HESI Major Depressive Disorder, Feeding and Eating Disorder

Psychological IntegrityThe client completes 2 weeks of nasogastric feedings and gains 4 lbs (1.81 kgs) and is now tolerating oral feedings. The client becomes upset to learn that weight monitoring is occurring on a weekly basis instead of daily. What is the nurse's best response to the client's concern? -"I hear your concern; however, let's focus on how you are feeling." -"Don't worry. The nursing staff will weigh you daily if you prefer." -"The physician has prescribed weekly weights for six months." -"I don't know what you are worried about! You have only gained 4 pounds (1.81 kg)."

-"I hear your concern; however, let's focus on how you are feeling." By not focusing on weight measurement and caloric intake, the nurse has a greater opportunity to explore the client's feelings and perceptions.

Before the client has the prescription for bupropion filled, the nurse should ensure that the client has not experienced which problem(s)? (Select all that apply. One, some, or all responses may be correct.) -Tachycardia. -Anorexia or bulimia. -Peptic ulcer disease. -Hypertension. -Seizures.

-Anorexia or bulimia. Anorexia and bulimia are both contraindications for bupropion because of a higher incidence of seizures experienced by clients treated for bulimia. -Seizures. Clients with a history of seizures are at higher risk for seizures when taking bupropion.

Medications The APRN-PMH changes the client's antidepressant to bupropion 300 mg once a day and orders lorazepam 0.50 mg twice a day prn for the client's anxiety. When picking up the prescription at the front desk the client asks the nurse about the medications. What information should the nurse discuss with the client about bupropion? -Take at bedtime. -May cause hand tremors. -Anxiety level may increase. -Use every other day.

-Anxiety level may increase. Clients who suffer from anxiety may experience increased agitation when taking this antidepressant.

Planning During the interview, the client identifies intense anxiety, irritability, and feelings of depression with thoughts of suicide as reasons for seeking treatment. The nurse develops a plan of care to assist the client in managing anxiety. Which approach is best for the nurse to use when assessing a client's risk for attempting suicide? -Tell the client to express which specific stress causes anxiety. -Find out from client how is their social life at work and at home. -Have the client explain what causes worse feelings. -Ask the client about having a plan to harm self.

-Ask the client about having a plan to harm self. Assessment of suicidal intent and determining if there is an actual, viable plan is the most important component of client assessment and care plan development.

Which statement by the nurse is most likely to encourage the client to talk about the issues that are contributing to the anxiety? -Explain what age has to do with anxiety. -Have client state what they think about current age. -Ask the client about the meaning of being a certain age. -Encourage the client to express what age means to the boss.

-Ask the client about the meaning of being a certain age. This question encourages the client to explore the relationship between age and level of anxiety.

What is the most important intervention the nurse should do once the client is taking the medication bupropion? -Have the client report the level of anxiety since on the increased bupropion. -Ask the client if there have been any suicidal thoughts since starting bupropion. -Get the client to explain any improvement in energy since increasing the bupropion. -Evaluate how much improvement the client feels has occured since starting the bupropion.

-Ask the client if there have been any suicidal thoughts since starting bupropion. Assessment for being a danger to oneself or others is always the first priority when assessing the depressed client.

The nurse knows that the client is still easily upset by the boss's behavior. How should the nurse respond to the client? -Instruct the client to explain plans on how to interact with the boss. -Try to relate what going back to work with the boss is like for the client. -Reiterate that the client did not report any concerns about the boss in the prior conversations. -Ask the client to express what feelings occur when talking to the boss about something of concern.

-Ask the client to express what feelings occur when talking to the boss about something of concern. The nurse is encouraging the client to focus on feelings to be able to recognize when stressful events occur and deal with the feelings.

The orientation phase of building the therapeutic relationship is important to the establishment in which rapport can grow. Which approach is best for the nurse to use when assessing for subjective information from the client? -Have the client say what is causing the anxiety. -Tell the client that it sounds like the anxiety is causing depression. -Get the client to explain how anxiety affects normal activities. -Ask the client to give an example of how they feel when they are anxious.

-Ask the client to give an example of how they feel when they are anxious. This statement of asking for an example can clarify vague statements made by a client with anxiety .

Physiological IntegrityThe nurse recognizes the importance of collaborative practice to meet the client's nutritional needs during the acute phase of treatment. Which member of the interprofessional team plays a major role in formulating the nasogastric feeding protocol? -Pediatric Nurse Practitioner. -Certified Nurse Assistant. -Clinical Nutritionist. -Health Care Practitioner.

-Clinical Nutritionist. The clinical nutritionist has expertise in enteral dietary management and provides consultation to the interprofessional team.

Which nursing action has the highest priority during one-on-one staffing? -Teach the client alternative coping strategies throughout the day. -Assess the client's mood and affect, using therapeutic communication. -Closely monitor the client and document the potential for self-harm. -Provide educational interventions with videos and written materials.

-Closely monitor the client and document the potential for self-harm. This is the priority during one-on-one staffing.

While the nurse is teaching the client about taking bupropion, the client asks if it is all right to drink alcohol when taking the medication. How should the nurse respond to the client's question? -Consuming wine or beer in moderation is all right. -In moderation, alcohol has no interaction with bupropion. -The client has to make the decision about whether to drink alcohol. -Do not consume alcohol while taking this medication or it can cause seizures.

-Do not consume alcohol while taking this medication or it can cause seizures. Alcohol should not be consumed when taking the medication because it may increase the risk of seizures.

During the conversation with the nurse on the clinic's emergency line, the client tells the nurse about thoughts of taking an overdose. The client tells the nurse about having prescriptions for lorazepam and bupropion. The nurse knows that an overdose of this combination of drugs could be lethal. How should the nurse respond to the client? -Inform the client of concern regarding safety and call the police. -Contact the client's family to tell them what the client is saying. -Tell the client to get rid all that medication by flushing it down the toilet. -Express concern and determine if someone can take the client to the hospital.

-Express concern and determine if someone can take the client to the hospital. At this point, the client should be assessed for possible hospital admission. Determining if someone is available to transport the client reduces the likelihood that the client will drive while feeling suicidal.

Psychosocial IntegrityThe primary HCP prescribes one-on-one nurse staffing for 24 hours. Safety measures are implemented, which include removing all contraband and being accompanied to meals and activities. Which nursing concern takes the highest priority for this client, according to Maslow's Hierarchy of Needs? -Unable to cope with stress. -A sense of feeling hopeless. -Unable to function on a daily basis. -Expressing feelings of self-harm.

-Expressing feelings of self-harm. The client disclosed having thoughts of self-harm during periods of increased anxiety, and she stated that she is currently feeling overwhelmed. This demonstrates the need for safety measures to be implemented with greater monitoring and observance of behaviors.

The client states that she is worried that she is being singled out, because she is the oldest of her coworkers and believes that everyone thinks she should be doing better because of her age. Which nursing diagnosis should the nurse add to the client's plan of care? -Feeling powerless related to work conflict. -An alteration in sensory perception related to false beliefs about being singled out. -An alteration in body image related to permanent change in body due to aging. -Feeling socially isolated related to work tension.

-Feeling powerless related to work conflict. The nurse can work with the client to feel more empowered to change own behavior and responses to the boss and coworkers. For example, the client may become more assertive or may decide to change jobs.

After 4 weeks of therapy, the client calls the clinic's emergency line, crying and reports that there is nothing to live for. Which is the most important information the nurse should obtain from the client? -If the client has a plan and means to harm self. -The client's desire to carry out a suicide plan. -Ask the client if there is anyone there with them. -Discuss with the client ways to make sure not to cause self harm.

-If the client has a plan and means to harm self. When assessing for suicidal ideation, the nurse must first determine if the client has a means to harm themselves, then the true desire to do self-harm. The second phase of suicide prevention involves making a no-self harm plan. Lastly, the presence/absence of a support system is useful information.

The client completes 24 hours of one-on-one nurse staffing and consistently reports to the nurses no feelings of self-harm. The primary HCP writes a prescription to discontinue one-on-one staffing. The client is now expected to participate in group therapies and has privileges to eat with the other clients in the cafeteria. The client is observed to experience difficulty communicating with peers and sits on the periphery of groups. Which nursing focus describes the client's current problem? -Inability to interact socially. -Feelings of hopelessness. -Unable to cope with stress. -Unable to perform roles in life.

-Inability to interact socially. The client is demonstrating discomfort in social situations, which is impaired social interaction.

Six months after the initial presentation, the client comes to the clinic for a regular visit. While waiting to be seen, the client tells the nurse about wanting to stop taking the medication. How should the nurse respond to the client's statement? -Reiterate that the client that this is a lifelong medication. -Tell the client to talk to the HCP about stopping the medicine. -Inform the client that the medication can be stopped now if desired. -Instruct the client that most clients do better by taking the medicine for months.

-Instruct the client that most clients do better by taking the medicine for months. It may take at lease 12 weeks for therapeutic effcts. Client's should be encouraged to continue their medication as prescribed.

Eight months after being discharged from the clinic, the client calls the clinic and wants to talk. How should the nurse respond to the client's request? -Terminate the call as quickly as possible. -Allow the client to talk as much as needed. -Keep the conversation focused on superficial topics. -Instruct the client to make an appointment for follow-up.

-Instruct the client to make an appointment for follow-up. The client should be encouraged to make an appointment so the client can discuss in depth the problems currently occurring. During the appointment, the need to reestablish care and a therapeutic relationship can be determined.

Physiological Adaptation The nurse recognizes that the client's nutritional deficits lead to a high risk for medical complications. Which nursing problems have the highest priority during the acute phase of treatment? (Select all that apply. One, some, or all options may be correct.) -Malnourishment. -Inability to cope effectively. -Distortion in body image. -Chronic poor self-esteem. -Deficiency in fluid volume.

-Malnourishment. Clients with anorexia nervosa have insufficient nutritional intake to meet metabolic needs. -Deficiency in fluid volume. Clients with anorexia nervosa present with inadequate fluid volume to support cardiac and vascular function.

What actions should the nurse take to implement the client's plan of care? (Select all that apply. One, some, or all options may be correct.) -Monitor fluid and electrolytes. -Supervise the client during and after feedings. -Increase the client's exercise regime. -Perform skin assessments each shift. -Measure and document intake and output.

-Monitor fluid and electrolytes. Deficient fluid volume is a major health risk in the client who is malnourished. -Supervise the client during and after feedings. Supervision is required to prevent the client from vomiting or siphoning off feedings. -Perform skin assessments each shift. Impaired skin integrity is a health risk for the client who is malnourished and dehydrated. -Measure and document intake and output. Maintenance of accurate fluid and caloric intake and output is an essential nursing function to evaluate the benefit of enteral feedings.

Physiological Integrity and Physiological AdaptationThe nasogastric feeding protocol is established and feedings are initiated. The nurse chooses to administer the feedings at night. Which is the best rationale for the nurse's decision? -The client is engaged in activities during the day. -The client has trouble sleeping during the night. -The nurse views this time schedule as being able to maintain control over the client's behavior. -Night feedings can prevent reinforcing attention and sympathy from others.

-Night feedings can prevent reinforcing attention and sympathy from others. The nurse administers the feedings in a neutral manner, remaining focused on the client's safety and health status.

Which laboratory finding result reveals the finding of protein malnutrition? -Albumin level 4.2 g/dL (4.2 gl/mL). -Prealbumin level 5 mg/dL (5 mg/mL). -Hematocrit level 38% (0.38 L/L). -Hemoglobin level 13 g/dL (13 mg/mL).

-Prealbumin level 5 mg/dL (5 mg/mL). Prealbumin is a sensitive indicator of malnutrition due to its short half-life of 2 days. The normal range is 15 to 36 mg/dL (15 to 36 mg/mL).

Physiological and Psychosocial IntegrityThe client completes 3 weeks of treatment and continues to express anxiety during mealtimes. The client now weighs 89 lbs (40.46 kgs), with a BMI of 17.4. The interprofessional team is preparing to transition the client to the eating disorders unit. What actions should the nurse take during this transitional phase? (Select all that apply. One, some, or all options may be correct.) -Provide a supportive approach regarding the client's expressed anxiety. -Continue to provide supervision during and after mealtimes. -Actively listen to the client's concerns. -Provide the client with greater flexibility and less structure. -Discontinue meal supervision.

-Provide a supportive approach regarding the client's expressed anxiety. Transition to the eating disorder unit can create additional fear and anxiety for the client. -Continue to provide supervision during and after mealtimes. It is important to maintain a structured plan of care with specific expectations during a period of transition. -Actively listen to the client's concerns. The nurse demonstrates the use of therapeutic communication during this period of transition.

Health Promotion and MaintenanceThe client transfers to the eating disorders unit. During the nurse's admission assessment, the client discloses thoughts of self-harm when feeling increasingly anxious and overwhelmed. The client denies having any intent for self-harm currently and does not have a plan, but admits to feeling vulnerable due to the transfer. Which nursing action should have the highest priority? -Report this data to the primary HCP and the interprofessional team. -Call the acute medical unit to discuss the client's history. -Allow the client to freely engage in unit activities. -Firmly ask the client why this information was withheld.

-Report this data to the primary HCP and the interprofessional team. New data concerning the client's safety is immediately communicated to the primary HCP and the interprofessional team.

Which nursing concerns would take priority when developing the client's care plan? (Select all that apply. One, some, or all responses may be correct.) -Severe anxiety. -Self-care deficit. -Possibility of harming self. -Having difficulty in coping. -Difficulty communicating verbally.

-Severe anxiety. The client's assessment findings are indicative of severe anxiety. -Possibility of harming self. The client shares about considering suicide, so is at a risk for self-harm. -Having difficulty in coping. The client shares having increasing difficulty at work and is experiencing physiological symptoms.

The client meets with the nurse. During the group session, the client tells the nurse about an extreme amount of stress at work. The client has filed multiple harassment complaints against the boss. The client states feeling it is necessary to hold self to a higher set of standards than coworkers because their boss uses a stricter set of standards for the client's performance appraisal. The nurse recognizes that the client is experiencing what level of anxiety? -Mild. -Moderate. -Severe. -Panic.

-Severe. The individual with severe anxiety can only focus on a narrowed area of concern, such as the client only focusing on her employer and coworkers.

Which clinical manifestations should the nurse observe as indicators of hypophosphatemia? (Select all that apply. One, some, or all options may be correct.) -Shallow respirations. -Weak cardiac contractions. Cardiac contractions can occur due to insufficient energy in myocardial cells. -Increased bone density. -Seizure activity. -Altered mental status.

-Shallow respirations. Respiratory changes can occur due to the electrolyte and musculoskeletal changes. -Weak cardiac contractions. Cardiac contractions can occur due to insufficient energy in myocardial cells. -Seizure activity. Central nervous system changes can occur with severe hypophosphatemia. -Altered mental status. Confusion and hallucinations are common presenting features of hypophosphatemia.

Physiological Integrity and Physiological AdaptationUpon initiation of nasogastric feedings during the client's acute care hospital stay, the nurse assessed the client as being at high risk for refeeding syndrome. When developing the plan of care for initiation of nasogastric feedings, the nurse recognizes which nursing intervention as having the highest priority? -Slow enteral feedings at the start of therapy. -Measure electrolytes on a weekly basis. -Increase the caloric rate of feedings. -Advance oral feedings as tolerated.

-Slow enteral feedings at the start of therapy. Nasogastric feedings should be started at a reduced caloric rate (25 to 50% of estimated requirements) to reduce the risk of refeeding syndrome.

The client tells the nurse about believing in doing a job right. The client goes on to say that the boss is discriminating because of age. The nurse further inquires about the statements made by the client about feeling regarding the work environment. Which behavior should the nurse encourage from the client? -Participate in developing a plan for managing anxiety. -Identify physical symptoms of stress. -State the sources for present anxiety. -Express the relationship between anxiety and stressors.

-State the sources for present anxiety. The nurse must understand the client's perception of the sources of her anxiety in order to help the client.

Assessment The triage nurse performs a more in-depth assessment of the client's complaints and reports the assessment to the Advanced Practice Registered Nurse in Psychiatric-Mental Health (APRN-PMH). These two nurses collaborate on development of the care plan to facilitate assessment and interventions for the client's anxiety. During the initial assessment, the nurse should focus on which areas that are most characteristic of anxiety? (Select all that apply. One, some, or all responses may be correct.) -Symptoms restlessness, difficulty concentrating, and irritability. -Social interactions such as withdrawal, shunning family and drinking alcohol. -Increasing symptoms of depression with consistently sad, low mood. -Behavioral alterations including hallucinations. -Suicidal ideation.

-Symptoms restlessness, difficulty concentrating, irritability. Hildegard Peplau identified four levels of anxiety defined by physical symptoms. Identification of the specific level of anxiety is essential because interventions are based on the degree of the client's anxiety .term-1 -Increasing symptoms of depression with consistently sad, low mood. There is a high comorbid rate of anxiety and depression. Often clients who are diagnosed with both of these diseases are at increased risk for suicidal ideation. -Suicidal ideation. There is a high comorbid rate of anxiety and depression. Often clients who are diagnosed with anxiety and depression are at increased risk for suicidal ideation.

Several days after starting the medication, the client calls the office and tells the nurse that the bupropion is causing headaches. How should the nurse respond to the client's report of headaches? -Interview the client for any other physical problems. -Explain that the headaches usually go away within a few days. -Ask the client about taking the medication daily at the same time. -Tell the client that this medication may cause clients to have headaches. Headaches are a common side effect.

-Tell the client that this medication may cause clients to have headaches. Headaches are a common side effect.

The nurse is concerned about the client's apparent continuing difficulties with the boss. The client is discharged from the clinic program after 6 additional months of treatment. The client can recognize the aspects of work that cause anxiety and is able to deal with these problems appropriately. The nurse-client relationship is terminated with the client's discharge from the mental health clinic. What makes termination important to the nurse-client relationship? -termination prevents further episodes of depression. -Saying good-bye allows for release of feelings of loss. -Termination summarizes the goals and objectives attained. -Those with mental illness have difficulties with termination.

-Termination summarizes the goals and objectives attained. This is an opportunity for the client to discuss ways to incorporate new coping strategies learned while in treatment with the nurse.

Outcomes It has now been 1 year since the client's initial presentation to the clinic and the nurse is conducting a regular follow-up interview, listening as the client describes the situation at work. The nurse recognizes that the client is using reaction formation as a defense mechanism. Which statement by the client is the nurse basing this assessment? -The client expresses thinking the boss does not like anyone with seniority. -The client explains about working harder than ever to make the boss happy. -The client describes tells the boss that nothing the boss does will cause distress anymore. -The client states about not caring anymore about what the boss does to upset those in the office.

-The client describes tells the boss that nothing the boss does will cause distress anymore. This is reaction formation, a type of defense mechanism that occurs when clients turn their feelings or impulses into their opposites, such as the client's statement about the boss.

Which evaluative measure demonstrates improvement in the client's ability to socially interact with peers? -The client verbalizes one way in which an eating disorder has affected the health of the family. -The client eats breakfast and lunch with select peers. -The client remains free from self-harm during hospitalization. -The client recognizes distorted perceptions of body image.

-The client eats breakfast and lunch with select peers. This demonstrates an improvement in socialization skills.

The client is admitted to the hospital for 5 days. Two weeks after discharge, the client returns to the mental health clinic for a follow-up visit. The APRN-PMH has prescribed 10 mg escitalopram at bedtime and 150 mg bupropion in the morning. Which statement by the client best suggests that the medication combination and therapy are working? -The client reveals having more success at getting things done. -The client states that the things that happen at work no longer bother her. This statement suggests that the client's initial complaints have been resolved. -The client states that thinking about committing suicide was a stupid thing. -The client reports that the next time a feeling of hopelessness occurs, the first step will be to call the clinic.

-The client states that the things that happen at work no longer bother her. This statement suggests that the client's initial complaints have been resolved.

Which short-term goal promotes safety measures when refeeding the client? -The client will gain no more than 1 to 2 lbs (0.45 to 0.91 kgs) during the initial week of refeeding. -The client will exercise 30 minutes each day during the first week of refeeding. -The client will gain at least 5 lbs (2.27 kgs) during the first week of refeeding. -The client will demonstrate a willingness to take oral foods during the first week.

-The client will gain no more than 1 to 2 lbs (0.45 to 0.91 kgs) during the initial week of refeeding. Refeeding is started slowly to prevent adverse effects from fluid and electrolyte shifts.

During the initial 8 hours of one-on-one nurse staffing, the client is able to verbally contract with the primary nurse to disclose any thoughts of self-harm. What is the nurse's primary purpose for establishing a treatment contract with the client? -To focus on the client's anxiety in relation to oral nutrition. -To allow the client to decide whether or not thoughts of self-harm will be disclosed. -To relieve the nurse of frequently assessing the client for suicidal ideation. -To provide the client with greater control over the expression of feelings.

-To provide the client with greater control over the expression of feelings. Enhancing the client's involvement in the decision-making process builds trust and a therapeutic relationship between the nurse and client.

Introduction Major Depressive Disorder

A client presents to the community mental health clinic. The client is divorced with no children. Job responsibilities include significant traveling. The client was working in the office this week and witnessed the collapse of a 6-story office building. The death toll from the collapse of that building was over 100. The client's medical history includes hypothyroidism and depression. The client tells the nurse about feeling increasingly depressed for a long time, easily irritated, anxious, and as someone who does not enjoy normal activities.

Introduction Feeding and Eating Disorder

An adolescent client presents to the ED with the parents and a therapist. The parents state that their child has been eating and then secretly vomiting and has become considerably more malnourished. In addition, the parents have found evidence of laxatives and diuretics in the client's room. The therapist expresses concerns that the client is physiologically unstable, losing excessive amounts of weight, and at this time needs medical care. The client has been lying to her parents and therapists about this behavior, which seems to be getting worse. The client currently weighs 84 pounds (38.10 kg) and is 5 feet tall. A BMI of 16.4 places the client in the moderate level of severity. The parents share that their child was sexually assaulted by a classmate a few years ago, which coincides with the start of binging and purging. The therapist expresses concern that the client has an unrealistic body image and has also been using cutting as a coping technique. The parents acknowledge that there is some conflict in the home, with one parent being overbearing, while the other parent is working long hours.

The client tells the nurse about sweating all the time and occasional chest pains, plus numbness in arms and hands. How should the nurse respond to the client's comments? -Tell the client that these issues are probably due to anxiety. -Ask the client about the most recent check-up. -Distract the client from worrying about these symptoms right now. -Have the client elaborate on experiencing chest pain.

Have the client elaborate on experiencing chest pain. It is important for the nurse to understand the client's perception of the problems before making further recommendations.