Psych: Chapter 17 Mood Disorders
A client is happy one month and sad and depressed the next. This client has rapid shifts in moods that leave people confused. What is the client demonstrating? a) Manic episode b) Mood lability c) Expansive mood d) Irritable mood
B Mood lability is alterations in moods with little or no change in external events. It is a term used for the rapid shifts in moods that often occur in bipolar disorder.
The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what? a) Develop rapport based on trust and understanding. b) Prevent self-destructive behavior. c) Assess the cause of his or her depression. d) Assist him or her in the expression of sad and helpless feelings.
B Preventing self-destructive behavior is the primary nursing goal. Other important goals, such as assisting the client in expressing feelings, assessing for causes of depression, and developing rapport, may be important for intervention after the primary goal of maintaining safety is met.
Which of the following statements regarding depression and gender is correct? a) Depressive disorders affect young men more than older women. b) Depressive disorders equally affect men and women. c) Depressive disorders are more common in women than men. d) Depressive disorders are more common in men than women.
C Depressive disorders are more prevalent in women than in men. Genetics, sociocultural factors, hormones, and other elements may account for this disparity.
Which of the following medication classifications is considered first-line drug therapy for bipolar disorder? a) Anticonvulsants b) Antipsychotics c) Mood stabilizers d) Antidepressants
C Mood stabilizers are first-line drugs for bipolar disorders. They stabilize depressive and manic cycles.
Limit setting is most appropriate in which patient population? a) Depressed b) Anxious c) Manic d) Suicidal
C Most of the time, anxious, depressed, and suicidal clients do not test the limits of the caregiver.
A mental health nurse is caring for a depressed client, whose wife passed away 2 months ago. The client sates, "I'm going to kill myself." Which of the following is a behavioral sign of suicide? a) Hopelessness b) Guilt c) Isolation d) Making a will
D Making a will is a behavioral sign of suicide. The other options are emotional/psychological signs.
A client who has liver damage is receiving lithium for treatment of bipolar disorder. The nurse understands that which of the following may occur when the client is receiving lithium? a) Increased plasma concentration b) Monitoring of plasma levels is not needed c) Decreased plasma concentration d) No alteration in plasma levels
A Hepatic and renal impairments increase plasma concentration of lithium.
A client has been diagnosed with major depressive disorder. The clinical symptoms that would be included when the clinician makes this diagnosis are what? a) A significant failure in an occupational or relational setting b) Claims by family, friends, or coworkers that the client is depressed c) A significant decrease in appetite d) Demonstrated examples of unwise decisions
C 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.
A nursing student learning about mood disorders correctly identifies which of the following to mean exaggerated feelings of well-being? a) Irritability b) Expansiveness c) Euphoria d) Paranoia
C An elevated mood can be expressed as euphoria, which is exaggerated feelings of well-being or elation. Examples include feeling high, ecstatic, and on top of the world. An expansive mood is characterized by lack of restraint in expressive feelings. Paranoia is rooted in suspicions about others, or delusions of persecution. For some, an irritable mood is feeling easily annoyed and provoked to anger, especially when their wishes are challenged or thwarted.
The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should ... a) Prepare the client for diagnostic genetic testing to confirm the diagnosis b) Educate the client regarding the symptoms of related physical disorders c) Assess for depression in the client's family history d) Encourage the client to seek genetic counseling before considering a pregnancy
C The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should assess for depression in the client's family history.
A client with bipolar disorder has been ordered a medication whose classification is anticonvulsant. Which of the following drugs does the nurse know falls within this class of medications? a) Lithium b) Methyldopa c) Mannitol d) Carbamazepine
D 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.
Although its therapeutic mechanism of action is unknown, electroconvulsive therapy (ECT) is effective treatment for severe depression in some clients. The nurse is aware that ECT would be contraindicated in which of the following clients? Select all answer choices that apply. a) Patients with recent cerebrovascular accidents (CVAs) b) Patients with recent retinal detachment c) Patients with increased intracranial pressure d) Patients who had recent myocardial infarctions (MIs) e) Patients who had acute renal failure f) Patients at risk for complications of anesthesia
A, B, C, D, F ECT is contraindicated in patients who have increased intracranial pressure; who have had a recent CVA, MI, or retinal detachment; and who are at risk for complications from anesthesia.
Which of the following clients is most likely to benefit from electroconvulsive therapy (ECT)? a) A man with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode b) A woman whose major depression has not responded appreciably to antidepressants c) A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy d) A client whose recent strange behavior has been attributed to cyclothymic disorder
B 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 with major depression is prescribed paroxetine (Paxil). The nurse develops an education plan for the client based on the understanding that this drug belongs to which class of drugs? a) Monoamine oxidase inhibitors b) Selective serotonin reuptake inhibitors c) Tricyclic antidepressants d) Serotonin norepinephrine reuptake inhibitors
B Paroxetine is a selective serotonin reuptake inhibitor. Serotonin norepinephrine reuptake inhibitors (SNRIs) include venlafaxine (Effexor), nefazodone (Serzone), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). Amitriptyline is an example of a tricyclic antidepressant. Monoamine oxidase inhibitors (MAOIs) include phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Emsam).
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? a) Cyclic antidepressant b) Selective serotonin reuptake inhibitor c) Monoamine-oxidase inhibitor d) Serotonin 2 antagonist
B Sertraline is a selective serotonin reuptake inhibitor.
Which medication classification has been effective in stabilizing moods in people with bipolar disorder? a) Antianxiety b) Anticonvulsants c) Antibiotics d) Anticoagulants
B Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness.
Which of the following terms describes a nonfatal, self-inflicted destructive act with an explicit or implicit intent to die? a) Suicidal ideation b) Parasuicide c) Suicidality d) Suicide attempt
D A suicide attempt is a nonfatal, self-inflicted destructive act with explicit or implicit intent to die. Suicidal ideation is thinking about and planning one's own death. Suicidality refers to all suicide-related behaviors and thoughts of completing or attempting suicide and suicide ideation. Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death.
A client has been diagnosed with major depression and placed on Elavil. Which of the following is a side effect of amitriptyline (Elavil)? a) Weight loss b) Diarrhea c) Excessive salivation d) Orthostatic hypotension
D Side effects of Elavil include orthostatic hypotension, constipation, weight gain, and dry mouth.
When teaching prevention to the parents of a 15-year-old client who recently attempted suicide by taking an overdose of Xanax (alprazolam), the nurse describes which of the following behavioral clues? a) Giving away valued personal items b) Experiencing the loss of a boyfriend or girlfriend c) Inquiry about doses of lethal drugs d) Angry outbursts at significant others
A The suicidal individual may exhibit behaviors that provide clues to his or her intent, including the following: • Talks about death, suicide, and wanting to be dead • Talks or thinks about punishment, torture, and being persecuted • Hears voices and suddenly seems very happy after being very depressed for some time • Is very aggressive or very impulsive, and acting suddenly and unexpectedly • Shows an unusual amount of interest in getting his or her affairs in order • Gives away personal belongings
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 husband arrives to take her home, the nurse discusses his wife's condition with him. Which of the following statements is best? a) "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." b) "Some confusion after ECT is normal. She will regain her memory in a few hours." c) "Confusion after ECT is not expected. Though it will resolve, she probably will not be a candidate for ECT in the future." d) "Some confusion after ECT is normal. Withhold her medications for today and call tomorrow to let us know how she's doing."
A 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.
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 of the following would be an appropriate intervention for this client? a) Remove all dangerous items from the client's room. b) Encourage the client to act on thoughts that are leading to aggression. c) Provide antianxiety medication to prevent an incident. d) Encourage the client to engage in calming group activities.
A Establishing geographic boundaries, such as room restriction or half-hall restriction, is part of ongoing monitoring. Also, clients likely will have "as-needed" medications ordered; nurses use them if aggressive or agitated behavior escalates. Other environmental approaches include reducing stimuli and opportunities for interaction with other clients in the milieu. Nurses remove all dangerous items from the client's room and monitor closely for use of any dangerous items. Nurses help clients learn to recognize what triggers violent thoughts and behaviors. They teach clients not to act on these thoughts but to leave the situation and find a staff member to talk to about them.
The wife of a client diagnosed recently with a mood disorder calls the nurse therapist to report a change in her husband's mood. She states, "He is clearly in a better mood than usual. I would say he seems mildly elated. He's functioning fine at work and home. He's energetic, up and doing things at 5:00 AM and really confident in himself again. It seems fantastic, but unusual. Is this something to worry about?" Which of the following potential responses by the nurse accurately assesses the situation? a) "He sounds hypomanic. Let's schedule an appointment for this week for an evaluation. He may need additional or different medication." b) "It sounds as though the antidepressants are working well. Just ask him if he is experiencing any side effects and let me know." c) "Since he is eating, sleeping, and not behaving inappropriately, there's nothing to worry about. Just let me know if he starts getting irritable or has trouble sleeping." d) "I'm concerned. Sometimes depressed people seem contented when they have decided to commit suicide. Let's schedule an appointment for tomorrow."
A Hypomania is a slightly less severe subcategory of mania. Differentiating points are that hypomania has no psychotic features and does not impair functioning to a level that necessitates hospitalization. Most hypomanic episodes in bipolar II disorder occur immediately before or after a major depressive episode.
After educating a class on factors that enhance the risk of suicide, the instructor determines the need for additional education when the class identifies which of the following? a) Cautiousness b) Family member committing suicide c) Loss d) Delusions
A 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 taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of which of the following? a) Side effect b) Desired effect c) Therapeutic effect d) Toxic effect
A Lithium has many side effects that can be handled with interventions. For diarrhea, the nurse can instruct the client to take the medication with meals and provide for fluid replacement. The nurse should tell the client to notify the prescriber if the diarrhea becomes severe--this development can be an early sign of lithium toxicity, which would warrant a change in medication. Diarrhea is not a toxic or desired effect. The therapeutic effect is the intended effect of a drug.
A nurse who works primarily with clients who have bipolar disorder identifies which group of clients as not being candidates to take lithium as treatment? a) Patients who take ACE inhibitors b) Patients who take bronchodilators c) Patients who drink decaffeinated coffee d) Patients with diabetes who take oral antidiabetic agents
A Lithium interacts with several different medications and foods. Clients who take ACE inhibitors should not take lithium, because the combination can increase the serum lithium level, leading to toxicity and impaired kidney function.
Cassandra, a 52-year-old woman with bipolar disorder, tells the nurse, "I read that there are chemicals in my brain that can cause my symptoms." Knowing that she is referring to neurotransmitters, which of the following would be the best response by the nurse? a) "Low levels of the neurotransmitter serotonin are associated with mania." b) "Clients with bipolar disorder often have high levels of GABA in manic states." c) "Recent studies have found that neurotransmitters do not play a role in bipolar disorders." d) "Low levels of the neurotransmitter dopamine are associated with mania."
A Mania has been associated with reduced serotonin and decreased sensitivity of serotonin receptors. Higher dopaminergic activity induced by reduced synaptic vesicle buffering capacity or higher dopaminergic receptor sensitivity also may be associated with mania. Clients with bipolar disorder may have low plasma levels of GABA during depressive and manic phases. (
The nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the greatest risk for a suicide attempt? a) Man with major depressive disorder b) Woman with somatoform disorder c) Man with bipolar I disorder d) Woman with acute stress disorder
A Men have a higher suicide completion rate than women. For men, suicide is the eighth leading cause of death, with a rate of 17.5 per 100,000, more than four times the rate in women. White men complete 73% of all suicides; 80% of these deaths are by firearms. Men are more likely to use means that have a higher rate of success, such as firearms and hanging. Most suicide deaths occur in men with a psychiatric disorder, primarily depression, in many cases complicated by substance abuse.
A client taking an antidepressant has experienced a 12 pound weight gain in 1 month as a side effect of the medication. Which of the following are nursing interventions to help this patient with this problem? Select all that apply. a) Advocate with the physician to change the medication. b) Recommend daily exercise. c) Reassure the patient that the weight gain is not that significant. d) Recommend a nutritionally balanced diet. e) Remind the patient that weight gain is better than feeling depressed.
A, B, D To relieve the side effect of weight gain from an antidepressant, appropriate nursing interventions are to help the client explore a change in medication, promote a nutritionally balanced diet, and recommend regular exercise.
Susan was abandoned by her parents at age 3, resulting in her perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of ... a) why Susan has become lesbian at the age of 23. b) a psychodynamic interpretation of Susan's major depressive disorder. c) a feminist viewpoint of depression. d) a biophysiological explanation for Susan's depressive disorder.
B 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. They cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.
A nursing instructor is reviewing the various biologic theories related to the etiology of depression. Which of the following would the instructor most likely include as being involved when describing psychoneuroimmunology ? a) Genetics b) Cytokines c) Hypothalmic axes d) Neurotransmitters
B Psychoneuroimmunology is a recent area of research into a diverse group of proteins known as chemical messengers between immune cells. These messengers, called cytokines, signal the brain and serve as mediators between immune and nerve cells. Neurotransmitters reflect the neurobiologic theories. Hypothalmic axes reflect the neuroendocrine and neuropeptides hypotheses. Genetics is a separate group that addresses the biologic theories for depression.
Which of the following is a primary risk factor for suicide? a) Unemployment b) Social isolation c) Economic deprivation d) Poverty
B 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.
Suicide is the leading cause of death in which of the following patient populations? a) Personality disorders b) Schizophrenia c) Anxiety disorders d) Eating disorders
B Suicide is the leading cause of premature death in people with schizophrenia.
A client with severe depression has experienced anhedonia for the past 3 months. The nurse caring for this client understands that this term describes which of the following? a) Feelings of hopelessness b) Loss of sexual drive c) Loss of interest or pleasure d) Feelings of sadness
C Anhedonia is the loss of interest or pleasure. The client with depression may report "not caring anymore" or not feeling any enjoyment in activities that were previously considered pleasurable.
The major difference between bipolar I and bipolar II disorder is that: a) Clients with bipolar I have no symptoms of mania, but only depression. b) The prognosis for bipolar I is much better than for bipolar II. c) Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances. d) Both disorders are the same, except that clients with bipolar I disorders have a much higher incidence of suicide.
C Bipolar II disorder is characterized by a major depressive episode (either current or past) and at least one hypomanic episode. Bipolar II disorder differs from bipolar I in that the client has never had a manic or mixed episode but may have had an episode in which he/she experienced a persistently elevated, expansive, or irritable mood. The hypomanic symptoms are not severe enough to cause marked social or occupational dysfunction.
A nurse is giving a presentation on mental health promotion at a community center. A participant states, "My friend tells me I'm depressed because I don't have a lot of energy and have trouble concentrating. I had to quit my full-time job because I don't seem to have the energy to manage it. But I don't want to kill myself or anything like that." Although more data are needed for diagnosis, the nurse suspects that the client may have which of the following? a) Cyclothymic disorder b) Bipolar II disorder c) Dysthymic disorder d) Major depressive disorder
C Dysthymia is a mild depressive illness in which symptoms, such as poor appetite or overeating, insomnia or excessive sleep, low energy, fatigue, low self-esteem, poor concentration, and difficulty making decisions, are chronic but less severe than with major depression. Diagnostic criteria include depressed or irritable mood most of the day, occurring more days than not for at least 2 years.
After assessing a client, you develop a nursing diagnosis of "Risk for Suicide." Which of the following would be your highest priority intervention? a) Communicate a desire to help the client. b) Provide mood-stabilizing medications per physician order. c) Remove means of suicide from the client's access. d) Determine the course of the client's suicidal thoughts.
C Immediate interventions involve removing the means of suicide to reduce the risk of it happening. If the person is hospitalized, methods may include ensuring pills or medications are not available to clients or that they are not taking any measures to accumulate needed drugs. If in a community or home care setting, nurses may enlist the help of family or friends to remove the means and to provide immediate support.
The mental health nurse appropriately provides education on phototherapy to a ... a) 50-year-old farmer whose major depression has not responded to any treatment modality b) 58-year-old showing signs of early Alzheimer's disease c) 20-year-old college student who reports being "too tired, sad and unfocused" to enroll for classes in the winter term d) 45-year-old lawyer whose medication therapy needs an additional treatment
C Phototherapy—-or the exposure to bright artificial light-—can markedly reverse the symptoms of seasonal affective disorder (SAD), which occurs in the fall and winter. Phototherapy would be most appropriate for a 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term.
Robin is a 42-year-old woman who is experiencing depression. Robin's mother died by suicide 20 years ago. Which of the following statements regarding Robin's risk for suicide is correct? a) Robin's risk for suicide will increase when she reaches the age of 50. b) Robin's risk is equivalent to that of the general population. c) Robin has a greater risk for suicide than the general population. d) Robin would have a greater risk for suicide if her father had died by suicide.
C 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.
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? a) Interaction of lithium with another medication b) Need for an increased dose of medication c) Moderate lithium toxicity d) Common side effects of the drug
C 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.
Carrie, age 20, was admitted to the inpatient unit following a suicide attempt. She is disheveled, disorganized, and dehydrated. The priority for her care during the first 24 hours of her admission is ... a) assessing Carrie's recent suicide attempt and identifying factors that may have contributed to it. b) assisting Carrie with her activities of daily living, including a shower and clean clothing. c) assessing Carrie's current suicidal ideation and putting her on suicide precautions. d) rehydrating Carrie by forcing fluids.
C The first step is to provide for Carrie's safety by assessing her risk for suicide. Because Carrie has attempted suicide, the nurse immediately places her on suicide precautions with frequent or continuous one-to-one observation and reassessment.
When assessing a child with major depression, which of the following would the nurse need to keep in mind? Select all that apply. a) The risk for suicide is less in children than adults. b) Children have more interaction with their peers than adults do. c) Mood may be more irritable than sad. d) Children more often have anxiety symptoms e) Somatic complaints are rarely noted.
C, D Children with depressive disorders have similar symptoms to those seen in adults with a few exceptions. They are more likely to have anxiety symptoms, such as fear of separation, and somatic symptoms, such as stomach aches and headaches. They may have less interaction with their peers and avoid play and recreational activities that they previously enjoyed. Mood may be irritable, rather than sad, especially in adolescents. The risk of suicide, which peaks during the mid-adolescent years, is very real in children and adolescents.
The nurse is told by a client that she is having suicidal thoughts. Which of the following interventions has lowest priority? a) Determining the client's concerns and if she has a plan b) Maintaining a safe, secure environment c) Assessing the client for past history of suicidal attempts d) Administering a mental status exam to assess for psychosis
D About 50% to 80% of people who commit suicide have previously attempted suicide; the more violent and lethal the plan, the higher the potential for suicide. Assessment of past attempts and current plan (not psychosis) as well as maintaining client safety would be priorities. Maintaining a safe, secure environment is an important intervention by the nurse to prevent a suicide attempt.
When assessing a client immediately following ECT, the nurse expects which of the following? a) Long-term memory impairment b) Numbness and tingling in the extremities c) Full of energy d) Confusion
D After ECT treatment, the client may be mildly confused or briefly disoriented. He or she is very tired and often has a headache. The client will have some short-term memory impairment. Numbness and tingling in the extremities is not an expected symptom.
A patient with severe depression is being treated with medications and is told to increase activity and to exercise at least 4 times a week. Which of the following domains would these nursing interventions address? a) Spiritual b) Social c) Psychological d) Biologic
D Biologic interventions center around education, pharmacologic interventions, and other somatic interventions. Activity and exercise are directly related to the body or somatic experience.
A client with bipolar disorder has been ordered a medication whose classification is anticonvulsant. Which of the following drugs does the nurse know falls within this class of medications? a) Methyldopa b) Mannitol c) Lithium d) Carbamazepine
D 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.
Which of the following sleep patterns is suggestive of a manic episode? a) A client reports having fitful sleep that is characterized by frequent awakenings and nightmares. b) A client experiences day-night reversal, sleeping until late in the afternoon, and going to bed near dawn. c) A client takes multiple short naps at varied times throughout the day and night. d) A client stays awake for several days and nights before "crashing" and sleeping for a long period.
D During a manic episode, an individual will typically go several nights without sleep before collapsing from exhaustion.
The nurse is aware that a client taking medication that is controlling the symptoms of his or her bipolar disorder will have better treatment outcomes when which of the following is initiated? a) Independent decision-making by the patient b) Controlled decision-making by the therapist c) Decision influences from many family members d) Shared decision-making
D During acute episodes, the client's judgment may be impaired, which may compromise his or her decision-making. Once treatment begins and starts to be effective, however, and manic or depressive symptoms subside, shared decision-making actually improves treatment outcomes.
After observing James, a bipolar client on the mental health unit, the nurse determines that the client is at risk for violence. Which of the following would be an appropriate intervention? a) Tell James that if he is violent, he will be sent home. b) Ask James to sit alone and write a letter. c) Encourage James to participate in an activity with other clients. d) Restrict James to his room until he calms down.
D If clients are determined to be at risk for violence, establishing geographic boundaries, such as room or half-hall restriction, is part of ongoing monitoring. Other environmental approaches include reducing stimuli and opportunities for interaction with other clients. Nurses remove all dangerous items from client rooms and monitor closely for use of any dangerous items. A pen or pencil that is used to write a letter can be a dangerous object.
Curtis is a psychiatric-mental health nurse who is conducting a suicide assessment with a client. Why is it important to conduct a lethality assessment? a) It may assist in evaluating the potential suicide protective factors of a client. b) It may assist in determining an individual's past suicide behaviors. c) It may assist in determining how long a client has been contemplating suicide. d) It may assist in predicting how likely a person is to die by suicide.
D 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 who has just been prescribed lithium for bipolar disorder is getting instructions from the nurse about this medication. Which of the following is important for the nurse to include in teaching? a) The higher the potassium level, the lower the lithium level will be. b) Changes in diet will not affect lithium levels. c) Lithium has few interactions with other drugs. d) The higher the sodium level, the lower the lithium level will be.
D 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.
When assessing a client who reports mild symptoms of depression, the nurse expects that the diagnostic tests ordered will include a) Coagulation time b) Platelet count c) Liver function test d) Thyroid Stimulating Hormone (TSH)
D Mood is also affected by the thyroid gland. Approximately 5% to 10% of clients with abnormally low levels of thyroid hormones may suffer from a chronic mood disorder. Clients with a mild, symptom-free form of hypothyroidism may be more vulnerable to depressed mood than the average person. Thus, diagnostic testing will likely include Thyroid Stimulating Hormone (TSH), not coagulation times, platelet counts, or liver function tests.
When completing discharge medication education for the client, he asks how long it will take before the effects of his prescribed SSRI could be felt. The nurse states that it will likely take? a) 5 to 7 days b) 1 to 2 days c) 3 to 4 weeks d) 2 to 3 weeks
D Most antidepressant medications do not become effective or reach a therapeutic level for at least 2 or 3 weeks.
Psychodynamic theory attributes the development of mood disorders to which of the following? a) Loss of cultural identity b) Current situational difficulties c) Repressed sexuality d) Unexpressed and unconscious anger
D Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. They cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.
A client who lost a child 6 years ago as a result of an automobile accident caused by a drunk driver is seen for counseling. During the session, the mental health nurse recognizes the priority need to ... a) Encourage the client to become an activist in organizations such as Mothers Against Drunk Driving (MADD) b) Express condolences over the loss of the child c) Assess the client for feelings regarding the driver responsible for the death d) Assess the client for suicidal ideations
D Research has shown that psychiatric-mental health nurses must assess for depression, distress, and suicidal ideation in clients who have experienced the sudden, violent death of a child. Furthermore, assessment may need to be repeated over time.
Mark is a 43-year-old man whose wife just died by suicide. Which of the following is a common emotional response by family members of those who die by suicide? a) Unpredictable behavior and a potential for risk-taking behaviors b) The development of a panic disorder c) Turning toward alcohol or drugs d) Anger toward the loved one who committed suicide
D Some of the emotional responses suicide survivors may experience include feelings of unreality, shock, disbelief, and emotional numbness; grief, sadness, and despair; confusion over not knowing why the loved one chose suicide; anger toward the mental health practitioner, another family member, or a friend for failing to prevent the suicide; self-anger and guilt for failing to prevent the suicide; feelings of anger toward and betrayal by the loved one who committed suicide; and social stigmatization and isolation.
Which of the following would be a priority diagnosis for the client in the manic phase of bipolar disorder who is exhibiting aggressive behavior? a) Impaired Social Interaction b) Ineffective Health Maintenance c) Disturbed Thought Processes d) Risk for Other-Directed Violence
D 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 is receiving lithium carbonate (Eskalith) for the treatment of mania. The nurse would reinforce which teaching component regarding lithium treatment? a) Watch for low urine output. b) Give medication on an empty stomach. c) Decrease fluid intake to prevent edema. d) Obtain scheduled lithium levels.
D There is a narrow range between therapeutic lithium levels and lithium toxicity. It is important to obtain scheduled drug levels to prevent toxicity from occurring. The nurse should monitor for polyuria. Teaching includes taking the medication with food or milk after meals and ensuring an adequate daily intake of fluid (2,500 to 3,000 mL) daily.
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? a) Sleep disturbance b) Decreased energy c) Suicide d) Dehydration
D 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 the other things, but they are not related to nutrition and the weight loss.
Women make how many suicide attempts for every one attempt by their male counterparts? a) One b) Two c) Four d) Three
D Women make three attempts to every one attempt by men. Women are less likely to complete a suicide, partly because they are more likely to choose less lethal methods.
Which of the following is an anticonvulsant used as a mood stabilizer? a) Bupropion (Wellbutrin) b) Phenelzine (Nardil) c) Venlafaxine (Effexor) d) Divalproex (Depakote)
D Depakote is an anticonvulsant that may be used as a mood stabilizer. Effexor, Wellbutrin, and Nardil are antidepressants.
Which mental health disorder is a major risk factor for suicide? a) Anxiety b) Mania c) Schizophrenia d) Depression
D Depression is a major risk factor of suicide. Anxiety, schizophrenia, and mania are not major risk factors for suicide.
A nurse is assessing a client with depression. During the assessment, the nurse notes that the client's emotional expression does not match what the client is saying. The nurse would document this as which type of affect? a) Inappropriate b) Labile c) Flat d) Blunted
A An inappropriate affect is a discordant affective expression accompanying the content of speech or ideation. A blunted affect is significantly reduced in intensity. A flat affect is characterized by an absent or nearly absent emotional expression. A labile affect is one that is varied, rapid, and abruptly shifts.
A 34-year-old client with depression is admitted to an inpatient psychiatric unit. The nurse enters her room and initiates interaction with the client. When talking with the client, which approach would be least appropriate? a) Animated and cheerful manner b) Quiet and empathetic manner c) Matter-of-fact manner d) Respectful, direct manner
A When communicating with clients who are depressed, the nurse should never use an overly enthusiastic approach. This approach can lead to irritation and block communication. Clients should be encouraged to set realistic goals to reconnect with their families and communities.
Which of the following is accurate regarding women and suicide? a) They are less likely to complete suicide than men. b) They are more likely to die from attempted suicide than men. c) They are more likely to choose a more lethal method than men. d) They attempt suicide less often than men.
A Women are less likely to complete a suicide than men, partly because they are more likely to choose a less lethal method. Women are less likely to die from an attempted suicide than men, but they attempt suicide more often.
Choice Multiple question - Select all answer choices that apply. A client who has been prescribed fluoxetine for depression and has just had his dosage increased comes the emergency department. The nurse suspects serotonin syndrome based on assessment of which of the following? a) Diaphoresis b) Ataxia c) Constipation d) Fever e) Hyporeflexia f) Change in mental status
A, B, D, F The symptoms of serotonin syndrome include altered mental status, autonomic dysfunction, and neuromuscular abnormalities. At least three of the following must be present for a diagnosis: mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea.
When teaching a client with newly diagnosed bipolar I disorder, the nurse states that the difference between bipolar I disorder and bipolar II disorder is what? a) Bipolar I disorder is often more disruptive than bipolar II disorder. b) Bipolar I disorder is characterized by hypomanic episodes. c) Bipolar I disorder more often affects women. d) Bipolar I disorder involves altered moods of anger and paranoia.
A Bipolar I disorder is often more severe, thus symptoms tend to create more disruption in functioning compared to bipolar II disorder. Bipolar I disorder is characterized by one or more manic or mixed episodes in which the individual experiences rapidly alternating moods accompanied by symptoms of a manic mood and a major depressive episode.
According to the biochemical theory of mood disorders, a client with a diagnosis of depression is likely to have alterations in the levels and function of which of the following neurotransmitters? a) Serotonin, norepinephrine, and dopamine b) Acetylcholine, adenosine, and glutamate c) Epinephrine, histamine, and melatonin d) Aspartate, GABA, and serine
A Monoamines such as serotonin, norepinephrine, and dopamine have been implicated in the etiology of mood disorders such as depression.
The nurse working on a mental health unit is teaching a nursing student learning about depression. The student asks the nurse about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response? a) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present." b) "The physician diagnosis depression when a client has feelings of sadness several times a year." c) "Depression is a mood variation to life events." d) "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression."
A Normal variations in mood (such as sadness, euphoria, and anxiety) occur in response to life events; they are time limited and not usually associated with significant functional impairment. The primary diagnostic criterion for major depressive disorder is one or more major depressive episodes (either a depressed mood or a loss of interest of pleasure in nearly all activities) for at least 2 weeks. Four of seven other symptoms must be present. Thus, the best response from the nurse is "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."
While caring for a client in the hospital, you become concerned that the client may be having thoughts of suicide. Which of the following statements would be most therapeutic? a) "What is concerning you?" b) "Have you tried taking medication?" c) "Are you feeling sad?" d) "Do you have support at home?"
A Nurses start with open-ended questions that invite clients to convey what is concerning them most at this particular time. Sensitivity and empathy allow nurses to gather information, engage clients, and develop the therapeutic relationship.
People who complete suicide often have extremely low levels of which neurotransmitter? a) Serotonin b) Acetylcholine c) GABA d) Norepinephrine
A People who complete suicide often have extremely low levels of the neurotransmitter serotonin. Impairments in the serotonergic system contribute to suicidal behavior. People who make near-lethal suicide attempts have much lower levels of the neurotransmitter dopamine and omega-3. Low levels of the other neurotransmitters have not been implicated in completed suicides.
You are conducting an admission assessment with Alberto, a 45-year-old man, who has been demonstrating signs of bipolar disorder. While conducting the assessment, Alberto starts speaking in illogical rhymes and uses word associations. What is the name for this thought pattern? a) Flight of ideas b) Delusions of grandeur c) Excessive euphoric speech d) Expansive ideas
A Rapid "flights of ideas" lead to excessive and illogical rhyming, punning, and word associations, along with pressured speech.
A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment finding would support this suspicion? Select all that apply. a) Agitated delirium b) Blurred vision c) Orthostatic hypotension d) Headache e) Warm, dry skin
A, B, E In acute overdose, almost all symptoms develop within 12 hours. Anticholinergic effects are prominent and include dry mucous membranes, warm and dry skin, blurred vision, decreased bowel motility, and urinary retention. CNS suppression (ranging from drowsiness to coma) or an agitated delirium may occur. Orthostatic hypotension and headache are side effects of MAOIs.
Which of the following statements regarding suicide is correct? a) Suicide has profound effects on those connected to the individual. b) Suicide is defined as the voluntary or unintentional act of taking one's own life. c) Suicide does not occur in affluent neighborhoods, indicating poverty is a factor. d) Suicide is more of a concern in countries other than the United States.
A 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. While the definition of suicide is simple (the voluntary and intentional act of taking one's own life), the processes surrounding it are complex.
Which of the following is the greatest predictor of a future suicide attempt? a) Previous attempt b) Suicide planning c) Degree of hopelessness d) Seriousness of suicidal ideation
A The greatest predictor of a future suicide attempt is a previous attempt, partly because that individual already has broken the "taboo" around suicidal behavior. Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, and suicide planning.
The monoamine hypothesis of depression ... a) holds that depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines. b) holds that depression is caused by sociocultural and psychological factors. c) holds that depression is caused by only one of the biogenic amines. d) relates to bipolar disorders, not to depression.
A The major monoamine hypothesis about depression is that absolute concentrations of norepinephrine, 5-HT, or both are deficient.
Pharmacotherapy is essential to the management of the client with bipolar disorder. The nurse understands that the goals for such therapy are which of the following? Select all that apply. a) Decreased frequency of manic episodes b) Cure of the disorder c) Rapid control of symptoms d) Decreased severity of manic episodes e) Prevention of future episodes
A, C, D, E Pharmacotherapy is essential to the successful management of bipolar disorder to achieve the goals of rapid control of symptoms and prevention of future episodes, or, at least, reduction in their severity and frequency.
The nurse is reviewing the medical records of several clients diagnosed with major depression. The nurse identifies which client as least likely to commit suicide? a) Married man b) Widowed woman c) Single woman d) Divorced man
A The nurse determines that the client least likely to commit suicide is the client who is married. Single, older men living in a rural area have the highest rates of suicide. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk for committing suicide. Women are less likely to complete a suicide but are more likely to attempt suicide. Marriage has been identified as a protective factor for mental disorders in older adults.
The nurse is caring for a white man age 30 years whose wife has 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? a) Ask the client if he is thinking about killing himself. b) Refer the client for long-term psychotherapy. c) Determine the client's risk of psychosis. d) Determine if anyone in the client's family has had depression.
A The nurse should first ask if the client is thinking about killing himself, because statistics show that in young, recently widowed white men between the ages of 20 and 34 years, the suicide risk is 17 times higher than that of married men in that same age group. 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.
After teaching a group of nursing students about major depression, the instructor determines that the education was successful when the group identifies which age group as having the highest onset? a) Individuals in their 20's b) Individuals in their 30's c) Teens d) Middle-aged persons
A The onset of depression may occur at any age. However, the initial onset may occur in puberty; the highest onset occurs within persons in their 20s.
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? a) Suicidal intent b) Suicidal gesture c) Suicidal threat d) Suicidal ideation
A The specificity and concreteness of the client's plan indicates suicidal intent. Suicidal ideations, threats, and gestures are typically more vague and less rooted in time and place.
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 which of the following? a) Grandiosity b) Anxiety c) Anorexia d) Depression
A 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.
You are working with a 50-year-old woman admitted for major depressive episode. The client has remained isolated and withdrawn since her admission and is reluctant to speak. Which of the following therapeutic communication skills is most likely to encourage the client to vent her feelings? a) Silence and active listening b) Reality orientation c) Direct confrontation d) Projective identification
A Silence and active listening are powerful tools for use with a client who is depressed and withdrawn. Direct confrontation can lead to feelings of shame or embarrassment. The client who is not psychotic does not need reality orientation, and projective identification is a primitive subconscious ego defense mechanism.
Based on current research, the psychiatric nurse expects that a newly diagnosed bipolar client with suicidal ideations will be prescribed a) Lithium b) Clozapine (Clozaril) c) (Prozac) d) Naltrexone (ReVia)
A Lithium has been proven to lower suicide rates in clients with the diagnosis of bipolar disorder.
A client was admitted to the psychiatric unit after being picked up by police officers who found her frantically running back and forth across the freeway. Her husband related that she stayed up all night, ate very little, and talked incessantly. Additional assessment findings that indicate a manic episode include what? a) Psychomotor retardation, fatigue, and apathy b) Catatonic excitement, loose associations, and recurrent illusions c) Pressured speech, combative behavior, and impaired judgment d) Self-destructive behavior, overidealization, and devaluation
A manic episode would be characterized by pressured speech, potentially combative behavior, and impaired judgment. Neither psychomotor retardation is present nor are recurrent illusions. Self-destructive behavior is not a classic symptom of mania; more often, clients may have accidents caused by their lack of judgment and psychomotor agitation.
A client taking lithium for bipolar disorder comes to the clinic and reports symptoms consistent with moderate lithium toxicity. Which of the following actions should the nurse perform? Select all that apply. a) Contact the physician. b) Push fluids. c) Withhold additional doses of lithium. d) Perform a 12-lead EKG. e) Obtain a blood sample for lithium level.
A, B, C, E If symptoms of moderate to severe toxicity to lithium are noted, the nurse should withhold the medication, obtain a blood sample to analyze the lithium level, push fluids, and contact the physician for further instructions.
A client comes to the clinic for an evaluation of headache, fatigue, and an overall feelings of being "down." When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply. a) "I'm so tired that all I ever want to do is sleep all the time." b) "I'm looking for a new job because my job is so stressful." c) "Most times, I feel like I'm trapped with no way out." d) "I've been going out with my friends about once or twice a week." e) "I've been drinking about three or four more beers every night."
A, C, E Warning signs for suicide include increased substance use (drinking three or four more beers every night), an inability to sleep or sleeping all the time, and feeling trapped. Social isolation or withdrawal (rather than going out with friends or looking for a new job) would suggest suicide.
Jackson is a 56-year-old man who suffers from seasonal affective disorder. Which of the following treatments is the most effective type of treatment for this condition? a) Antidepressant therapy b) Phototherapy c) Electroconvulsive therapy d) Psychotherapy
B
A 50-year-old man who has recently been diagnosed with amyotrophic lateral sclerosis (ALS) has announced to the nurse his intention to commit suicide in order to prevent future suffering. Which of the following facts should underlie the nurse's response to this client? a) The nurse must refer the client to a physician who is authorized to assist the man with a suicide. b) The nurse is obliged to protect the client from self-harm. c) The nurse is required to document the client's wishes and begin to facilitate an assisted suicide. d) The nurse is ethically obliged to inform law enforcement.
B While the nurse is not obliged to inform law enforcement, he or she is ethically obligated to protect the client from self-harm. Participation or referral for assisted suicide has not been recognized as an acceptable component of nursing practice.
A client taking a monoamine-oxidase inhibitor (MAOI) for depression should be instructed to avoid which of the following when taking the medication? Select all that apply. a) Spinach b) Red wine c) Aged cheese d) Red meat e) Beer
B, C, E If co-administered with food or other substances containing tyramine (aged cheese, beer, red wine) MAOIs can trigger a hypertensive crisis.
After being diagnosed with a chronic disease, Muriel has been feeling depressed. Which of the following diagnoses has the strongest association with an increased suicide risk? a) Chronic obstructive pulmonary disease b) Congestive heart failure c) Acquired immunodeficiency syndrome d) Coronary heart disease
C The WHO notes that chronic physical illness and certain physical illnesses contribute to higher suicide risk in some individuals. Neurologic diseases such as epilepsy and spinal and brain injury have been associated with increased suicide risk. HIV infection and AIDS also pose increased suicide risk, particularly at the time of diagnosis. Pain also has been identified as a significant contributing factor.
The nurse is providing a presentation for a group of health professionals about suicide. Which of the following would the nurse address as a major contributing factor to the rising suicide rate among men? a) Lack of conflict resolution skills b) Parenting practices c) Substance abuse d) Media influences
C Substance abuse, aggression, hopelessness, emotion-focused coping, social isolation, and lack of purpose in life have been associated with suicidal behavior in men. In addition, just under 50% of suicide attempts in men between the ages of 42 and 77 years involve firearms. The media, lack of conflict resolution skills, and parenting practices can play a role, but are not considered major factors.
In the past year, Caitlin has experienced six manic episodes, each lasting for 3 weeks. This is known as: a) Hypomania b) Hypermania c) Cyclothymic biopolar disorder d) Rapid cycling
D In rapid cycling, clients have four or more manic episodes for at least 2 weeks in a single year. The episodes are marked by either partial or full remission for at least 2 months or a switch to an episode of opposite type.
A client is receiving amitriptyline. The health care provider orders a drug plasma level. The client receives a dose at 8 a.m. At which time would the nurse have the sample obtained? a) 4 p.m. b) 10 a.m. c) 12 noon d) 8 p.m.
D The TCAs, including imipramine (Tofranil), desipramine (Norpramin), amitriptyline (Elavil), and nortriptyline (Pamelor), have standardized valid plasma levels that can be useful in determining therapeutic dosages, although therapeutic plasma levels may vary from individual to individual. Blood samples should be drawn as close as possible to 12 hours away from the last dose.
