WEEK 11 [ADN240] "DEPRESSION, POSTPARTUM, MOOD & AFFECT"
The nurse on the postpartum unit demonstrates techniques to the mother to feed the newborn. The nurse then observes the mother following her technique. The patient is exhibiting which stage of maternal role attainment
Anticipatory
Which term describes affect that is congruent with the immediate situation?
Appropriate
A client experiencing situational depression after losing a good job tells the nurse, "I am tired of always having to start over." What can the nurse do to assist this client?
Ask what the client has done in the past to make "starting over" so successful. Encourage the client to maintain a consistent exercise plan. Encourage the client to take the time to rest and relax.
The client states to the nurse, "I take citalopram (Celexa) 40 mg every day, and I have also been taking St. John 's wort 750 mg daily for the past 2 weeks." Which manifestations would lead the nurse to suspect that the client is developing serotonin syndrome? (Select all that apply.)
Ataxia Headache Diaphoresis
The nurse is conducting a follow-up interview with a client using alternative therapy to aid in the treatment of depression. Which observations indicate that yoga therapy has been helpful for this client? (Select all that apply.)
Attentive during the interview Motivated to return to work Expressed satisfaction with treatment
The nurse is providing medication teaching with Harold Jackson, a 22-year-old male client who is prescribed a monoamine oxidase inhibitor. What should the nurse emphasize when teaching Harold about this medication?
Avoid foods containing tyramine
The nurse is preparing an educational seminar on depression for a community health fair. Which strategies should the nurse include to reduce depressive episodes? (Select all that apply.)
Be aware of family risk factors Obtain adequate rest Have regular visits with the healthcare provider Build a strong support system
Danial Kvitkova is an 85-year-old Caucasian male client who has been receiving hemodialysis for several years for chronic renal failure. The nurse notes a change in Danial's affect over the last several hemodialysis treatments. Which would be the most appropriate assessment of Danial by the nurse?
Change in spouse's health status or loss of spouse
During a health interview, 38-year-old female client, Doreen Macintyre, does not directly answer any of the nurse's questions and demonstrates despondency. How should the nurse document Doreen's affect during the interview?
Client has a depressed affect.
The nurse is visiting the home of a new mother and full-term infant. During the course of the visit, the nurse suspects that the mother is experiencing early signs of postpartum depression. How did the nurse come to this conclusion?
Client scored 13 on the Edinburgh Postnatal Depression Scale
What kinds of weather will cause symptoms related to seasonal affective disorder (SAD) to be more prominent?(Select all that apply.)
Cold Rainy Cloudy
During the morning report, the nurse learns that a client 's affect is flat. What should the nurse expect when interacting with this client?
Complete lack of emotional response
A client diagnosed with major depressive disorder is admitted to the mental health unit because of attempted suicide. The nurse identified the problem of impaired self-care. Upon evaluation, What data indicate that the client achieved the outcome identified for this problem
Completes shower and brushes teeth independently
What are the risk factors for the development of depression?(Select all that apply.)
Dysfunctional family relationship Family member with depression Childhood sexual abuse
The nurse is assessing a new client on the mental health unit. The client states that she has been depressed most of the time for the past 2 years, is unable to cope with family responsibilities, and has frequent thoughts of suicide and death. Based on these data, which type of diagnosis does the nurse anticipate?
Dysthymic disorder
Stephanie Willard is a 33-year-old woman who comes to the health clinic for her follow-up postpartum appointment. She admits that she has felt overwhelming sadness since the birth of her infant. Which screening tool should the nurse use to assess her emotional status?
Edinburgh Postnatal Depression Scale (EPDS)
The nurse is providing care to a postpartum mother who also has a child, age 3, at home. Which action by the nurse would facilitate bonding between the new baby and the sibling?
Educating the new parents on the open visitation and rooming-in policy at the hospital
A nurse is performing research on the etiology, pathophysiology, and treatment of adjustment disorder with depressed mood. What research will the nurse most likely find regarding exercise and this disorder?
Evidence suggests that physical exercise is as effective as cognitive-behavioral therapy (CBT) or medication in reducing depression.
Which are cognitive characteristics of a manic state?Select all that apply.
Experiences hallucinations Believes self is unusually beautiful Grandiose self-beliefs
A client's spouse complains that his wife 's depression isn't any better after taking an antidepressant medication for 1 week. What action should the nurse initially take?
Explain that it may take 1-3 weeks to see any improvement.
The nurse is assessing a client for postpartum blues. Which feelings voiced, or behaviors observed, might the nurse document regarding a client experiencing postpartum blues? (Select all that apply.)
Fatigue Tearfulness Overwhelmed
The nurse is completing a health history on a client with seasonal affective disorder (SAD). What data should the nurse obtain during this interview? (Select all that apply.)
Feelings of guilt Medical history Anhedonia Sleep disturbances
Mrs. Harper gave birth 12 hours ago and successfully bonded with her newborn. What activity would the nurse recommend to best encourage attachment between mother and infant?
Fingertipping
The spouse of a client who passed away a few moments ago is sitting in the room staring into space. When asked if there is anything that can be done at this time, the spouse begins to laugh. Which terms should the nurse use to describe the spouse's affect at this time? (Select all that apply.)
Flat Inappropriate
The mother of twin toddler girls asks the nurse to separate them at the time of annual inoculations because they will both"fly off the handle" at the same time, making it difficult to control the situation. Which information about affect is this mother describing to the nurse?
Genetic influence
A nurse is caring for a client with an adjustment disorder with depressed mood. The nurse wants to perform interventions that will promote hope for the client. What intervention best promotes hope in this client?
Help clients to identify ways in which they have control of their lives.
The nurse is caring for a client with postpartum depression. Which intervention should the nurse include in the client's care? (Select all that apply.)
Help facilitate bonding with the infant Use a depression scale to assess the client's status Educate the client and family about signs and symptoms of postpartum depression Provide resources and referrals as needed
A client experiencing situational depression over the loss of a spouse is overwhelmed with having to close the spouse's business, settle finances, and figure out a way to survive financially. What can the nurse do to help this client?
Help the client prioritize things that need to be accomplished Help the client focus on strengths
During a routine physical examination, a client tells the nurse, "I don't know what to do anymore since my husband died and left me alone." Which nursing diagnosis would be appropriate for the client at this time?
Helplessness
The nurse is caring for a client in whom postpartum depression is suspected. Which question is most appropriate for the nurse to ask this client during the diagnostic process?
How many hours of sleep are you getting each night?
During a health history assessment, the nurse first believed that a client was experiencing manifestations of grief until a specific comment was made. What did the client state that helped the nurse determine that the client is experiencing depression?
I am a complete failure.
A client is being admitted for treatment of major depressive disorder. Which symptom should the nurse anticipate the client would experience during hospitalization?
Insomnia
Which terms do healthcare professionals use to describe affect?Select all that apply.
Intensity Congruence Stability Range
At the conclusion of an appointment with a behavioral therapist, a client with anger management issues asks the nurse why the therapist believes the client needs to start taking serotonin. Which response should the nurse make to the client?
It is associated with aggressive behavior.
Madison Grange is a 27-year-old female with symptoms of hyperactivity, confusion, hallucinations, and delusions. The nurse determines that Ms. Grange is most likely experiencing postpartum psychosis. Which medication does the nurse anticipate will be ordered for Ms. Grange?
Lithium
A client, who usually demonstrates an appropriate affect, becomes irritated and angry after learning that a community health clinic is closing and care will need to be obtained 20 miles away. What should the nurse suspect as being the reason for this client's change in affect?
Location of the clinic 20 miles away
A 42-year-old was admitted to the mental health unit after a failed suicide attempt by drug overdose. The client sought help when her husband informed her of his decision to leave her and the children after 21 years of marriage. Upon initial contact with the nurse, the client looked exhausted, affect was sad, movements and responses were slowed, and self-care impairments were evident. What type of disorder would the nurse suspect the client is experiencing?
Major depressive disorder
You are taking a mental health assessment of Mrs. Castillo, a woman in her 30's. Mrs. Castillo tells you that she has been having feelings of deep sadness all summer and that she has never experienced this type of long-lasting sadness before. She tells you that she is usually optimistic and energetic, but in the past 4 months her mood has completely changed. Upon further questioning, you learn that Mrs. Castillo has two children, ages 2 and 5, and that a year ago she and her family moved to a new city where she has no friends or extended family members. Based on this information, which mood disorder is Mrs. Castillo most likely experiencing?
Major depressive disorder
A severely depressed client received electroconvulsive therapy (ECT) this morning. Which finding would the nurse recognize as normal posttreatment?
Memory loss
The nurse is assessing a client and asks how she is feeling. In response to the nurse's question, the postpartum client states she has been experiencing ongoing appetite changes, sleep deprivation, crying spells, anxiety, and poor concentration. The nurse determines that the client needs to be referred for evaluation. Which referral would be most appropriate for this client?
Mental health professional
Which type of antidepressant requires the client to follow a tyramine-free diet?
Monoamine oxidase inhibitor (MAOI)
Which are theories used to explain mood disorders?Select all that apply.
Neurobiological Biological rhythms Cognitive Intrapersonal
The nurse is providing care to a breastfeeding client diagnosed with postpartum depression. Which medication order is appropriate for this client?
Nortriptyline
The nurse is planning care for a client with seasonal affective disorder (SAD). After which intervention would the nurse expect to see improvement in emotional stability?
Phototherapy
The nurse is planning care for a client diagnosed with major depressive disorder. Which activity should the nurse encourage the client to participate in based on the diagnosis?
Playing a card game
The home care nurse hears the spouse of an older client say "You have been so sick but you insist on living in this huge home that you cannot maintain but expect me to." The client engages in an argument with the spouse. What does the home care nurse identify as occurring with this couple?
Possible situational depression for both client and spouse
The home care nurse is providing care for a postpartum client. The client begins to cry during the assessment process and states,"I don 't know why I am crying all the time. I am so in love with my baby."Which postpartum disorder does the nurse suspect that the client is experiencing
Postpartum blues
A postpartum client returns to the clinic for her scheduled appointment 3 weeks after delivery. She reports extreme fatigue, feelings of sadness, and insomnia. Based on these assessment findings, which diagnosis does the nurse anticipate for this client?
Postpartum depression
A nurse is providing a workshop about nursing care for clients experiencing a postpartum illness. Which discharge teaching strategy suggested by the nurse would be inappropriate?
Prioritizing tasks
Miss Laura Luke, an 18-year-old client, is isolating herself from peers and refuses to go to school. She refuses to maintain her ADLs. Upon admission to a mental health unit, Miss Luke is diagnosed with major depressive disorder. Which intervention should you initiate upon admission to the unit?
Provide a safe, protective environment.
Which are symptoms of depression?Select all that apply.
Psychomotor retardation Feeling apathetic Changes in sleep Experiences anhedonia
Discharge teaching is being conducted by the charge nurse to a client with postpartum depression. Which resource option would be inappropriate for the nurse to provide to the client?
Referrals to public health nursing services
A client experiencing situational depression after the traumatic death of the spouse tells the nurse, "Since I started taking a walk every day, I've been feeling better." How has exercise impacted this client?
Relieved stress Elevated the client's mood
A client informs the nurse, "My mother keeps telling me to get over the death of my spouse, but I'm having a hard time doing that." What should the nurse do to assist the client and family?
Remind the client and family that the grief process is different for everyone, and that no time limit can be set.
Which priority problem should the nurse include when planning care for a client diagnosed with major depressive disorder?
Risk for violence directed at self
The nurse is assessing a client for risk factors associated with postpartum depression. Which data item found in the health history is not associated with postpartum depression?
Second pregnancy
The nurse sees a client crying after being dropped off for a physician's appointment in the clinic. The client tells the nurse that not being able to drive anymore is making the client a burden to her daughter. What should the nurse realize the client is at risk for developing?
Situational depression
What are some of the clinical manifestations of depression?(Select all that apply.)
Sleep disturbances Guilt Feelings of hopelessness
Which alternative therapy for depression cannot be safely combined with prescription antidepressants?
St. John's wort
Which are alternative therapies used to treat mood disorders?(Select all that apply.)
St. John's wort
At the conclusion of a health history, the nurse is concerned that a middle-aged client is experiencing physical manifestations of depression. What did the nurse assess to come to this conclusion? (Select all that apply.)
States a considerable loss of energy Inability to recall the last time ingested food Clothing rumpled; hair not washed or combed
Mrs. Jones, a 75-year-old client, lives alone in an apartment after the death of her husband. Her only child lives 225 miles away and visits every other month. She is complaining of memory loss, insomnia, loss of appetite, and irritability. Mrs. Jones indicates that the symptoms have persisted for the past 3 months. When completing a health history with Mrs. Jones, what data are essential for you to obtain?
Suicidal ideations
A treatment program for clients with postpartum depression includes pharmacologic and nonpharmacologic approaches. The nurse suggests that which nonpharmacologic treatment provides couples with opportunities to share common experiences and concerns?
Support groups
A nurse is teaching a family about possible therapies for a client with postpartum psychosis. Which clinical therapy would the nurse state is used to treat the client experiencing this condition? (Select all that apply.)
Support groups Supervision when caring for infant or other children Lithium and antipsychotics Short-term institutionalization
A client with depression is prescribed an omega-3 fatty acid supplement. What should the nurse suggest when the client takes this supplement?
Take with orange juice
he nurse is planning care for a client diagnosed with situational depression. Which intervention is essential to include when planning care?
Teach assertiveness techniques.
The nurse learns that a client experiencing situational depression after the death of the client's mother has returned to work, is caring for her family, and spends quiet time reflecting on her life and future. What is this client demonstrating?
The ability to work through the grief process
A nurse is making follow-up calls to postpartum clients. Which client should the nurse schedule to be seen immediately?
The client reporting hearing voices talking about the baby
A client with depression is admitted to the mental health unit because of attempted suicide. Which short-term goal should be given high priority for this client?
The client will seek out the nurse when feeling self-destructive.
The mother of an adolescent diagnosed with depression was hoping that the child would not have the problem even though both she and her spouse struggle with depression every day. Which is the best response by the nurse to the mother?
The genetic risk for children to be diagnosed with depression is greatest if both parents have the disorder.
The nurse is caring for several clients on a postpartum unit. Which client is at the greatest risk for developing postpartumdepression?
The first-time mom
The nurse is reviewing orders written for a client demonstrating signs of depression. Which diagnostic test should the nurse expect to be prescribed for this client?
Thyroid function
A client is prescribed electroconvulsive therapy as treatment for depression. What should the nurse review with the client about these treatments?
Treatments will be 3 times a week for 12 treatments
While reviewing previous documentation, the nurse notes that a client is described as demonstrating passive behavior. What should the nurse expect when communicating with this client? (Select all that apply.)
Unexpected explosions of anger Avoiding conflict or confrontation
The nurse is admitting a client to the mental health unit for possible persistent depressive disorder. What data should the nurse collect when completing the client's physical assessment
Vital signs
Ms. Carla Simmons, age 26, is admitted to a mental health unit. She has been avoiding her family responsibilities, has not left the house for a month, and has not had a good appetite. During the past 2 months, she has lost over 20 pounds. Ms. Simmons is diagnosed with severe depression. At an interdisciplinary conference, the recommendation is made for electroconvulsive therapy (ECT). When would the nurse start preparing the client for this procedure?
When the client and her family are presented with the treatment plan by the healthcare provider
A client is admitted to a mental health unit for depression. After a week, the client continues to withdraw from others. Which statement by the nurse would most likely promote interaction with other clients?
come and play cards.
Shavona Wilson is a 36-year-old client who had a normal vaginal delivery of a healthy 8 lb, 4 oz female infant 4 days ago. During her initial follow-up check, she tells the nurse that she has been crying at times during the day, is sleeping a lot, and has no appetite. She asks, "What is wrong with me when I should be so happy right now? I have two beautiful children!" Which response by the nurse would be most appropriate while assessing Ms. Wilson?
"Do you have a history of depression or anxiety?
The adult daughter of Zora Koskovich, an 80-year-old client being treated for a foot wound, is concerned that her mother is depressed. What is the best response by the nurse to the daughter's concern?
"That is possible since over 10% of people over the age of 80 have symptoms of depression."
The nurse is caring for an adolescent client diagnosed with depression. Which assessment findings support this diagnosis?
Self-neglect
