NUR210 PrepU Ch. 21, 22, & 23
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 increased energy throughout the day?" "Are you experiencing insomnia every day?" "Have you recently lost weight without dieting?" "Do you have a fear of dying?" "Have you experienced difficulty with concentration when working?"
"Are you experiencing insomnia every day?" "Have you recently lost weight without dieting?" "Have you experienced difficulty with concentration when working?"
A bipolar client presents to the clinic with reports of headaches and feeling more irritable than usual. What is the best nursing response? "Let's get some bloodwork done." "Can you tell me more about these symptoms?" "Have you been taking your medication correctly?" "Continue to take your medication because the symptoms are minor."
"Can you tell me more about these symptoms?"
Electroconvulsive therapy would be contraindicated for a client with: increased intracranial pressure. myocardial infarction, five years ago. hypertension. stroke, 10 years ago.
increased intracranial pressure.
A client with mania attempts to hit the nurse during a conversation. Which is the best response by the nurse? "Do not swing at me again. If you cannot control yourself, we will help you." "Why do you continue that kind of behavior? You know I won't let you do it." "Stop that. I didn't do anything to provoke an attack." "If you do that one more time, you will be put in seclusion immediately."
"Do not swing at me again. If you cannot control yourself, we will help you."
The nurse is working with a client who has been diagnosed with depression. When performing a strength assessment with the client, what is the nurse's best statement or question? "It's important that you remember that you're an exceptionally strong and capable person." "What can the care team do to help you become a stronger person?" "Do you consider yourself to be a strong person overall?" "How have you dealt with feelings like this in the past?"
"How have you dealt with feelings like this in the past?"
A client with a history of self-harm reports lethargy, loss of appetite and insomnia to the nurse. The client states that she relies heavily on sleep medications that her primary care provider prescribed. What is the nurse's priority assessment question? "How many of the sleeping pills do you have at home right now?" "Have you ever had to take sleeping pills at any other point in your life?" "How do you feel about having to take medication to help you sleep?" "Are their any strategies you've tried so that you wouldn't need sleeping pills?"
"How many of the sleeping pills do you have at home right now?"
The nurse provides medication teaching to a client with bipolar disorder. Which statement indicates that teaching about divalproex sodium was effective? "I can take this with my herbal supplements." "I will stop taking if side effects occur." "I can take this with a meal." "I can drink a cocktail with dinner."
"I can take this with a meal."
At 1 a.m., 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. What would be the nurse's most therapeutic response? "You must really be upset to want a pass immediately; I'll give you some medication." "I can't call the psychiatrist now, but you and I can talk about your request for a pass." "Go to the day room and wait while I call your psychiatrist." "Don't be unreasonable. I can't call the psychiatrist at this time of night."
"I can't call the psychiatrist now, but you and I can talk about your request for a pass."
The nurse is providing emotional support and education to a client experiencing severe depression. Which statement made by the client indicates the teaching is effective?
"I know I can't help this behavior since it is an imbalance of chemicals." Rationale: Neurobiologic theories posit that 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.
After educating a client with bipolar disorder on his prescribed lithium therapy, the nurse determines that additional education is needed when the client states which of the following? "I need to avoid drinking any alcohol." "I need to report any problems with severe diarrhea or slurred speech." "I can use sugarless candies to help with any metallic taste." "I need to cut back on my salt intake when it's really hot outside."
"I need to cut back on my salt intake when it's really hot outside." Rationale: Clients should increase their intake of salt during periods of perspiration (e.g., when it is hot outside) and periods of increased exercise and dehydration. Severe diarrhea and slurred speech suggest moderate toxicity, which needs to be evaluated. Alcohol interacts with lithium, causing increased serum concentrations of the drug, placing the client at risk for toxicity. Sugarless candies and throat lozenges can help to combat metallic taste.
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 used to enjoy taking ecstasy, but I know it isn't safe with my new medication." "I stopped taking St. John's wort 4 weeks ago." "I started taking diet pills to assist with weight loss." "I stopped drinking red wine when I started taking my new prescription."
"I started taking diet pills to assist with weight loss."
An inpatient psychiatric-mental health nurse was recently hired to work on the inpatient unit. Which statement made by the nurse would indicate a need for further teaching about the nurse's inpatient-setting client responsibilities? "In this setting, nurses will be administering medications and closely monitoring the client's symptoms." "Inpatient settings focus on utilizing technology for the client psychotherapy sessions." "Nurses are responsible for conducting psychoeducational groups with clients and their families." "An important aspect of the inpatient setting is to structure and maintain a therapeutic environment for the client."
"Inpatient settings focus on utilizing technology for the client psychotherapy sessions."
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 correlated with low intellectual ability Onset of depression is most common in middle-aged persons Onset of depression is common in adolescence Depression is twice as common in women than in men
Depression is twice as common in women than in men
In a report, the nurse learns that a client with mania has not slept since admission 2 days ago. On entering the day room, the nurse finds this client dancing to loud music. The best response by the nurse would be ... "Turn the radio down so we can hear ourselves talk." "Let's go to the conference room and talk for a while." "How are you ever going to get any rest if you keep that music on?" "Do you think you could sit still for a few minutes so we can talk?"
"Let's go to the conference room and talk for a while."
A client who suffers from bipolar disorder is admitted to a mental health unit for a manic episode. Which statement by the client supports this diagnosis? "I feel really tired today. I'm gonna just rest for a while." "Look at my new purple hat. It goes well with my zebra-striped pants." "You need to tell those other patients to be quiet so I can sleep." "I can't go to therapy looking like this. My hair is a mess."
"Look at my new purple hat. It goes well with my zebra-striped pants."
A psychiatric-mental health nurse has learned about the treatment goals for clients diagnosed with depression. Which statement made by the nurse would indicate a need for further teaching? "Psychiatrists are the primary discipline treating clients diagnosed with depression." "Symptoms are aimed to be reduced in the client." "A focus of treatment is to decrease the likelihood of a recurrence depressive event for the client." "Occupational and psychosocial functioning should increase for the client with treatment."
"Psychiatrists are the primary discipline treating clients diagnosed with depression."
A client taking paroxetine reports to the nurse that they are experiencing nausea since beginning the medication. Which is the best response by the nurse? "Contact the health care provider for a change in medication." "Take the medication with food or a light snack." "Stop the medication for a few days to see if the nausea goes away." "This is an expected side effect that will improve with time."
"Take the medication with food or a light snack." Rationale: Taking selective serotonin reuptake inhibitors with food usually eliminates nausea. There is a delayed therapeutic response to antidepressants. The client should not stop taking the drug. It would be appropriate to reassure the client that this is an expected side effect that will improve with time, but that would not be done initially. A change in medication may be indicated if the nausea is intolerable or persistent, but that would not be done initially.
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? "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression." "The physician diagnoses depression when a client has feelings of sadness several times a year." "Depression is a mood variation to life events." "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."
"The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."
A client who is depressed begins to cry and states, "I'm just really sick of feeling this way. Nothing ever seems to go right in my life." Which would be the most appropriate response by the nurse? "Don't cry. Try to look at the positive side of things." "Hang in there. Your medication will start helping in a few days." "Nothing ever goes right?" "You are feeling really sad right now. It's a hard time."
"You are feeling really sad right now. It's a hard time." Do not cut off interactions with cheerful remarks or platitudes. Do not belittle the client's feelings. Accept the client's verbalizations of feelings as real, and give support for expressions of emotions, especially those that may be difficult for the client (like anger). Allow (and encourage) the client to cry. It is important that the nurse does not attempt to "fix"the client's difficulties
A client with bipolar disorder states to the nurse that they have been experiencing mania and depression every day for 2 weeks and cannot work or take care of their children. Which is the best response by the nurse? "That is typical in bipolar disorder and happens to all clients at some point in the illness." "We will have to keep you in the hospital involuntarily since you could be a danger to yourself." "You are rapid-cycling and we may need to make an adjustment with your medication." "Are you sure that you are taking your medication for bipolar disorder as prescribed?"
"You are rapid-cycling and we may need to make an adjustment with your medication." Rationale: A mixed episode is diagnosed when the person experiences both mania and depression nearly every day for at least 1 week. These mixed episodes are often called rapid cycling. The medication regimen may need to be altered to control these symptoms. These symptoms are not typical with all clients with bipolar disorder. The nurse should not respond in an accusatory manner with questioning the client about not taking medication. This can occur even when a client takes their medication as prescribed. The client does not meet the criteria for involuntary admission and may be managed in an outpatient setting.
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? "The medication has eliminated your symptoms so you'll need to keep taking it for the rest of your life." "Since you have no more symptoms, you can stop taking the medications tomorrow." "You'll need to continue the medication for about 6 to 12 months to see how things go." "It's probably best to continue the medication for another month, gradually decreasing the dosage over that time."
"You'll need to continue the medication for about 6 to 12 months to see how things go." Rationale: Even after the first episode of major depression, medication should be continued for at least 6 months to 1 year after the client achieves complete remission of symptoms. If the client experiences a recurrence after tapering the first course of treatment, the regimen should be reinstituted for at least another year, and if the illness reoccurs, medication should be continued indefinitely.
Which is an anticonvulsant used as a mood stabilizer? Venlafaxine Phenelzine Bupropion Divalproex
Divalproex
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? 2.0 mEq/L 2.6 mEq/L 1.0 mEq/L 1.6 mEq/L
1.0 mEq/L
A patient with bipolar I disorder being treated with lithium is brought to the emergency department. Assessment reveals moderate ataxia, slurred speech, asymmetric deep tendon reflexes, muscle twitching and increased muscle tone. The nurse suspects moderate lithium toxicity. Which lithium blood level would support the nurse's suspicion? 1.0 mEq/L 2.2 mEq/L 1.4 mEq/L 2.8 mEq/L
1.0 mEq/L
A client who was receiving a monoamine oxidase inhibitor (MAOI) is to be switched to a selective serotonin reuptake inhibitor (SSRI). The nurse would expect to begin administering the SSRI how many days after the MAOI is discontinued? 7 days 14 days 21 days 28 days
14 days
A client with bipolar disorder has been taking lithium, and today the client's serum lithium level is 2.0 mEq/L (2.0 mmol/L). What effects would the nurse expect to see? Fever, muscle rigidity, and disorientation Constipation and postural hypotension Nausea, diarrhea, and confusion None; the serum level is in therapeutic range
Nausea, diarrhea, and confusion
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? Euphoria along with poor decision making ability Disregard for personal hygiene including cleanliness and appearance A loss of interest or inability to derive pleasure for previously enjoyed activities A stooped posture and nonverbal signs of a depressed mood
A loss of interest or inability to derive pleasure for previously enjoyed activities
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 feminist viewpoint of depression. A psychodynamic interpretation of the client's major depressive disorder. A reason the client has become lesbian at the age of 23. A biological explanation for the client's depressive disorder.
A psychodynamic interpretation of the client's major depressive disorder.
A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what? Demonstrated examples of unwise decisions Self-report of being sad after a break up A significant decrease in appetite Claims by family, friends, or coworkers that the client is depressed
A significant decrease in appetite
A client experiencing acute mania from bipolar disorder refuses hospitalization. Which type of treatment would the nurse anticipate being prescribed for this client? intensive outpatient program primary care visits community clinic virtual health care
intensive outpatient program
A client has just been diagnosed with a major depressive disorder following recent problems with the client's mood, work performance, and sleep quality. When planning this client's care, the nurse should anticipate what interventions? Select all that apply. Administration of a selective serotonin re-uptake inhibitor (SSRI) Administration of a monoamine oxidase inhibitor (MAOI) Phototherapy Cognitive therapy Repetitive transcranial magnetic stimulation (rTMS)
Administration of a selective serotonin reuptake inhibitor (SSRI) Cognitive therapy
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. Remind the patient that weight gain is better than feeling depressed. Advocate with the physician to consider changing the medication. Reassure the patient that the weight gain is not that significant. Recommend a nutritionally balanced diet. Recommend daily exercise.
Advocate with the physician to consider changing the medication. Recommend a nutritionally balanced diet. Recommend daily exercise. Rationale: To relieve the side effect of weight gain from an antidepressant, appropriate nursing interventions are to help the client explore a change in medication, promote a nutritionally balanced diet, and recommend regular exercise.
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? The presence of objective signs of depression without the presence of anhedonia The client's admission of a mood disorder An elevated mood that lasts for at least 1 week Failure to respond to conventional pharmacological treatments for mood disorders
An elevated mood that lasts for at least 1 week
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? Anticoagulants Antibiotics Anticonvulsants Antianxiety
Anticonvulsants
A psychiatric-mental health nurse is working at a community mental health center that serves a large pediatric population. When assessing children for depression, which information would be most important for the nurse to keep in mind? Children commonly experience the same symptoms of depression as adults. The mood observed in children with depression is more often sad than irritable. The risk of suicide is low in children and adolescents. Anxiety symptoms are more commonly noted in children who are depressed.
Anxiety symptoms are more commonly noted in children who are depressed.
A client is admitted to the psychiatric-mental health unit for severe depression. Two days after being admitted, the client has more energy and appears happy. What is the nurse's priority intervention with the client? Assess the client for suicide risk. Evaluate the medication effects. Praise the client for overcoming their depression. Complete a full head-to-toe assessment on the client.
Assess the client for suicide risk.
The nurse provides care to a hospitalized client who is diagnosed with major depressive disorder (MDD). Which is the priority when planning care for this client? Document the client's response to prescribed medications. Monitor the client for side effects and adverse reactions to prescribed medications. Teach the client about alternative and complementary therapies. Assess the client's risk for suicide.
Assess the client's risk for suicide.
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?" "Continue to take your medication because the symptoms are minor." "Let's get some bloodwork done." "Have you been taking your medication correctly?"
Can you tell me more about these symptoms?
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? Mannitol Lithium Methyldopa Carbamazepine
Carbamazepine
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? Worthlessness Catatonia Insomnia Fatigue
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 pacing around the bedroom. Client has experienced work-related stress. Client has stayed up most of the night watching television. Client is avoiding eye contact and visibly shaking.
Client is avoiding eye contact and visibly shaking.
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 pacing around the bedroom. Client has stayed up most of the night watching television. Client has experienced work-related stress. Client is avoiding eye contact and visibly shaking.
Client is avoiding eye contact and visibly shaking.
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? Describe the benefits of exercise to the client and state that privileges will be lost if the client does not participate Collaborate with the client to choose a manageable amount of exercise and acknowledge the client's subsequent effort Teach the client isometric exercises that the client can complete while in bed Arrange for the client to exercise approximately 1 hour after antidepressant administration
Collaborate with the client to choose a manageable amount of exercise and acknowledge the client's subsequent effort
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 will be performed first? Decrease the client's environmental stimuli. Tell the client about hospital rules and policies. Give the client feedback about the client's behavior. Introduce the client to other staff on the unit.
Decrease the client's environmental stimuli.
A nurse is preparing to administer pharmacotherapy as part of the treatment plan for a client with bipolar disorder. The nurse understands that this therapy is designed to achieve which goal? Select all that apply. Decreased frequency of manic episodes Prevention of future episodes Rapid control of symptoms Cure of the disorder Decreased severity of manic episodes
Decreased frequency of manic episodes Prevention of future episodes Rapid control of symptoms Decreased severity of manic episodes
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 Sleep disturbance Suicide Decreased energy
Dehydration Rationale: With significant weight loss in older adults with moderate to severe depression, assess for dehydration. monitor for suicide, sleep disturbance, and decreased energy, however they are not related to the weight loss/nutrition
The nurse provides care to a client who is experiencing side effects due to prescribed antidepressant medication. Which nonpharmacologic intervention does the nurse include in the plan of care for the client who is experiencing dry mouth? Select all that apply. Drink 6 to 8 cup of water per day. Increase consumption of fresh fruits and vegetables. Use sugarless gum and/or lozenges. Change positions slowly. Exercise daily.
Drink 6 to 8 cup of water per day. Use sugarless gum and/or lozenges. Rationale: Nonpharmacologic interventions to treat dry mouth, caries, and inflammation of the mouth include the use of sugarless gum or lozenges, increasing the intake of water to at least 6 to 8 cups per day, and using a toothpaste that is specific for dry mouth. If these interventions are ineffective, pharmacologic interventions can be implemented including bethanechol and pilocarpine drops. Exercising daily is an intervention for the client who experiences weight gain due to pharmacologic antidepressant therapy. Changing positions slowly is a nonpharmacologic intervention for the client who experience orthostatic hypotension, not dry mouth. Increasing the consumption of fresh fruits and vegetables is an appropriate intervention for the client experiencing constipation, not dry mouth.
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? Ensure that a family member takes responsibility for administering medications. Remind the client that the client owes it to the client's spouse and children to stay well. During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. Point out that each time the client stops taking medication, the client becomes manic again.
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? Cyclothymic disorder Dysthymic disorder Hypomania Seasonal affective disorder
Dysthymic disorder
Which signs would a nurse expect in a client diagnosed with serotonin syndrome? Select all that apply. Elevated temperature Hyporeflexia Elevated heart rate Agitation Constipation
Elevated temperature Elevated heart rate Agitation
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 consider meditation. Encourage the client to track dietary intake through journaling. Encourage the client to start with easy tasks, such as talking to a friend. Encourage the client to join a support group.
Encourage the client to start with easy tasks, such as talking to a friend.
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? Encouraging attendance at group cognitive-behavioral therapy on the unit. Ensuring that the client is not permitted to use anything that would be potentially dangerous. Encouraging the client to express feelings of isolation following the recent immigration. 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. Rationale: 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.
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? Visual hallucinations Dysphoria Grandiose delusions Neologisms
Grandiose delusions
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? Anorexia Depression Anxiety Grandiosity
Grandiosity
Which meal would the nurse provide to best meet the nutritional needs of a client who is manic? Peanut butter sandwich, chips, cola Fried chicken, mashed potatoes, milk Ham sandwich, cheese slices, milk Spaghetti, garlic bread, salad, tea
Ham sandwich, cheese slices, milk Rationale: Finger foods, or things clients can eat while moving around, are the best options to improve nutrition. Such foods should be as high in calories and protein as possible. Sandwiches and cheese are finger foods and are calorie-dense. Chips and cola are not nutritious, even though they are high in calories. Fried chicken, potatoes and spaghetti cannot be eaten while the client is moving.
Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder? Insulting, provocative behavior directed at staff Bizarre, colorful, inappropriate dress Grandiose thinking and poor concentration Hyperactivity, dismissing meals, and sleep disturbance
Hyperactivity, dismissing meals, and sleep disturbance Rationale: Safety needs are always the first priority in care planning. A client who has not eaten or slept for several days and has been extremely hyperactive may be at risk for exhaustion and malnutrition and the implications of those states. Although thought disorder, expansive mood, and dress are important assessment information, priority interventions must center on the basic needs of hyperactivity, dismissing meals, and sleep disturbance.
A nurse is assessing a client with depression. During the assessment, the nurse notes that the client's emotional expression does not match what the client is saying. The nurse would document this as which type of affect? Blunted Incongruent/Inappropriate Labile Flat
Incongruent/Inappropriate
Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? Get daily exercise Increase hydration Take medication with food Eat a nutritionally balanced diet
Increase hydration
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. Lack of coping abilities Life and environmental stressors Family history of depression Current substance use or abuse Medical comorbodity
Lack of coping abilities Life and environmental stressors Current substance use or abuse
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? Antidepressant therapy Light therapy Psychotherapy Electroconvulsive therapy
Light therapy
A psychiatric-mental health nurse is preparing a review class for a group of nurses at the community mental health center. The topic is mood-stabilizing drugs. After teaching the class about the different drugs that may be prescribed, the nurse determines that the teaching was successful when the group identifies which drug as being prescribed most often? Lithium Carbamazepine Lamotrigine Divalproex
Lithium Rationale: Mood-stabilizing drugs include lithium carbonate (Lithium), divalproex sodium (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal). Of these, lithium is the most widely used.
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? Thyroid level Liver function etc etc
Liver function
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? Switch to a DASH diet. Limit fluid intake to 6-8 oz (180-340 mL) glasses a day. Maintain daily sodium intake. Monitor weight pattern.
Maintain daily sodium intake.
A client with bipolar disorder takes lithium 300 mg 3 times daily. The nurse is educating the client on its use, side effects, and need for compliance. Which outcome does the nurse evaluate that indicates the dose is having the beneficial response for the client? Minimal mood swings Increased feelings of self-worth Weight gain of 7 pounds in the last 6 months Feels sleepy and less energetic
Minimal mood swings
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? Interaction of lithium with another medication Need for an increased dose of medication Common side effects of the drug Moderate lithium toxicity
Moderate lithium toxicity
A client in an acute manic phase is pacing the halls and talking in a loud voice with pressured speech. The client is overly involved with coclients and frequently threatens and disrupts others on the unit. After administering lithium treatment for the client, the nurse can expect the plan of care to include which additional intervention? Assessing for post-electroconvulsive therapy disorientation and confusion. Monitoring phototherapy response. Monitoring blood levels of the medication. Teaching the client to avoid foods with tyramine.
Monitoring blood levels of the medication.
Which of the following is an adverse effect of lithium? Ataxia and urinary retention Anxiety and motor retardation Constipation and insomnia Nausea and diarrhea
Nausea and diarrhea
The mental health nurse provides care to clients who are hospitalized for the treatment of depression. Which is the priority nursing action when administering medications to a client who was admitted after a suicide attempt? Compare baseline and current laboratory results. Assess for adverse reactions and side effects. Monitor the client's vital signs. Observe the client for cheeking.
Observe the client for cheeking.
A depressed older adult client is being treated with a tricyclic antidepressant (TCA). For which clinical manifestations should the nurse monitor the client? Diarrhea and electrolyte imbalance Photosensitivity and skin rashes Pseudoparkinsonism and tardive dyskinesia Orthostatic hypotension and urinary retention
Orthostatic hypotension and urinary retention Rationale: Orthostatic hypotension and urinary retention are common side effects of TCAs. Photosensitivity, skin rashes, pseudoparkinsonism, and tardive dyskinesia are common side effects of older antipsychotics. Diarrhea and electrolyte imbalances are side effects of lithium.
A 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? Bipolar disorder Mild depressive disorder Rapid cycling disorder Persistent depressive disorder
Persistent depressive disorder
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? Disinhibition and elevated mood Increased muscle tension and anxiety Poor judgment and hyperactivity Vegetative signs and poor grooming
Poor judgment and hyperactivity
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? Decreased complaints of pain Increased focus Increased energy level Psychomotor retardation
Psychomotor retardation
A client has been admitted to a psychiatric-mental health facility in a manic state. The client's spouse accompanies the client to the facility and informs the nurse that the client has been displaying manic symptoms for the past 2 weeks. The spouse reports that the client has not slept for the past 2 days and that the client has not eaten anything for at least 3 days. Which would be the priority nursing diagnosis for this client? Ineffective health maintenance Risk for other-directed violence Risk for suicide Risk for imbalanced nutrition
Risk for imbalanced nutrition
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 nursing diagnosis has priority? Ineffective coping related to inadequate stress management Risk for suicide related to highly lethal plan Hopelessness related to recent divorce Spiritual distress related to conflicting thoughts about suicide and sin
Risk for suicide related to highly lethal plan
Which type of antidepressants are rarely fatal in overdose? Tricyclics MAOIs SSRIs Atypical
SSRIs
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? Monoamine oxidase inhibitors Tricyclic antidepressants Selective serotonin reuptake inhibitors Serotonin norepinephrine reuptake inhibitors
Selective serotonin reuptake inhibitors
A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. Which is the priority action by the nurse? Take the client out of the dining room and avoid lunch until the client calms down. Inform the client that they will lose the privilege of eating in the dining room. Allow the client to take the food and replace the other clients' trays. Set and maintain limitations on behavior to avoid threat to others' rights.
Set and maintain limitations on behavior to avoid threat to others' rights. Rationale: The nurse must set limits on this intrusive behavior because other clients have the right to be protected. The client is in the manic phase; the client may not calm down after lunch. The behavior could be an imminent threat to individual safety for many reasons, infection control included. The client's need for food and fluids does not supersede any of the other clients' needs for food and fluids.
A nurse is assessing a client who is brought to the emergency department. The nurse suspects that the client is experiencing mania. Which finding would support the nurse's suspicion? Select all that apply. Easily distractible Sleepiness Slowness of speech Statements of self-importance Flight of ideas
Statements of self-importance Flight of ideas Easily distractible
A client with depression is 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 Giving the client several choices of projects so the client can choose a favorite Staying away from the client during the session to encourage free expression Allowing the client to direct participation at the client's own pace
Structuring the activity to facilitate completion of one specific task
A nurse is preparing a presentation about suicide for a local community group. What would the nurse most likely include? Men often use pills to commit suicide. Hispanic individuals have the highest rates of suicide. Suffocation is a common means of suicide among children. Women typically use firearms in their attempts.
Suffocation is a common means of suicide among children.
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 tolerating the initial drug therapy. Suicidality is of little concern. The level of depression is mild to moderate. The client is experiencing catatonia.
The client is experiencing catatonia. 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).
A client is prescribed sertraline for the treatment of depression. Which outcome would be appropriate to determine an early favorable response to antidepressant medication? The client will demonstrate assertive communication skills. The client will establish a balance of rest, sleep, and activity. The client will describe signs and symptoms of major depression. The client will make plans to attend one community social activity a week.
The client will establish a balance of rest, sleep, and activity. Ability to balance rest, sleep, and activity demonstrates improvement in major depression. Understanding the disorder may occur later when client cognition has improved enough to be able to process information. Initiation of community social activity occurs when the client has increased energy. Assertive communication is learned and practiced after the depression lifts.
The nurse is creating a plan of care for a client with major depressive disorder. Which outcome will the nurse assign as the highest priority? The client will independently carry out activities of daily living. The client will avoid causing harm to others. The client will be free from stress. The client will not experience agitation.
The client will independently carry out activities of daily living.
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 record the number of clothing changes per day. The client will verbalize feelings of low self-esteem with nursing staff. The client will refrain from being intrusive with others and change clothing only twice per day. The client will identify two trusted staff members of the opposite sex to help choose appropriate dress.
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. The client will differentiate between reality and fantasy. The client will identify factors that contribute to depression. The client will discuss the cause of the fatigue.
The client will reframe negative thoughts in a more positive way.
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 potassium level, the lower the lithium level will be. The higher the sodium level, the lower the lithium level will be. Changes in diet will not affect lithium levels. Lithium has few interactions with other drugs.
The higher the sodium level, the lower the lithium level will be. Rationale: Lithium is a salt, so the interaction between lithium and sodium levels in the body and between lithium level and fluid volume in the body are crucial issues to consider. The higher the sodium levels, the lower the lithium level will be and vice versa.
Which is a true statement regarding depressive disorders? It is the fourth leading cause of years lost because of disability. The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated. They are more prevalent in men than women. Depression in older adults is easier to diagnose.
The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated.
Which of the following is a cognitive intervention for clients diagnosed with depression? Social skills training Problem solving Thought stopping Activity scheduling
Thought stopping
When completing a baseline assessment of a client with depression, which diagnostic tests would the nurse anticipate? Coagulation profile Thyroid function tests Renal function tests Abdominal ultrasound
Thyroid function tests
The nurse is screening clients in the community for major depressive disorder (MDD). Which client has the greatest risk for developing MDD? an older adult female client of African descent with a personal history of depression an older adult male client of Native American/First Nations heritage who is diagnosed with diabetes mellitus a young adult White female client with a family history of depressive disorder a young adult male client of Hispanic heritage with a current diagnosis of substance use disorder
a young adult White female client with a family history of depressive disorder
The nurse is working with a client with a depressive disorder. Which of the following should be a nursing care focus for this client? activity intolerance related to anergia altered body image perception self-harm related to reckless behavior sleep deprivation
activity intolerance related to anergia anergia is a common symptom of depression
A 10-year-old client is being evaluated for severe physical and verbal outbursts that occur approximately three times a week. The rage outbursts are disruptive to the child's school performance and have been occurring for 2 years. What diagnosis would the client be evaluated for? disruptive mood dysregulation disorder premenstrual dysphoric disorder persistent depressive disorder (dysthymia) major depressive disorder
disruptive mood dysregulation disorder
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... assessing Carrie's current suicidal ideation and putting her on suicide precautions. assessing Carrie's recent suicide attempt and identifying factors that may have contributed to it. rehydrating Carrie by forcing fluids. assisting Carrie with her activities of daily living, including a shower and clean clothing.
assessing Carrie's current suicidal ideation and putting her on suicide precautions. 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 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. obsessive desire to exercise excessive guilt disruption in sleep disruption in concentration disruption in appetite
excessive guilt disruption in sleep disruption in concentration disruption in appetite
A nurse is caring for a client diagnosed with depression. The provider believes the depression is caused by a deficiency or dysregulation with the client's neurotransmitters or in their receptor functions. Which theory supports the provider's beliefs on etiology of the client's depression? neurobiological theory neuroendocrine theory psychoneuroimmunology genetic theory
neurobiological theory
A client with bipolar disorder has a plasma lithium concentration of 2.7mE/L. Which finding would a nurse most likely assess in this client? Select all that apply. fasciculations tinnitus incoordination seizures nystagmus
fasciculations seizures nystagmus Rationale: A plasma lithium concentration of 2.7 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 2.5mE/L.
A psychiatric-mental health nurse is teaching a client with mania and family about signs and symptoms associated with relapse. The nurse determines that the teaching was successful when the patient and family identify which sign or symptom? Select all that apply. Inability to concentrate on a topic Loss of appetite Decreased energy level Talking faster than usual Irritability
inability to concentrate on a topic talking faster than usual irritability
A client is being screened for risk factors of depression. Which risk factor(s) is associated with the development of depression? Select all that apply. responsive support system family history of depressive disorder prior episode(s) of depression present of life and environmental stressors current substance use of abuse lack of coping ability
family history of depressive disorder prior episode(s) of depression present of life and environmental stressors current substance use of abuse lack of coping ability
A client is being evaluated 3 days after beginning a new prescription for an antidepressant medication. Upon assessment, the client is agitated, has a fever, and is shivering. Which adverse reaction is the client experiencing? hypertensive crisis suicidal ideations anticholinergic syndrome serotonin syndrome
serotonin syndrome
When developing a plan of care for a client with depression who is receiving medication therapy, what would the nurse identify as the primary goal during the acute phase? discontinuation effective prophylaxis relapse reduction symptom reduction
symptom reduction