Davis (Ohman) 38: Anxiety and Mood Disorders
A nurse is assessing a client, attempting to differentiate the client's symptoms between delirium and depression. Which symptoms of the client are unique to depression? SELECT ALL THAT APPLY. 1. Sadness 2. Disturbance in sleep patterns 3. Fluctuating levels of consciousness 4. Labile affect 5. Lack of motivation 6. Presence of hallucinations
ANSWER: 1, 5 Clients with depression experience sadness, depression, apathy/lack of motivation, and decreased energy to complete activities. Both clients with depression and clients with delirium experience sleep disturbances, fluctuating levels of consciousness, and labile affect. Presence of hallucinations is associated with delirium, not depression.
An experienced nurse is teaching a new nurse about establishing therapeutic relationships with clients on a mental health unit. Which intervention should the nurse suggest when attempting to establish a therapeutic relationship with a client diagnosed with major depressive disorder? 1. Sit with the client in silence. 2. Ask the client to join others to watch a 2-hour movie. 3. Invite the client to attend an exercise class. 4. Ask the client how his or her day should be scheduled.
ANSWER: 1 An effective therapeutic intervention is to sit with the client in silence. Nonverbal communication conveys respect, understanding, and interest. Clients diagnosed with depression have decreased attention spans and concentration. Lack of energy is a common symptom of depression. Clients with depression are often indecisive and dependent.
A client diagnosed with an anxiety disorder tells a nurse that being in crowds creates thoughts of losing control and the need to hurriedly leave. What should the nurse recommend as an effective, nonpharmacological therapy for managing the client's symptoms of anxiety? 1. Cognitive behavioral therapy (CBT) 2. Electroconvulsive therapy (ECT) 3. Family systems therapy 4. Psychoanalytical therapy
ANSWER: 1 Cognitive behavioral therapy is a treatment that focuses on patterns of thinking that are maladaptive and would be an effective choice for the described symptoms. Electroconvulsive therapy is primarily used as an intervention for major depression. Family systems therapy is an intervention warranted when a client's symptoms signal the presence of dysfunction within the whole family. Psychoanalytic therapy focuses on repressed conflicts that are both conscious and unconscious.
A nurse is educating a client about prescription antidepressant medications and the appropriate expectations when taking these. Which statement by the nurse is accurate? 1. "It is important to continue taking antidepressant medication even after you feel better." 2. "Your symptoms will subside about 72 hours after starting the antidepressant medication." 3. "The most potent antidepressant is fluoxetine (Prozac®)." 4. "Some common side effects of SSRIs are dry mouth, blurred vision, and urinary retention."
ANSWER: 1 Evidence-based practice guidelines recommend continuing antidepressant medication a minimum of 6 months after recovery following the first episode of depression to decrease the chance of relapse. Symptom improvement begins approximately 2 weeks after medication is initiated and often takes 6 to 8 weeks at a therapeutic dose to achieve significant remission of symptoms. Antidepressants are equally efficacious. The individual's personal and family history and specific cluster of symptoms guide medication selection. Dry mouth, blurred vision, and urinary retention are anticholinergic side effects associated with tricyclic antidepressants (TCA), not a serotonin selective reuptake inhibitor (SSRI).
A nurse is educating a client diagnosed with depression who is experiencing insomnia. Which intervention should the nurse recommend to reduce episodes of insomnia? 1. Maintain regular bedtime hours. 2. Sleep late on weekends to catch up on missed sleep. 3. Fight insomnia when it occurs. 4. Establish a regular exercise program a few hours before bedtime.
ANSWER: 1 Maintaining a regular bedtime is a recommended sleep hygiene practice. Sleep experts recommend avoiding sleeping late on weekends and avoiding stimulating activities, including exercise, close to bedtime. Instead of fighting insomnia, the client should get out of bed and do something non-stimulating until feeling tired again.
A client reports becoming involved with legislation that promotes gun safety after the death of a child by accidental shooting. Which defense mechanism is the client exhibiting? 1. Sublimation 2. Identification 3. Denial 4. Intellectualization
ANSWER: 1 Sublimation involves redirecting unacceptable feelings or drives into an acceptable channel. Identification involves taking on attributes and characteristics of someone admired. Denial is the refusal to accept a painful reality by pretending that it did not happen. Intellectualization involves excessive focus on reasoning to avoid feelings associated with a situation.
A client diagnosed with mania tells a nurse, "I think you're very pretty. Maybe we could go to my room." Which response by the nurse is most therapeutic? 1. "It's time for occupational therapy." 2. "That's not appropriate and I'm offended." 3. "I don't have that kind of relationship with clients." 4. "Let's walk down to the seclusion room."
ANSWER: 1 The most therapeutic response by the nurse is to redirect the client. Hypersexual behavior and impulsivity are symptoms of mania. Rather than confront the client or acknowledge the provocative comment, it is more effective to redirect the client as clients with mania are easily distracted. Secluding the client is unnecessary.
A nurse is assessing a client with suspected major depression. Which findings would support a diagnosis of major depression? SELECT ALL THAT APPLY. 1. Loss of interest or pleasure nearly daily for at least 2 weeks 2. Presence of psychomotor agitation nearly daily for at least 2 weeks 3. Feelings of worthlessness nearly daily for at least 2 weeks 4. Having a depressed mood nearly daily for at least 2 weeks 5. Talking rapidly with pressured speech nearly daily for at least 2 weeks 6. Impaired concentration nearly daily for at least 2 weeks
ANSWER: 1, 2, 3, 4, 6 Loss of interest or pleasure, psychomotor agitation, feelings of worthlessness, depressed mood, and impaired concentration are symptoms that meet diagnostic criteria for a major depressive disorder. Rapid, pressured speech is a diagnostic criterion for bipolar disorder and not major depressive disorder.
A nurse is teaching an education class to clients with mild to moderate anxiety. Which teaching strategies should the nurse practice when educating the clients? SELECT ALL THAT APPLY. 1. Maintain a calm, nonthreatening manner. 2. Create an atmosphere of low stimuli. 3. Encourage the client to verbalize thoughts and feelings that could contribute to symptoms of anxiety. 4. Reinforce reality by focusing on the "here and now." 5. Limit the length of class time and the amount of provided information. 6. Create an environment free from hazardous objects that the client could use to cause harm.
ANSWER: 1, 2, 3, 5 A client with anxiety develops a sense of security when in the presence of a calm staff person. A client's anxiety level may increase in a stimulating environment. A client's verbalization of thoughts and feelings can assist in understanding and managing anxiety symptoms. A client with anxiety has a decreased attention span and diminished level of concentration. Reinforcing reality is a teaching strategy used with a thought disorder for a psychotic condition. Self-harming behavior in a client with mild to moderate anxiety would not be commonly present.
A client diagnosed with major depressive disorder has the nursing diagnosis of Disturbed sleep pattern. When developing a plan of care for this client, which nursing actions are most appropriate? SELECT ALL THAT APPLY. 1. Determine sleep patterns prior to hospitalization. 2. Discourage sleeping during the day. 3. Record and limit caffeinated drinks. 4. Reinforce reality thinking. 5. Encourage measures that aid in relaxation.
ANSWER: 1, 2, 3, 5 Determining past sleep patterns is important in determining what is normal for the client. Limiting daytime sleeping promotes nighttime sleep routines. Caffeine is a stimulant that interferes with sleep patterns. Measures such as soft music and relaxation exercises may be helpful in promoting sleep. Encouraging reality thinking would be an appropriate intervention for a thought disorder.
A nurse is reviewing diet restrictions with a client taking a monoamine oxidase inhibitor (MAOI). Which symptom could occur with nonadherence to diet restrictions while taking a MAOI? 1. Agranulocytosis 2. Explosive occipital headache 3. Severe hypotension 4. Akathisia
ANSWER: 2 Explosive occipital headache is a symptom of hypertensive crisis, which is a major concern with the combination of a monoamine oxidase inhibitor (MAOI) and certain foods (e.g., aged cheeses, overripe fruit, and sausage). Agranulocytosis, hypotension, and akathisia (unpleasant sensations of "inner" restlessness that results in an inability to sit still) are not symptoms associated with MAOIs and food restrictions.
A nurse is assessing a client with dysthymia who reports symptoms of depressed mood. Which assessment finding supports the essential feature of dysthymia? 1. Recurrent thoughts of death 2. Chronically depressed mood for most of the day for at least 2 years 3. Significant weight loss 4. Diminished ability to think or concentrate
ANSWER: 2 Individuals diagnosed with dysthymia describe their mood as sad or "down in the dumps" more days than not for at least 2 years. The depressive symptoms are chronic but less severe and may not be easily distinguished from the person's usual functioning. Recurrent thoughts of death, significant weight loss, and decreased concentration are neurovegetative symptoms most commonly associated with a major depressive disorder.
A client tells a nurse about an intense fear of dogs that causes the client to avoid visiting others unless it is confirmed that there are no dogs on the premises. The client further explains that these fears seem unreasonable, but the fear continues in spite of this acknowledgment. Based on the client's report, which conclusion by the nurse is accurate? 1. The client has a recognized fear, but there is no evidence of psychopathology. 2. A fear that is recognized as excessive and unreasonable is a DSM-IV criterion for phobias. 3. True phobias are rare in the general population. 4. Phobias begin in childhood and are diagnosed more often in men.
ANSWER: 2 Marked fear cued by the presence or anticipation of a specific object (e.g., dogs), recognition that the fear is excessive, and avoidance of the object/situation are diagnostic criteria for a specific phobia. The client's symptoms meet diagnostic criteria for a psychopathological disorder. Specific phobias frequently occur concurrently with other anxiety disorders and are common among the general population. Phobias can occur at any age. The disorder is diagnosed more often in women than in men. While phobias are common, people seldom seek treatment unless the phobia interferes with their ability to function.
A nurse is assessing a client recently admitted to a psychiatric unit who is experiencing acute mania. Which nursing action should the nurse plan when caring for a client with acute mania? 1. Sustain conversations to improve the client's concentration. 2. Provide finger foods that the client can carry while moving around the unit. 3. Teach the client and family about available community resources. 4. Help the family understand that anger directed at them is likely to escalate unless they confront the client's behavior.
ANSWER: 2 Provide finger foods as nutritional status may be compromised because of hyperactive behaviors. This strategy provides a convenient method for eating and maintaining nutritional integrity for clients who may be too distracted to sit down for a meal. Conversations should be brief while the client is hypomanic or manic to minimize confusion and frustration. Client and family teaching about community resources is an appropriate nursing action but is not appropriate at this time (acute mania). Client's anger is likely to be transitory and will improve as mania subsides. Family should avoid sensitive or volatile topics while the client is in a manic phase.
A nurse observes that a client diagnosed with major depressive disorder who recently started on an antidepressant is acting differently. Two days ago, the client appeared sad and remained in bed. Now the client is awake at 4 a.m. and planning a unit party. What is the most likely explanation for the change in behavior? 1. The client is responding positively to the antidepressant. 2. The client was misdiagnosed and what was thought to be a depression is bipolar disorder. 3. The client is more familiar with the unit milieu and is able to be self-expressive. 4. The client is happy because the client expects to be discharged soon.
ANSWER: 2 The clinical presentation of unipolar and bipolar depression can be similar and both conditions should be considered when making treatment choices. Clients receiving an antidepressant without a concurrent mood stabilizer can have a manic episode precipitated. Option 1 could be correct if the client had been receiving an antidepressant for 3 to 4 weeks. The phrase of "recently started" would rule out this choice. The information given does not support the conclusions in options 3 or 4.
A client of Latino/Hispanic ethnicity reports of poor appetite, lack of energy, and feeling hopeless nearly every day for the past 3 weeks. An admitting nurse notices that the client does not make eye contact upon questioning. What is the most likely explanation for the client's behavior? 1. The client is suicidal. 2. The client is demonstrating respect. 3. The client is psychotic. 4. The client does not like the nurse.
ANSWER: 2 The most likely explanation for the client's lack of eye contact is that the client is demonstrating respect for the nurse. Persons of Latino/ Hispanic ethnicity have traditionally been taught to avoid eye contact with figures of authority as a sign of respect.
A recently discharged veteran reports symptoms of recurring intrusive thoughts, insomnia, and hypervigilance. Which mental health diagnosis would a nurse suspect for this client? 1. Narcolepsy 2. Posttraumatic stress disorder 3. Trichotillomania disorder 4. Obsessive compulsive disorder
ANSWER: 2 The reported symptoms are consistent with the diagnosis of posttraumatic stress disorder and are often present with veterans who have been exposed to combat trauma. Narcolepsy is a disorder that produces excessive sleepiness. Trichotillomania disorder is defined as the recurrent pulling out of one's own hair. Obsessive-compulsive disorder is characterized by involuntary recurring thoughts, but is not characterized by hypervigilance.
A nurse assesses a client who reports feeling full of energy in spite of being awake for the past 48 hours. Which diagnosis is the nurse likely to find documented in the client's medical record? 1. Obsessive-compulsive disorder 2. Bipolar disorder/manic type 3. Bipolar disorder/mixed type 4. Korsakoff's psychosis
ANSWER: 2 The symptoms of increased psychomotor activity with diminished need for sleep are suggestive of bipolar disorder of the manic type. The client is not reporting recurrent and persistent thoughts or impulses. There is no mention of mood fluctuations of both depression and mania. The symptoms of confusion, loss of recent memory, and confabulation would be present in Korsakoff's psychosis.
A nurse is teaching a class to assistive personnel on depression. Which statement(s) by the nurse provide accurate information about depression? SELECT ALL THAT APPLY. 1. Depression is a condition in which behaviors can fluctuate between low mood and euphoria. 2. Women are approximately twice as likely as men to develop depression. 3. The rate of depression among adolescents increases with age. 4. Children in all age groups can become depressed. 5. Symptoms of perfectionism and rigid thought patterns are indicative of depression.
ANSWER: 2, 3, 4 The reasons for gender susceptibility are unclear, with suspected reasons being stress, lifestyle, and hormonal factors. The rate of depression rises after puberty to the late teenage years. Fluctuating mood is characteristic of bipolar disorder and not depression. Perfectionism and rigid thought patterns are characteristic of obsessive-compulsive disorder, not depression.
A nurse is meeting with a client who is being discharged after hospitalization for suicidal ideation. Based on knowledge of expert consensus of warning signs for suicide, the nurse should plan to advise the client to seek help by contacting a mental health professional or calling the national suicide prevention hotline if experiencing: SELECT ALL THAT APPLY 1. sadness. 2. hopelessness. 3. severe anxiety and agitation. 4. feeling of being trapped. 5. increasing alcohol or drug use.
ANSWER: 2, 3, 4, 5 Consensus warning signs are hopelessness, rage/anger or seeking revenge, acting reckless, feeling trapped (like there is no way out), increasing alcohol or drug use, withdrawing from family or friends, severe anxiety or agitation, dramatic changes in mood, and feeling no reason for living. Sadness can be a normal mood variation.
A nurse is admitting a client diagnosed with generalized anxiety disorder. During the client's assessment, the nurse determines that which findings would be consistent with generalized anxiety disorder? SELECT ALL THAT APPLY 1. Expansive mood with pressured speech 2. Restlessness or feeling keyed up or on edge 3. Difficulty controlling the anxiety 4. Irritability 5. Muscle tension
ANSWER: 2, 3, 4, 5 Restlessness or feeling keyed up, difficulty controlling anxiety, irritability, and muscle tension are DSM-IV criteria for generalized anxiety. Expansive mood and pressured speech are symptoms of bipolar disorder, not generalized anxiety.
A nurse is interviewing a client at a mental health clinic. Which care setting should the nurse determine is most appropriate for the client who recently attempted suicide and continues to report suicidal ideation? 1. An outpatient clinic 2. A community mental health center 3. An inpatient mental health unit 4. A nursing home
ANSWER: 3 A client with a history of suicidal behavior with current suicidal ideation is at-risk and in need of hospitalization. The most appropriate setting is an inpatient mental health unit that is equipped to handle the safety issues of risky behaviors. The remaining choices do not provide the level of safety that is required for the client.
A nursing assistant (NA) comments to the nurse about a recently admitted client. "I think the new admit is just faking being sick. Yesterday we couldn't get a word out of the client and today the client is talking nonstop." Which response by the nurse is most appropriate in reflecting empathy for the client? 1. "Thanks for letting me know. I think the client is just looking for attention." 2. "Please refer to the client by name and not as the new admission." 3. "The client has a condition called rapid-cycle bipolar disorder; quickly changing moods is part of the illness." 4. "The client has the right to be difficult to assess."
ANSWER: 3 About one in six clients seeking care for bipolar disorder present with a rapid-cycling pattern, with a significantly higher incidence among females. Stating that the client is seeking attention and/or is difficult does not convey client empathy. Although the information is correct in response 2, it is not the best response. Response 4 is likely to illicit defensiveness and a missed teaching opportunity with the NA.
A client is being discharged after hospitalization for a suicide attempt. Which question asked by the nurse assesses the learned prevention and future coping strategies of the client? 1. "How did you try to kill yourself?" 2. "Do you have the phone number of the suicide prevention center?" 3. "What skills can you utilize if you experience problems again?" 4. "Why did you think life wasn't worth living?"
ANSWER: 3 Asking the client directly regarding what skills he or she could utilize if similar problems occurred in the future provides the client with an opportunity to reflect on learned behaviors and to determine a plan for future prevention. How suicide was initially attempted would have been addressed during the initial assessment and does not determine future coping. Although asking the client if the suicide prevention center number is known would be helpful, the question does not determine learned coping strategies. Asking the client a "why" question is not helpful and conveys a judgmental attitude.
A nurse is developing a care plan for a client diagnosed with bipolar disorder. The inclusion of the nursing diagnosis Risk for imbalanced nutrition demonstrates that the nurse understands that clients diagnosed with bipolar disorder: 1. are compulsive eaters. 2. often suffer from poor nutrition. 3. have a greater risk for obesity. 4. take medications that can cause weight loss.
ANSWER: 3 Clients diagnosed with bipolar disorder have a greater risk for obesity. There is emerging data concerning weight gain in clients diagnosed with bipolar disorder. The reasons are multifactorial, and a client who understands the concept will be better prepared for self-monitoring and making healthy diet choices. Weight gain is a significant factor in medication noncompliance and relapse. Poor nutrition and compulsive eating are not evidence-based concepts related to bipolar disorder. Mood stabilizers cause weight gain, not weight loss.
A client who is receiving amitriptyline (Elavil®) 150 mg daily is scheduled for surgery. Which statement reflects accurate understanding of safety concerns in this situation? 1. Client could be switched to doxepin (Sinequan®) instead of amitriptyline. 2. Amitriptyline should be continued as the stress of surgery will worsen depression. 3. Amitriptyline can cause hypertensive episodes during surgery. 4. Amitriptyline can be safely reduced to 100 mg daily rather than discontinuing it.
ANSWER: 3 Hypertensive episodes have occurred during surgery with tricyclic antidepressants (TCAs). Amitriptyline is in this drug category. For client safety, the dosage should be gradually decreased and discontinued several days prior to surgery. Doxepin is in the same drug category as amitriptyline. The remaining responses do not support the client safety requirements.
A nurse is developing a care plan for an older adult female client diagnosed with depression. The inclusion of the nursing diagnosis Risk for injury due to osteopenia demonstrates that the nurse understands which evidence-based concept related to the client's medical diagnosis? 1. Geriatric female clients are more prone to injury. 2. Geriatric female clients diagnosed with depression tend to engage in self-destructive behavior. 3. Geriatric female clients with hip bone loss are at increased risk for depression. 4. Geriatric female clients have a higher incidence of confusion.
ANSWER: 3 Researchers have found a significant relationship between older female clients diagnosed with depression and increased loss of bone density. Options 1, 2, and 4 have no basis for evidence-based conclusions.
A nurse is establishing a plan of care for a client scheduled for electroconvulsive therapy (ECT). Which planned action by the nurse is unsafe when caring for this client? 1. Administering a short-acting barbiturate prior to the procedure 2. Monitoring vital signs before, during, and after the procedure 3. Administering succinylcholine after the procedure to decrease recovery time 4. Educating the client that experiencing confusion, tiredness, headache, muscle pain, or back pain after the procedure is normal
ANSWER: 3 Succinylcholine is administered before the procedure to paralyze muscles and prevent fractures. If continued after the procedure it can result in respiratory arrest. Short-acting barbiturate is administered to induce sleep during the ECT. ECT can decrease blood pressure, increase heart rate, and/or cause heart rhythm disturbances. Vital signs need to be taken prior to the procedure and be continually monitored for safety. Mild disorientation, fatigue, headache, and muscle and back pain are expected and common symptoms after ECT.
A nurse is assessing a client's alcohol intake as part of a routine screening examination. The client reports drinking 3 to 4 beers; five times per week. The client is being treated for depression with sertraline (Zoloft®) 100 mg daily. Which statement by the nurse about the client's alcohol consumption is accurate? 1. A moderate amount of alcohol helps the client forget problems and can decrease depression. 2. As long as the client does not exceed five drinks in any 24-hour period, alcohol intake is within normal limits. 3. Alcohol worsens depression and makes treatment of depression more difficult. 4. Alcohol is a stimulant that will help the client be more social.
ANSWER: 3 The nurse is correct when stating that alcohol worsens depression and makes treatment of depression more difficult. Alcohol is a central nervous system depressant. Combining alcohol and prescription medications can increase the risk of adverse effects. Additionally, alcohol blocks neurotransmitter receptor sites, decreasing effectiveness of antidepressant medication. Clients with depression use alcohol as an escape; however, avoiding problems undermines self-esteem and increases stressors which exacerbate depression. NIH guidelines define at-risk drinking as more than 14 drinks per week. Client's alcohol intake of 15-20 beers weekly exceeds that amount. Alcohol is a depressant, not a stimulant; it impairs judgment and increases impulsivity.
A client reports becoming physically ill with frequent crying spells, intense feelings of worthlessness, and loss of appetite on the anniversary of the death of the client's spouse. The client reports this has occurred for the last 5 years. Based on the reported symptoms, what should a nurse conclude that the client is experiencing? 1. Uncomplicated grief 2. Delayed grief reaction 3. Distorted grief reaction 4. Depression
ANSWER: 3 The nurse should determine that the client is experiencing a distorted grief reaction. The symptoms reported by the client are exaggerated and prolonged. In uncomplicated grief, the client's self-esteem remains intact with symptom resolution. Delayed grief reaction is the absence of the expression of grief during situations when a grief reaction is expected. A depression disorder is a form of an exaggerated or distorted grief response.
A nurse is caring for a client diagnosed with acute mania. The nurse observes coarse hand tremors and learns that the client's serum lithium level is 1.8 mEq/L. Which action should be taken by the nurse? 1. Continue to administer lithium as ordered. 2. Advise the client to limit fluids. 3. Withhold the medication and notify the physician. 4. Acknowledge that the side effects are unpleasant.
ANSWER: 3 The nurse should withhold the medication and notify the physician. Lithium is at a toxic level. This is a medical emergency requiring rapid treatment. Limiting fluids would worsen lithium toxicity. Coarse hand tremor is a symptom of lithium toxicity. not an unpleasant side effect.
Which nursing diagnosis should a nurse give highest priority when caring for a client with major depressive disorder? 1. Powerlessness 2. Potential for spiritual distress 3. Potential for injury 4. Disturbed sleep patterns
ANSWER: 3 The potential for suicidal behavior is the highest priority for clients diagnosed with major depressive disorder. The presence of powerlessness, spiritual distress, and disturbed sleep patterns are concerning but do not take priority over the potential for suicide.
A nurse is planning care for a client diagnosed with acute mania. What situation must occur prior to initiating treatment with lithium carbonate? 1. Room seclusion has proven ineffective in controlling the client's behavior. 2. The client has been fasting for 12 hours. 3. The client's history and physical results, including laboratory results, are reviewed. 4. Administration of benzodiazepine has been terminated.
ANSWER: 3 The use of lithium carbonate requires initial and ongoing health assessment and laboratory monitoring. Because lithium is excreted by the kidneys, a baseline evaluation has to be completed before treatment begins. Room seclusion is used as a last resort and is unrelated to medication administration. Having the client fast is unnecessary. Benzodiazepines are often used in treatment during the initiation phase to aid in controlling mania, as it can take up to a week for lithium to become effective.
A nurse is interpreting the serum laboratory report for a client in an emergency department. The history and reports reveal that the client has been diagnosed with bipolar disorder and receives lithium carbonate. Based on the findings of the serum laboratory report, which result would explain the client's condition of impaired consciousness, nystagmus, and seizures? Creatinine 0.8 mg/dL BUN 10 mg/dL Na 140 mEq/L Lithium 3.8 mEq/L 1. Creatinine 2. BUN 3. Na 4. Lithium
ANSWER: 4 Symptoms of lithium toxicity appear at levels greater than 1.5 mEq/L. At a level greater than 3.5 mEq/L, the symptoms of toxicity include coma, nystagmus, seizures, and cardiovascular collapse. The results of kidney function tests (blood urea nitrogen [BUN] and creatinine) are within normal limits (normal BUN values are 5-25 mg/dL; normal creatinine is 0.5-1.5 mg/dL). Normal sodium (Na) is 135-145 mEq/L.
A client is newly prescribed tramadol hydrochloride (Ultram®) for chronic pain. The client is also taking fluoxetine (Prozac®) 40 mg daily for depression. Which statement by the nurse accurately explains the interactions between the two drugs? 1. "There is no major concern with this drug combination." 2. "Tramadol hydrochloride (Ultram®) may decrease the effectiveness of fluoxetine (Prozac®)." 3. "This drug combination can increase the risk of serotonin syndrome." 4. "Selective serotonin reuptake inhibitors (SSRIs) should not be taken within 14 days of the last dose of tramadol hydrochloride (Ultram®)."
ANSWER: 3 Tramadol hydrochloride is a centrally acting analgesic that binds to mu-opioid receptors. It inhibits the reuptake of serotonin and norepinephrine in the central nervous system (CNS). Fluoxetine is an SSRI that selectively inhibits the reuptake of serotonin in the CNS. The combination of tramadol hydrochloride and fluoxetine can overactivate central serotonin receptors resulting in serotonin syndrome, a life-threatening but rare event. There is a significant potential for drug interaction with this drug combination. Tramadol hydrochloride intensifies the action of fluoxetine. SSRIs should not be taken within 14 days of an MAOI (monoamine oxidase inhibitor).
A depressed client tells a nurse, "Nothing gives me joy. Things seem hopeless." Which actions should be taken by the nurse when caring for this client? Prioritize the nurse's actions by placing each step in the correct order. _____ 1. Demonstrate genuine empathy and caring in discussing client's feelings about suicide. ______ 2. Evaluate the client's risk for suicide by direct questioning (asking about suicide intent and plan). ______ 3. Initiate suicide precautions as needed, according to policy and standards of care. ______ 4. Continue to support and monitor prescribed medical and psychosocial treatment plans. ______ 5. Assist client in maintaining nutritional needs, hygiene, and grooming. ______ 6. Contact the client's support system in collaboration with case manager and/or social services.
ANSWER: 3, 1, 2, 5, 4, 6 First evaluate the client's risk for suicide by direct questioning (asking about suicide intent and plan). Then initiate suicide precautions as needed, according to policy and standards of care. Demonstrate genuine empathy and caring in discussing client's feelings about suicide. Next, assist client in maintaining nutritional needs, hygiene, and grooming. Continue to support and monitor prescribed medical and psychosocial treatment plans. Finally, contact the client's support system in collaboration with case manager and/or social services.
A client recently diagnosed with depression tells a nurse that she is 2 months pregnant and is reluctant to take an antidepressant medication. The client asks what other treatment options are available. Which type of therapy should a nurse recommend as an alternate treatment for depression? 1. Client-centered therapy 2. Gestalt therapy 3. Therapeutic touch therapy 4. Cognitive behavioral therapy
ANSWER: 4 Cognitive behavioral therapy is a research-supported treatment that focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking. The aim of therapy is to influence and change disturbed thinking patterns and the messages that the client gleans. Client-centered and gestalt therapies are psychoanalytic modalities and not evidenced-based practices for the treatment and management of depression. Client-centered therapy is a humanistic approach that emphasizes expression of feelings through reflection and clarification. Gestalt therapy emphasizes self-expression, self-exploration, and self-awareness in the present. Therapeutic touch is used to reduce pain and anxiety and to promote relaxation.
During a client education class, a nurse is asked: "What is an effective treatment for seasonal affective disorder?" Which intervention should the nurse recommend as an evidence-based practice for the first-line treatment of seasonal effective disorder? 1. A 2-week trial of lithium carbonate 2. Individual therapy with a psychologist 3. Prescribing quetiapine (Seroquel®) 4. Light therapy
ANSWER: 4 Light therapy is an evidence-based practice to use as a first-line treatment for seasonal affective disorder. This intervention has proven effectiveness compared to psychopharmacological treatments in various placebo controls. Lithium carbonate is used to treat bipolar disorder and not seasonal affective disorder. Although there may be situations in which a person with seasonal affective disorder could seek therapy with a psychologist, it is not a first-line treatment intervention. Quetiapine (Seroquel®) is an atypical antipsychotic used for treatment of schizophrenia
A nurse is assessing a recently admitted client who is exhibiting agitation that appears to be related to acute mania. Which action should a nurse plan to utilize when caring for a client experiencing agitation related to acute mania? 1. Apply restraints to prevent the client from harming self or others 2. Involve the client in group activities to provide structure 3. Leave the client alone 4. Maintain a low level of stimuli in the client's environment
ANSWER: 4 Maintaining a low level of stimulation minimizes anxiety, agitation, and suspiciousness. The client should be offered the least restrictive treatment alternative. Restraints should be used as a last resort if other interventions are unsuccessful and the client presents imminent risk of harm to self or others. Group activities could increase level of stimuli and worsen agitation. The client's behavior must be closely observed to ensure safety. Correct nursing action is to stay with the client.
A nurse is assessing a client for suspected depression. The client is recently divorced and has a court appearance for a driving while intoxicated (DWI) charge the following week. Which response by the nurse is most therapeutic? 1. "Were you surprised that your spouse left after you got a DWI?" 2. "You aren't thinking about hurting yourself, are you?" 3. "I think you should have a substance abuse evaluation before we treat your depression." 4. "I'm concerned about your drinking. I'd like you to talk with our chemical dependency staff."
ANSWER: 4 Stating concern and referring the client to someone specializing in chemical dependency is the most therapeutic response. The client needs to be assessed for substance abuse/dependence. Response 1 projects a judgmental attitude and is not a helpful comment. Any client with suspected depression should be screened for suicide risk. However, response 2 uses poor therapeutic technique. Response 3 fails to acknowledge that both chemical dependency and depression are considered primary and need simultaneous treatment.
