health and illness concepts II- Ch. 1

A client is admitted to a mental health unit with a diagnosis of depression and is participating in group sessions. The client asks a nurse if they are married or in a romantic relationship. What is the best response by the nurse to maintain a therapeutic relationship? - "Group therapy is not the appropriate time to discuss my relationships." - "It sounds as though you are interested in developing a relationship with me." - "Tell me how you knew that I was not married or in a romantic relationship." - "I'm curious about your question but I want to know how you are feeling today."

- "I'm curious about your question but I want to know how you are feeling today."

A man on parole robs a bank in a small town and wounds two police officers during a shoot-out while trying to escape. The robber is fatally shot. The police officers are being hailed as heroes in the news, and the man's previous and current criminal history is prominently featured. The nurse is caring for the bank robber's sibling, who is in the emergency department with emotional problems and suicidal ideation. Which type of grief may the sibling be experiencing, which could be contributing to the current emotional state? - Anticipatory - Disenfranchised - Uncomplicated - Dysfunctional

- Disenfranchised

The nurse is working with a client with depression and suicidal ideation. The nurse heard the client say, "I am disappointed because thought I'd be feeling better by now since I started medication and therapy a week ago." What would be the primary nurse therapist's most therapeutic response? - "It probably took a while for you to get into this state, and you can't expect for things to get better overnight." - "I'm glad you are taking ownership of your problems and trying to see how you can move things along for your recovery." - "Try to be patient and hopeful. The medication takes several weeks to reach a therapeutic level." - "It takes time and can be frustrating to experience the physical and emotional symptoms of depression all while you learn more about yourself and try new strategies as your medication takes effect."

- "It takes time and can be frustrating to experience the physical and emotional symptoms of depression all while you learn more about yourself and try new strategies as your medication takes effect."

The nurse is caring for a client who lost a spouse 4 months ago to a brain tumor, and the client shares a plan to get remarried in a few months. The client states having truly loved the first spouse, but being happy again and excited to move forward with life with the fiancé. What is the nurse's best response? - "I am happy for you but I am very concerned that you are rushing into things. Did you see a grief counselor?" - "Getting married so soon after your spouse passed away must be very stressful. Would you like to talk about it?" - "It sounds like you are in a good place in your life now. Congratulations! I wish you all the best in your new marriage." - "I am sure your spouse is looking down from Heaven and is happy that you have found happiness. Congratulations!"

- "It sounds like you are in a good place in your life now. Congratulations! I wish you all the best in your new marriage."

The nurse is caring for a client who has just undergone electroconvulsive therapy (ECT) for the treatment of severe depression that is unresponsive to medication. What is the nurse's most important intervention immediately postprocedure? - Assess vital signs. - Administer analgesics. - Provide oral fluids. - Reorient the client to the environment.

- Assess vital signs.

A parent of a 7-year-old child and a 10-year-old child is concerned about what they should tell their children regarding their spouse's impending death from aggressive breast cancer. How should the nurse respond to the client's spouse? - Refer the family to pastoral care services. - Encourage the client's spouse to come to terms with their own grief. - Suggest that the health care provider (HCP) tell the children about the seriousness of their parent's illness. - Begin education about strategies for communication with their children.

- Begin education about strategies for communication with their children.

In the community room, a nurse observes a client who suffers from depression. The client paces swiftly around the room, swings both arms, and rubs both hands together. What term should the nurse use to describe these behaviors to members of the health care team? - psychomotor agitation - tardive dyskinesia - compulsions - mania

- psychomotor agitation

The nurse is caring for a client who has a new prescription for amitriptyline for depression and is preparing to be discharged. What assessment is the nurse's priority? - orthostatic hypotension - constipation and dry mouth - suicidal ideation - extrapyramidal effects

- suicidal ideation

A school nurse interviews the parent of a middle school student who is exhibiting behavioral problems, including substance abuse, following a sibling's suicide. The parent says "I'm a single parent who has to work hard to support my family, and now I've lost one child and my other child is acting out and making me crazy! I just can't take all this stress!" Which concern regarding this family has top priority at this time? - the parent's ability to emotionally - support the adolescent in this crisis - the potential suicidal thoughts/plans of both family members - the adolescent's anger - the parent's frustration

- the potential suicidal thoughts/plans of both family members

When caring for an adolescent diagnosed with depression, the nurse should remember that depression manifests differently in adolescents than it does in adults. In an adolescent, signs and symptoms of depression are likely to include: - helplessness, hopelessness, hypersomnolence, and anorexia. - truancy, a change of friends, social withdrawal, and oppositional behavior. - curfew breaking, stealing from family members, truancy, and oppositional behavior. - hypersomnolence, obsession with body image, and valuing of peers' opinions.

- truancy, a change of friends, social withdrawal, and oppositional behavior.

Assessment tools for depression

-Beck Depression Inventory -Hamilton Depression Scale -Geriatric Depression Scale -Zung Depression Scale - PHQ-9

A client with a history of suicidal thoughts and depression has just attended an outpatient day therapy group session. The nurse hears from the client that they plan to forgo lunch and the afternoon session, stating, "I just need to go home and have a nap." What would be the day therapy nurse's best response? - Ask the client if they are angry. - Remind the client that the program schedule will benefit the client only if the client stays for the whole day. - Ask the client if they are hungry or if they have not been enjoying the food at the outpatient program. - Ask the client to sit for a few minutes to discuss missing the afternoon session.

- Ask the client to sit for a few minutes to discuss missing the afternoon session.

A nurse assesses an 82-year-old client for depression. Because of the client's age, the nurse's assessment should be guided by which factor? - Sadness of mood may be masked by other symptoms. - Impairment of cognition usually is not present. - Psychosomatic tendencies do not tend to dominate. - Antidepressant therapies are less effective in older adults.

- Sadness of mood may be masked by other symptoms.

symptoms of depressive disorders

sadness, emptiness, irritability, somatic concerns, impairment of thinking.

During the nurse's conversation with a depressed client, the client states, "I have no reason to be sad. I have a great job and a wonderful spouse and family." Which comment would be best for the nurse to make at this time? - "Why do you think you are depressed?" - "Think about how fortunate you are." - "You have many positive qualities." - "Depression can be caused by a chemical imbalance in the brain."

"Depression can be caused by a chemical imbalance in the brain."

A spouse brings the client to the emergency department. The spouse reports that since the death of their 7-month-old daughter 8 weeks earlier, the client has been neglecting the housework and family, has lost 20 lb (9.1 kg), and has not left the house. Which additional assessment findings would indicate to the nurse that the client may be experiencing extreme depression? Select all that apply. - discussing how beautiful the daughter was - obvious neglect of personal hygiene - speaking in soft monotone voice - inconsolable weeping - meticulously folding clothes to place in the drawer

- obvious neglect of personal hygiene - speaking in soft monotone voice - inconsolable weeping

power of attorney for healthcare

Appoints another to make medical decisions if you cannot. They do not have to be terminally ill to allow action on their behalf.

DSM-V

Diagnostic and Statistical Manual of Mental Disorders. change from previous functioning. at least five of the following almost everyday for a minimum of 2 weeks. at least one symptom is depressed mood or loss of interest/pleasure.

Hospice care

multidisciplinary team approach to reduce symptoms, not cure. -life expectancy of 6 months or less.

Euthymia

normal, healthy fluctuations in mood from sadness to happiness.

premenstrual dysphoric disorder (PMDD)

associated with the luteal phase of menstrual cycle; symptoms severe enough to interfere with work and personal interactions. Tx: diet, exercise, relaxation therapy, hormonal contraception, SSRIs.

Disruptive Mood Dysregulation Disorder (DMDD)

constant, severe irritability and anger; irritability, anger and temper tantrums must be present in at least two settings. symptom-based approach, parent training, CBT.

Kubler-Ross stages of grief

denial, anger, bargaining, depression, acceptance

palliative care for clients with dementia.

difficult behaviors can communicate discomfort. Anticipate needs to prevent/reduce behaviors.

Therapeutic Procedures for depression

electroconvulsive therapy, repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), light therapy, exercise. (Read all definitions on ch.1 powerpoint)

seasonal affective disorder (SAD)

form of depression occurring seasonal when there is less daylight; light therapy is first line treatment.

Grief

inner emotional response to a loss, normal, complex process.

living will

legal document outlining how and where one wishes to die. Activated only when a person is terminally ill and incapacitated.

Persistent Depressive Disorder (Dysthymia)

milder form of depression; symptoms occur most of the day, majority of days; usually early onset lasting 2 years for adults, 1 year for children; at least 3 symptoms of MDD; may become MDD in adulthood; tx with CBT, antidepressants.

palliative care

patient and family centered care that optimizes quality of life by anticipating, preventing, and treating suffering. - specialized care for patients living with serious illnesses.

bereavement

period of grieving after death.

Antidepressants

positively impact poor self-concept, social withdrawal, vegetative signs, and activity level.

two components of advance directives.

power of attorney and living will.

Advanced directives

statement of how you want medical decisions to be made if you cannot make them yourself.

mounring

things people do to cope with grief; everyone griefs but not everyone engages in mourning.

peripartum depression

two-week period of depressed mood or loss of interest in all activities.

dysphoria

when mood persistently disrupts functional status.

The family of a client who died unexpectedly arrives to the care area. In which way should the nurse support the family at this time? Select all that apply. - Provide emotional support. - Serve as an attentive listener. - Expect the family to express grief. - Arrange for the family to view the body. - Direct the family to the funeral home.

- Provide emotional support. - Serve as an attentive listener. - Expect the family to express grief. - Arrange for the family to view the body.

Assessment of a client who has just been admitted to the inpatient psychiatric unit reveals an unshaven face, noticeable body odor, visible spots on the shirt and pants, slow movements, gazing at the floor, and a flat affect. Which of the following should the nurse interpret as indicating psychomotor retardation? - Slow movements. - Flat affect. - Unkempt appearance. - Avoidance of eye contact.

- Slow movements.

A young adult client with severe depression and suicidal ideation has been started on the selective serotonin reuptake inhibitor (SSRI) sertraline. Which client statement would indicate the client needs further teaching about sertraline? - "I can take this medicine with food." - "It may take several weeks for the depression to get better " - "Being on sertraline will significantly decrease the chances that I might hurt myself." - "Sexual side effects are pretty common with sertraline."

- "Being on sertraline will significantly decrease the chances that I might hurt myself."

The partner of a postpartum client asks the nurse what is wrong with the infant's mother and why she isn't more joyful about the birth of their child. Which would be the most appropriate response by the nurse? - "How many days has it been since she gave birth?" - "How many hours does she sleep at night?" - "What risk factors does she have for postpartum depression?" - "Do any family members suffer from depression?"

- "How many days has it been since she gave birth?"

The parents of an infant who just died from sudden infant death syndrome (SIDS) are angry at God and refuse to see any members of the clergy. How would the nurse respond? - "Faith can be a wonderful support after such a devastating event." - "I respect your choice not to seek spiritual support at this time." - "Is there anyone else I can call to support you at this time?" - "Can you tell me more about your spiritual beliefs and practices?"

- "Is there anyone else I can call to support you at this time?"

A client asks the nurse if she is at risk for developing postpartum depression. Which of the following assessment data would further assist the nurse to identify a postpartum depression risk? Select all that apply. - The client states she has a history of postpartum depression. - The client has had multiple pregnancies. - The client states she has a history of depression. - The client's partner has stated the couple has financial problems. - The client's pregnancy has had multiple complications.

- The client states she has a history of postpartum depression. - The client states she has a history of depression. - The client's partner has stated the couple has financial problems. - The client's pregnancy has had multiple complications.