(PrepU) Mood & Affect / Mental Health Concepts: Nursing Concepts

A first episode of depression that occurs after what age can be a precursor to dementia?

65 A first episode of depression that occurs after 65 years of age can be a precursor to dementia and should precipitate both assessment and treatment of the depression, as well as a thorough evaluation for dementia. Early intervention often greatly retards the progression of dementia, maintaining the person's independence and quality of life.

A nurse is talking with a 10-year-old child and parent about the current treatment plan for the child's asthma. The child stands behind the parent and does not ask questions or look at the nurse. What should the nurse consider the child's behavior could indicate?

The child may be shy and have some reluctance about communicating. It is difficult to assess how shy children feel when they are reluctant to communicate about such things as the long-term effect a disease will have. If they do not proved much verbal feedback, the tendency is to believe they do not have a concern. The nurse should give the child time to warm up in the conversation. Because this child may not talk much, therapeutic play could help and involve the child in the education process. There is no way to know if the child is just shy, angry, delayed or just does not want to be treated until a way is found to communicate with the child.

A client has recently received a diagnosis of depression and has been prescribed citalopram. The nurse is providing health education and the client states, "I'm relieved to have some medication to help with my mood, because it's my daughter's wedding next weekend and I'll be feeling better." What is the nurse's best response?

"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." Peak benefits of SSRIs can take up to six weeks to be realized, and a client is unlikely to notice an effect within a few days. Antidepressants improve mood, not just energy and concentration.

After telling a nurse to "pray for me," a client gives away personal possessions and shows a sudden calmness. What is the best question for the nurse to ask the client next?

"Are you thinking about suicide?" Verbal clues to suicidal ideation include such statements as "Pray for me" and "I won't be here when you get back." Nonverbal clues include giving away personal possessions, a sudden calmness, and risk-taking behaviors. The nurse would recognize the combination of these signs as indicating suicidal ideation, so asking about suicide is an appropriate question. Asking about depression or about personal possessions is appropriate, but neither is the most important query considering the combination of cues the client has displayed. Clients with major depression generally do not exhibit suicidal behavior until their outlook on their problems begins to improve. Asking the client about a Bible does not provide safety or demonstrate alertness to the client's messages.

A nurse assesses that a patient is at increased risk for depression based on which of the following?

Co-existing medical problems Risk factors for depression include a medical comorbidity, family history, stressful situations, female gender, prior episodes of depression, an onset before age 40 years, past suicide attempts, lack of support systems, history of physical or sexual abuse, and current substance abuse. Sporadic alcohol ingestion does not indicate substance abuse.

On admission to the psychiatric unit, a client is dressed in a red leotard and exercise bra, with an assortment of chains and brightly colored scarves on the client's head, waist, wrists, and ankles. The client's first words to the nurse are, "I'll punch you, munch you, crunch you," as the client dances into the room, shadow boxing. The client shakes the nurse's hand and says cheerfully, "We need to become better acquainted. I have the world's greatest intellect, and you are probably an intellectual midget." How can the nurse document the client's mood?

Expansive and grandiose. The client is demonstrating an expansive and grandiose mood state. Although the client also exhibits aspects of belligerence, the client does not have a blunted affect. The client is not demonstrating anxious or unpredictable behavior, suspicion, or paranoia.

The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication?

Let the child hold the medication cup. Droppers and oral syringes can be used to administer medications to infants and young children. Medication cups and spoons can be used to administer liquid medications to the older child. The child can hold the medication cup and drink the liquid medication. Depending upon the age of the child, he or she may still prefer to take liquid medications via the syringe. It makes taking the medication fun when the child can squirt it into the mouth by himself or herself. The child who is lying down when being given medications should have the head of the bed elevated to at least 45 degrees A 5-year-old child does not need to be restrained for medication administration.

A client with aggressive behavior shows no psychotic symptoms. Which medication should the nurse expect to be ordered for this client?

Lorazepam Lorazepam is the most effective drug in reducing aggression in a client who does not have any other psychotic symptoms. Valproate, haloperidol, and carbamazepine drugs are useful in reducing aggression in those clients who have coexistent psychotic symptoms.

A nurse on the crisis team in the emergency department is caring for a client who is angry and is experiencing delusional episodes. The client says to the nurse, "I'm going to kill my wife and chop her up to get rid of her." What is the nurse's priority action in this situation?

Notify the wife that she may be in danger. The client is making statements that may be acted on. The nurse is obliged to notify the wife that she might be in danger. If the nurse believes the statements reflect a new symptom, such as delusions, the attending psychiatrist should be contacted for further direction. The other options are incorrect because they do not protect the client's wife, whom he has clearly indicated he has a plan to harm.

After surviving an ischemic stroke, a client has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which brain structure?

The components of the client's limbic system The neural structures that constitute the limbic system are primarily responsible for the regulation of emotion. The occipital lobe interprets visual information, while language is the domain of the Wernicke area. The parietal lobe processes sensory input.