Chapter 69: Caring for Clients with Mood Disorders

A client with depression mentions to the nurse that he has gained about 5 lbs recently. He says, "I'm always craving sugary and starchy foods—pasta, cakes, cereals." How would the nurse most accurately explain this symptom to the client?

"Carbohydrates stimulate a temporary increase in serotonin production, and serotonin levels are often decreased in clients with depression."

A client who attempted suicide 5 years ago is brought to the emergency department (ED) by a friend. The client states, "I just don't feel like living anymore. No one would care if I lived or died." What question should the nurse ask next?

"Do you have a plan for suicide at this time?"

At 1 am, the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. Which response by the nurse would be the most therapeutic?

"I can't call the psychiatrist now, but you and I can talk about your request for a pass."

A client taking a monoamine oxidase inhibitor (MAOI) is attending a follow-up appointment. During the interview, the client says to the nurse, "I'm starting to become really discouraged. I've been on this medicine for 4 weeks now, and nothing has changed." Which would be the best response from the nurse?

"It can take up to 6 weeks before symptoms improve when taking your type of medication."

A client with mania is demonstrating hypersexual behavior: blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which of the following interventions is indicated at this time?

"Let's go to the conference room and talk for a while."

A client has recently lost her spouse and has been experiencing depression as a result. Which of the following statements from the nurse about the client's condition is most accurate?

"Usually, the kind of depression you are experiencing resolves with time."

A nurse is caring for a client who will undergo electroconvulsive therapy (ECT) for treatment of depression. When assessing a client immediately following ECT, the nurse expects which of the following?

Confusion

Which intervention should be of primary importance to the nurse working with a client to modify the client's negative expectations?

Have the client identify positive aspects of self.

A client has been undergoing transcranial magnetic stimulation to treat his depression. Which of the following complications would the nurse most expect the client to report?

Headache

A client hospitalized in an acute manic phase of bipolar disorder is pacing the halls and talking in a loud voice and with pressured speech. The client is overly involved with co-clients and frequently threatens and disrupts them. Providing medication treatment, the nurse can expect the plan of care to include:

Monitoring blood lithium levels.

Serotonin syndrome is a potentially life-threatening condition that results from elevated levels of serotonin in the blood secondary to drug therapy. What factors place a client at risk for serotonin syndrome?

Other serotonergic agonists, drugs that stimulate serotonin receptors, are combined with antidepressant therapy. Antidepressants from different classes such as MAOIs and SSRIs are coprescribed. . The time between weaning from one antidepressant drug to initiating another is inadequate to compensate for the first antidepressant's half-life.

A client on the psychiatric unit is receiving lithium therapy and has a lithium level of 1 mEq/L. The nurse notes that the client has fine tremors of the hands. What should the nurse do?

Realize that a fine tremor is expected.

A client with bipolar disorder has been taking lithium, as prescribed, for the past 3 years. Today, family members brought this client to the hospital because the client hadn't slept, bathed, or changed clothes for 4 days; had lost 10 lb (4.5 kg) in the past month; and woke the entire family at 4 a.m. with plans to fly them to Hawaii for a vacation. Based on this information, what may the nurse assume?

The lithium level should be measured before the client receives the next lithium dose.

A 65-year-old client seeks crisis intervention in a community senior citizen center. She states she has very few financial resources, and her children never call or visit. She is sobbing and states, "I can't take it anymore. My life is so lonely and hard. I am living too long and shouldn't be here anymore." What is the most important assessment data for the nurse to further assess?

The meaning of the statement "I cannot take it anymore."

A client with major depression asks why he is taking mirtazapine (Remeron), a serotonin reuptake inhibitor, instead of imipramine (Tofranil), a tricyclic antidepressant. Which explanation is most accurate?

The serotonin reuptake inhibitors have few adverse effects.

A client is taking lithium and asks for explanations for why regular blood tests are needed. The nurse explains that it is to detect lithium toxicity. The nurse can best explain lithium toxicity as which of the following?

Too much medication in the blood serum.

Seasonal affective disorder (SAD) is a mood disorder that has its onset during darker winter months and spontaneously disappears in the spring. Clients feel sleepy, fatigued, and lethargic. What would not be part of what you would teach a client with SAD?

Use eyeglasses or contact lenses that are coated to shield ultraviolet radiation.

A client reports to the emergency department with suicidal ideation and feelings of worthlessness. He has a family history of suicide. In assessing the client to determine treatment recommendations, the most important factor for the nurse to consider is:

an active suicide plan and the means to carry it out

Which is not a category of drugs that relieves the symptoms of depression?

beta adregenic blockers

Which is not a category of drugs that relieves the symptoms of depression?

beta-adrenergic blockers

Which is not a suicide precaution?

checking on the client at least once every 60 minutes temporary confiscation of any personal items that could be used for self-harm requiring that the client dress in hospital garb with slippers designating a staff person to care for and observe only the suicidal person

What is the clinical definition of a mood disorder?

extreme moods that interfere with social relationships

A client's health care provider suspects the client is suffering from depression. What other conditions mimic depression?

hypothyroidism, diabetes mellitus, drug abuse

A client is not coping well because of feelings of depression and hopelessness. What interventions would be helpful to use in caring for this client?

indicate a desire to help. Acknowledge the client's feeling of despair. Explore other courses of action rather than suicide.

Within the theory of monoamine hypothesis, depression results from imbalances in one or more of the monoamine neurotransmitters. What imbalance of serotonin is proposed within the theory?

lower

A client who is recently widowed is unable to sleep, is without an appetite, and has trouble focusing on any topic. This client's condition can be attributed to:

reactive depression.

A nurse is assessing a client's suicide risk level using the mnemonic SLAP as a guide. What does SLAP stand for?

specificity, lethality, availability, proximity

A client with bipolar disorder has abruptly stopped taking prescribed medication. Which behavior would indicate the client has experienced a manic episode?

thoughtless spending

A depressed older adult client is being treated with a tricyclic antidepressant (TCA). The nurse should observe the client carefully for:

Orthostatic hypotension and urinary retention.

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale?

Other clients need to be protected from the intrusive behavior.

A physician is switching a client from a tricyclic antidepressant (TCA) to a monoamine-oxidase inhibitor (MAOI). How much time would the nurse instruct the client to let pass as a minimum before stopping the TCA and beginning the MAOI?

14 days

The mobile crisis unit of a large city receives an emergency call from a client who states, "My life is worthless. I do not want to live anymore." The mobile crisis unit is on the way to the home. The nurse's best first response would be which of the following?

Attempt to calm and support the client.

A client has been prescribed phenelzine sulfate, an MAO inhibitor. Which of the following foods should the nurse caution the patient to avoid eating?

Cheddar cheese and bratwurst

A 24-year-old woman taking lithium carbonate is allowed a 3-day pass from the mental health unit to go home. What is the best health teaching the nurse should advise this client?

Continue to maintain normal sodium intake while at home.

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:

Decelerated movements and flat affect.

How would a health care provider define a diagnosis of depression?

Eliminate other possible conditions.

A client is extremely depressed and expresses increasing suicidal ideation to the primary nurse. The priority nursing intervention should be:

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

A client who is on long-term lithium therapy is considering pregnancy. What would the nurse explain to the client?

Lithium crosses the placental barrier; therefore, its use is contraindicated in pregnant women.

A client, age 79 years, tells the home visiting nurse, "I've been feeling down for the last few days. I don't have much to live for. My family and friends are all dead. My money's running out, and my health is failing." The nurse should assess this as:

Evidence of high suicide potential.

Which communication guideline should the nurse use when talking with a client experiencing mania?

Focus and redirect the conversation as necessary.

A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse she has been taking fluoxetine 20 mg PO daily for the past 3 weeks and that she has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take?

Inform the patient that a decrease in weight is normal with this medication.

The mental health nurse knows that limit setting is most appropriate in which client population?

Manic

An older adult client is admitted to the medical division after a fall. At home he is taking amitriptyline 25 mg three times per day. What adverse effect could be related to the patient's fall?

Orthostatic hypotension

A client arrives at the psychiatric unit exhibiting extreme agitation, disorientation, and incoherence of speech with frantic and aimless physical activity and grandiose delusions. Which of the following concerns takes highest priority in planning your nursing interventions?

Risk for injury.

What acronym is helpful in remembering the multiple physiologic and thought changes of major depression?

SAD IMAGES

A client with mania hospitalized on a general unit constantly belittles other clients and is demanding special favors from the nurses. The most appropriate nursing intervention is:

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

To elevate mood for a client with depression, the nurse should recommend high intake of:

carbohydrates.

Which nursing intervention is necessary after administering medications to a client who is at risk for suicide?

inspecting the client's mouth