Ch 17 - PrepU Mood and suicide

A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder?

Anticonvulsants

A client comes to the clinic for an evaluation of headache, fatigue, and an overall feeling of being "down." When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply.

"I've been drinking about three or four more beers every night." "I'm so tired that all I ever want to do is sleep all the time." "Most times, I feel like I'm trapped with no way out."

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?

Persistent depressive disorder

Which is the greatest predictor of a future suicide attempt?

previous attempt

A client with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation?

The client is experiencing catatonia.

The nurse is assessing a client who has presented to the emergency department in emotional distress. What client data represents the greatest risk for suicide?

The client overdosed on pills 2 years earlier

Psychodynamic theory attributes the development of mood disorders to what?

Unexpressed and unconscious anger

A client has been successfully treated on the psychiatric mental health unit following a suicide attempt. In preparation for discharge, the nurse should prioritize what action?

Ensuring a plan is in place for the client's community-based care

A client diagnosed with bipolar disorder is admitted to an inpatient psychiatric facility with acute mania and threats of attacking others in the household. Which would be the priority?

Ensuring safety

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

A client has just been diagnosed with bipolar disorder and is upset with the diagnosis. The client tells the nurse, "It is probably my mother's fault, she has bipolar too." Which is the best response by the nurse?

"While bipolar disorders are genetic, there are other causes as well."

A 38-year-old client has been diagnosed with major depressive disorder. The client is being placed on an antidepressant and the nurse is providing medication teaching. Which would be appropriate information to provide to the client?

"You may not notice an improvement in your symptoms for 2 to 6 weeks."

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 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?"

When conducting a focused assessment on a newly admitted client who attempted suicide, which question should the nurse include to ensure the client's safety? Select all that apply.

"Do you still have a plan to harm yourself?" "Have you ever tried to hurt yourself before?" "Are you willing to tell us if you plan to harm yourself again?"

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?"

The nurse is interviewing a client with a diagnosis of depression and the client states, "Honestly, I know my family would be a lot better off if I wasn't around to be a burden on them. That's just between you and me, though, okay?" What is the nurse's best response?

"I'm obliged to share what we talk about with the other people on your 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?

"It sounds like this is a really difficult time for you."

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!"

For maintenance therapy of mania, the therapeutic serum level of lithium is ...

0.6-1.2 mEq/L.

A client with bipolar disorder is receiving lithium therapy. The nurse is reviewing the client's serum plasma drug levels and determines that the client's level is therapeutic based on what?

1.0 mEq/L

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

14 days Studies have shown that the risk for suicide increases within the first 2 to 3 weeks after starting antidepressant medication, usually because the client's mood has not lifted as quickly as physical energy has returned.

A client was abandoned by the parents at age 3, resulting in the client's perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of what?

A psychodynamic interpretation of the client's major depressive disorder.

The mental health nurse appropriately provides education on light therapy to which client?

20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

Which sleep pattern is suggestive of a manic episode?

A client stays awake for several days and nights before "crashing" and sleeping for a long period.

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 loss of interest or inability to derive pleasure for previously enjoyed activities

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?

Ability to concentrate and process the information

After being diagnosed with a chronic disease, a client has been feeling depressed. Which diagnosis has the strongest association with an increased suicide risk?

Acquired immunodeficiency syndrome

Which characteristic is most common among suicidal clients?

Ambivalence

The nurse is seeing a 26-year-old client and the client's family. The client's family describes the client as being "very, very different." The family describes a history of periods of unpredictable behavior and disregard for consequences occurring a few times each year. The client has recently been diagnosed with bipolar I disorder, a condition that is characterized by what?

An elevated mood that lasts for at least 1 week

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

Anger toward the loved one who committed suicide

Most suicides occur in which month?

April The natural energy that accompanies increased sunlight in spring is believed to explain why most suicides occur in April.

A nurse is caring for a white, 30-year-old man 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?

Ask the client whether he is thinking about killing himself.

The policies and procedures at a community psychiatric-mental health center include an emphasis on case finding. How can a nurse at the center best perform case finding?

Assessing all clients carefully to identify those at risk for suicide

A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications?

Carbamazepine Carbamazepine is an anticonvulsant with mood-stabilizing effects. Lithium is a mood stabilizer. Mannitol and methyldopa are not used in the treatment of bipolar disorder.

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

Catatonia Catatonia is a state of motor or physical activity associated with manic states in bipolar illness. Catatonia is also seen in clients with schizophrenia who have periods of immobility interrupted by episodes of extreme agitation. Fatigue is a lack of energy common during a severely depressed state. Severely depressed clients frequently have difficulty falling asleep or wake early in the morning and are unable to go back to sleep as with insomnia. Feelings of worthlessness or excessive/inappropriate guilt are commonly associated with depression.

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 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.

When a nurse assesses prior self-harm behavior, this can provide information about the motivation behind the client's actions and allows the nurse to do what?

Communicate concern and empathy to the client

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

Confusion 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 of ECT.

A client comes to the health clinic stating that the client wants to commit suicide. The client has made a detailed plan and has access to a weapon. Currently, the client presents as disoriented. The nurse would assess this client's degree of suicide risk as what?

High

An elderly client is admitted to the hospital with fatigue and weight loss of 20 pounds in 1 month. Upon further assessment, the client is diagnosed with depression. What other thing should the nurse assess this client for based on the weight loss?

Dehydration

Which is an anticonvulsant used as a mood stabilizer?

Divalproex

A 35-year-old client with bipolar disorder has a history of discontinuing medication when feeling well and then becoming manic again. During the client's last episode of mania, the client lost several thousand dollars in risky investments. Which intervention will be most helpful in achieving medication adherence?

During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse.

A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which is the nurse's priority intervention for this client?

Ensuring that the client is not permitted to use anything that would be potentially dangerous.

During an interview, the nurse has asked a client with depression about any hopes or plans for the future. In response, the client silently made a gesture of drawing the index finger from one side of the client's throat to the other. The nurse has informed the client that this must be communicated to the care team. What is the main rationale for the nurse's action?

Ensuring the client's safety

Following the failure of a woman's recent in vitro fertilization (IVF), the nurse recognizes that she may be at risk of depression. Which intervention is considered a primary suicide prevention measure?

Establishing a support system for the woman and teaching her some coping measures

The nurse knows that the most dangerous time period following a previous suicide attempt is what?

First 3 months The first 2 years after a suicide attempt represent the highest risk period, especially the 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?

Flight of ideas

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?

Giving away valued personal items

A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of what?

Grandiosity

A nurse is caring for a client with major depression. The client tells the nurse that the client "just isn't sure that life is worth living." The nurse documents which nursing diagnosis as the priority?

Hopelessness related to symptoms of depression

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

Hyperactivity, dismissing meals, and sleep disturbance

A nurse is preparing a client for discharge. As part of the discharge process, the nurse provides education to the client regarding safety from self-harm. Which intervention should the nurse employ?

Include family members to provide a better understanding of symptoms of the illness

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

Increase hydration

A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition?

Light therapy Phototherapy has proven effective for clients with symptoms of depression associated with a seasonal pattern. This condition, called seasonal affective disorder, may be related to lack of light and decreased melatonin production.

Which psychotropic medication is administered based on an individualized dosage according to blood levels of the drug?

Lithium carbonate

A nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the highest risk for a suicide attempt?

Man with major depressive disorder

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what?

Middle insomnia

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what?

Middle insomnia The most common sleep disturbance associated with major depression is insomnia, which is categorized according to three categories: initial insomnia (difficulty falling asleep), middle insomnia (waking up during the night and having difficulty returning to sleep), and terminal insomnia (waking too early and being unable to return to sleep). Less frequently, the sleep disturbance is hypersomnia (prolonged sleep episodes at night or increased daytime sleep).

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

Moderate depression Cognitive psychotherapy is as effective as antidepressant medication in the treatment of mild to moderate depression. It is less likely to address depression that has a demonstrated medical etiology. The primary treatment for postpartum psychosis is medication. Therapy is not relevant in cases of anaclitic depression since the problem occurs in infants.

A client in an acute manic phase is pacing the halls and talking in a loud voice with pressured speech. The client is overly involved with coclients and frequently threatens and disrupts others on the unit. After administering lithium treatment for the client, the nurse can expect the plan of care to include which additional intervention?

Monitoring blood levels of the medication.

Which medication classification is considered first-line drug therapy for bipolar disorder?

Mood stabilizers

Which biogenic amines have been implicated in depression?

Norepinephrine and serotonin The monoamines that have been implicated in depression are norepinephrine (NE), dopamine (DA), and serotonin (5-HT). Disturbances in mood may result when absolute concentrations of NE, 5-HT, or both are deficient.

Which is a true statement regarding depressive disorders?

Norepinephrine, dopamine, and serotonin have been implicated.

A client with bipolar disorder is experiencing a major depressive episode. Which would the nurse expect to assess? Select all that apply.

Obsessive rumination Hypersomnia Difficulty concentrating

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

Orthostatic hypotension

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 Orthostatic hypotension and urinary retention are common side effects of TCAs. Photosensitivity, skin rashes, pseudoparkinsonism, and tardive dyskinesia are common side effects of older antipsychotics. Diarrhea and electrolyte imbalances are side effects of lithium.

A newly admitted client's history includes multiple suicide attempts. How can the nurse on the psychiatric-mental health unit best protect the client's safety?

Performing vigilant assessment and close observation

A client on the inpatient psychiatric-mental health unit was discovered attempting to asphyxiate himself or herself using a blanket. Which measure should the care team prioritize in the client's immediate care?

Placing the client under constant observation

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

Prevent self-destructive behavior.

A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client's feelings of sadness and hopelessness, the nurse would expect to assess what?

Psychomotor retardation

The nurse is caring for a client with major depressive disorder who has been admitted to a psychiatric-mental health facility. After assessing the client, the nurse has developed a nursing diagnosis of "risk for violence toward others related to agitation and low tolerance level." Which would be an appropriate intervention for this client?

Remove all dangerous items from the client's room.

Which would be the priority diagnosis for the client in the manic phase of bipolar disorder who is exhibiting aggressive behavior?

Risk for other-directed violence

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

Self-injury

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

Self-injury During a manic episode, client safety is a priority. Risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may believe that life is not worth living. During a manic episode, the client may believe that he or she has supernatural powers, such as the ability to fly. Although changes in sleep, fluid balance (such as dehydration), and inadequate nutrition manifested by weight loss would be important to assess, safety and prevention of self-injury are the priority.

A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what?

Side effect

The nurse is working with a 50-year-old client admitted for a major depressive episode. The client has remained isolated and withdrawn since admission and is reluctant to speak. Which therapeutic communication skill is most likely to encourage the client to verbalize the client's feelings?

Silence and active listening

Before a client became depressed, the client was an active, involved parent with three children, often attending their school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals that the client feels like an unnecessary burden on the client's family. Which nursing diagnosis is most appropriate?

Situational low self-esteem

Which is a primary risk factor for suicide?

Social isolation

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?

Substance use

The nurse is working with an inpatient who has a history of suicide attempts. What action by the client should the nurse follow up on because it may constitute a suicide planning behavior?

The client has requested extra bedding despite the warm weather

A mental health nurse has formed a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. An appropriate outcome for this nursing diagnosis would include what?

The client will demonstrate improved ability to express self.

A 29-year-old first-time mother has been diagnosed with postpartum psychosis after her partner reported the client was hearing voices and told the partner she "saw someone trying to steal the baby." In the planning of this client's care, which outcome should the nurse prioritize?

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

A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis?

The client will reframe negative thoughts in a more positive way.

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

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

A client who has just been prescribed lithium for bipolar disorder is being given education from the nurse about this medication. Which is important for the nurse to include in teaching?

The higher the sodium level, the lower the lithium level will be. 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.

Which nursing action would be a protective factor in the prevention of suicide for a client who has been identified at risk?

The nurse facilitates a referral to a drug and alcohol recovery program.

When completing a baseline assessment of a client with depression, which diagnostic tests would the nurse anticipate?

Thyroid function tests

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

Wrist slashing The least lethal of the options is wrist slashing. Hanging, overdose of benzodiazepines, and jumping are more lethal methods of suicide.

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:

anhedonia.

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 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?

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 ...

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?

selective serotonin reuptake inhibitor

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

substance abuse