prepu Chapter 17: Mood Disorders and Suicide
For maintenance therapy of mania, the therapeutic serum level of lithium is ... 0.6-1.2 mEq/L. greater than 2.6 mEq/L. 2.1-2.5 mEq/L. 1.6-2.0 mEq/L. therapy of mania, dieu tri hung phan
0.6-1.2 mEq/L. Explanation: For maintenance therapy, lithium serum level should be 0.6 to 1.2 mEq/L. The serum levels should be monitored every 2 months once the client's condition is stabilized. Toxicity occurs with serum lithium levels of 1.5 mEq/L or above.
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? Serotonin 2 antagonist Monoamine-oxidase inhibitor Selective serotonin reuptake inhibitor Cyclic antidepressant
Selective serotonin reuptake inhibitor Explanation: Sertraline is a selective serotonin reuptake inhibitor.
A mental health nurse has formed a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. An appropriate outcome for this nursing diagnosis would include what? The client will demonstrate improved ability to express self. The client will differentiate between reality and fantasy. The client will identify factors that reduce activity tolerance. The client will discuss the cause of the fatigue.
The client will demonstrate improved ability to express self. An appropriate outcome would include demonstrating improved ability to express self.
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?" "How would you describe your relationship with your parents?" "Do you feel like your antidepressant is helping your mood?" "What are your plans for the next few days?"
"Do you ever feel like your situation is hopeless?" 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 teaching to a client with depression. Which statement by the client would indicate that the education has been effective? "I didn't realize so many factors could cause depression." "All old people get depressed. It's a natural part of aging." "I'll begin to feel better in about 3 or 4 days." "When I reduce the stress in my life, the depression will go away."
"I didn't realize so many factors could cause depression." Depression has long been understood as a multifactorial disorder that occurs when environmental factors (e.g., death of family member) interact with the biologic and psychological makeup of the individual. Most older clients with symptoms of depression do not meet the full criteria for major depression. However, it is estimated that 8% to 20% of older adults in the community and as many as 37% in primary care settings experience depressive symptoms. Treatment is successful in 60% to 80%, but response to treatment is slower than in younger adults.
The nurse reviews the medication list for a client who is newly prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which client statement indicates a need to assess the client for serotonin syndrome? "I stopped drinking red wine when I started taking my new prescription." "I used to enjoy taking ecstasy, but I know it isn't safe with my new medication." "I started taking diet pills to assist with weight loss." "I stopped taking St. John's wort 4 weeks ago."
"I started taking diet pills to assist with weight loss." Explanation: Serotonin syndrome is a potentially serious side effect caused by drug-induced excess of intrasynaptic serotonin, 5-hydroxytryptamine (5-HT). Combining medications that increase CNS serotonin levels, such as SSRIs + MAOIs, St. John's wort, diet pills, dextromethorphan, or alcohol (especially red wine) or an SSRI + street drugs (e.g., LSD, MMDA, or ecstasy). The client statement "I started taking diet pills to assist with weight loss." requires the nurse to assess the client for symptoms of serotonin syndrome, which include mental status changes, agitation, ataxia, myoclonus, hyperreflexia, fever, shivering, diaphoresis, and diarrhea. The other client statements do not indicate that the client is at risk for serotonin syndrome.
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? "Bipolar disorders have not been found to be genetic." "While bipolar disorders are genetic, the gene can only be passed on by a father." "Genetics are a minor factor in bipolar; it is more heavily influenced by psychological factors." "While bipolar disorders are genetic, there are other causes as well."
"While bipolar disorders are genetic, there are other causes as well." Although a single definitive cause has not been pinpointed, scientists agree that a combination or interaction of genes, neurobiology, environment, life history, and development can result in bipolar disorders. Bipolar disorders are highly inheritable.
A nursing instructor is reviewing a case study with students about a client with mania who was admitted to a mental health unit. The instructor asks the students what medical diagnosis is most likely responsible for the mania. Which would be the best answer by a student? Anxiety disorder Many psychiatric disorders have symptoms of mania Bipolar disorder Adolescent conduct disorder
Bipolar disorder In most cases, mania is a symptom that manifests in people with underlying bipolar disorder. Mania is reflected in periods of euphoria, exuberant activity, grandiosity, and a false sense of well-being. There can be periods of mood instability and irritability as well. euphoria: hung phan exuberant activity: hd soi noi
A nursing instructor is reviewing a case study with students about a client with mania who was admitted to a mental health unit. The instructor asks the students what medical diagnosis is most likely responsible for the mania. Which would be the best answer by a student? Anxiety disorder Many psychiatric disorders have symptoms of mania Bipolar disorder Adolescent conduct disorder
Bipolar disorder In most cases, mania is a symptom that manifests in people with underlying bipolar disorder. Mania is reflected in periods of euphoria, exuberant activity, grandiosity, and a false sense of well-being. There can be periods of mood instability and irritability as well.
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? Mannitol Lithium Carbamazepine Methyldopa
Carbamazepine 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.
A client who otherwise is healthy is admitted for depression and reports feeling "all alone" following a recent divorce. The client admits to drinking at least 12 beers every day. The client has which risk factors for the depression? Select all that apply. Family history of depression Lack of coping abilities Current substance use or abuse Life and environmental stressors Medical comorbodity
Current substance use or abuse Life and environmental stressors Lack of coping abilities Risk factors for depression include prior history of depression, family history of depressive disorder, lack of social support, lack of coping abilities, presence of life and environmental stressors, current substance use or abuse, and medical comorbidity. This client's assessment findings include a recent life stressor in the form of divorce and excessive use of alcohol. In addition, the client's social isolation and heavy drinking indicate lack of healthy coping abilities. The client's data do not include a family history or prior history of depression or any other health issues.
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 Decreased energy Sleep disturbance Suicide
Dehydration Explanation: When there is a significant wight loss in older adults with moderate to severe depression, they need to be assessed for dehydration as well as weight changes. They also need to be monitored for suicide, sleep disturbance, and decreased energy, but they are not related to nutrition and the weight loss.
A client has been diagnosed with depression and states that the client is reluctant to receive treatment, stating that the client "would prefer to just wait this out." What is the nurse's most appropriate action? mien cuong Assess the client's knowledge of depression and describe the risks of suicide Explain to the client that untreated depression often becomes increasingly severe and frequent over time Document a nursing diagnosis of ineffective denial and choose interventions accordingly Document a nursing diagnosis of noncompliance and educate the client about the benefits of treatment
Explain to the client that untreated depression often becomes increasingly severe and frequent over time Untreated depression tends to increase in severity and in the frequency of episodes. The client's statement does not necessarily indicate noncompliance, but rather the client's initial preference. Similarly, the client's statement does not necessarily suggest denial. Assessing the client's knowledge of depression is necessary, but describing the risks of suicide does not directly address the client's expressed preference.
A nurse providing community education for parents regarding adolescent suicide should include in the teaching session that the most frequent cause or motive for suicide in this age group is what? Feelings of alienation or isolation Reunion wish or fantasy Feelings of anger or hostility Progressive failure to adapt
Feelings of alienation or isolation In adolescent clients, the developmental task is of a sense of belonging. When adolescents feel alienated or isolated, suicidal thoughts may emerge. In adolescence, therefore, the most common motives are feelings of alienation or isolation.
The nurse knows that the most dangerous time period following a previous suicide attempt is what? First 9 months First 3 months First 6 months First year
First 3 months The first 2 years after a suicide attempt represent the highest risk period, especially the first 3 months.
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? Terminal illness Disengagement of family Lack of conflict resolution skills Genetic predisposition khuynh huong
Genetic predisposition Suicide rates tend to be higher in families in which suicide has occurred, which are genetic and familial factors. First-degree relatives of individuals who have completed suicide have a two- to eight-times higher risk for suicide than do individuals in the general population.
Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? Get daily exercise Take medication with food Increase hydration Eat a nutritionally balanced diet
Increase hydration Increasing hydration and sitting or standing up slowly are nonpharmacologic interventions for orthostatic hypotension. Taking medications with food would counteract nausea and vomiting. Daily exercise and eating a nutritionally balanced diet would help with weight gain that occurs in clients taking antidepressants.
Police officers bring a client to the mental health unit for admission. The client had been directing traffic on a busy city street, shouting rhymes such as "to work, you jerk, for perks" and making obscene gestures at cars that came close to the client. When the client's spouse is contacted at work, the spouse reports that the client stopped taking lithium 3 weeks ago and has not slept or eaten for 3 days. With which two features characteristic of the manic phase of bipolar disorder can the nurse identify? Vegetative signs and poor grooming Disinhibition and elevated mood Poor judgment and hyperactivity Increased muscle tension and anxiety
Poor judgment and hyperactivity Symptoms of poor judgment (e.g., directing traffic, making obscene gestures at cars) and hyperactivity (e.g., not sleeping or eating) are assessment findings in this scenario that relate to mania. Increased muscle tension and anxiety are symptoms of anxiety disorders, and vegetative signs and poor grooming are notable in major depressive episodes. Although disinhibition and elevated mood can be assessed in the manic phase of bipolar disorder, these symptoms are not described in this scenario.
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? Increased energy level Psychomotor retardation Increased focus Decreased complaints of pain
Psychomotor retardation Associated signs and symptoms of depression include an inability to think or concentrate, increas
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 ... encourage the client to identify and attend outpatient support groups. help the client to identify and explore other options. organize a family meeting. provide distraction by organizing therapeutic recreation.
help the client to identify and explore other options. A client who is seriously considering suicide is doing so because the client sees it as their only option. The nurse should directly, but empathically, challenge this view. This client's high level of suicidality would preclude referral to outpatient support groups. Distraction is often beneficial but does not serve to challenge the client's beliefs. Similarly, a family meeting may or may not challenge the client's belief that suicide is the only option.
A nursing instructor is teaching about different depressive disorders and identifies a need for further instruction when a student states what? "Dysthymic disorder is milder than major depression." "With dysthymic disorder, depressed mood exists for most days for at least 2 years." "Dysthymic disorder is less chronic than major depression." "Dysthymic disorder can significantly affect a patient's functioning." dysthymic chung kho tieu
"Dysthymic disorder is less chronic than major depression." Explanation: Dysthymic disorder is milder but more chronic than major depression and is diagnosed when the depressed mood is present for most days for at least 2 years with two or more other symptoms present.
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 confusion after ECT is normal. Withhold the client's medications for today and call tomorrow to let us know how the client is doing." "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." "Some confusion after ECT is normal. The client will regain memory in a few hours." "Confusion after ECT is not expected. Though it will resolve, the client probably will not be a candidate for ECT in the future."
"Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." A frequent consequence of ECT is memory impairment, ranging from mild forgetfulness of details to severe confusion. This may persist for weeks or months after treatment but usually resolves.
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 is more of a concern in countries other than the United States." "Suicide rates among older adults are low." "Suicide has profound effects on those connected to the individual." "Suicide does not occur in affluent neighborhoods, indicating poverty is a factor."
"Suicide has profound effects on those connected to the individual." Explanation: Suicide is a major public health concern, both in the United States and around the world. Although certain factors may increase risk for suicide, suicide knows no bounds of person, age, class, race, or gender. It is an act that profoundly affects those left in its wake. Suicide among the older adult population has increased.
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? "Many people who are battling depression find that support groups are beneficial." "That shows an admirable level of perseverance on your part. Well done!" "Excellent! This shows that you're nearly recovered from your depression." "You really showed that you're able to rise above your fear and anxiety."
"That shows an admirable level of perseverance on your part. Well done!" Acknowledging the effort and perseverance that it took for the client to attend the support group is a good example of validation. Because the client has depression, the client likely had to battle hopelessness more than fear or anxiety. A statement about the benefits of support groups is irrelevant and does not validate the client. It is presumptuous to claim that the client has nearly recovered.
When conducting a suicide risk assessment with a client, the nurse should identify the client as a high imminent risk if which statement is made? "My son is really the only reason I stick around." "There are no solutions to my problems." "I just need someone to talk to" "I think about starving myself to death sometimes"
"There are no solutions to my problems." Hopelessness is the pervasive belief that undesirable events are likely to occur coupled with the belief that one's situation is unlikely to improve. A significant evidence base has been established linking hopelessness, loneliness, and other cognitive symptoms to suicide ideation. Depressed persons who are hopeless are more likely to consider suicide than those who are depressed but hopeful about the future. Furthermore, it appears that lack of positive thoughts about the future is more likely to predict suicidal behavior than negative thoughts even though both contribute to hopelessness. The statement, "There are no solutions to my problems" is consistent with the risk that the client has lost hope; therefore, the risk of suicide is high and possibly imminent. The nurse should ensure the suicide risk assessment and associated interventions are a high priority. Having a child can be a protective factor against suicide. Stating one is not going to engage in the act of suicide because of a family member lowers the risk of an imminent attempt. The client who states he or she thinks about starving sometimes has made a vague statement with a plan that is not highly lethal. The risk is likely low with this client but support should be provided, nonetheless. The client who reaches out by asking for someone to talk to is calling for help and being proactive before getting to the point of making the decision to commit suicide.
Which client is most likely to benefit from electroconvulsive therapy (ECT)? A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy A client whose major depression has not responded appreciably to antidepressants A client with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode A client whose recent strange behavior has been attributed to cyclothymic disorder
A client whose major depression has not responded appreciably to antidepressants While ECT is used to treat an increasing range of psychiatric-mental health problems, individuals with major depression are often among the best candidates for the treatment. ECT would not be used as a response to noncompliance, and a person who is currently experiencing a manic episode is less commonly treated with ECT. Cyclothymic disorder is less severe than bipolar II disorder and is consequently less likely to warrant ECT.
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. A biological explanation for the client's depressive disorder. A reason the client has become lesbian at the age of 23. A feminist viewpoint of depression.
A psychodynamic interpretation of the client's major depressive disorder. Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. Such anger begins in childhood when basic developmental needs are not met. Clients cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward. postulate gia dinh
A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what? Demonstrated examples of unwise decisions Self-report of being sad after a break up Claims by family, friends, or coworkers that the client is depressed A significant decrease in appetite
A significant decrease in appetite Among the nine clinical symptoms of a major depressive episode is a significant increase or decrease in appetite. Failures may precipitate or exacerbate decisions and others may confirm the client's depression, but these are not diagnostic criteria. Unwise decision making is not a hallmark of depression, but indecisiveness is a diagnostic criterion.
The community mental health nurse is providing care for a large number of clients. What client should the nurse monitor most closely for the warning signs of suicide? An older adult client who has recently been diagnosed with early stage Alzheimer disease A middle-aged female client who is receiving treatment for obsessive-compulsive disorder A young male with schizophrenia who is in danger of becoming homeless An adult female who is mourning the death of her husband 5 months ago
A young male with schizophrenia who is in danger of becoming homeless Being a young male, having a mental illness, and facing a situational crisis are all significant risk factors for suicide. This constellation of factors is likely to create a greater risk for suicide than a client with a new diagnosis of dementia, a bereaved client, or a client with obsessive-compulsive disorder.
Which signs would a nurse expect in a client diagnosed with serotonin syndrome? Select all that apply. Constipation Elevated temperature Agitation Hyporeflexia Elevated heart rate
Agitation Elevated temperature Agitation Signs of serotonin syndrome include mental status changes (hallucinations, agitation, coma), autonomic instability (tachycardia, hyperthermia, changes in blood pressure), neuromuscular problems (hyperreflexia, incoordination), and gastrointestinal disturbance (nausea, vomiting, diarrhea). Constipation and hyporeflexia would not be expected.
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 client's admission of a mood disorder Failure to respond to conventional pharmacological treatments for mood disorders The presence of objective signs of depression without the presence of anhedonia
An elevated mood that lasts for at least 1 week During manic episodes that characterize bipolar disorder, the individual exhibits an abnormal, persistently elevated, or irritable mood that lasts for at least 1 week. Failure to respond to treatment, the presence of signs of depression without anhedonia, and the client's admission of a mood disorder are neither diagnostic nor typical of bipolar disorder.
A nurse is caring for a middle aged male client whose spouse 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? Determine the client's risk of psychosis. Refer the client for long-term psychotherapy. Ask the client whether they are thinking about killing themselves Determine whether anyone in the client's family has had depression.
Ask the client whether they are thinking about killing themselves The nurse should first ask if the client is thinking about killing themself, because statistics show that recently widowed men is higher than that of married men. Social isolation and access to firearms play important roles in this group. Information related to psychosis, psychotherapy, or family history would be less of a priority at this time.
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? Encouraging clients not to be ashamed of previous suicide attempts or suicidal thoughts Organizing the layout of the center to allow observation of clients Assessing all clients carefully to identify those at risk for suicide Modifying the center's environment to maximize client safety
Assessing all clients carefully to identify those at risk for suicide Case finding involves the identification of people who are at risk for suicide so that proper treatment can be initiated. Modifying the layout of the center would not be necessary in order to carry out the necessary assessments. Observation would not be a part of community-based care. The nurse should address the shame that often accompanies suicide, but this action is not a key component of case finding.
A 42-year-old client with major depression is in an inpatient psychiatric hospital. The client has been taking phenelzine, a monoamine oxidase inhibitor (MAOI), for depression. The therapist writes an order to discontinue the phenelzine and begin fluoxetine. Which action by the nurse is indicated? Call the therapist to discuss the need for a washout period before starting fluoxetine. Begin educating the client about selective serotonin reuptake inhibitors. Note in the medication administration record to check the client's blood pressure for the first 2 days after starting fluoxetine. Begin educating the client about food restrictions when taking fluoxetine.
Call the therapist to discuss the need for a washout period before starting fluoxetine. If the client is switching from an MAOI to fluoxetine, the provider should allow a washout period of at least 5 weeks (half-life of MAOI). Conversely, if a client is switching from fluoxetine to an MAOI, providers should allow a "washout" period of at least 2 weeks (half-life of fluoxetine) before beginning the MAOI.
After presenting to a group on factors that enhance the risk of suicide, a nurse determines the need for additional education when the group identifies which item as a risk factor? Delusions Loss Family member committing suicide Cautiousness
Cautiousness Impulsivity, rather than cautiousness, enhances suicide risk. Other factors include a family member having completed suicide, psychotic thoughts such as delusions, and loss.
A client has just been admitted to the inpatient psychiatry unit following a suicide attempt. During the client's first 24 hours of care, what outcome should be identified? Client will implement strategies for managing stress Client will state that the client feels optimistic about the client's future Client will express that the client feels safe on the unit Client will participate actively in cognitive behavioral therapy
Client will express that the client feels safe on the unit The initial care of a client who has had a suicide attempt focuses on helping the client feel safe and instilling the beginnings of hope. It would be premature to expect the client to learn and apply new stress management strategies after only 24 hours. Cognitive behavioral therapy would not begin during the acute stage of recovery. A sense of overall optimism will likely require long-term therapy to achieve it.
A client who otherwise is healthy is admitted for depression and reports feeling "all alone." The client reports recently losing a spouse to divorce. The client admits to drinking at least 12 beers every day. The client has which risk factors for the depression? Select all that apply. Life and environmental stressors Medical comorbodity Current substance use or abuse History of depression Lack of coping abilities
Current substance use or abuse Life and environmental stressors Lack of coping abilities Risk factors for depression include prior history of depression, family history of depressive disorder, lack of social support, lack of coping abilities, presence of life and environmental stressors, current substance use or abuse, and medical comorbidity. This client's assessment findings include a recent life stressor in the form of divorce and excessive use of alcohol. In addition, the client's social isolation and heavy drinking indicate lack of healthy coping abilities. The client's data do not include a family history or prior history of depression or any other health issues.
A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of what? Grandiosity Anorexia Anxiety Depression vi dai
Grandiosity Explanation: Grandiosity is elevated self-esteem and may range from unusual self-confidence to grandiose delusions. Speech is pressured; the person is more talkative than usual and at times is difficult to interrupt. There is often a flight of ideas or racing thoughts.
Trying to kill oneself and surviving the ordeal is identified as what? Suicidal behavior Parasuicide Suicidal ideation Suicide attempt
Suicide attempt An attempt of suicide can be characterized as living through an experience of suicide despite having expected or intended to die.
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 Interact with other clients in order to witness improvements in their condition Take a leave of absence until the symptoms have stopped Confide in one of the psychiatrists who gives care on the unit
Dialogue with a trusted colleague about these feelings A nurse who has experienced secondary trauma may benefit from talking about his or her experience. It would be inappropriate to seek informal care from a psychiatrist on the unit, however. The nurse should likely try talking about the event and seeking outpatient treatment before taking a leave of absence. Interacting with other patients is unlikely to bring the nurse relief.
Following the failure of a woman's recent in vitro fertilization (IVF), the nurse recognizes that she may be at risk of depression. Which intervention is considered a primary suicide prevention measure? Beginning a course of therapy with a nurse-therapist or psychologist Placing the woman on suicide precautions and establishing a no-suicide contract Beginning treatment with a selective serotonin reuptake inhibitor Establishing a support system for the woman and teaching her some coping measures
Establishing a support system for the woman and teaching her some coping measures Primary prevention involves the identification and elimination of factors that cause or contribute to the development of an illness or disorder that could lead to suicide. Medication management, psychotherapy, and suicide precautions are more aggressive measures that would not be classified as primary prevention.
A nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, "I'm just so beautiful. Everyone just stops and stares at how gorgeous I am. People constantly want to have sex with me." The nurse interprets these statements as indicative of which type of mood? Irritable Expansive Elevated Euphoric
Expansive Explanation: The client's statements reflect an expansive mood, which is characterized by lack of restraint in expressing feelings, an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions. An irritable mood is characterized by easy annoyance and provocation to anger, particularly when wishes are challenged or thwarted. An elevated mood can be expressed as euphoria (exaggerated feelings of well-being) or elation (feeling high), "ecstatic," "on top of the world," "up in the clouds"). euphoria hưng phấn
Which would be a finding related to perceptual disturbances during the mental status exam in the client with mania? Limited insight Increased motor activity Hallucinations Inappropriate affect
Hallucinations roi loan nhan thuc 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 psychiatric-mental health nurse is conducting a suicide assessment with a client. Why is it important to conduct a lethality assessment? gây chết nguoi It may assist in determining an individual's past suicide behaviors. It may assist in predicting how likely a person is to die by suicide. It may assist in determining how long a client has been contemplating suicide. It may assist in evaluating the potential suicide protective factors of a client.
It may assist in predicting how likely a person is to die by suicide. Lethality assessment is part of conducting a risk assessment. Once it is determined that someone is thinking of suicide, a lethality assessment is necessary. It is an attempt to predict how likely a person is to die by suicide.
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? Terminal insomnia Hypersomnia Middle insomnia Initial insomnia
Middle insomnia The most common sleep disturbance associated with major depression is insomnia, which is categorized according to three categories: initial insomnia (difficulty falling asleep), middle insomnia (waking up during the night and having difficulty returning to sleep), and terminal insomnia (waking too early and being unable to return to sleep). Less frequently, the sleep disturbance is hypersomnia (prolonged sleep episodes at night or increased daytime sleep).
Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what? Anaclitic depression Postpartum psychosis A mood disorder due to a general medical condition Moderate depression
Moderate depression Cognitive psychotherapy is as effective as antidepressant medication in the treatment of mild to moderate depression. It is less likely to address depression that has a demonstrated medical etiology. The primary treatment for postpartum psychosis is medication. Therapy is not relevant in cases of anaclitic depression since the problem occurs in infants.
A client who has been taking lithium for bipolar disorder is admitted to the hospital with the following symptoms: dry mouth, nausea and vomiting, blurred vision, dizziness, and muscle twitching. What should the nurse suspect? Common side effects of the drug Need for an increased dose of medication Interaction of lithium with another medication Moderate lithium toxicity
Moderate lithium toxicity Side effects associated with moderate lithium toxicity include severe diarrhea, dry mouth, nausea and vomiting, mild to moderate ataxia, lack of coordination, dizziness, slurred speech, tinnitus, blurred vision, increasing tremors, muscle rigidity, asymmetric deep tendon reflexes, and increased muscle tone.
Which medication classification is considered first-line drug therapy for bipolar disorder? Antidepressants Mood stabilizers Antipsychotics Anticonvulsants
Mood stabilizers Mood stabilizers are first-line drugs for bipolar disorders. They stabilize depressive and manic cycles.
Which would be the priority diagnosis for the client in the manic phase of bipolar disorder who is exhibiting aggressive behavior? Disturbed thought processes Ineffective health maintenance Impaired social interaction Risk for other-directed violence
Risk for other-directed violence The priority nursing diagnosis is risk for other-directed violence. The other diagnoses are utilized for the client in the manic phase of bipolar disorder but are not the priority in this situation.
A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has priority? Hopelessness related to recent divorce Risk for suicide related to highly lethal plan Ineffective coping related to inadequate stress management Spiritual distress related to conflicting thoughts about suicide and sin
Risk for suicide related to highly lethal plan Safety is the priority. The overall goals for the client who is suicidal is first to keep the client safe and later to help him or her develop new coping skills that do not involve self-harm. Hopelessness related to recent divorce, ineffective coping related to inadequate stress management, and spiritual distress related to conflicting thoughts about suicide and sin would not be the priority diagnosis for this client.
The nurse is caring for a client diagnosed with bipolar disorder. During a manic episode, which takes priority? Safety Security Social needs Physiologic needs
Safety During a manic episode, client safety is a priority. Risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may believe that life is not worth living. During a manic episode, the client may believe that he or she has supernatural powers, such as the ability to fly. Physiologic needs, security, and social needs would not take priority for this client.
A client with which psychiatric disorder is at high risk for suicide? Anxiety disorders Schizophrenia Eating disorders Personality disorders
Schizophrenia Suicide is a high risk for people diagnosed with schizophrenia.
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 Dehydration Weight loss Sleep disruption
Self-injury During a manic episode, client safety is a priority. Risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may believe that life is not worth living. During a manic episode, the client may believe that he or she has supernatural powers, such as the ability to fly. Although changes in sleep, fluid balance (such as dehydration), and inadequate nutrition manifested by weight loss would be important to assess, safety and prevention of self-injury are the priority.
Which is a primary risk factor for suicide? Poverty Social isolation Economic deprivation Unemployment
Social isolation Social isolation is a primary risk factor for suicide. Other social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among young people.
In a therapy session, a client with a diagnosis of major depression admits to the nurse-therapist, "I actually went out driving on the interstate this morning and had every intention of getting up to speed and plowing right into the overpass by my exit. Maybe tomorrow." The nurse would recognize the client's statement as what? Suicidal intent Suicidal ideation Suicidal threat Suicidal gesture
Suicidal intent The specificity and concreteness of the client's plan indicates suicidal intent. Suicidal ideations, threats,
A parent of four small children lost a spouse in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since the spouse's death, the client's mood has been somber; until now, the client has refused treatment. What is this client at high risk for? Schizophrenia Dysthymic disorder Bipolar disorder Suicide
Suicide If depression persists over time and is left untreated, it has a significant negative effect on quality of life and increases the risk of suicide.
The nurse is assessing a 42-year-old client who is experiencing depression. The client's mother died by suicide 20 years ago. Which statement regarding this client's risk for suicide is correct? The client would have a greater risk for suicide if the client's father had died by suicide. The client has a greater risk for suicide than the general population. The client's risk for suicide will increase when the client reaches the age of 50. The client's risk is equivalent to that of the general population.
The client has a greater risk for suicide than the general population. Risk for suicide increases when there is a family history of suicide. Risk of suicide is two to eight times higher in first-degree (parents, siblings, or children) relatives of people who died by suicide than in the general population.
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 The client has been treated with a variety of antidepressants over the years. The client sits silently after being asked several of the assessment questions The client states, "Everything just seems really dark right now."
The client overdosed on pills 2 years earlier The greatest predictor of suicide risk is a previous attempt. All of the other listed variables must be addressed, but none is as significant a risk factor as a previous suicide attempt.
The nurse plans care for a client who is hospitalized due to a suicide attempt. Which short-term outcome does the nurse include in the client's plan of care? The client will no longer experience suicidal ideations with a plan. Admission to an inpatient psychiatric facility for maintenance therapy. The client will experience a safe environment. The client and family will identify behaviors indicating a suicidal crisis.
The client will experience a safe environment. The most desirable treatment outcome is the client's recovery with no future suicide attempts. Short-term outcomes include maintaining the client's safety, averting suicide, and mobilizing the client's resources. Whether the client is hospitalized or cared for in the community, their emotional distress must be reduced. Long-term outcomes must focus on maintaining the client in psychiatric treatment, enabling the client and family to identify and manage suicidal crises effectively, and widening the client's support network.
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. The client will differentiate between reality and fantasy. The client will identify factors that contribute to depression. The client will discuss the cause of the fatigue.
The client will reframe negative thoughts in a more positive way. An appropriate outcome for hopelessness would be for the client to reframe and redefine an event positively rather than negatively, which can help the client view the situation in an alternative way, thereby fostering hope. Discussing the cause of fatigue is unrelated to hopelessness. Identifying factors contributing to depression would reflect a knowledge deficit. The ability to differentiate reality from fantasy would be inappropriate for this client. There is nothing to support that the client is not focused in the here and now.
For which client would the nurse be obligated to take immediate and focused action to prevent imminent death? The client with depression who lives in poverty and has chronic pain The client who is grieving is often tearful and does not want to be left alone The client with depression who has been using alcohol and owns a gun The client with depression who is withdrawn and spends most of the time playing video games obligate bat buoc imminent /é mờ nờnt/ happening soon
The client with depression who has been using alcohol and owns a gun A true psychiatric emergency exists when an individual presents with one or more symptoms associated with imminent risk for suicidal behavior. Immediate and focused action is needed to prevent the patient's death. The client who is depressed, using alcohol and has access to the most lethal means to commit suicide is the highest risk and requires imminent intervention. The client who is depressed, lives in poverty and has chronic pain meets criteria for someone at risk, however, the risk in this case is not imminent and would not warrant immediate intervention. The client who is depressed, withdrawn and spending most of the time playing video games would certainly warrant assessment and therapeutic intervention, however, based on the information provided the client would not be deemed an imminent risk. The grieving client who is tearful and does not want to be left alone is experiencing a normative response to death and does not meet the criteria for imminent suicide intervention.
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 potassium level, the lower the lithium level will be. Changes in diet will not affect lithium levels. Lithium has few interactions with other drugs. The higher the sodium level, the lower the lithium level will be.
The higher the sodium level, the lower the lithium level will be. Lithium is a salt, so the interaction between lithium and sodium levels in the body and between lithium level and fluid volume in the body are crucial issues to consider. The higher the sodium levels, the lower the lithium level will be and vice versa. The other options do not represent correct information.
The nurse is creating a plan of care for a client with depression and suicidal ideations. Which nursing action would be a protective factor in the prevention of suicide for this client? incorporating therapy along with antidepressant medications counseling the client to avoid conflict and stress encouraging the client to spend more time alone reflecting on issues emphasizing medical interventions for depression
incorporating therapy along with antidepressant medications Protective factors buffer individuals from suicidal thoughts and behavior. Protective factors have not been studied as extensively as risk factors, but identifying and understanding them are very important. Protective factors include effective clinical care for mental, physical, and substance abuse disorders. Although medical interventions for depression are important, effective depression treatment is multitudinal and should incorporate psychosocial and spiritual care as well. Clients should not be told to avoid conflict; rather, the nurse should assist the client in building personal capacity to manage conflict in adaptive ways. Clients who are at risk for suicide would find social support to be a protective factor in mitigating or preventing self-harm. Client's should be encouraged to be connected to family and community support whenever possible.
