Chapter 17: Mood Disorders and Suicide

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Women are how many times more likely than men to attempt suicide?

4 Explanation: Women are four times more likely to attempt suicide, although men commit 72% of suicides.

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

14 days

Research has shown that risk of suicide increases within which timeframe for initiation of antidepressant therapy? a) 35 days b) 42 days c) 28 days d) 14 days

14 days Explanation: 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. (less)

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) 3 to 4 weeks b) 5 to 7 days c) 1 to 2 days d) 2 to 3 weeks

2 to 3 weeks Explanation: Most antidepressant medications do not become effective or reach a therapeutic level for at least 2 or 3 weeks.

The mental health nurse appropriately provides education on phototherapy to a a) 45-year-old lawyer whose medication therapy needs an additional treatment b) 50-year-old farmer whose major depression has not responded to any treatment modality c) 58-year-old showing signs of early Alzheimer's disease d) 20-year-old college student who reports being "too tired, sad and unfocused" to enroll for classes in the winter term

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

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 individual has the greatest number of risk factors for the development of depression?

A 50-year-old woman who just lost her spouse and has a family history of depression

A client is prescribed phenelzine (Nardil) to treat her depression. She is at a local café for lunch with a friend. Which of the following items on the menu would be least appropriate for the client to order? a) A Cobb salad with blue cheese and Roquefort salad dressing b) Medium-well steak, French fries, and broccoli c) Scrambled eggs, toast, and grape jelly d) Roast beef, mashed potatoes, and gravy

A Cobb salad with blue cheese and Roquefort salad dressing Explanation: Phenelzine is a monoamine oxidase inhibitor (MAOI). If co-administered with food or other substances containing tyramine (e.g., aged cheese, beer, red wine), MAOIs can trigger a hypertensive crisis that may be life threatening. The blue cheese is aged, and the Roquefort salad dressing contains aged cheese.

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 To best assure successful outcomes related to client education of an individual experiencing a manic episode, the nurse's initial assessment is focused on the client's ability to concentrate and process the information

A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time?

Accompany the client to his or her room to get dressed. Redirecting the client to appropriate behavior without confrontation is most effective.

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

A nurse is preparing a presentation for a local community group about antidepressant therapy and suicidality. When describing those who would be at increased risk for suicide, which group would the nurse include?

Adolescents

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.

Advocate with the physician to consider changing the medication. Recommend a nutritionally balanced diet. Recommend daily exercise.

A client diagnosed with depression is being treated with Phenelzine (Nardil). The nurse should teach the client to avoid which of the following foods? a) Aged cheese b) Chicken c) Oranges d) Rice

Aged cheese Explanation: Hypertensive crisis is the most serious side effect and is life-threatening when a client prescribed an MAOI ingests tyramine-containing foods, such as aged cheese.

Which must be present in a client diagnosed with serotonin syndrome? Select all that apply.

Agitation Diaphoresis Ataxia Fever

Which characteristic is most common among suicidal clients?

Ambivalence Explanation: Suicide involves ambivalence. Many fatal accidents may be impulsive suicides. It is impossible to know, for example, whether the person who drove into a telephone pole did this intentionally.

Suicide is the intentional act of killing oneself. Which characteristic is most common among suicidal clients? a) Anger b) Remorse c) Ambivalence d) Psychosis

Which actions would indicate an increased suicidal risk?

An abrupt improvement in mood Calling family members to make amends Statements such as "Everything will be better soon"

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.

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

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

A 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 decrease in appetite b) Demonstrated examples of unwise decisions c) A significant failure in an occupational or relational setting d) Claims by family, friends, or coworkers that the client is depressed

A significant decrease in appetite Explanation: 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.

Which of the following clients is most likely to benefit from electroconvulsive therapy (ECT)? a) A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy b) A woman whose major depression has not responded appreciably to antidepressants c) A client whose recent strange behavior has been attributed to cyclothymic disorder d) A man with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode

A woman whose major depression has not responded appreciably to antidepressants Explanation: 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.

13) The nurse determines that a client is at imminent risk for suicide. Which priorities are most appropriate to include in the client's plan of care? (Select all that apply.) A) Listening intently and nonjudgmentally B) Validating the client's feelings and experience C) Instituting strict restriction on the client's activity D) Using cognitive interventions to foster hope

A, B, D

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

A loss of pleasure or interest in a client diagnosed with depression would be documented as what?

Anhedonia

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?

Animated and cheerful manner

A nurse has discussed suicide prevention information with a client suffering with moderately severe acute depression. Which client statement(s) demonstrates that the implementation of effective suicide prevention education has occurred? (Select all that apply.) A. "My brother has been there for me and I am so grateful." B. "I have got some hope now that medication seems to be working." C. "It is sad when committing suicide seems to be your only option." D. "It felt good being able to help my mom with the house repair she needed done." E. "Going to the support group has certainly given my a lot if information about depression."

Ans: A, B, D, E

. 2. The nurse is reviewing the electronic health records of several clients diagnosed with major depression. The nurse identifies which client as most likely to commit suicide? A) Divorced man B) Widowed man C) Woman living with a roommate D) Married woman

11. After presenting to a group on factors that enhance the risk of suicide, the nurse determines the need for additional education when the group identifies which item as a risk factor? A) Family member committing suicide B) Cautiousness C) Delusions D) Loss

19. A nurse is with an adolescent who tells the nurse that there is nothing to live for and that the client just wishes to be dead. Which nursing action is appropriate? A) Telling the client's psychiatrist of the client's suicidal ideation B) Staying with the client to explore more of the client's thoughts about suicide C) Putting the client in seclusion with a staff assigned to watch the client at all times D) Ascertaining the client's beliefs about what happens when you die

8. A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. The client's suicidal risk has lessened considerably, and the client currently denies having any desire to perform suicide. In addition, the client is able to identify reasons to be alive. Which nursing intervention is appropriate A) Assigning nursing staff to stay with the client during this suicidal crisis B) Developing a personal plan for managing suicidal thoughts when they occur C) Advising the client to consider electroconvulsive therapy treatments D) Administering psychotropic drugs that decrease the client's serotonin levels

The nurse is caring for a patient receiving a tricyclic antidepressant and is monitoring for anticholinergic side effects. Anticholinergic effects include which of the following? a) Blurred vision b) Hyperactive bowel sounds c) Urinary incontinence d) Moist skin

Blurred vision Explanation: Anticholinergic effects are prominent with tricyclic antidepressants. These include potentiation of CNS drugs, dry mucous membranes, warm and dry skin, blurred vision, decreased bowel motility, and urinary retention.

1. 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 bipolar I disorder B) Woman with acute stress disorder C) Man with major depressive disorder D) Woman with somatoform disorder

16. A nurse is performing an assessment of a client with suicidal ideation. Which question should the nurse ask to determine the degree of planning? A) "How seriously do you want to die?" B) "Have you attempted suicide before?" C) "Could you stop yourself from killing yourself?" D) "How much do the thoughts distress you?"

17. A nurse determines that a client has poor social skills that have interfered with their ability to engage others, which has contributed to the client's feelings of purposelessness, hopelessness, and withdrawal. Which recommendation is most important for the nurse to make in order to help the client begin to develop social skills? A) Self-help group B) Recovery group C) Interpersonal nurse-client relationship D) Limit setting

3. A family member of an adolescent who has expressed a desire to commit suicide asks the nurse, "What might predict the possibility of future suicide attempts?" Which element would the nurse include in the response? A) Unemployment B) Death of a spouse C) Previous suicide attempt D) Polydrug use

9. A nurse is presenting a discussion for a local community group about suicide. Which comment from an audience member indicates the need to clarify the information? A) "Warning signs about the person's intention often occur." B) "People who are suicidal are undecided about living or dying." C) "Asking about suicide, may put the idea in people's heads." D) "People who talk about suicide need to be taken seriously."

Which is an anticonvulsant used as a mood stabilizer?

Divalproex

What are the most common types of side effects from SSRIs?

Dizziness, drowsiness, and dry mouth

Which activities would be appropriate for a client with mania?

Drawing a picture Playing table tennis Stretching exercises

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.

Which disorder is characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode? a) Dysthymic disorder b) Seasonal affective disorder c) Cyclothymic disorder d) Hypomania

Dysthymic disorder Explanation: Dysthymic disorder is characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode. Cyclothymic disorder is characterized by 2 years of numerous periods of hypomanic symptoms that do not meet the criteria for bipolar disorder. Seasonal affective disorder occurs in the winter or spring. Hypomania is a period of abnormally and persistently elevated, expansive, or irritable mood lasting 4 days.

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 what?

Dysthymic disorder Explanation: 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.

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?

Emotional lability

Emotional lability Emotional 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.

Emotional lability Explanation: Emotional 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 nurse provides education to a client who is experiencing wellness challenges due to a diagnosis of depression in which the client reports of lack of energy and sadness. Which strategy is appropriate to enhance coping with a lack of energy and sadness?

Encourage the client to start with easy tasks, such as talking to a friend.

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 with severe depression after immigrating to the United States and the loss of an infant expresses increasing suicidal ideation to the primary nurse. The priority nursing intervention should be: a) Ensuring that the client is not permitted to use anything that would be potentially dangerous. b) Encouraging the client to express feelings of isolation following the recent immigration. c) Encouraging attendance at group cognitive-behavioral therapy on the unit. d) Exploring the grief and loss issues concerning the baby's death.

Ensuring that the client is not permitted to use anything that would be potentially dangerous. Explanation: Although grief, loss, and isolation may be influencing the client's depressed state, the priority intervention is to prevent self-harm. All the interventions listed are appropriate, but ensuring safety from potential danger is the priority

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

A client is prescribed a selective serotonin reuptake inhibitor (SSRI) as treatment for depression. Which would the nurse most likely administer?

Escitalopram

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?

Explain to the client that untreated depression often becomes increasingly severe and frequent over time

A client's physician has prescribed paroxetine (Paxil) for the treatment of her depression. Which of the following teaching points should the nurse include in the client education related to this treatment? a) "Make sure that you don't change the quantity or timing of your medication without first consulting your doctor." b) "The advantage of Paxil is that it will normally relieve depression in a few weeks and it has no side effects." c) "If you don't feel noticeably better within three weeks, increase your dose by 50 %." d) "If you forget to take a dose one day, take a double dose the next day and be sure to let your doctor know."

Make sure that you don't change the quantity or timing of your medication without first consulting your doctor." Explanation: During client education, it is necessary to stress the importance of consulting the prescriber before discontinuing or changing the dosing of any medication. Paxil, like all drugs, carries the potential of adverse side effects.

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 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?

Mania

Limit setting is most appropriate in which client population?

Manic

The nurse is planning a presentation about suicide to a group of health professionals. Which should be included in the nurse's teaching plan?

Men are more likely to commit suicide than women are.

The nurse is caring for a client with major depression. The client tells the nurse that she "just isn't sure that life is worth living." The nurse documents which nursing diagnosis as the priority? a) Hopelessness related to symptoms of depression b) Thought Processes, Disturbed, related to memory loss and depression c) Self-esteem, Low, related to depressive episode d) Anxiety related to lack of energy for self-care activities

Hopelessness related to symptoms of depression Explanation: The priority nursing diagnosis is Hopelessness related to symptoms of depression. There is no evidence to suggest Low Self-Esteem, Anxiety, or Disturbed Thought Processes.

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

Identify the serum lithium level for maintenance and safety.

I 0.5 to 1.5 mEq/L

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 nurse is preparing to discharge a client from the inpatient facility where the client was treated following an unsuccessful suicide attempt. The priority assessment for the nurse to make is to assess whether or not the client can do what?

Identify a person to whom he or she can turn to for help after discharge.

A nurse is reviewing information about the drug, lithium carbonate. The nurse demonstrates understanding of the information by identifying which situation as a potential cause of lithium toxicity? Select all that apply.

If body fluid decreases significantly because of a hot climate, strenuous exercise, vomiting, diarrhea, or a drastic reduction in fluid intake, then lithium concentrations can rise sharply, causing an increase in side effects and a progression to lethal lithium toxicity.

Which of the following would not be associated with learned helplessness? a) Negative expectations b) Hopelessness c) Passivity d) Impulsivity

Impulsivity Explanation: Behaviors that define learned helplessness include passivity, negative expectations, and feelings of helplessness, hopelessness, and powerlessness.

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

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 Explanation: In addition to trying to reduce the stigma that the client and family may associate with suicide, the nurse must educate them about depression, suicidal behavior, and treatments. When possible, the nurse should schedule educational sessions to include significant others so that they will better understand the client's illness and also learn what is necessary in providing outpatient care.

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?

Patients who take ACE inhibitors 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.

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 is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also reports having felt unhappy most of the time for "as long as I can remember." Which diagnosis should the nurse anticipate for this client?

Persistent depressive disorder

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which of the following nursing diagnoses has the highest priority? a) Hopelessness related to recent divorce b) Ineffective coping related to inadequate stress management c) Spiritual distress related to conflicting thoughts about suicide and sin d) Risk for suicide related to highly lethal plan

Risk for suicide related to highly lethal plan Explanation: Safety is the priority. The overall goals for the client who is suicidal is to first keep the client safe and later to help him or her to develop new coping skills that do not involve self-harm. Answers A, B, and C would not be the priority diagnosis for this client.

Which type of antidepressants is rarely fatal in overdose? a) SSRIs b) MAOIs c) Tricyclics d) Atypical

SSRIs Explanation: SSRIs are rarely fatal in overdose, but cyclic and MAOI antidepressants are potentially fatal. Prescriptions may need to be limited to only a 1-week supply at a time if concerns linger about overdose.

The nurse is caring for a client diagnosed with bipolar disorder. During a manic episode, which takes priority?

Safety

The priority concern for people with mood disorders is which of the following? a) Occupational functioning b) Basic care c) Safety d) Social functioning

Safety Explanation: The overriding concern for people with mood disorders is safety because these individuals may experience self-destructive thoughts and suicidal ideation. Social and occupational functioning and basic care would not take priority.

A client is receiving lithium carbonate for the treatment of mania. The nurse would reinforce which teaching component regarding lithium treatment?

Schedule bloodwork for lithium levels.

A client with which psychiatric disorder is at high risk for suicide?

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?

Selective serotonin reuptake inhibitor

Selective serotonin reuptake inhibitor Explanation: Sertraline is a 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

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 Explanation: Paroxetine is a selective serotonin reuptake inhibitor. Serotonin norepinephrine reuptake inhibitors include venlafaxine, nefazodone, duloxetine, and desvenlafaxine. Amitriptyline is an example of a tricyclic antidepressant. Monoamine oxidase inhibitors include phenelzine, tranylcypromine, isocarboxazid, and selegiline.

A client has been diagnosed with major depressive disorder. A common symptom would include which of the following? a) Assertiveness b) Increased energy c) Ability to sleep without interruption d) Self-blame

Self-blame Explanation: Symptoms of major depressive disorder include self-blame, feelings of worthlessness, decreased energy, insomnia, and difficulty making decisions.

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 client with depression is prescribed fluoxetine. On a return visit to the clinic, the client tells the nurse that he also just started taking St. John's wort to feel better. The nurse assesses the client for which of the following? a) Serotonin syndrome b) Water intoxication c) Hypertensive crisis d) Increased depressive symptoms

Serotonin syndrome Explanation: Fluoxetine is a selective serotonin reuptake inhibitor that when combined with St. John's wort can lead to serotonin syndrome. Water intoxication is possible with mood stabilizers such as lithium. The combination of fluoxetine and St. John's wort leads to an increase in intrasynaptic serotonin. Thus, a potential for toxicity is present. Hypertensive crisis occurs when MAOIs are taken with tyramine rich foods

A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior?

Setting limits on aggressive and intimidating behavior It is necessary to set limits when clients cannot set limits on themselves. Giving the client the opportunity to exercise self-control is most therapeutic.

Which is a primary risk factor for suicide?

Social isolation

A client with depression appears lethargic and apathetic but agrees to participate in a leisure activity group. Which nursing intervention is most likely to help the client successfully participate?

Structuring the activity to facilitate completion of one specific task Clients who are depressed may find decision-making and multitasking stressful and overwhelming. It is therapeutic for the nurse to help the client focus his or her pace and efforts on a specific, achievable task.

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

Substance abuse

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

In a therapy session, a client with a diagnosis of major depression admits to the nurse-therapist, "I actually went out driving on the interstate this morning and had every intention of getting up to speed and plowing right into the overpass by my exit. Maybe tomorrow." The nurse would recognize the client's statement as what?

Suicidal intent

A father of four small children lost his wife in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since his wife's death, his mood has been somber; until now, he has refused treatment. For what is this patient at high risk? a) Schizophrenia b) Dysthymic disorder c) Bipolar disorder d) Suicide

Suicide Explanation: If depression persists over time and is left untreated, it has a significant negative effect on quality of life and increases the risk of suicide.

The nurse is assessing a client for warning signs of suicide. Which would be a concern?

The client has engaged in risky behaviors and tends to be impulsive.

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. Explanation: Electroconvulsive therapy is an effective treatment for clients with severe depression. It is generally reserved for those whose disorder is refractory or intolerant to initial drug treatments and who are so severely ill that rapid treatment is required (e.g., clients with malnutrition, catatonia, or suicidality).

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

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 nurse taking an admission history from a patient suspects that they physician will diagnose major depression. For the physician to make this diagnosis, the patient will have to demonstrate at least four of seven symptoms. The nurse knows that some of these symptoms include which of the following? (Select all that apply.) a) Obsessive desire to exercise b) Disruption in concentration c) Disruption in sleep d) Excessive guilt e) Disruption in appetite

• Disruption in concentration • Disruption in sleep • Excessive guilt • Disruption in appetite Explanation: Four of seven symptoms must be present along with the episodes of depressed mood to qualify for a diagnosis of major depressive disorder. Symptoms include disruption in sleep, appetite, concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation.

A nurse taking an admission history from a patient suspects that they physician will diagnose major depression. For the physician to make this diagnosis, the patient will have to demonstrate at least four of seven symptoms. The nurse knows that some of these symptoms include which of the following? (Select all that apply.) a) Disruption in concentration b) Disruption in appetite c) Excessive guilt d) Obsessive desire to exercise e) Disruption in sleep

• Disruption in sleep • Disruption in appetite • Disruption in concentration • Excessive guilt Explanation: Four of seven symptoms must be present along with the episodes of depressed mood to qualify for a diagnosis of major depressive disorder. Symptoms include disruption in sleep, appetite, concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation.

A group of nursing students is reviewing information about the epidemiology of depressive disorders. The students demonstrate understanding of the information when they identify which of the following as possible risk factors? Select all that apply. a) Inadequate coping skills b) Prior episode of anxiety disorder c) Concomitant medical illnesses d) History of substance abuse as a teenager e) Little social support

• Little social support • Inadequate coping skills • Concomitant medical illnesses Explanation: Generally agreed-upon risk factors for depression include a prior episode of depression, family history of depressive disorder, lack of social support, lack of coping abilities, presence of life and environmental stressors, current substance use or abuse, and medical comorbidity.

The nurse is planning care for a client with major depression. Which is an appropriate expected outcome?

The client will independently carry out activities of daily living.

A client taking lithium for bipolar disorder comes to the clinic and reports symptoms which the nurse interprets as consistent with moderate lithium toxicity. Which action should the nurse perform? Select all that apply.

Withhold additional doses of lithium. Obtain a blood sample for lithium level. Push fluids. Contact the physician.

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

Wrist slashing

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) a biophysiological explanation for Susan's depressive disorder. b) a psychodynamic interpretation of Susan's major depressive disorder. c) why Susan has become lesbian at the age of 23. d) a feminist viewpoint of depression.

a psychodynamic interpretation of Susan's major depressive disorder. Explanation: 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.

Carrie, age 20, was admitted to your 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) assisting Carrie with her activities of daily living, including a shower and clean clothing. b) assessing Carrie's current suicidal ideation and putting her on suicide precautions. c) rehydrating Carrie by forcing fluids. d) assessing Carrie's recent suicide attempt and identifying factors that may have contributed to it.

assessing Carrie's current suicidal ideation and putting her on suicide precautions. Explanation: 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.

A client who is prescribed a tricyclic antidepressant is brought to the emergency department with a suspected overdose. Which would the nurse assess to support this suspicion? Select all that apply.

blurred vision urinary retention In acute overdose, almost all symptoms develop within 12 hours. Anticholinergic effects are prominent and include dry mucous membranes, warm and dry skin (not pale, moist skin), blurred vision, decreased bowel motility (not diarrhea), and urinary retention.

Which mental health disorder has the most significant risk factor for suicide?

depression

A 20-year-old client was admitted to the inpatient unit following a suicide attempt. The client is disheveled, disorganized, and dehydrated. The priority for the client's care during the first 24 hours of admission will be what?

Assessing the client's current suicidal ideation and putting the client on suicide precautions.

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's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action?

Assess the client's blood pressure

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?"

The nurse assesses a client who reports being depressed for over 2 weeks. Which question does the nurse include in the interview portion of the assessment process to determine if the client meets the criteria for major depressive disorder (MDD)? Select all that apply.

"Are you experiencing insomnia every day?" "Have you recently lost weight without dieting?" "Have you experienced difficulty with concentration when working?"

A client says to the nurse, "You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse?

"Are you thinking of suicide?"

A client who has a recent diagnosis of bipolar I disorder is scheduled to begin therapy with lithium. Which instruction should the nurse provide to this client?

"Avoid exercise at the hottest times of the day." Heavy perspiration increases the possibility of adverse effects during lithium therapy. A high-fluid diet with normal levels of salt is indicated, and doses should not be independently adjusted.

A bipolar client presents to the clinic with reports of headaches and feeling more irritable than usual. What is the best nursing response?

"Can you tell me more about these symptoms?"

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?"

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?" Explanation: Hopelessness is a significant risk factor for suicide among persons who are depressed. For an adult client, relationships with parents are significant but not among the major risk factors for suicide. Similarly, the client's perception of medication effectiveness is important but not a key risk factor. It is common for depressed individuals to lack firm plans for their days, and a lack of planning does not necessarily indicate a heightened suicide risk.

Which question should the nurse ask to assess the client's degree of suicide planning when the client states, "Everyone would be better off without me. I will just use my gun to end it all!"?

"Do you have access to a firearm?"

A client is to receive three treatments of electroconvulsive therapy (ECT) per week for 3 weeks. After the third treatment, the client is forgetful and confused. When the client's spouse arrives to take the client home, the nurse discusses the client's condition with the spouse. Which statement is best?

"Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer."

A client with bipolar disorder begins taking lithium carbonate (lithium) 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." Which is the best response by the nurse?

"Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks."

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?"

During a night shift, a hospitalized client with depression tells a nurse that the client is going to kill himself or herself. The client is placed on constant observation. When the client asks to use the toilet, the nurse follows the client into the bathroom. The client says, "You don't need to follow me into the bathroom. Give me some space." Which response by the nurse is most appropriate?

"I must stay with you until we are sure you will not hurt yourself."

The nurse is teaching a 70-year-old man about his depression. Which of the following statements by the client would indicate that teaching has been effective? a) "I never knew depression could just happen for no specific reason." b) "All old people get depressed at times." c) "I'm glad I'll feel better in 2 or 3 days." d) "When I reduce the stress in my life, the depression will go away."

"I never knew depression could just happen for no specific reason." Explanation: Depression can be endogenous, with no external cause or event. Clients must understand that depression is an illness, not a lack of willpower or motivation. Major depression typically involves 2 or more weeks of a sad mood or lack of interest in life activities with at least four other symptoms of depression

The nurse observes that a client with depression sat at a table with two other clients during lunch. Which is the best feedback the nurse could give the client?

"I see you were sitting with others at lunch today."

The nurse reviews the medication list for a client who is newly prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which client statement indicates a need to assess the client for serotonin syndrome?

"I started taking diet pills to assist with weight loss."

A client has been recently diagnosed with depression and has just begun medication management. Which of the client's following statements indicates an accurate understanding of this aspect of treatment? a) "I know that few people actually see an improvement in their mood with antidepressants, but I suppose I'll try anyhow." b) "I understand that I probably won't feel much better for a couple of weeks after I start the drugs." c) "I can tell that I get a lift each morning after I take my antidepressant." d) "I'm still trying to decide whether antidepressants will be helpful in my treatment."

"I understand that I probably won't feel much better for a couple of weeks after I start the drugs." Correct Explanation: Antidepressants are proven therapy in the treatment of depression, but effects are not normally observable or felt until 2 to 3 weeks after treatment starts.

Which statement by a client would indicate the need for additional education regarding a prescribed lithium treatment regimen?

"I will restrict my intake of processed foods high in sodium." Clients taking lithium must maintain a normal sodium intake or risk symptoms of lithium toxicity.

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."

"I'm obliged to share what we talk about with the other people on your care team." Explanation: The nurse has a binding obligation to communicate information suggesting a suicide risk to other members of the care team. The nurse should certainly assess the motivations for the client's desire for secrecy, but the priority is clearly communicating to the client that this is not possible. The nurse should avoid trite advice ("Nothing good ever comes ..."). The client's permission is not required to share this information, though the nurse should make efforts to preserve rapport and trust.

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 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?

"Low levels of the neurotransmitter serotonin are associated with mania."

A psychiatric-mental health nurse is conducting an in-service education program about suicide for a group of nurses working at a community mental health center. The nurse determines that the teaching was successful based on which statement by the group?

"Suicide has profound effects on those connected to the individual."

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!"

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?

"The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

The nurse working on a mental health unit is precepting a nursing student learning about depression. The student asks the preceptor 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) "Depression is a mood variation to life events." c) "The physician diagnosis depression when a patient has feelings of sadness several times a year." d) "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." Explanation: 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."

The nurse provides teaching to the family of a client who is hospitalized after a suicide attempt. Which family member statement indicates a need for additional teaching?

"There is no sense discouraging suicidal thoughts because it doesn't help."

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."

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?

"What have you had to eat or drink today?"

A client comes to the emergency department complaining of a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and his pulse is racing. The client states that he is being treated for depression with selegiline. Which question by the nurse would be most important to ask at this time? a) "Are you having any chest pain?" b) "What have you had to eat or drink today?" c) "Do you use any herbal remedies?" d) "When did you last have blood drawn to check your drug level?"

"What have you had to eat or drink today?" Explanation: The client is exhibiting signs of a hypertensive crisis, which can occur when a client is receiving MAOI therapy (selegiline) and ingests food or other substances that contain tyramine. Thus, the nurse should ask the client what he has had to eat or drink. Drug levels are used to monitor tricyclic antidepressants. Asking about chest pain would be appropriate after obtaining information related to what the client has ingested. Herbal remedies can interact with medications, but this information would be obtained after determining if the client has ingested tyramine-containing foods and fluids

When a woman in the last weeks of her pregnancy expresses concern over experiencing postpartum depression (PPD) after the birth of her baby, which response by the nurse indicates the use of therapeutic communication?

"What makes you feel that you'll get depressed after your baby's birth?"

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."

7. A nurse has just completed a suicide risk assessment of a widowed client, 76 years of age. In addition to documenting the presence or absence of suicidal thoughts, a suicide plan, and the client's available means, the nurse would also document which information? A) Use of substances 6 hours before the assessment B) Speech patterns C) Availability of support resources D) Amount of sleep in past 24 hours

14. A client who has attempted suicide has an underlying diagnosis of depression. Which of the following would the nurse anticipate being ordered for the client? A) Selective serotonin reuptake inhibitor B) Mood stabilizer C) Tricyclic antidepressant D) Atypical antipsychotic

15. The nurse is working with a client who will be signing a commitment to treatment statement. After teaching the client about this statement, the nurse determines the need for additional instruction when the client makes which statement? A) "Signing this statement means that I will not commit suicide." B) "I am agreeing to get emergency treatment if I have suicidal thoughts." C) "I will be open and honest about my feelings about treatment." D) "I am agreeing to participate in the necessary treatment for my condition."

6. The nurse is providing a presentation for a group of health professionals about suicide. Which would the nurse address as a major contributing factor to the rising suicide rate among men? A) Substance abuse B) Media influences C) Lack of conflict resolution skills D) Parenting practices

12. A client comes to the clinic for an evaluation of headache, fatigue, and an overall feeling of sadness. When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? (Select all that apply.) A) "I've been drinking about three or four more beers every night." B) "I've been going out with my friends about once or twice a week." C) "I'm so tired that all I ever want to do is sleep all the time." D) "Most times, I feel like I'm trapped with no way out." E) "I'm looking for a new job because my job is so stressful."

A, C, D

The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should a) Assess for depression in the client's family history b) Prepare the client for diagnostic genetic testing to confirm the diagnosis c) Encourage the client to seek genetic counseling before considering a pregnancy d) Educate the client regarding the symptoms of related physical disorders

Assess for depression in the client's family history Explanation: 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 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 has been diagnosed with bipolar disorder. After teaching the client about the different medication classifications used to help stabilize mood, the nurse determines that the teaching was successful when the client identifies which class of medications?

Anticonvulsants (Mood stabilizers = first line though...)

A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm?

Approximately 2 weeks after starting antidepressant medication Observe the client closely for suicide potential, especially after antidepressant medication begins to raise the client's mood. Risk for suicide increases as the client's energy level is increased by medication. The other choices are not significantly associated with increased risk for suicide.

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.

Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder?

Bananas

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?

Bipolar I

Bipolar I Bipolar I disorder is characterized by one or more manic episodes, usually alternating with major depressive episodes.

Which statement about bipolar disorders and gender is correct?

Bipolar I and II occur almost equally in men and women.

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.

What is the difference between depressive disorders and bipolar disorders?

Bipolar disorders involve mood swings ranging from depression to mania.

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

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 Explanation: 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 or psychological symptom as being associated with depression?

Catatonia

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

The client's spouse calls the health clinic stating that the client is having a manic episode. What information should alert the nurse to recommend that the client should go to the emergency room for treatment?

Client is avoiding eye contact and visibly shaking.

A client who suffers from bipolar disorder is admitted to a mental health unit for a manic episode. The nurse knows that which takes priority?

Client safety

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.

The nurse is planning the inpatient care of a client who has been admitted with major depression. The client's plan of care includes regular exercise, but the client is reluctant to participate due to a lack of energy and motivation. What is the nurse's best action?

Collaborate with the client to choose a manageable amount of exercise and acknowledge the client's subsequent effort

The nurse is providing client education to an individual who has recently been diagnosed with bipolar disorder and is starting divalproex sodium therapy. What priority information should the nurse include in the plan of care?

Confirm baseline labs have been ordered prior to starting therapy.

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

Confusion

A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment findings would support this suspicion? Select all that apply.

Confusion Hallucinations Agitation

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

Orthostatic hypotension

A client who otherwise is healthy is admitted for depression and reports feeling "all alone" following a recent divorce. The client admits to drinking at least 12 beers every day. The client has which risk factors for the depression? Select all that apply.

Current substance use or abuse Life and environmental stressors Lack of coping abilities

10. A group of nurses are reviewing information about suicide and associated concepts. The group demonstrates understanding of the information when they define which term as the probability that a person will successfully complete suicide? A) Parasuicide B) Suicidal ideation C) Suicidality D) Lethality

18. After educating a group of new nurses on various concepts involving suicide, the nurse determines that the education was successful when the new nurses provide which definition for the term parasuicide? A) Voluntary act of killing oneself B) All suicide-related behaviors and suicidal thoughts C) Nonfatal act with the intent to die D) Voluntary attempt without death as the aim

5. The nurse is caring for a 30-year-old white man whose wife 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) Refer the client for long-term psychotherapy. B) Determine the client's risk of psychosis. C) Determine whether anyone in the client's family has had depression. D) Ask the client whether he is thinking about killing himself.

A nurse is completing an admission assessment of a young adult client who has a history of depression, and who was brought to the hospital by a friend. In response to the nurse's question regarding suicidal ideation, the client discloses that they often think about attempting suicide. Which question is appropriate for the nurse to ask? A) "What does your friend think about your desire to kill yourself?" B) "What are your spiritual beliefs about suicide?" C) "What will killing yourself accomplish?" D) "What thoughts have you had about how you would kill yourself?"

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

For which reason is depression in older adults often undiagnosed and untreated?

Older adult depression is often seen as "normal aging."

A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first?

Decrease the client's environmental stimuli.

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

A differential diagnosis for older clients is critical because symptoms of depression in this age group can be confused with symptoms related to which condition? Select all that apply.

Dementia Cerebrovascular accident (CVA)

A client states, "I'm worthless, and I don't deserve to live." This theme in the client's expressed thought may signal a maladaptive response to which disorder?

Depression

A nurse is preparing a presentation for family members of clients who have been diagnosed with depression. When describing the family response to depression, which would the nurse include?

Depression in one family member affects the entire family.

A nurse is preparing a presentation for family members of clients who have been diagnosed with depression. When describing the family response to depression, which of the following would the nurse include? a) Family members typically can understand how disabling depression can be. b) Abuse of the depressed person is a rare occurrence in families. c) Depression in one family member affects the entire family. d) Families of women older than 55 years of age with depression experience the majority of problems.

Depression in one family member affects the entire family. Explanation: Depression in one member affects the whole family. Spouses, children, parents, siblings, and friends experience frustration, guilt, and anger when the family member is immobilized and cannot function. It is often hard for others to understand the depth of the mood and how disabling it can be. The lack of understanding and difficulty of living with a depressed person can lead to abuse. Women between the ages of 18 and 45 years constitute the majority of those experiencing depression, and thus their families experience the majority of problems.

After teaching a group of nursing students about major depression, the instructor determines that the education was successful when the group identifies which information is accurate?

Depression is twice as common in women than in men

Which statement regarding depression and gender is correct?

Depressive disorders are more common in women than men.

Which statement regarding depression and gender is correct?

Depressive disorders are more common in women than men. Explanation: Depressive disorders are more prevalent in women than in men. Genetics, sociocultural factors, hormones, and other elements may account for this disparity.

A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. The client's suicidal risk has lessened considerably, and the client currently denies having any desire to kill himself or herself. In addition, the client is able to identify reasons why the client wants to be alive. Which nursing intervention would be most appropriate at this time?

Developing a personal plan for managing suicidal thoughts when they occur

A client on the psychiatric mental health unit completed suicide. A nurse who cared for the client has been experiencing insomnia and anxiety attacks since the event. What is the nurse's first action?

Dialogue with a trusted colleague about these feelings

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?

Exposure to repetitive subthreshold stressors at vulnerable times

A client has entered the manic phase of bipolar disorder. To maintain the client's nutrition, which of the following should be offered?

Finger foods

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

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

Following a change in job position, a minister asks a client how the client likes the new job. The client states, "Oh everything is great. I can really see myself going far in this new position." However, the client's voice is monotone and the client's face is nearly absent of affective expression. The minister is worried about this client and describes this facial expression as what?

Flat

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

Which term typifies the speech of a person in the acute phase of mania?

Flight of ideas

Flight of ideas Explanation: Rapid "flights of ideas" lead to excessive and illogical rhyming, punning, and word associations, along with pressured speech.

Which of the following antidepressant medications is classified as a selective serotonin reuptake inhibitor (SSRI)? a) Tranylcypromine (Parnate) b) Phenelzine (Nardil) c) Isocarboxazid (Marplan) d) Fluoxetine (Prozac)

Fluoxetine (Prozac) Explanation: The SSRIs include Lexapro, Prozac, Zoloft, Luvox, Paxil, and Celexa. The monoamine oxidase inhibitors include Nardil, Marplan, and Parnate.

A client has been on lithium for 3 weeks now. The client approaches the nurse, saying, "I feel like I'm going to throw up, and I can't even hold this cup of coffee straight. Why can't I do the crossword puzzle? I usually can do them in about 5 minutes." What is the appropriate nursing intervention at this time?

Further assess the client's symptoms, call the physician, hold the client's next dose of lithium, and have a blood level drawn because the client is showing symptoms of toxicity.

After teaching a group of nursing students about the neurobiologic theories of depression, the instructor determines the need for additional teaching when the students identify which neurotransmitter as playing a role? a) Dopamine b) Gamma-amino butyric acid (GABA) c) Norepinephrine d) Serotonin

Gamma-amino butyric acid (GABA) Explanation: According to the neurobiologic theories, major depression is caused by a deficiency or dysregulation in central nervous system concentrations of the neurotransmitters norepinephrine, dopamine, and serotonin or in their receptor functions. GABA has not been implicated

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?

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?

Giving away valued personal items

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 Explanation: The suicidal individual may exhibit behaviors that provide clues to his or her intent, including the following: • Talking about death, suicide, and wanting to be dead • Talking or thinking about punishment, torture, and being persecuted • Hearing voices and suddenly seeming very happy after being very depressed for some time • Being very aggressive or very impulsive, and acting suddenly and unexpectedly • Showing an unusual amount of interest in getting his or her affairs in order • Giving away personal belongings

The police bring a client to the hospital. They found the client in a hospital gown, swimming in a local creek. The client states that the client was "being baptized by Mother Nature, who loves and worships me." How would the nurse describe the client's current alterations in mental status?

Grandiose delusions

The psychiatric nurse engages in evidence-based best practices when including nursing interventions into the care plan of a client diagnosed with bipolar disorder. This care plan supports both the administration of prescribed medications and ...

Group psychoeducation

Which would be a finding related to perceptual disturbances during the mental status exam in the client with mania?

Hallucinations

Which would be a finding related to perceptual disturbances during the mental status exam in the client with mania?

Hallucinations Explanation: Perceptual disturbances include hallucinations and delusions, anxiety, and grandiose delusions involving power, wealth, fame, or knowledge. Increased motor activity is assessed in appearance and general behavior. Inappropriate affect is assessed in mood and affect. Limited insight is part of the judgment and insight assessment.

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

Increase hydration

Electroconvulsive therapy (ECT) has been shown to be an effective treatment for people with severe depression. However, ECT is contraindicated in which of the following disease processes? a) Anxiety disorder b) Diabetes mellitus c) Hypertension d) Increased intracranial pressure

Increased intracranial pressure Explanation: ECT is contraindicated for patients with increased intracranial pressure. Other high-risk groups include those with recent myocardial infarction, recent cerebrovascular accident, retinal detachment, or pheochromocytoma. ECT is prescribed as a treatment modality for depression.

To care for an acutely suicidal client, which is the most effective initial mode of treatment?

Inpatient care

A group of nursing students is reviewing information about suicide and associated concepts. The group demonstrates understanding of the information when members identify which term as the probability that a person will successfully complete suicide?

Lethality

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

What is the rationale for a person taking lithium to have enough water and salt in his or her diet?

Lithium is a salt that has greater affinity for receptor sites than sodium chloride.

A client is prescribed lithium to treat mania. The client also has a history of hypertension for which the client takes lisinopril and hydrocholorothiazide. When monitoring this client, the nurse would be especially alert for signs and symptoms of which condition?

Lithium toxicity Lisinopril is an ACE inhibitor; hydrochlorothiazide is a thiazide diuretic. Both drugs interact with lithium to increase serum lithium levels.

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 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

Liver function

The nurse makes a home visit to a client who has dysthymic disorder. Which of the following would the nurse expect to assess? a) Agitation b) Normal appetite c) Intense concentration d) Low energy

Low energy Explanation: Dysthymic disorder is milder but more chronic and is diagnosed when the depressed mood is present for most days for at least 2 years. Two or more of the following symptoms should be present for this disorder: poor appetite or overeating, low energy or fatigue, low self-esteem, poor concentration, and feelings of hopelessness.

A client is admitted to an inpatient unit for treatment of mania. Which priority action should the nurse implement?

Maintain round-the-clock monitoring of the client.

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 most likely to be appropriate in the care of a client who has been diagnosed with which one of the following? a) Moderate depression b) Postpartum psychosis c) A mood disorder due to a general medical condition d) Anaclitic depression

Moderate depression Explanation: 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.

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

Mood stabilizers

A client with bipolar disorder has been taking lithium, and today the client's serum lithium level is 2.0 mEq/L. What effects would the nurse expect to see?

Nausea, diarrhea, and confusion The client would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination.

Which biogenic amines have been implicated in depression?

Norepinephrine and serotonin

Which biogenic amines have been implicated in depression?

Norepinephrine and serotonin Explanation: 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.

Police officers bring a client to the mental health unit for admission. The client had been directing traffic on a busy city street, shouting rhymes such as "to work, you jerk, for perks" and making obscene gestures at cars that came close to the client. When the client's spouse is contacted at work, the spouse reports that the client stopped taking lithium 3 weeks ago and has not slept or eaten for 3 days. With which two features characteristic of the manic phase of bipolar disorder can the nurse identify?

Poor judgment and hyperactivity

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?

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?

Pressured speech, combative behavior, and impaired judgment

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

Prevent self-destructive behavior.

According to the Learned Helplessness behavioral theory, the psychiatric nurse shows an understanding of therapeutic supportive care of a client depressed over the loss of employment when a) Providing a list of community services to reassure the client that resources are available to help until employment is found b) Determining how the client reacted to stressors like this before in order to evaluate the effectiveness of his coping skills c) Providing positive reinforcement concerning the client's ability to find another job by helping him identify his employable skills d) Helping the client realize he was not responsible for the loss of his job but rather it is a result of circumstances outside of his control

Providing positive reinforcement concerning the client's ability to find another job by helping him identify his employable skills Explanation: According to the Learned Helplessness behavioral theory, the psychiatric nurse shows an understanding of therapeutic supportive care of a client depressed over the loss of employment when providing positive reinforcement concerning the client's ability to find another job by helping him identify his employable skills

The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which?

Psychomotor agitation

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

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 Explanation: Associated signs and symptoms of depression include an inability to think or concentrate, increased complaints of pain, psychomotor retardation, and lack of energy and fatigue.

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.

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.

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?

The mania symptoms of bipolar II disorder have little effect on functioning.

Which of the following is a true statement regarding depressive disorders? a) They are more prevalent in men than women. b) The monoamines norepinephrine, dopamine, and serotonin have been implicated. c) Depression in older adults is easier to diagnosis. d) It is the leading cause of U.S. disability in clients older than 44 years of age.

The monoamines norepinephrine, dopamine, and serotonin have been implicated. Explanation: 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. Depressive disorders are more prevalent in women than in men. Depression in older adults may be difficult to diagnose because many older people have co-morbid diseases. It is currently the leading cause of U.S. disability in clients 15 to 44 years of age.

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

Which of the following is a cognitive intervention for clients diagnosed with depression?

Thought stopping

A patient is admitted to the hospital. When the nurse takes a medication history, the patient reports use of St. John's wort. The nurse knows that this herb is used for which of the following? a) To fight high cholesterol b) To prevent cancer c) To fight depression d) To prevent enlarged prostate

To fight depression Explanation: St. John's wort is a herb used to fight depression. When taken with an antidepressant that affects serotonin regulation, the combination may cause serotonin syndrome, which includes altered mental status and autonomic dysfunction

A client with acute mania is prescribed lithium. During this time, the nurse would anticipate obtaining blood concentrations how often?

Twice weekly

The patient is taking an MAOI for depression. The nurse teaches the patient to avoid foods containing which of the following while taking this medication? a) Sugar b) Tyramine c) Calcium d) Potassium

Tyramine Explanation: If co-administered with food or other substances containing tyramine, MAOIs can trigger a hypertensive crisis, which may be life threatening. MAOIs given with foods containing calcium, potassium, or sugar do not cause a hypertensive crisis.

Psychodynamic theory attributes the development of mood disorders to what?

Unexpressed and unconscious anger

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 Explanation: Social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among the younger population. Internal distress, low self-esteem, and interpersonal distress have long been associated with suicide. Cognitive risk factors include problem-solving deficits, impulsivity, rumination, and hopelessness. Impulsivity, anger, and reduced inhibition increase the risk of suicide. Fear of growing older is not a common concern for this population. With the likelihood of a positive outcome, acute illness is not generally viewed as being hopeless. Chronic medical illnesses increase the likelihood of chronic depression, which in turn contributes to the increased suicide rate of those older than the age of 65 years. While starting a new business may create a degree of anxiety, it is usually viewed with hopefulness and enthusiasm.

The majority of suicides among men are attributed to:

firearms.

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

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.

The monoamine hypothesis of depression a) holds that depression is caused by sociocultural and psychological factors. b) holds that depression is caused by only one of the biogenic amines. c) relates to bipolar disorders, not to depression. d) holds that depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines.

holds that depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines. Explanation: The major monoamine hypothesis about depression is that absolute concentrations of norepinephrine, 5-HT, or both are deficient

A client with mania begins dancing around the day room. When she twirled her skirt in front of the male clients, it was obvious she had no underwear on. The nurse distracts her and takes her to her room to put on underwear. The nurse acted as she did to

minimize the client's embarrassment about her present behavior.

A nurse maintains a safe environment for a client who is suicidal by ...

observing the client frequently.

A client with bipolar disorder has a plasma lithium concentration of 2.7 mE/L. Which finding would a nurse most likely assess in this client? Select all that apply.

seizures, nystagmus, and fasciculations A plasma lithium concentration of 2.7mEq/L indicates severe toxicity manifested by seizures, nystagmus, and fasciculations. Tinnitus and incoordination are noted with moderate toxicity, with plasma drug concentration ranging from 1.5 to 2.5 mEq/L

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

To best minimize the risk of a client's noncompliance with new drug therapy for a mood disorder, the nurse discusses (Select all that apply.) a) Social barriers against psychiatric treatments b) Detailed description of possible side effects c) Importance of staying in touch with mental health care provider d) That the length of time treatment is anticipated e) That there is a possibility that two or more drugs will be prescribed

• That the length of time treatment is anticipated • That there is a possibility that two or more drugs will be prescribed • Detailed description of possible side effects • Importance of staying in touch with mental health care provider Explanation: To best minimize the risk of a client's noncompliance with new drug therapy for a mood disorder, the nurse discusses anticipated length of treatment time, the possibility of two more drugs being prescribed, possible side effects of the drug(s), and the importance of staying in touch with a mental health care provider.

While caring for a client in the hospital, the nurse becomes concerned that the client may be having thoughts of suicide. Which statement would be most therapeutic?

"I've noticed something is bothering you. Please share you thoughts with me."

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."

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

Which individual has the highest number of risk factors for the development of depression?

A 50-year-old woman who just lost her spouse and has a family history of depression

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.

Which client is most likely to benefit from electroconvulsive therapy (ECT)?

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

A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what?

A significant decrease in appetite

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

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.

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

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.

After assessing a client, the nurse identifies that the client is at risk for suicide. Which would be the nurse's priority intervention?

Remove means of suicide from the client's access.

A client hospitalized for uncontrolled manic behavior constantly belittles other clients on the general ward and is demanding special favors from the nurses. Which is the most effective nursing intervention for this client?

Set limits with specific and consistent consequences for belittling or demanding behavior.

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

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

Trying to kill oneself and surviving the ordeal is identified as what?

Suicide attempt

The nurse is assessing a 42-year-old client who is experiencing depression. The client's mother died by suicide 20 years ago. Which statement regarding this client's risk for suicide is correct?

The client has a greater risk for suicide than the general population.

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 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

A client admitted to the inpatient psychiatric unit changes clothes eight or nine times a day, wears heavy eye makeup, is intrusive with other clients, and makes inappropriate sexual advances toward staff members. Which goal would be most appropriate for this client?

The client will refrain from being intrusive with others and change clothing only twice per day.

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.

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 obliged to protect the client from self-harm.

Which is an accurate statement regarding women and suicide?

They are less likely to complete suicide than men.

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

Thyroid function tests

Withhold additional doses of lithium. Obtain a blood sample for lithium level. Push fluids. Contact the physician.

A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the client will have to demonstrate specific symptoms. What are some of these symptoms? Select all that apply.

disruption in sleep disruption in appetite disruption in concentration excessive guilt

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

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