, but let's talk about it first." This response informs the client of the nurse's planned actions and allows time to discuss the client's actions. the first two responses put the client in a defensive position and may set up a power struggle. The third response ignores the psychological implications of the client's actions.
A client who was admitted to the psychiatric unit in a manic state attacked another client. Seclusion has been ordered, and the nurse is assessing the client every 15 minutes. Which assessment should receive the highest priority? -Level of psychomotor agitation -Vital signs -Nutritional intake -Verbal and nonverbal behavior
Vital signs Physiological safety and stability precede all other assessments. Therefore, priority is always given to assessing the client's airway, breathing, and circulation. This information can be obtained through the assessment of vital signs. The other assessments are valid, but don't take precedence over the client's physiological well-being.
After being laid off from work, a client becomes increasingly withdrawn and fatigued, spends entire days in bed, is unkempt, and doesn't eat for 2 to 3 days. Based on these findings and Elizabeth Kubler-Ross's theoretical framework, the nurse should recognize that this client is in which stage of grieving? -Anger -Denial -Depression -Bargaining
Depression The client's symptoms are characteristic of depression. Anger may be expressed in many forms, ranging from irritability to physical aggression. Denial is typified by disbelief. Bargaining is exemplified by attempting to strike a deal in return for the lost object.
A nurse is caring for a client who is suicidal. When accompanying the client to the bathroom, the nurse should: -give him privacy -allow him to shave -open the window and allow him to get some fresh air -observe him
Observe him The nurse has a responsibility to continuously observe an acutely suicidal client. The nurse should watch for clues, such as communicating suicidal thoughts, threats, and messages; hoarding medications; and talking about death. By accompanying the client to the bathroom, the nurse will naturally prevent the client from attempting to hang himself or otherwise injure himself, The nurse should check the client's area and fix dangerous conditions, such as exposed pipes and windows without safety glass. The nurse should also remove potentially dangerous objects, such as belts, razors, suspenders, glass, and knives.
A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication? -Calcium -Sodium -Chloride -Potassium
Sodium Lithium is clinically similar to sodium. When sodium levels are reduced, such as from sweating or diuresis, lithium is reabsorbed by the kidneys, increasing risk of toxicity. Clients taking lithium shouldn't restrict their intake of sodium and should drink adequate amounts of fluid each day. Calcium, chloride, and potassium are important for normal body functions, but sodium is most important to the absorption of lithium.
Which concept refers to the role of the professional nurse in client advocacy? -The nurse makes decisions for clients who can't make decisions for themselves. -The nurse follows the basic standards of care and hospital policies and procedures for providing care for clients - The nurse promotes and protects the client's rights and interests -The nurse adapts a paternalistic approach to the care of the client
The nurse promotes and protects the client's rights and interests The nurse who understands the advocacy role promotes, protects, and thereby advocates a client's interests and rights in the effort to make the client well. The nurse doesn't make decisions for the client but provides care for the acutely ill client with the consent of his significant other, a POA, or his living will. Standards of care and set minimum criteria for proficiency on the job, enabling the nurse and others to judge the quality of care provided. Paternalism violates self-determination and advocacy by acting for another.
A nurse working on an inpatient unit is assigned to care for two clients diagnosed with severe depression and attempted suicide. After reviewing the client care assignment, the nurse should institute which nursing action? -Consult with the admitting physician about the client's conditions -Ask the supervisor to move both clients to the same room -Request that the client care assignment be changed -Document on the client's chart the lack of staffing resources
Request that the client care assignment be changed The request for an assignment change would help ensure client safety and is a reasonable nursing action. Suicidal clients require frequent assessments, and the nurse can't safely monitor both clients. The nurse is free to consult with the admitting physician; however, the assignment situation must be worked out at the nursing unit level. Moving the clients to the same room wouldn't ensure client safety. Documenting the situation on a performance improvement form or on an incident report would be an appropriate action, but only after steps to ensure the client safety have been taken.
After an upsetting divorce, a client threatens to commit suicide with a handgun and is involuntarily admitted to the psychiatric unit with major depression. Which nursing diagnosis takes highest priority for this client? -Hopelessness related to recent divorce -Ineffective coping related to inadequate stress management -Spiritual distress related to conflicting thoughts about suicide and sin -Risk for self-directed violence related to planning to commit suicide by handgun
Risk for self-directed violence related to planning to commit suicide by handgun Although all of these nursing diagnoses may apply to this client, the nurse's first priority in caring for any suicidal client is safety. The presence of a plan increases the level of suicidal risk. The nurse can address the client's hopelessness, ineffective coping, and spiritual distress later in therapy.
A client with major depression tells the nurse "Life isn't worth living. I can't stand the pain any longer." The nurse should recognize this statement as indicative of: -the need for a suicide assessment -the need for a pain assessment -the need to administer an antidepressant -the need to provide diversional stimuli
the need for a suicide assessment Because the client has verbalized passive suicidal ideation, the nurse should begin a suicide assessment with a direct question about suicide. A pain assessment is inappropriate because the client is referring to psychological pain. An antidepressant isn't the best choice because the client may be contemplating suicide imminently. Diversional stimuli don't provide for the client's safety.
A client admitted with depression has been receiving sertraline (Zoloft) and is to continue this medication on discharge. Which statement by the client would indicate the need for further teaching? -"I'll take my medication in the morning after brushing my teeth." -"I'll take my medication with food and lots of fluids." -"I'll continue to take my medications, even if I develop adverse symptoms, because they will resolve." -"I'll continue to take this medication even when I feel less depressed."
"I'll continue to take my medications, even if I develop adverse symptoms, because they will resolve." Sertraline, a serotonin inhibitor, can cause a potentially fatal syndrome that's reversible when the drug is discontinued. Signs and symptoms include increased anxiety, excessive sweating, and fever. When the medication is taken in the morning, it eliminates a common adverse reaction, insomnia. Nausea is another common adverse reaction that can be avoided when the medication is taken with food. Discontinuing the medication lowers blood levels and could cause a relapse of depression.
A nurse is developing a care plan for a client with acute mania. Arrange the following behaviors to show the typical progression of acute mania. 1) Delusions of grandeur 2) Relevant, calm speech patterns 3) Highly productive and competitive in work and leisure activities 4) Easily irritated 5) Poor judgment and impulse control
2, 3, 4, 1, 5 Relevant and calm speech patterns indicate normal behavior. once mania begins, the client may become highly productive and competitive in all activities. Sleep isn't a priority. As mania progresses, emotional manifestations heighten and the client is easily irritated, begins to have delusions of grandeur, and may require medication to reduce restlessness and agitation. Client safety is the primary goal due to poor judgment and impulse control.
A client with major depression must take the monoamine oxidase (MAO) inhibitor tranylcypromine (Parnate). Which foods should the nurse teach this client to avoid? SATA 1) Free range poultry 2) Whole grain bread 3) Aged cheese 4) Fresh fish 5) Wine 6) Preserved fruits
3, 5, 6 The client should avoid concomitant use of the MAO inhibitor and high-tyramine foods, such as aged cheese, wine, and preserved fruits, because their interaction may produce a life-threatening hypertensive crisis. The client may safely consume low-tyramine foods, such as poultry, whole grain bread, and fresh fish.
During the manic phase of bipolar disorder, a client's lithium level measures 0.15 mEq/L. The client dresses flamboyantly, acts provocatively, and has seriously impaired judgment. What is the nurse's first priority when planning this client's care? -Administer lithium carbonate I.M. -Provide a safe, nonstimulating environment -Begin aversion therapy to extinguish undesirable behaviors. -Initiate suicide precautions
Provide a safe, nonstimulating environment Because the client with manic symptoms is easily overstimulated and has impaired judgment, the nurse should observe him closely to protect him from acting on dangerous impulses. The nurse should provide a safe, nonstimulating environment. Although lithium carbonate is used to control mania, it's available only in oral form. Aversion therapy is inappropriate because the client can't control his behavior. Suicide precautions also are inappropriate because the client hasn't displayed suicidal intentions. However, the nurse should be alert for rapid changes in mood, which place the client at suicidal risk.
Recently, an adolescent has become increasingly withdrawn, has grown irritable with family members, and has been getting lower grades on schoolwork. After giving away a stereo and some favorite clothes, the adolescent is brought to the community mental health agency for evaluation. Which problem is the adolescent at risk for? -Suicide -Anorexia -School phobia -Psychotic episode
Suicide Changes in academic performance, familial communication, social withdrawal, and the giving away of treasured behaviors that suggest this adolescent is contemplating suicide. Anorexia would cause weight loss and related symptoms. This adolescent's signs and symptoms suggest no fear of school and typify depression - not psychosis.
A client has taken a bottle of acetaminophen (Tylenol) in an attempt to commit suicide. In response to the client's situation, the nurse follows proper protocol. List in chronological order the priority of the nursing actions that should be taken. Use all options. - Speak directly about the suicide attempt -Don't leave the client alone -Focus on the current crisis -Evaluate the need for medication
2, 1, 3, 4 When executing protocol for a client who has attempted suicide, the nurse should institute one-on-one observation so that the client is never left alone. After observation is established, the nurse should speak openly and directly about the suicide attempt. The nurse should accept the client's thoughts and feelings, especially negative feelings. Discussion should focus on the client's current crisis situation. After performing these actions, the client should be evaluated for the need for antidepressant therapy, if warranted.
A client with major depression sleeps 18 to 20 hours a day, has no interest in previously enjoyed activities, and reports a 17-lb (7.7-kg) weight loss in the past month. Because this is the client's first hospitalization, the physician is most likely to prescribe which drug? -Phenelzine (Nardil) -Thiothixene (Navane) -Fluoxetine (Prozac) -Trazodone (Oleptro)
Fluoxetine (Prozac) The selective serotonin reuptake inhibitor fluoxetine is used in first-time drug therapy because it has few anticholinergic and sedative adverse effects and is less cardiotoxic than other drugs. Phenelzine isn't prescribed initially because it has many adverse effects and requires dietary restrictions. Thiothixene is an antipsychotic drug and is therefore inappropriate for use in uncomplicated depression. Although trazodone is an antidepressant, it generally isn't used as a first-line drug.
A client has been receiving treatment for depression for 3 weeks. Which behavior suggests that the client is recovering? -He talks about the difficulties of returning to college after discharge -He spends most of the day sitting alone in the corner of the room - He wears a hospital gown instead of street clothes -He shows no emotion when visitors leave
He talks about the difficulties of returning to college after discharge By talking about returning to college, the client is demonstrating an interest in making plans for the future, which is a sign of recovery from depression. Decreased socialization, lack of interest in personal appearance, and lack of emotion are all symptoms of depression.
A client with bipolar disorder is energetic, impulsive, and engages in loud verbalizations in the community room. To prevent injury to himself or others while complying with the least restrictive environment principle, which action should the nurse take to prevent escalation of the client's mood? - Place the client in seclusion, and keep the door open -Obtain a court mandate for a higher level of treatment -Help the client channel his energy into appropriate activities -Monitor the client for escalation of manipulative behavior
Help the client channel his energy into appropriate activities Helping the client channel his energy into appropriate activities, such as folding laundry, would be a positive way to keep him from using his energy in inappropriate or destructive ways. Placing the client in a seclusion room and leaving the door open would allow him to leave the room; it also doesn't comply with the principle of using the least restrictive environment. Obtaining a court order for a higher level of treatment isn't an appropriate nursing action. It's more effective to intervene before a crisis occurs, rather than waiting for the client's manipulative behavior to escalate.
A client has just been transferred to the locked psychiatric unit from the emergency department after attempting suicide by taking 200 acetaminophen (Tylenol) tablets. Now the client is awake and alert but refuses to speak with the nurse. What is the nurse's first priority in this situation? -Establish a rapport with the client -Place the client in full leather restraints -Try to communicate with the client in writing -Maintain safety by initiating suicide precautions
Maintain safety by initiating suicide precautions The nurse's first priority is to keep a suicidal client safe and alive. Although establishing rapport is important in psychiatric nursing, it isn't the highest priority. Use of restraints is inappropriate and could be interpreted as punishment of the client or a convenience for the nurse. Trying to communicate in writing also is inappropriate because the client can hear.
A 35-year-old client - who's a divorced parent of three - was admitted 5 days ago with major depression after a suicide attempt. He was prescribed a daily dosage of fluoxetine (prozac). Since starting the medication, his appetite and participation in group therapy have improved. Which nursing diagnosis should receive the highest priority? - Risk for self-directed violence related to suicide attempt - Deficient knowledge related to antidepressant therapy -Chronic low self esteem related to recurrent depression -Anxiety related to disruption in role performance
Risk for self-directed violence related to suicide attempt Despite the improvement in appetite and group participation, the client's risk for self-inflicted harm remains a priority. When depression is resolving, the client can focus more on carrying out a suicide plan. The other nursing diagnoses are important but don't take precedence over the client's safety.
A client in the manic phase of bipolar disorder constantly belittles other clients and demands special favors from the nurses. Which nursing intervention is the most appropriate for this client? -Ask other clients and staff members to ignore the client's behavior -Set limits with consequences for belittling and demanding behavior -Offer the client an antianxiety drug when belittling or demanding behavior occurs -Offer the client various stimulating activities to distract him from belittling or making demands of others.
Set limits with consequences for belittling and demanding behavior To protect others from a client who exhibits belittling and demanding behaviors, the nurse may need to set limits with consequences for noncompliance. Asking others to ignore the client is likely to increase the undesirable behaviors. Offering the client an antianxiety drug or stimulating activities provides no motivation for the client to change problematic behaviors.
A nurse admits a client who presents with symptoms of severe depression and a diagnosis of rapid cycling bipolar disorder. Several hours later, the nurse observes the client pacing in the hall. The client asks the nurse to check him because he thinks he has a fever. his vital signs are: BP 148/90 , Pulse 133 beats/min, respirations 24 breaths/min, temp 99.2 F. What should the nurse infer from these findings? -The client has an infection -The client is experiencing a depressive episode - The client is experiencing a conversion reaction -The client needs further evaluation for illness
The client needs further evaluation for illness The nurse should always evaluate the client for illness when he has abnormal symptoms. Delaying treatment of a medical cause could result in deterioration of the client's physical and mental condition. In this scenario, the client's behavior changed quickly. Even though his vital signs are slightly elevated, these changes are most likely due to the rapid cycling bipolar disorder; however, the nurse can't make that assumption and must investigate the symptoms further. The client's symptoms are more suggestive of a manic episode than a depressive one. A conversion reaction isn't likely in this case because the client has no obviouc physical complaints.
