NUR 1511 Mental Health Chapter 17: Mood Disorders and Suicide

Which question by a depressed, inpatient, psychiatric-mental health client should the nurse interpret as a potential suicide clue?

"Are clients allowed to keep drugstore medications at their bedside?"

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

Which actions would indicate an increased suicidal risk?

An abrupt improvement in mood Calling family members to make amends Statements such as "Everything will be better soon"

A client's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action?

Assess the client's blood pressure

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."

Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder?

Bananas

When teaching a client who is recently diagnosed bipolar I disorder, the nurse correctly tells the client that the difference between bipolar I disorder and bipolar II disorder is what?

Bipolar I disorder is often more disruptive than bipolar II disorder.

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

A psychiatric-mental health nurse is conducting a refresher class for a group of psychiatric-mental health nurses returning to the field. After teaching about depressive disorders, the nurse determines a need for additional teaching when the class identifies which physical or psychological symptom as being associated with depression?

Catatonia

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

Confusion

A depressed older adult client is being treated with a tricyclic antidepressant (TCA). For which clinical manifestations should the nurse monitor the client?

Orthostatic hypotension and urinary retention

A client states, "I'm worthless, and I don't deserve to live." This theme in the client's expressed thought may signal a maladaptive response to which disorder?

Depression

Which is an anticonvulsant used as a mood stabilizer?

Divalproex

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

What is the rationale for a person taking lithium to have enough water and salt in his or her diet?

Lithium is a salt that has greater affinity for receptor sites than sodium chloride.

A client is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also reports having felt unhappy most of the time for "as long as I can remember." Which diagnosis should the nurse anticipate for this client?

Persistent depressive disorder

A client was admitted to the psychiatric unit after being picked up by police officers who found the client frantically running back and forth across the freeway. The client's spouse reports that the client stayed up all night, ate very little, and talked incessantly. Additional assessment findings that indicate a manic episode include what?

Pressured speech, combative behavior, and impaired judgment

The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what?

Prevent self-destructive behavior.

The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which?

Psychomotor agitation

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

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 is receiving lithium carbonate for the treatment of mania. The nurse would reinforce which teaching component regarding lithium treatment?

Schedule bloodwork for lithium levels.

For which client would the nurse be obligated to take immediate and focused action to prevent imminent death?

The client with depression who has been using alcohol and owns a gun

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

depression

The majority of suicides among men are attributed to:

firearms.

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 client with mania begins dancing around the day room. When she twirled her skirt in front of the male clients, it was obvious she had no underwear on. The nurse distracts her and takes her to her room to put on underwear. The nurse acted as she did to

minimize the client's embarrassment about her present behavior.

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."

A client with which psychiatric disorder is at high risk for suicide?

Schizophrenia

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 34-year-old client with depression is admitted to an inpatient psychiatric unit. The nurse enters the client's room and initiates interaction with the client. When talking with the client, which approach would be least appropriate?

Animated and cheerful manner

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 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 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

Liver function

A client says to the nurse, "You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse?

"Are you thinking of suicide?"

A bipolar client presents to the clinic with reports of headaches and feeling more irritable than usual. What is the best nursing response?

"Can you tell me more about these symptoms?"

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?"

Which question should the nurse ask to assess the client's degree of suicide planning when the client states, "Everyone would be better off without me. I will just use my gun to end it all!"?

"Do you have access to a firearm?"

A client with bipolar disorder begins taking lithium carbonate (lithium) 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." Which is the best response by the nurse?

"Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks."

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?"

During a night shift, a hospitalized client with depression tells a nurse that the client is going to kill himself or herself. The client is placed on constant observation. When the client asks to use the toilet, the nurse follows the client into the bathroom. The client says, "You don't need to follow me into the bathroom. Give me some space." Which response by the nurse is most appropriate?

"I must stay with you until we are sure you will not hurt yourself."

The nurse observes that a client with depression sat at a table with two other clients during lunch. Which is the best feedback the nurse could give the client?

"I see you were sitting with others at lunch today."

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 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!"

The nurse working on a mental health unit is teaching a nursing student. The student asks the nurse about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response?

"The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

The nurse provides teaching to the family of a client who is hospitalized after a suicide attempt. Which family member statement indicates a need for additional teaching?

"There is no sense discouraging suicidal thoughts because it doesn't help."

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."

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

Research has shown that risk of suicide increases within which time frame for initiation of antidepressant therapy?

14 days

A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what?

A significant decrease in appetite

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.

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

The nurse is seeing a 43-year-old client whose spouse just died by suicide. Which is a common emotional response that the nurse should anticipate from this client?

Anger toward the loved one who committed suicide

The client's spouse calls the health clinic stating that the client is having a manic episode. What information should alert the nurse to recommend that the client should go to the emergency room for treatment?

Client is avoiding eye contact and visibly shaking.

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.

The nurse is providing client education to an individual who has recently been diagnosed with bipolar disorder and is starting divalproex sodium therapy. What priority information should the nurse include in the plan of care?

Confirm baseline labs have been ordered prior to starting therapy.

A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment findings would support this suspicion? Select all that apply.

Confusion Hallucinations Agitation

A client on the psychiatric mental health unit completed suicide. A nurse who cared for the client has been experiencing insomnia and anxiety attacks since the event. What is the nurse's first action?

Dialogue with a trusted colleague about these feelings

What are the most common types of side effects from SSRIs?

Dizziness, drowsiness, and dry mouth

Which activities would be appropriate for a client with mania?

Drawing a picture Playing table tennis Stretching exercises

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 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

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.

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 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

Which term typifies the speech of a person in the acute phase of mania?

Flight of ideas

A 32-year-old client is admitted to the inpatient unit for depression with suicidal thoughts. During the nursing assessment, why it is important for the nurse to assess and explore if there is any family member who has committed suicide?

Genetic predisposition

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

Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder?

Hyperactivity, dismissing meals, and sleep disturbance

Identify the serum lithium level for maintenance and safety.

I 0.5 to 1.5 mEq/L

The nurse is preparing to discharge a client from the inpatient facility where the client was treated following an unsuccessful suicide attempt. The priority assessment for the nurse to make is to assess whether or not the client can do what?

Identify a person to whom he or she can turn to for help after discharge.

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

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

Increase hydration

Limit setting is most appropriate in which client population?

Manic

The nurse is planning a presentation about suicide to a group of health professionals. Which should be included in the nurse's teaching plan?

Men are more likely to commit suicide than women are.

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

Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what?

Moderate depression

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

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

Orthostatic hypotension

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

Substance abuse

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

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

A nurse is caring for a client diagnosed with bipolar disorder. The client is experiencing a manic episode. The nurse would be especially alert for signs indicating what?

Self-injury

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.

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

The nurse is assessing a client for warning signs of suicide. Which would be a concern?

The client has engaged in risky behaviors and tends to be impulsive.

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.

The nurse is working with an outpatient who has a history of depression and suicide attempts. What assessment finding should the nurse interpret as indicating a high degree of planning for a future attempt?

The client recently purchased a large bottle of over-the-counter analgesics

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?

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

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.

Psychodynamic theory attributes the development of mood disorders to what?

Unexpressed and unconscious anger

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

Wrist slashing