Ch. 17 Mood Disorders
Which question by a depressed, inpatient, psychiatric-mental health client should the nurse interpret as a potential suicide clue? "Are clients allowed to keep drugstore medications at their bedside?" "When is my next scheduled electroconvulsive therapy session?" "When do you think the doctor will let me get my street clothes back?" "Are we allowed to use the client kitchen whenever we want?"
"Are clients allowed to keep drugstore medications at their bedside?"
The nurse has been asked to assess a client to determine if the client has a suicide plan. Which question would assist the nurse in assessing this area? "Are you a religious person?" "Do you have people in your life who are supportive of you?" "Are you thinking about killing yourself right now?" "How do you generally cope with problems in your life?"
"Are you thinking about killing yourself right now?"
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?"
A nursing instructor is teaching about depressive disorders and identifies a need for further instruction when a student states what? "Dysthymic disorder is milder than major depression." "Dysthymic disorder is less chronic than major depression." "It is also known as persistent depressive disorder." "Major depression may be preceded by dysthymic disorder."
"Dysthymic disorder is less chronic than major depression."
The nurse is providing care for a client who deliberately overdosed on acetaminophen several days ago. The nurse should assess the current severity of the client's suicidal ideation by asking what question? "How often are you having thoughts about suicide this morning?" "Do you have access to any more pills that we don't know about?" "Do you see a way out from your depression apart from suicide?" "What caused you to take all those pills last week?"
"How often are you having thoughts about suicide this morning?"
The nurse is seeing a client for counselling in a mental health clinic. The nurse notes the client has new superficial cuts to the inside of the upper forearm. Which is the best way for the nurse to discuss this observation with the client? "I notice some cuts on your arm. Am I correct to think that things have been difficult?" "I notice some cuts on your arm. Are our counseling sessions not working for you?" "I notice some cuts on your arm. Have you not been using the coping skills I taught you?" "I notice some cuts on your arm. Do you want me to put a dressing on the wounds?"
"I notice some cuts on your arm. Am I correct to think that things have been difficult?"
The nurse is assessing a female client who discloses she is having thoughts of killing herself. The client tells the nurse she owns a gun. The client tells the nurse she is not ready for anyone to know she feels this way and would prefer that the information not be shared with anyone else. What is the nurse's best response? "I'm going to keep you safe. In order to do that I need to share how you are feeling with the health care team." "This must be so difficult for you to share. I will respect your privacy and let you disclose when you are ready." "You are high risk for harming yourself. I am obligated by law to disclose what you just told me." "You are a individual with rights. You have the right to privacy, however, you should tell family members."
"I'm going to keep you safe. In order to do that I need to share how you are feeling with the health care team."
A client with major depression is admitted to the health facility and expresses feelings of worthlessness and abandonment by significant others. Which replies by the nurse would convey empathy? "I can understand what is going on with you." "Are you feeling like others have abandoned you?" "It sounds like this is a really difficult time for you." "Can you tell me what you are thinking right now?"
"It sounds like this is a really difficult time for you."
Psychodynamic theory attributes the development of mood disorders to what? Hardships in adulthood Loss of cultural identity Repressed sexuality Unexpressed and unconscious anger
Unexpressed and unconscious anger
When caring for a client with mania, which would the nurse most likely assess? Logical thinking Unusual self-confidence Narrowed focus Slow, repetitive speech
Unusual self-confidence
What is the difference between depressive disorders and bipolar disorders? Bipolar disorders do not involve periods of sadness or unhappiness. Bipolar disorders involve mood swings ranging from depression to mania. Depressive disorders involve times of elation that are not found in bipolar disorder. Depressive disorders cannot be treated but bipolar disorders are treatable.
Bipolar disorders involve mood swings ranging from depression to mania.
A 52-year-old client with bipolar disorder tells the nurse, "I read that there are chemicals in my brain that can cause my symptoms." Knowing that the client is referring to neurotransmitters, which would be the best response by the nurse? "Clients with bipolar disorder often have high levels of gamma-aminobutyric acid (GABA) in manic states." "Low levels of the neurotransmitter serotonin are associated with mania." "Recent studies have found that neurotransmitters do not play a role in bipolar disorders." "Low levels of the neurotransmitter dopamine are associated with mania."
"Low levels of the neurotransmitter serotonin are associated with mania."
A client with a diagnosis of depression tells the nurse that the client's mood was especially bad this morning but that the client pushed through it to attend a support group. How can the nurse best validate the client? "That shows an admirable level of perseverance on your part. Well done!" "Many people who are battling depression find that support groups are beneficial." "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!"
The nurse working on a mental health unit is teaching a nursing student. The student asks the nurse about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response? "Depression is a mood variation to life events." "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present." "The physician diagnoses depression when a client has feelings of sadness several times a year." "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression."
"The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."
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? "I just need someone to talk to" "There are no solutions to my problems." "My son is really the only reason I stick around." "I think about starving myself to death sometimes"
"There are no solutions to my problems."
The nurse is assessing a client with depression and a colleague suggests that the client be encouraged to sign a no-suicide contract. What is the nurse's best response to the colleague? "There's no demonstrated benefit of no-suicide contracts, though they're not believed to be harmful." "The most recent evidence suggests that these contracts can actually provoke a suicide attempt." "Yes, there are some benefits to no-suicide contracts, but they're ethically questionable." "It's best to let the client bring up the issue of no-suicide contracts rather than us suggesting them."
"There's no demonstrated benefit of no-suicide contracts, though they're not believed to be harmful."
A client comes to the emergency department reporting a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and the client's pulse is racing. The client states that the client is being treated for depression with an MAOI. Which question by the nurse would be most important to ask at this time? "Do you use any herbal remedies?" "Are you having any chest pain?" "What have you had to eat or drink today?" "When did you last have blood drawn to check your drug level?"
"What have you had to eat or drink today?"
The nurse is working with a client who makes the statement, " I don't have anyone in my life who cares what happens to me." What is the nurse's most appropriate response? "What you are going through right now must be so difficult for you. Please tell me why you think no one cares." "I am here with you now. I care about you very much." "You are safe with me. There is so much you have to live for." "You likely haven't been sleeping well and that can decrease mood significantly. Some additional sleep will help."
"What you are going through right now must be so difficult for you. Please tell me why you think no one cares."
A client has just been diagnosed with bipolar disorder and is upset with the diagnosis. The client tells the nurse, "It is probably my mother's fault, she has bipolar too." Which is the best response by the nurse? "While bipolar disorders are genetic, the gene can only be passed on by a father." "Bipolar disorders have not been found to be genetic." "While bipolar disorders are genetic, there are other causes as well." "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."
A client has experienced a first episode of major depression and has received medication and treatment, which has led to a complete remission of the symptoms. The client asks the nurse, "How much longer will I need to take the medication?" Which response by the nurse would be most appropriate? "You'll need to continue the medication for about 6 to 12 months to see how things go." "It's probably best to continue the medication for another month, gradually decreasing the dosage over that time." "Since you have no more symptoms, you can stop taking the medications tomorrow." "The medication has eliminated your symptoms so you'll need to keep taking it for the rest of your life."
"You'll need to continue the medication for about 6 to 12 months to see how things go."
Which client is most likely to benefit from electroconvulsive therapy (ECT)? A client with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy A client whose recent strange behavior has been attributed to cyclothymic disorder A client whose major depression has not responded appreciably to antidepressants
A client whose major depression has not responded appreciably to antidepressants
A 46-year-old client comes to the community mental health center because the client thinks they might be suffering from depression. When assessing this client, which symptom would the nurse identify as being necessary for the diagnosis of major depressive disorder to be made? A stooped posture and nonverbal signs of a depressed mood Euphoria along with poor decision making ability A loss of interest or inability to derive pleasure for previously enjoyed activities Disregard for personal hygiene including cleanliness and appearance
A loss of interest or inability to derive pleasure for previously enjoyed activities
The nurse who is conducting a suicide risk assessment with a client determines the lethality of the plan is as high if which condition is present? A male client keeps a loaded firearm in the closet A female client has several bottles of over-the-counter medications An adolescent client refuses to consume any more food An older adult client verbalizes the desire to drown in the river
A male client keeps a loaded firearm in the closet
Research has shown that risk of suicide increases within which time frame for initiation of antidepressant therapy? 14 days 35 days 42 days 28 days
14 days
A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what? Claims by family, friends, or coworkers that the client is depressed Self-report of being sad after a break up Demonstrated examples of unwise decisions A significant decrease in appetite
A significant decrease in appetite
A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what? Self-report of being sad after a break up A significant decrease in appetite Demonstrated examples of unwise decisions Claims by family, friends, or coworkers that the client is depressed
A significant decrease in appetite
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 adult female who is mourning the death of her husband 5 months ago 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
A young male with schizophrenia who is in danger of becoming homeless
A client is admitted to the unit in an acute manic episode. The client has had three major depressive episodes in the past 10 years and two other hospitalizations for mania. Which disorders would reflect the client's symptom profile? Cyclothymic disorder Bipolar II Bipolar I Euthymic state
Bipolar I
When teaching a client who is recently diagnosed bipolar I disorder, the nurse correctly tells the client that the difference between bipolar I disorder and bipolar II disorder is what? Bipolar I disorder is often more disruptive than bipolar II disorder. Bipolar I disorder is characterized by hypomanic episodes. Bipolar I disorder involves altered moods of anger and paranoia. Bipolar I disorder more often effects women.
Bipolar I disorder is often more disruptive than bipolar II disorder.
The mental health nurse appropriately provides education on light therapy to which client? 45-year-old lawyer whose medication therapy needs an additional treatment 58-year-old showing signs of early Alzheimer's disease 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term 50-year-old farmer whose major depression has not responded to any treatment modality
20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term
When completing discharge medication education for the client, the client asks how long it will take before the selective serotonin reuptake inhibitor (SSRI) medication will help the client's mood improve. Which is the correct response by the nurse? 1 to 2 days 7 to 10 days 3 to 4 weeks 5 to 7 days
7 to 10 days
Which client is most likely to benefit from electroconvulsive therapy (ECT)? A client with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode 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 whose recent strange behavior has been attributed to cyclothymic disorder
A client whose major depression has not responded appreciably to antidepressants
A nurse is providing psycho-education to a client who has been admitted to the inpatient mental health unit for a manic episode. In order to ensure the teaching is effective, the nurse must first determine which regarding the client? Cognitive awareness and intellectual abilities Interest in learning about the disorder Likelihood to assume responsibility for self-care Ability to concentrate and process the information
Ability to concentrate and process the information
The parent of a suicidal adolescent is concerned that "only crazy people commit suicide." When helping the parent understand a daughter's suicidal behavior, the nurse would explain what? Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. Suicide attempts are very common in teenage girls. Fifty percent of all suicides occur as a result of major psychoses. Suicidal tendencies are inherited.
Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy.
The nurse is seeing a 43-year-old client whose spouse just died by suicide. Which is a common emotional response that the nurse should anticipate from this client? Anger toward the loved one who committed suicide Turning toward alcohol or drugs The development of a panic disorder Unpredictable behavior and a potential for risk-taking behaviors
Anger toward the loved one who committed suicide
A 34-year-old client with depression is admitted to an inpatient psychiatric unit. The nurse enters the client's room and initiates interaction with the client. When talking with the client, which approach would be least appropriate? Quiet and empathetic manner Animated and cheerful manner Matter-of-fact manner Respectful, direct manner
Animated and cheerful manner
A client is admitted to the psychiatric unit after taking various medications and illegal substances to get "high." In addition to the underlying diagnosis of bipolar disorder, the client is diagnosed with delirium. Currently the client is experiencing mild hallucinations and confusion. Which intervention should the nurse do first? Arrange for an unlicensed assistant to sit with the client. Obtain an order for haloperidol. Ask a family member to stay with the client and report any concerns. Loosely apply a vest restraint.
Arrange for an unlicensed assistant to sit with the client.
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 participate actively in cognitive behavioral therapy Client will implement strategies for managing stress Client will express that the client feels safe on the unit Client will state that the client feels optimistic about the client's future
Client will express that the client feels safe on the unit
The major difference between bipolar I and bipolar II disorder is what? Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances. Both disorders are the same, except that clients with bipolar I disorders have a much higher incidence of suicide. The prognosis for bipolar I is much better than for bipolar II. Clients with bipolar I have no symptoms of mania, but only depression.
Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances.
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? Take a leave of absence until the symptoms have stopped Confide in one of the psychiatrists who gives care on the unit Interact with other clients in order to witness improvements in their condition Dialogue with a trusted colleague about these feelings
Dialogue with a trusted colleague about these feelings
To care for an acutely suicidal client, which is the most effective initial mode of treatment? Inpatient care Group therapy Behavioral therapy Outpatient care
Inpatient care
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? Decreased energy Suicide Sleep disturbance Dehydration
Dehydration
Which statement regarding depression and gender is correct? Depressive disorders are more common in men than women. Depressive disorders are more common in women than men. Depressive disorders equally affect men and women. Depressive disorders affect young men more than older women.
Depressive disorders are more common in women than men.
Before a client became depressed, the client was an active, involved parent with three children, often attending school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals feeling like an unnecessary burden on the family. Which nursing diagnosis is most appropriate? Anxiety related to side effects of medication Disturbance of self-concept related to feelings of worthlessness Anger related to marital disagreements Apathy related to fatigue and sleeplessness
Disturbance of self-concept related to feelings of worthlessness
A 35-year-old client with bipolar disorder has a history of discontinuing medication when feeling well and then becoming manic again. During the client's last episode of mania, the client lost several thousand dollars in risky investments. Which intervention will be most helpful in achieving medication adherence? During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. Ensure that a family member takes responsibility for administering medications. Point out that each time the client stops taking medication, the client becomes manic again. Remind the client that the client owes it to the client's spouse and children to stay well.
During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse.
A client with a diagnosis of bipolar disorder is described by a family member as "flip-flopping between being happy and loving to irritable and hostile." Which characteristic symptoms of this disorder is the family member referring to? Euthymic mood Emotional lability Manic episode Grandiosity
Emotional lability
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? Document a nursing diagnosis of ineffective denial and choose interventions accordingly Assess the client's knowledge of depression and describe the risks of suicide 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
Explain to the client that untreated depression often becomes increasingly severe and frequent over time
After educating a class on the etiology of bipolar disorders, a nursing instructor determines that the education was successful when the class describes the kindling theory as involving what? A dysregulation in the circadian rhythm, leading to sleep disturbance A single gene or sequence of genes causing pathologic changes Exposure to repetitive subthreshold stressors at vulnerable times "Wear and tear" on the body from mood episodes leading to increased problems
Exposure to repetitive subthreshold stressors at vulnerable times
The nurse knows that the most dangerous time period following a previous suicide attempt is what? First 9 months First 6 months First year First 3 months
First 3 months
The nurse is conducting an admission assessment with a 45-year-old client who has been demonstrating signs of bipolar disorder. While conducting the assessment, the client starts speaking in illogical rhymes and using word associations. What is the name for this thought pattern? Delusions of grandeur Flight of ideas Expansive ideas Excessive euphoric speech
Flight of ideas
A 32-year-old client is admitted to the inpatient unit for depression with suicidal thoughts. During the nursing assessment, why it is important for the nurse to assess and explore if there is any family member who has committed suicide? Terminal illness Lack of conflict resolution skills Genetic predisposition Disengagement of family
Genetic predisposition
When teaching prevention to the parents of a 15-year-old client who recently attempted suicide by taking an overdose of alprazolam, the nurse describes which behavioral clue? Experiencing the loss of a boyfriend or girlfriend Giving away valued personal items Angry outbursts at significant others Inquiry about doses of lethal drugs
Giving away valued personal items
Which would be a finding related to perceptual disturbances during the mental status exam in the client with mania? Increased motor activity Limited insight Hallucinations Inappropriate affect
Hallucinations
Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder? Bizarre, colorful, inappropriate dress Grandiose thinking and poor concentration Insulting, provocative behavior directed at staff Hyperactivity, dismissing meals, and sleep disturbance
Hyperactivity, dismissing meals, and sleep disturbance
A nurse is preparing a client for discharge. As part of the discharge process, the nurse provides education to the client regarding safety from self-harm. Which intervention should the nurse employ? Avoid inclusion of significant others to ensure confidentiality of client Remind the client to make an outpatient appointment for follow-up care Discuss how the client's risk factors have decreased following the hospitalization Include family members to provide a better understanding of symptoms of the illness
Include family members to provide a better understanding of symptoms of the illness
Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? Eat a nutritionally balanced diet Take medication with food Increase hydration Get daily exercise
Increase hydration
A psychiatric-mental health nurse is conducting a suicide assessment with a client. Why is it important to conduct a lethality assessment? It may assist in determining an individual's past suicide behaviors. 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.
It may assist in predicting how likely a person is to die by suicide.
A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy? Liver function Thyroid level White blood cell (WBC) count Cardiac enzymes
Liver function
A 30-year-old woman has been brought to the emergency department after causing a disturbance. She is wearing a pair of tight, pink yoga pants, high heels, a sports bra, and a bright-colored hat. The woman's care providers would recognize that the woman's dress may suggest what? Antisocial personality disorder Acute confusion Mania Chronic low self-esteem
Mania
Limit setting is most appropriate in which client population? Manic Anxious Suicidal Depressed
Manic
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? Initial insomnia Terminal insomnia Hypersomnia Middle insomnia
Middle insomnia
Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what? A mood disorder due to a general medical condition Postpartum psychosis Anaclitic depression Moderate depression
Moderate depression
Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what? Anaclitic depression Moderate depression A mood disorder due to a general medical condition Postpartum psychosis
Moderate depression
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 Moderate lithium toxicity Interaction of lithium with another medication Need for an increased dose of medication
Moderate lithium toxicity
Which medication classification is considered first-line drug therapy for bipolar disorder? Antipsychotics Mood stabilizers Anticonvulsants Antidepressants
Mood stabilizers
Which biogenic amines have been implicated in depression? Dopamine and histamine Epinephrine and serotonin Norepinephrine and serotonin Epinephrine and dopamine
Norepinephrine and serotonin
Which is a true statement regarding depressive disorders? They are more prevalent in men than women. Depression in older adults is easier to diagnosis. Norepinephrine, dopamine, and serotonin have been implicated. It is the leading cause of U.S. disability in clients older than 44 years of age.
Norepinephrine, dopamine, and serotonin have been implicated.
A depressed older adult client is being treated with a tricyclic antidepressant (TCA). For which clinical manifestations should the nurse monitor the client? Orthostatic hypotension and urinary retention Diarrhea and electrolyte imbalance Pseudoparkinsonism and tardive dyskinesia Photosensitivity and skin rashes
Orthostatic hypotension and urinary retention
The nurse is caring for an adolescent client who returned to the psychiatric unit from therapeutic pass with superficial cuts to the insides of both forearms. The nurse knows the client is engaging in which self-harm behavior? Suicide attempt Volition Copycat suicide Parasuicide
Parasuicide
The nurse is seeing an adolescent female client who has superficial cuts to both wrists and ankles. The client denies the desire to kill herself but reports recent family stress due to her parents recently separating. Which phenomena explains the client's response to stress? Parasuicide Suicide attempt Suicide contagion Impulsivity
Parasuicide
A client is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also states feeling unhappy most of the time for "as long as the client can remember." Which diagnosis should the nurse anticipate for this client? Mild depressive disorder Bipolar disorder Rapid cycling disorder Persistent depressive disorder
Persistent depressive disorder
A client with major depression and a suicide attempt is admitted to the inpatient facility. The client is started on antidepressant therapy. The next day, the client demonstrates significantly higher energy and says, "I'll feel much better." The nurse would interpret this behavior as suggesting what? An act to cover up the client's true feelings A typical response to the medication Effectiveness of the drug therapy Possible decision to complete a suicide attempt
Possible decision to complete a suicide attempt
A client was admitted to the psychiatric unit after being picked up by police officers who found the client frantically running back and forth across the freeway. The client's spouse reports that the client stayed up all night, ate very little, and talked incessantly. Additional assessment findings that indicate a manic episode include what? Psychomotor retardation, fatigue, and apathy Pressured speech, combative behavior, and impaired judgment Catatonic excitement, loose associations, and recurrent illusions Self-destructive behavior, overidealization, and devaluation
Pressured speech, combative behavior, and impaired judgment
After assessing a client, the nurse identifies that the client is at risk for suicide. Which would be the nurse's priority intervention? Communicate a desire to help the client. Determine the course of the client's suicidal thoughts. Provide mood-stabilizing medications per physician order. Remove means of suicide from the client's access.
Remove means of suicide from the client's access.
After observing a bipolar client on the mental health unit, the nurse determines that the client is at risk for violence. Which would be an appropriate intervention? Restrict the client to the client's room until the client can calm down. Tell the client that if the client is violent, the client will be sent home. Ask the client to sit alone and write a letter. Encourage the client to participate in an activity with other clients.
Restrict the client to the client's room until the client can calm down.
A client with which psychiatric disorder is at high risk for suicide? Eating disorders Schizophrenia Personality disorders Anxiety disorders
Schizophrenia
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? Cyclic antidepressant Monoamine-oxidase inhibitor Selective serotonin reuptake inhibitor Serotonin 2 antagonist
Selective serotonin reuptake inhibitor
A client with major depression is prescribed paroxetine. The nurse develops an education plan for the client based on the understanding that this drug belongs to which class of drugs? Selective serotonin reuptake inhibitors Serotonin norepinephrine reuptake inhibitors Monoamine oxidase inhibitors Tricyclic antidepressants
Selective serotonin reuptake inhibitors
A nurse is caring for a client diagnosed with bipolar disorder. The client is experiencing a manic episode. The nurse would be especially alert for signs indicating what? Sleep disruption Weight loss Dehydration Self-injury
Self-injury
In response to a change in the community health nurse, a client has recently discontinued use of lithium. As a result of the discontinuation of the medication, the client has began to exhibit early signs of mania. The client is brought to the emergency department at the hospital for assessment. Which is the best nursing approach for this client? Setting limits, providing a low-stimulation environment, and maintaining a neutral attitude Allowing the client maximum opportunity for freedom and self-expression Insisting that the client remain active throughout the day so the client will sleep Offering high-calorie meals and insisting the client finish all meals
Setting limits, providing a low-stimulation environment, and maintaining a neutral attitude
Before a client became depressed, the client was an active, involved parent with three children, often attending their school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals that the client feels like an unnecessary burden on the client's family. Which nursing diagnosis is most appropriate? Anxiety related to side effects of medication Situational low self-esteem Ineffective coping related to marital disagreements Ineffective activity planning related to depression
Situational low self-esteem
To confirm that a client is experiencing a manic episode, the nurse must eliminate the possibility that the client's symptoms are related to which problem? Overexcitment Insomnia Inflated self-esteem or grandiosity Substance use
Substance use
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 ideation Suicidal threat Suicidal intent Suicidal gesture
Suicidal intent
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? Bipolar disorder Suicide Schizophrenia Dysthymic disorder
Suicide
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 states, "Everything just seems really dark right now." The client has been treated with a variety of antidepressants over the years. The client overdosed on pills 2 years earlier The client sits silently after being asked several of the assessment questions
The client overdosed on pills 2 years earlier
The nurse is working with an outpatient who has a history of depression and suicide attempts. What assessment finding should the nurse interpret as indicating a high degree of planning for a future attempt? The client recently purchased a large bottle of over-the-counter analgesics The client stopped attending a depression support group, despite initially benefiting from it The client told the nurse, "I just want to stop being a burden to my wife and kids." The client has told the nurse, "I'm pretty sure my meds aren't working."
The client recently purchased a large bottle of over-the-counter analgesics
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 differentiate between reality and fantasy. The client will identify factors that contribute to depression. The client will reframe negative thoughts in a more positive way. The client will discuss the cause of the fatigue.
The client will reframe negative thoughts in a more positive way.
When teaching a group of new mental health nurses about the major difference between bipolar I and bipolar II disorders, which would be most appropriate for the nurse to include? Both disorders are the same, except the risk for suicide is greater with bipolar I disorder. Unlike bipolar II, bipolar I disorder involves no symptoms of mania, but only depression. The mania symptoms of bipolar II disorder have little effect on functioning. Bipolar II is more often recognized than bipolar I.
The mania symptoms of bipolar II disorder have little effect on functioning.
Which is a true statement regarding depressive disorders? They are more prevalent in men than women. Depression in older adults is easier to diagnose. The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated. It is the fourth leading cause of years lost because of disability.
The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated.
A 50-year-old client who has recently been diagnosed with a chronic degenerative illness has announced to the nurse the intention to commit suicide in order to prevent future suffering. Which fact should underlie the nurse's response to this client? The nurse is required to document the client's wishes and begin to facilitate an assisted suicide. The nurse is obliged to protect the client from self-harm. The nurse must refer the client to a physician who is authorized to assist the client with a suicide. The nurse is ethically obliged to inform law enforcement.
The nurse is obliged to protect the client from self-harm.
After being prescribed several medications that were ineffective, a client is diagnosed with refractory mania. The physician decides to prescribe lamotrigine, an anticonvulsant that has been found to be effective for refractory mania. Which would the nurse need to include in the client's education plan? The potential for life-threatening side effects such as Stevens-Johnson syndrome The potential for the development of addiction to the medication The need to have blood levels drawn on a monthly basis The need to avoid certain types of foods while on the medication
The potential for life-threatening side effects such as Stevens-Johnson syndrome
A nurse is developing a presentation for families who have members who have been diagnosed with bipolar disorders. When describing this condition to the group, which would the nurse most likely include? As the person ages, the episodes tend to decrease. Risk-taking behaviors are more common during a depressive episode. The risk for suicide is high with either depression or mania. Environmental stressors are a key cause of these disorders.
The risk for suicide is high with either depression or mania.
When completing a baseline assessment of a client with depression, which diagnostic tests would the nurse anticipate? Renal function tests Coagulation profile Thyroid function tests Abdominal ultrasound
Thyroid function tests
A client is being screened for clinical symptoms related to depression over the past 2 weeks. Which self-assessment screening instruments would be most appropriate? Zung Self-Assessment Scale Beck Depression Inventory Hamilton Rating Scale for Depression Geriatric Depression Scale
Zung Self-Assessment Scale
During assessment of a client with depression, the client states, "I just feel so sad and hopeless. I just don't care anymore. I don't even enjoy doing the crossword puzzles like I used to." The nurse documents this finding as indicative of: psychosis. dysthymic disorder. anhedonia. delusion.
anhedonia
The nurse educates a class on factors that enhance the risk of suicide. The instructor determines the need for additional education when the class identifies what as one of these factors? family member committing suicide delusions cautiousness loss
cautiousness
Which mental health disorder has the most significant risk factor for suicide? depression anxiety schizophrenia mania
depression
A nurse is reviewing the medical record of a young client to determine the client's risk for suicide. Which factor would alert the nurse to an increased risk for this client? diagnosed with an acute illness fears of growing older experiencing unemployment that has lasted a year starting a new business with friends
experiencing unemployment that has lasted a year
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 ... provide distraction by organizing therapeutic recreation. help the client to identify and explore other options. organize a family meeting. encourage the client to identify and attend outpatient support groups.
help the client to identify and explore other options.
A client who has attempted suicide has an underlying diagnosis of depression. Which would the nurse anticipate being ordered for the client? mood stabilizer tricyclic antidepressant atypical antipsychotic selective serotonin reuptake inhibitor
selective serotonin reuptake inhibitor
