Chapter 17: Mood Disorders and Suicide - PREPU

The nurse has been asked to assess a client to determine if the client has a suicide plan. Which question would assist the nurse in assessing this area?

"Are you thinking about killing yourself right now?"

Which statement is true about delusional disorder?

Behavior is relatively normal except when focused on the delusion.

Which statement regarding depression and gender is correct?

Depressive disorders are more common in women than men.

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

Moderate depression

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

Self-injury

A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy?

Liver function

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

Placing the client under constant observation

The 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 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."

A nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which would a nurse expect to find?

Living with one or more delusions for a period of time

A client taking lithium therapy has a serum therapeutic level of 0.8 mEq/L. What priority dietary instruction should the nurse include in the teaching plan?

Maintain daily sodium intake

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

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

The nurse is working with a client with schizophrenia who has cognitive deficits. It is time for the client to get up and eat breakfast. Which statement by the nurse would be most effective in helping the client prepare for breakfast?

"First, wash your face and brush your teeth. Then put your clothes on."

The family of a 22-year-old client with bipolar disorder is having difficulty coping with the client's rapid mood swings, irritability, grandiose delusions, and overly intrusive behaviors. Following a visit to the unit, the parents discuss their frustration and anger with the nurse and ask what they should do to help the client. Which reply by the nurse is most appropriate?

"Help the client monitor medication adherence and watch for changes in mood and sleep."

A client with major depression is admitted to the health facility and expresses feelings of worthlessness and abandonment by significant others. Which replies by the nurse would convey empathy?

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

A client 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."

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 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."

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

14 days

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

A client whose major depression has not responded appreciably to antidepressants

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 community mental health nurse is providing care for a large number of clients. What client should the nurse monitor most closely for the warning signs of suicide?

A young male with schizophrenia who is in danger of becoming homeless

A nurse is providing psycho-education to a client who has been admitted to the inpatient mental health unit for a manic episode. In order to ensure the teaching is effective, the nurse must first determine which regarding the client?

Ability to concentrate and process the information

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

Acquired immunodeficiency syndrome

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

Which constitutes a negative symptom associated with schizophrenia?

Asociality

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.

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

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.

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 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 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

A client who otherwise is healthy is admitted for depression and reports feeling "all alone." The client reports recently losing a spouse to 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

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 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

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

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

A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the education was effective when they state that which should be reported immediately?

Elevated temperature

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

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.

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

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

The nurse suspects that a client is experiencing a brief psychotic episode based on what? Select all that apply.

Evidence of hallucinations Intense changes in affect Recent life stressor

Which statement regarding gender and suicide is correct?

Females engage in suicidal behaviors more frequently than males.

The nurse is conducting an admission assessment with a 45-year-old client who has been demonstrating signs of bipolar disorder. While conducting the assessment, the client starts speaking in illogical rhymes and using word associations. What is the name for this thought pattern?

Flight of ideas

When teaching prevention to the parents of a 15-year-old client who recently attempted suicide by taking an overdose of alprazolam, the nurse describes which behavioral clue?

Giving away valued personal items

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

Grandiosity

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

Hallucinations

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 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

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.

A client who has been taking lithium for bipolar disorder is admitted to the hospital with the following symptoms: dry mouth, nausea and vomiting, blurred vision, dizziness, and muscle twitching. What should the nurse suspect?

Moderate lithium toxicity

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

Mood stabilizers

Which has not been proposed as a potential mechanism for the etiology of thought disorders?

Neglect in childhood

A nurse is reviewing the medical record of a client with bipolar disorder. The nurse would most likely expect to find a history of what?

Panic disorder

A client with schizoaffective disorder (SAD) is prescribed clozapine. The nurse understands that in addition to the drug's antipsychotic effects, it is also effective in which area?

Reducing the risk for suicide

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

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

A client with depression is admitted to an inpatient psychiatric unit. The nurse provides a unit orientation. While observing the client's unpacking, the nurse can expect the client to exhibit what?

Slow movements and flat affect

Assessment of violence potential is an important part of nursing care on the inpatient unit. Which is an indicator that the client with schizophrenia may be at high risk for violence while in the hospital?

The client assaulted an officer prior to admission.

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.

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.

Research related to the development of schizophrenia has shown what?

The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors.

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.

A client with major depression has been prescribed escitalopram. The nurse should address what topic in client education?

The possibility of gastrointestinal upset

After being prescribed several medications that were ineffective, a client is diagnosed with refractory mania. The physician decides to prescribe lamotrigine, an anticonvulsant that has been found to be effective for refractory mania. Which would the nurse need to include in the client's education plan?

The potential for life-threatening side effects such as Stevens-Johnson syndrome

The majority of suicides among men are attributed to:

firearms.