Mood & Affect
An 85-year-old male client has been receiving hemodialysis for several years for chronic renal failure. The nurse notes a change in the client's affect over the last several hemodialysis treatments. Which additional client-related issue should the nurse anticipate to be occurring more? A. Change in spouse's health status or loss of spouse B. Fear of hospitalization because of the renal failure C. Discrimination and language difficulties D. Distrust of members in the medical community
A. Change in spouse's health status or loss of spouse Rationale: For the older adult, life challenges that may increase the risk for depression include the loss or illness of a spouse. Discrimination and language difficulties would be applicable for the client who is an immigrant. Fear of hospitalization and distrust of the medical community are characteristics associated more with an African American client.
At the conclusion of a health interview, the nurse suspects a middle-aged adult female client is experiencing seasonal affective disorder. Which clinical manifestation did the nurse assess to make this determination? (Select all that apply.) A. Increased sleep B. Negative thoughts C. Increased appetite D. Decreased energy E. Weight gain
A. Increased sleep C. Increased appetite D. Decreased energy E. Weight gain Rationale: Manifestations of seasonal affective disorder include decreased energy, increased sleep and appetite, and weight gain. Negative thoughts can lead to feelings of incompetence and unworthiness that are not associated with seasonal affective disorder.
A client is being screened for depression. Which symptom should lead the nurse to suspect depression? (Select all that apply.) A. Psychomotor retardation B. Feeling apathetic C. Changes in sleep D. Experiencing anhedonia E. Mood swings
A. Psychomotor retardation B. Feeling apathetic C. Changes in sleep D. Experiencing anhedonia Rationale: Symptoms of depression include a lack of pleasure in normal activities (anhedonia), apathy, changes in sleep, and psychomotor retardation. Mood swings are a manifestation of bipolar disorders. Next Question
A family member of a client with depression gets tired from taking care of the family and client. Which intervention should the nurse deploy for the family member? A. Reinforce coping skills for the family member. B. Ask the family member if the client is taking medications. C. Teach the family member about the illness and plan. D. Discuss the treatment plan with the family member.
A. Reinforce coping skills for the family member. Rationale: The care of a client with depression can lead to role strain, as the family member(s) often have to care for children, work, and compensate for the mentally ill person's inability to perform usual tasks. The family member has stated role strain and interventions should be geared to that issue. After addressing the role strain, other interventions shall be completed.
The nurse is learning about classes of medications. Which classification of medications is prescribed for mood disorders? (Select all that apply.) A. Selective serotonin reuptake inhibitors B. Carbonic anhydrase inhibitors C. Tricyclic antidepressants D. Benzodiazepines E. Monoamine oxidase inhibitors
A. Selective serotonin reuptake inhibitors C. Tricyclic antidepressants E. Monoamine oxidase inhibitors Rationale: Medication classifications prescribed for mood disorders include tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors. Benzodiazepines are used for a variety of anxiety disorders. Carbonic anhydrase inhibitors are diuretics used to treat glaucoma.
A nurse is assessing a woman who gave birth 2 weeks ago. The client states that she spends most of the day crying. Which action should the nurse take next? A. Ask the client to complete the Mood and Feelings Questionnaire (MFQ). B. Ask the client to complete the Edinburgh Postnatal Depression Scale (EPDS). C. Ask the client to compete the Mood Disorder Questionnaire (MDQ). D. Ask the client to complete the Beck Depression Inventory (BDI).
B. Ask the client to complete the Edinburgh Postnatal Depression Scale (EPDS). Rationale: The Edinburgh Postnatal Depression Scale (EPDS) is a self-reported form that may be used in any setting to screen postpartum mothers for depression. The Mood Disorder Questionnaire (MDQ) and Mood and Feelings Questionnaire (MFQ) are for use in children. The Beck Depression Inventory (BDI) is for adults.
The client states to the nurse, "I take citalopram (Celexa, an SSRI) 40 mg every day, and I have also been taking St. John's wort 750 mg daily for the past 2 weeks." Which manifestation should lead the nurse to suspect that the client is developing serotonin syndrome? (Select all that apply.) A. Constipation B. Ataxia C. Diaphoresis D. Headache E. Confusion
B. Ataxia C. Diaphoresis D. Headache E. Confusion Rationale: Serotonin syndrome can occur if a selective serotonin reuptake inhibitor is combined with a monoamine oxidase inhibitor, a tryptophan-serotonin precursor, or St. John's wort. Signs and symptoms of serotonin syndrome include restlessness or agitation, headache, diaphoresis, ataxia, myoclonus, shivering, tremor, diarrhea, nausea, abdominal cramps, and hyperreflexia. Constipation is not associated with serotonin syndrome.
A client has been diagnosed with persistent depressive disorder (dysthymia). Which assessment would the nurse expect to find in the client with this disorder? A. Client has been severely depressed for 6 months. B. Client has exhibited a depressed mood that is present most of the day, more days than not, for at least 2 years. C. Client has exhibited a depressed mood that is present most of the day, more days than not, for at least 2 weeks. D. Client has been depressed for 1 year along with weight loss.
B. Client has exhibited a depressed mood that is present most of the day, more days than not, for at least 2 years. Rationale: Dysthymia may be diagnosed when a depressed mood is present most of the day, more days than not, for at least 2 years. Symptoms of dysthymia are similar to but less severe than those of major depressive disorder. One year, 2 weeks, and 6 months are not long enough to be diagnosed with persistent depressive disorder (dysthymia).
At the conclusion of a health history, the nurse is concerned that a middle-aged client is experiencing physical manifestations of depression. Which clinical manifestation did the nurse assess to come to this conclusion? (Select all that apply.) A. Became tearful during the interview. B. Clothing is rumpled; hair is not washed or combed. C. States a considerable loss of energy. D. Reports sleeping 1 to 2 hours each night. E. Unable to recall the last time food was ingested.
B. Clothing is rumpled; hair is not washed or combed. C. States a considerable loss of energy. E. Unable to recall the last time food was ingested. Rationale: Physical manifestations of depression include a loss of energy, lack of appetite, and appearing unkempt with poor hygiene. Sleeping 1 to 2 hours each night is a physical manifestation of mania. Tearfulness is an affective characteristic of depression.
The nurse is conducting a follow-up interview with a client using alternative therapy to aid in the treatment of depression. Which observation indicates that regular brisk walking has been helpful for this client? (Select all that apply.) A. Asked when feelings of fatigue would subside B. Expressed satisfaction with treatment C. Attentive during the interview D. Motivated to return to work E. Requested information to treat chronic headaches
B. Expressed satisfaction with treatment C. Attentive during the interview D. Motivated to return to work Rationale: Aerobic exercise has been found to improve life satisfaction, attentiveness, motivation, and energy in clients with depression. Experiencing chronic headaches and fatigue indicates that exercise has not been effective in the treatment of depression in the client.
A nurse is assessing a client with a mood disorder. Which statement reflects the relationship between mood disorders and violence? A. Potentiate eating disorders B. Increase the risk of suicide C. Potentiate substance abuse D. Increase the onset of depression
B. Increase the risk of suicide Rationale: Violence is related to mood disorders in that mood disorders increase the risk of suicide. The relationship between mood disorders and violence does not lead to eating disorders, substance abuse, or an increase in the onset of depression
A client is unresponsive to therapy and complains, "I have been taking my medications, but they cost a lot and they don't make me feel good." Which response is best to assess compliance with the treatment plan? A. "Would you like me to see about changing the medications to a better medication?" B. "Can you describe how they make you feel and how you take your medications?" C. "Please tell me why you can't afford the medications?" D. "Can you tell me why you don't take your medications?"
B. "Can you describe how they make you feel and how you take your medications?" Rationale: Nurses should investigate the reasons for nonadherence. When barriers to treatment are identified (e.g., financial constraints, trouble obtaining and/or taking medication, uncomfortable side effects), the nurse can work with the client to develop strategies to overcome these barriers or possibly to seek another means of treatment. Medications should not be changed until it is determined that they have been taken properly. Asking "why" of a client is exploring and nontherapeutic.
An 8-year-old child has violent temper tantrums, does not feel tired, and has racing thoughts. The parents ask about a mental health consult. Which statement is best based on the parent's assessment of the child's behavior? A. "Your child is just going through a developmental change, and this behavior will stop soon." B. "Your child will be assessed for developmental issues, but other medical problems must be ruled out first." C. "Your child must be responding to some stress at home." D. "Your child has bipolar disorder and will need medications to control the symptoms."
B. "Your child will be assessed for developmental issues, but other medical problems must be ruled out first." Rationale: Diagnosis of bipolar disorder in children may be made after other possibilities have been ruled out. Treatment of children with bipolar disorders may include medications to reduce severity of symptoms and psychotherapy to learn how to adapt to stressors and build relationships. Children are assessed based on their personal baseline, as children of the same age may be at different developmental stages. It is not possible to blame the changes on stress at this time. Next Question
A client has been diagnosed with depression after the loss of a spouse. The client has begun treatment with selective serotonin reuptake inhibitors (SSRIs) and has started to feel better. Which is a priority nursing action while caring for the client? A. Assess for side effects of medications. B. Assess for response to treatment. C. Assess for risk of suicide. D. Assess for client's feelings about the treatment plan.
C. Assess for risk of suicide. Rationale: The risk of suicide increases with initiation of SSRI therapy as clients in the severest stage of depression begin to improve. They have sufficient energy and cognitive ability to plan and successfully implement a suicide plan. While all assessments are appropriate for the client, suicide risk is a priority.
A client who is being assessed for depression is now exhilarated and speaking in a rushed pattern. The client states, "I feel great, and can I go home now?" Which disorder should the nurse suspect based on the assessment of the client? A. Major depressive disorder B. Suicidal ideations C. Bipolar disorder D. Persistent depressive disorder (dysthymia)
C. Bipolar disorder Rationale: The bipolar disorders are a group of mood disorders that are characterized by manic, hypomanic, and depressive episodes. The client can cycle between depression and mania. Cases of an individual constantly considering, planning, or thinking about suicide are considered suicidal ideation. Major depressive disorder and persistent depressive disorder do not have a manic episode.
A client desires to meet the nurse for drinks once the treatment is complete. Which nursing action needs to be addressed with the client? A. Monitor client response to treatment. B. Teach assertive behavior. C. Maintain professional boundaries. D. Support family functioning.
C. Maintain professional boundaries. Rationale: While all these nursing actions are important for care of a client, maintaining professional boundaries with clients is vital. Clients who do not have hope have a tendency to form dependent relationships. Nurses must work from the first contact with these clients to minimize the likelihood that maladaptive dependence occurs in the nurse-client relationship. The client has suggested inappropriate contact and needs to be told that it is not allowed.
A client reports feelings of sadness and sleep disturbances only during winter. Which disorder should the nurse suspect? A. Adjustment disorder with depressed mood B. Major depressive disorder C. Seasonal affective disorder D. Persistent depressive disorder (dysthymic disorder)
C. Seasonal affective disorder Rationale: Seasonal affective disorder is when depressive symptoms occur in relation to the seasons, usually during the winter months, when days are shorter. The other types of depression are not related to changes in the seasons.
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 by the nurse is best? A. "It will facilitate the use of other neurotransmitters in your metabolism." B. "It will address sleep problems that you might be having." C. "It is associated with aggressive behavior." D. "It will reduce your excitability."
C. "It is associated with aggressive behavior." Rationale: A serotonin deficiency is associated with anxiety, aggression, and self-destructive behavior. Serotonin does not affect excitability. An acetylcholine deficiency is associated with sleep disorders. The protein p11 manages how brain cells respond to serotonin.
A client has been going through cognitive-behavioral therapy. Which statement by the client suggests the therapy is effective? A. "My children don't like to talk to me." B. "I know my coworkers talk about me." C. "My son leads a busy life, but he calls me when he can." D. "My husband was late for work again today, and I know he will be fired."
C. "My son leads a busy life, but he calls me when he can." Rationale: "My son leads a busy life, but he calls me when he can" is a statement that is an example of cognitive-behavioral therapy—using cognitive modification of negative thought patterns. The client is turning negative thoughts to more positive thought processes. The other statements are all negative thinking that reinforce that type of thinking in the future.
The nurse is caring for clients with mood and affect disorders. Which information is related to the effects of age and gender on mood and affect? A. Women are less likely to physically express their emotions than men. B. Men are more than twice as likely as women to experience mood disorders. C. Mood swings are more common with adults than with adolescents. D. Women tend to internalize and dwell on their emotions more than men.
D. Women tend to internalize and dwell on their emotions more than men. Rationale: Women tend to internalize and dwell on their emotions more than men. Women are more likely to physically express their emotions than men. Women are twice as likely as men to experience mood disorders. Mood swings are more common to adolescents than adults.