depressive/ bipolar disorder

Complications of SGAs

- Metabolic syndrome - orthostatic hypotension - anticholinergic effects - agitation, dizziness, sedation, sleep disruption - mild EPS, such as a tremor - elevated prolactin levels - sexual dysfunction

second generation antipsychotics

- relief of psychotic manifestations in other disorders such as bipolar disorder - Risperidone (Risperdal) - clozapine (clozaril) - olanzapine (zyprexa) - paliperidone (Invega) - Quetiapine (Seroquel) - Ziprasidone (Geodon) - Aripiprazole (Abilify)

electroconvulsive therapy (ECT) procedure care

-Tx is typical 2 to 3 times a week for a total of 6 to 12 treatment for depression -30 min pre procedure IM injection atropine or glycopyrrolate is admin to prevent aspiration and bradycardia.

major depression disorder clinical finding

-depressed mood -difficulty sleeping or excessive sleeping -indecisiveness -decrease ability to concentrate -suicide ideation -increase or decrease in weight of more than 5% -decrease or increase mortor activity

electroconvulsive therapy (ECT) indication

-major depressive client who's manifestation is not responsive to pharmacological treatment - risk of the tx out risk the ECT - client who are suicidal and homicidal who need fast treament - for client who have schizophrenia with catatonic disorder with manifestation -schizoaffective client - client who have bipolar disorder with with rapid cycling( 4 or more acute mania within 1 yr) - manic pt who are unresponsive to lithium and antipsych meds.

Sx acute dystonia:

-severe spasms of tongue, neck, face, or back

A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering? A. Amantadine B. Bupropion C. Phenelzine D. Hydroxyzine

A. Amantadine This client is experiencing Parkinsonism, which is an adverse effect of the antipsychotic medication chlorpromazine. Amantadine is an antiparkinsonian medication used to treat the extrapyramidal manifestations that can occur with chlorpromazine therapy.

A nurse is planning discharge teaching for a client who has major depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine? A. Broiled beef steak B. Macaroni and cheese C. Pepperoni pizza D. Smoked salmon

A. Broiled beef steak Phenelzine, an MAOI, is an antidepressant. This medication interacts with a variety of foods to produce a hypertensive crisis. Beef steak and other meats that are fresh do not interact with phenelzine and are safe to consume.

A nurse is collecting data from a client who was recently admitted for treatment of major depressive disorder (MDD). Which of the following findings should the nurse expect the client to report? (Select all that apply)

A. Difficutly sleeping for several weeksB. Inability to concentrate on simple tasks.D. Not bathing for severa dayE. Lack of enjoyment from a long-time hobby of gardening.

A nurse is teaching a client who has seasonal affective disorder (SAD) about the use of light therapy. Which of the following statements should the nurse make?

A. Light therapy suppresses the natural nighttime release of melatonin.

A nurse is reinforcing teaching about stress management techniques with a parent who has admitted to verbally abusing her children. Which of the following strategies is the nurse providing?

A. Tertiary prevention

A nurse is caring for a client who is taking carbamazepine. The nurse should monitor the client for which of the following adverse effects of carbamazepine?

A. Thrombocytopenia

A nurse is caring for a client who has schizophrenia and started taking a first-generation antipsychotic medication 3 weeks ago. The client reports a feeling of inner restlessness, rocks back and forth when sitting down, and paces frequently. The nurse should identify that the client is experiencing which of the following adverse effects of antipsychotic medications? A. Neuroleptic malignant syndrome B. Akathisia C. Anticholinergic toxicity D. Opisthotonos

B. Akathisia Akathisia is an extrapyramidal adverse effect that can occur in a client within the first 2 months of beginning a first-generation antipsychotic medication.

A nurse is caring for a client who has major depressive disorder. Which of the following should the nurse identify as a risk factor for depression? (SATA) A. Male sex B. History of chronic bronchitis C. Recent death in client's family D. Family history of depression E. Personal history of panic disorde

B. History of chronic bronchitis C. Recent death in client's family D. Family history of depression E. Personal history of panic disorder

A nurse is assisting with planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following are appropriate nursing interventions? (Select all that apply.) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client complaints E. Use a firm approach with communication

B. Offer concise explanations C. Establish consistent limits E. Use a firm approach with communication

A nurse in a providers office is reviewing the medical record of a client who has major depressive disorder and a new prescription for phenelzine. Which of the following items in the clients history should the nurse report to the provider?

B. The client has frequent headaches

A nurse is interviewing a 25-year old client who has a new diagnosis of Persistent Depressive Disorder (dysthymia). Which of the following findings should the nurse expect? A. the report of a minimum of five clinical findings of depression B. the presence of manifestations for at least two years C. there are wide fluctuations in mood D. there is an inflated sense of self esteem

B. the presence of manifestations for at least two years

A nurse is caring for a client who has been taking lithium for the past several months. Which of the following findings should indicate that the client is experiencing advanced lithium toxicity?

B.Ataxia

client has at least 1 episode of mania alternating with major depression

Bipolar I Disorder

client has one or more hypomanic episodes alternating with major depressive episodes

Bipolar II Disorder

Sx Parkinsonism:

Bradykinesia, rigidity, shuffling gait, drooling, tremors

A nurse working in an outpatient clinic is providing teaching to a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I m menstruating."ʻ B. "I will use light therapy 30 minutes a day to prevent further recurrences of PMDD." C. "I am aware that my PMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active."

C. "I am aware that my PMDD causes me to have rapid mood swings."

A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. " Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The treatment of MDD during the maintenance phase last for 6 to 12 weeks." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are most effective during the acute phase of MDD.

C. "The client is at greatest risk for suicide during the first weeks of an MDD episode."

A nurse is leading a peer group discussion about the indications for electroconvulsive therapy (ECT). Which of the following is appropriate to include in the discussion? A. Borderline personality disorder B. Acute withdrawal related to substance use disorder C. Bipolar disorder with rapid cycling D. Dysthymic disorde

C. Bipolar disorder with rapid cycling

A nurse on an inpatient mental health unit is planning care for a client who was admitted following a suicide attempt. Which of the following actions should the nurse include in the plan?

C. Observe the client swallow medications

A nurse is caring for a client who has bipolar disorder and a new prescription for valproic acid. Which of the following actions should the nurse take? A. Monitor the client's liver function B. Avoid giving the medication with food or milk C. Counsel the client regarding medication dependency D. Limit intake of foods containing tyramine

Correct Answer: A. Monitor the client's liver function Valproic acid can cause severe hepatotoxicity and liver failure. The nurse should monitor the client's liver function at baseline and periodically thereafter. The nurse should also teach the client about the manifestations of liver failure.

A nurse is assessing a client prior to administering lithium. The client began taking lithium 1 week ago for the treatment of mania. For which of the following findings should the nurse withhold the dose? A. Report of nausea with frequent episodes of emesis B. Weight gain of 1.8 kg (4 lb) since the start of treatment C. Fine hand tremors in both hands D. Serum lithium level of 1.1 mEg/L

Correct Answer: A. Report of nausea with frequent episodes of emesis Gastrointestinal upset with nausea and frequent mess is an early indication of lithium toxicity; therefore, the nurse should withhold the prescribed dose and obtain a serum lithium level. The nurse should assess the client for indications of dehydration, which further increases the risk of lithium toxicity.

A nurse is assessing a client who has bipolar disease. Which of the following actions is an indication the client is experiencing a manic stage? A. The client speaks rapidly with a sense of urgency B. The client touches everything within her reach C. The client states that she is unable to enjoy her favorite activities D. The client moves slowly and maintains a fixed gaze

Correct Answer: A. The client speaks rapidly with a sense of urgency The nurse should recognize that a client who is experiencing a manic episode often talks with pressured speech. This form of speech is rapid, frenetic, and often incoherent and has a false sense of urgency.

A nurse is providing discharge teaching to a client who has been hospitalized for major depressive disorder and has a prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? A. "I will take amitriptyline in the morning because l'll likely have trouble falling asleep if I take it in the evening." B. "I will move slowly when I stand up because amitriptyline can cause my blood pressure to decrease." C. "I can drink a glass of beer or wine with my evening meal because amitriptyline doesn't interact with alcohol." D."I will avoid foods that are high in fiber because amitriptyline can cause diarrhea."

Correct Answer: B 'I will move slowly when I stand up because amitriptyline can cause my blood pressure to decrease." Amitriptyline can cause orthostatic hypotension. The nurse should instruct the client to take precautions to prevent an injury due to a fall while taking amitriptyline. Amitriptyline is a tricyclic antidepressant that has a sedative effect.

A nurse is teaching a client who has major depressive dilforder and is scheduled to begin electroconvulsive therapy (ECT). Which of the following pieces of information should the nurse include? A. "If you're taking a benzodiazepine medication, you should take it before the procedure." B. "You can expect to wake up about 15 minutes after the procedure." C. "After the first procedure, you should expect to have ECT sessions monthly for a year." D. "ECT is the primary treatment for most clients who have depression."

Correct Answer: B. "You can expect to wake up about 15 minutes after the procedure." A client who undergoes ECT usually wakes up about 15 minutes after the procedure and can be disoriented for several hours after.

A nurse is obtaining a client's medical history prior to scheduling the client for electroconvulsive therapy (ECT). Which of the following findings should the nurse identify as a potential complication of the procedure? A. Severe depression B. Cardiac arrhythmia C. Bipolar disorder D. Parkinson's disease

Correct Answer: B. Cardiac arrhythmia A client who has cardiac arrhythmia needs further evaluation since the greatest risk of death due to ECT is related to cardiac complications.

A nurse is updating the plan of care for a client who has major depression and a new prescription for amitriptyline. The nurse should plan to monitor the client for which of the following adverse effects? A. Hypertension B. Drowsiness C. Panic attacks D. Diarrhea

Correct Answer: B. Drowsiness Drowsiness is an expected side effect of amitriptyline and other tricyclic antidepressants. Sedation is most likely to be present during the first weeks of treatment with amitriptyline and can increase the risk of falls.

A nurse is reviewing the medications of a client who has bipolar disorder and a new prescription for lithium. Which of the following medications may be administered safely while the client is taking lithium? A. Ibuprofen B. Haloperidol C. Valproic acid D. Hydrochlorothiazide

Correct Answer: C. Valproic acid Valproic acid and lithium are both indicated for the treatment of bipolar disorder. The nurse may safely administer both of these medications to the client.

A nurse is assessing a client who is taking lithium to treat bipolar disorder and has a lithium level of 2.2 mEq/L. Which of the following findings should the nurse expect? A. Muscle weakness B. Oliguria C.Vomiting O. Blurry vision

Correct Answer: D. Blurry vision Manifestations of lithium toxicity with levels between 2 and 2.5 mEq/L include blurry vision, ataxia, clonic twitching, severe hypotension, and polyuria.

A nurse is assessing a school-aged child who has ADHD and has been taking desipramine. Which of the following adverse effects should the nurse expect the child's parent to report? A. Hyperactivity B. Depression c. Diarrhea D. Sedation

Correct Answer: D. Sedation The nurse should recognize that tricyclic antidepressants can cause sedation, along with other anticholinergic effects. Therefore, the nurse should expect the parent to report that the child has been sedated.

A nurse is caring for a client who is taking a tricyclic antidepressant. Which of the following adverse effects should the nurse report to the client's provider immediately? A. Dry mouth B. Constipation C. Drowsiness D. Urinary retention

Correct Answer: D. Urinary retention Urinary retention can lead to bladder infection and, ultimately, a loss of bladder tone. The nurse should apply the safety and risk reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client.

A nurse is assessing a client who has panic disorder and has been taking paroxetine. Which of the following assessments should the nurse identify as an adverse effect of the medication? A. Peripheral edema B. Chest congestion C. Shuffling gait D. Weight gain

Correct Answer: D. Weight gain Weight gain is an expected adverse effect of paroxetine and other SSRls. Other adverse effects include nausea, headaches, insomnia, and sexual dysfunction.

the client has at least 2 years of repeated hypomanic manifestations that do not meet criteria for hypomanic episodes alternating with minor depressive episodes

Cyclothymic disorder

A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for lithium. Which of the following directions should the nurse provide?

D. Increase fluid intake to 2000mL (67.6) daily

A nurse in an acute mental health facility is caring for a client who is experiencing a mixed episode of bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior. B. Administer prescribed medications as scheduled. C. Provide the client with step-by-step instructions during hygiene activities. D. Monitor the client for escalating behavior.

D. Monitor the client for escalating behavior.

A nurse was reinforcing discharge teaching with the guardians of an adolescent who has bipolar disorder. Which for the following manifestations should the nurse identify as an indication of acute mania? Select all that apply.

D. Spends excessive amounts of money E. Speaks using a loud and crass voice.

---uses electrical current to induce brief seizure activity while the client is anesthetized. the seizure activity can enhance the effect of neurotransmitter (serotonin, dopamine, and norepinephrine) in the brain.

Electroconvulsive therapy

A nurse is planning care for a client who has bipolar disorder and has acute mania. Which of the following interventions should the nursE include in the plan

Encourage the client to have frequent rest periods -The nurse should encourage the client to have frequent rest periods throughout the day to decrease the client's risk of exhaustion. Because of the constant activity associated with acute mania, the nurse should encourage brief rest periods each hour.

A nurse in an acute care mental health facility observes a client who has bipolar disorder begin to shout and use offensive language toward a visitor. Which of the following actions should the nurse take?

Give the client 2 options for ending the situation -Giving the client several options (e.g. 2 different locations in which to be away from visitors and other clients) prevents the client from feeling powerless and gives the client some responsibility for making choices.

A nurse is reviewing the plan of care for a client who has bipolar disorder. Which of the following is an effect of using cognitive behavioral therapy (CBT) for a client who has bipolar disorder

Helps the client deal with distorted thought processes.

A nurse is caring for a client who has bipolar disorder. Which of the following manifestations is the priority finding for the nurse to identify?

Hyperactivity -The greatest risk to this client is an injury from hyperactivity; therefore, the priority finding for the nurse to identify is hyperactivity. The nurse should intervene to redirect the client from unsafe activities. Constant activity can lead to exhaustion and even death.

a less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania; hospitalization not required; client with hypomania is less impaired--can progress to mania; no delusions or hallucinations

Hypomania

an abnormally elevated mood, which can also be described as expansive or irritable; usually requires hospitalization; episodes last at least 1 week (delusions or hallucinations may be present)

Mania

agitation with irritability, flight of ideas, impulsitivity, neglect of ADL's (including nutrition and hydration--client may not eat or drink), possible presence of delusions or hallucinations, demanding or manipulative behavior, denial of illness

Manic characteristics

----- IS is a rare and serious adverse effect of antipsychotic medications. -Manifestations of this disorder include a high fever, hypertension, tachycardia, and muscle rigidity.

Neuroleptic malignant syndrome

A nurse in a mental health clinic is assessing a client who has a history of mania. Which of the following findings indicates that the client is experiencing a relapse?

Pressured speech -Pressured speech is an indication of a relapse in a client who has mania

A nurse is reinforcing teaching with a client who has depression and is scheduled for transcranial magnetic stimulation (TMS). The nurse should reinforce with the client that TMS can cause which fo the following adverse effects?

Seizures

Unable to stand still or sit, and is continually pacing and agitated

Sx akathisia

a single episode or recurrent episode of unipolar depression( associated with mood swings from major depression to mania) resulting in a significant change in client's normal accompanied by at least 5 specific clinical finding

major depression disorder

a milder form of depression that usually has an early onset (in childhood and adolescence) and last at leats 2 yrs for adult and ( 1 yrs for children). at least 3 clinical finding.

persistent depressive disorder

a depressive disorder associated with luteal phase of menstrual cycle. emotional manifestation can include lack of energy, overeating, hyper- or insomnia, breast tenderness, aching, bloating and weight gain.

premenstrual dysphoric disorder

a form of depression that occurs seasonally, usually during winter, when there is less daylight. light therapy is the first treatment

seasonal affective disorder

clinical findings of depression that are associated with the use of, or withdrawal from, drugs and alcohol

substance-induced depressive disorder

electroconvulsive therapy (ECT) contraindication

there are no contraindication some medical condition can place the pt at risk such as: - cardiovascular disease. bc ect increase stress on the heart -cerebralvascular disorder: ECT in creases intracranial pressure on the brain during treatment