Mood and Affect Practice Questions

As a nurse in the emergency department, you are caring for a patient who is exhibiting signs of depression. What is a priority nursing intervention you should perform for this patient? a. Assess for depression and ask directly about suicide thoughts. b. Ask the care provider to prescribe blood lab work to assess for depression. c. Focus on the presenting problems and refer the patient for a mental health evaluation. d. Interview the patient's family to identify their concerns about the patient's behaviors.

ANS: A Assessing directly for thoughts of harm to self or others is a priority intervention for any patient exhibiting signs of a mental health disorder. It is estimated that 50% of individuals who succeed in suicide had visited a health care provider within the previous 24 hours. Currently there is no serum lab that identifies depression. The risk of self-harm is a priority safety issue that is monitored in all health care within the scope of the nurse. It is important to obtain information directly from the patient when possible, and then validate the information from family or other secondary sources. REF: Page 319 |Page 322

A patient who has been diagnosed with depression is scheduled for cognitive therapy in addition to receiving prescribed antidepressant medication. The nurse understands that the goal of cognitive therapy will be met when what is reported by the patient? a. "I will tell myself that I am a good person when things don't go well at work." b. "My medications will make my problems go away." c. "My family will help take care of my children while I am in the hospital." d. "This therapy will improve my response to neurotransmitter impulses."

ANS: A Cognitive therapy helps patients restructure their patterns of thinking to various events or thoughts in a more healthy way. Medication alters neurotransmitters but does not make problems go away. Family support is important but is not the goal of cognitive therapy. Neurotransmitters are affected by medication and brain stimulation therapy, not by cognitive therapy. REF: Page 322

An older adult has experienced severe depression for many years and is unable to tolerate most antidepressant medications due to adverse effects of the medications. He is scheduled for electroconvulsive therapy (ECT) as a treatment for his depression. What teaching should the nurse give the patient regarding this treatment? a. There are no special preparations needed before this treatment. b. Common side effects include headache and short-term memory loss. c. One treatment will be needed to cure the depression. d. This treatment will leave you unconscious for several hours.

ANS: B Common side effects of ECT include headache, sleepiness, short-term memory loss, nausea, and muscle aches. Preparations before and after the procedure are the same as any operative procedure involving the patient receiving anesthesia. Treatment is typically three sessions a week for 4 weeks, not once. Patients are not unconscious after the procedure due to the use of precisely placed electrodes and the use of anesthesia. REF: Page 322

A patient has been resistant to treatment with antidepressant therapy. The care provider prescribes a monoamine oxidase inhibitor (MAOI) medication. What teaching is critical for the nurse to give the patient? a. Serum blood levels must be regularly monitored to assess for toxicity. b. To prevent side effects, the medication should be administered as an intramuscular injection. c. Eating foods such as blue cheese or red wine will cause side effects. d. This medication class may only be used safely for a few days at a time.

ANS: C MAOIs have serious food interactions when ingested with tyramine-containing foods such as aged or processed foods. Serum levels are routinely monitored when mood stabilizers such as lithium carbonate are prescribed. It is not necessary to administer this class intramuscularly. This medication takes several weeks to show effectiveness and should not be stopped abruptly; short-term use will not be effective. REF: Page 323

A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant. After taking the new medication, the patient states, "This medication isn't working. I don't feel any different." What is the best response by the nurse? a. "I will call your care provider. Perhaps you need a different medication." b. "Don't worry. You can try taking it at a different time of day to help it work better." c. "It usually takes a few weeks for you to notice improvement from this medication." d. "Your life is much better now. You will feel better soon."

ANS: C Seeing a response to antidepressants takes 3 to 6 weeks. No change in medications is indicated at this point of treatment because there is no report of adverse effects from the medication. If nausea is present, taking the medication with food may help, but this is not reported by the patient, so a change in administration time is not needed. Telling a depressed patient that their life is better does not acknowledge their feelings. REF: Page 322

A nurse is developing a plan of care for a patient admitted with a diagnosis of bipolar disorder, manic phase. Which nursing diagnoses address priority needs for the patient? SATA a. Risk for caregiver strain b. Impaired verbal communication c. Risk for injury d. Imbalanced nutrition, less than body requirements e. Ineffective coping f. Sleep deprivation

ANS: C, D, F Risk for injury, poor nutrition, and impaired sleep are priority needs of the patient experiencing mania related to their impulsivity, inability to attend to activities of daily living such as diet and hygiene, and disruption of sleep. Caregiver strain is important to be addressed but is not a priority need on admission for the patient. Verbal communication improves when the mania is managed, and racing thoughts return to normal patterns. Ineffective coping will require stabilization of the acute phase along with cognitive therapy over time. REF: Page 322 |Page 323

A patient who is taking prescribed lithium carbonate is exhibiting signs of diarrhea, blurred vision, frequent urination, and an unsteady gait. Which serum lithium level would the nurse expect for this patient? a. 0 to 0.5 mEq/L b. 0.6 to 0.9 mEq/L c. 1.0 to 1.4 mEq/L d. 1.5 or higher mEq/L

ANS: D Diarrhea, blurred vision, ataxia, and polyuria are all signs of lithium toxicity, which generally occurs at serum levels above 1.5 mEq/L. Serum levels within the normal range of 0.8 to 1.4 mEq/L are not likely to cause signs of toxicity. REF: Page 323

A patient with a diagnosis of depression and suicidal ideation was started on an antidepressant 1 month ago. When the patient comes to the community health clinic for a follow-up appointment he is cheerful and talkative. What priority assessment must the nurse consider for this patient? a. The medication dose needs to be decreased. b. Treatment is successful, and medication can be stopped. c. The patient is ready to return to work. d. Specific assessment for suicide plan must be evaluated.

ANS: D Energy levels increase as depression lifts; this may increase the risk of completing a suicide plan. An increase in mood would not indicate a decrease or discontinuation of prescribed medication. The patient may be ready to return to work, but assessment for suicide risk in a patient who has had suicidal ideation is the priority assessment. REF: Page 323 |Page 324

A patient newly diagnosed with depression states, "I have had other people in my family say that they have depression. Is this an inherited problem?" What is the nurse's best response? a. "There are a lot of mood disorders that are caused by many different causes. Inheriting these disorders is not likely." b. "Current research is focusing on fluid and electrolyte disorders as a cause for mood disorders." c. "All of your family members raised in the same area have probably learned to respond to problems in the same way." d. "Members of the same family may have the same biological predisposition to experiencing mood disorders."

ANS: D Research is showing a genetic or hereditary role in the predisposition of experiencing mood disorders. These tendencies can be inherited by family members. Fluid and electrolyte imbalances cause many problems, but neurotransmitters in the brain are more directly linked to mood disorders. Mood disorders are not a learned behavior, but are linked to neurotransmitters in the brain. REF: Page 319

An older client tells the nurse about rarely going outdoors in the winter because of a lack of energy or desire. What might this client be experiencing? A) Seasonal affective disorder B) Side effect of medication C) Situational depression D) Anxiety

Answer: A Explanation: A decreased exposure to sunlight will reduce the production of serotonin in the brain, and that can cause a type of depression termed seasonal affective disorder. Older individuals are prone to isolation during the winter, so this is a likely explanation for the client's feelings. The nurse does not have enough information to determine if the client is experiencing a side effect of medication or anxiety. Situational depression is a depressive episode that occurs after an identifiable life event. Page Ref: 1780

The nurse observes a client being treated for depression sitting with the head down and avoiding conversation with peers. What would be the nurse's priority intervention for this client? A) Ask open-ended questions about the client's feelings. B) Ask the client close-ended questions. C) Encourage a peer to sit with the client and the nurse. D) Tell the client that lack of involvement leads to more depression.

Answer: A Explanation: An open-ended question encourages more than a one-word response. Depressed clients should be comfortable with a one-to-one interaction prior to other client involvement. A closed-ended question is unlikely to encourage continued communication. Telling the client that if he does not get involved he will become more depressed is not encouraging communication. Page Ref: 1801-1802

An older client receiving pain medication for abdominal discomfort reports no relief of pain and continues to describe multiple somatic complaints. What action should the nurse take at this time? A) Further assessment and consider treatment for depression B) Obtaining an order for different pain medication C) Contacting the family to talk to the client D) Review of the client's lab values

Answer: A Explanation: Major clues to depression in the older adult include multiple somatic complaints and reports of persistent chronic pain and some vague pain. Many older people have more physical than emotional complaints. Therefore, further assessment for depression is warranted. The lab values are not indicated in this case, and obtaining different pain medication would not treat potential psychological problems. The family may also be ineffective in determining the client's psychological need. Page Ref: 1800

Which client observation indicates that interventions provided to a client in the manic phase of bipolar disorder has improved self-care activities? A) Completed morning bath and changed clothes B) Washes hands after using the toilet C) Cleaned liquid spilled on floor but did not change clothes D) Brushes own teeth every time when reminded

Answer: A Explanation: The client completing a morning bath and changing clothes are evidence that the interventions succeeded in improving the client's self-care activities. The client needing to be reminded to brush teeth would not be a successful outcome. The client washing hands after using the toilet may or may not be an improvement. The client cleaning spilled liquid on the floor but not changing clothes is not evidence of improvement in self-care activities. Page Ref: 1813

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? A) The ability to work through the grief process B) The denial of the mother's death C) Ineffective coping D) Anxiety

Answer: A Explanation: The client has returned to work, cares for her family, and reflects on her life and future. These are all indications that the client has the ability to work through the grief process, which will reduce the negative consequences associated with situational depression. The client is not denying the death of her mother. The client is not demonstrating anxiety or ineffective coping. Page Ref: 1805

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? A) Helplessness B) Anxiety C) Imbalanced Nutrition D) Overload Stress

Answer: A Explanation: The client states that she does not know what to do since her spouse died. This information would support the diagnosis of Helplessness. The client may or may not be anxious or stressed. There is not enough information to determine whether the client is or is not experiencing imbalanced nutrition. Page Ref: 1806

The home care nurse determines that a client being treated for postpartum depression is improving. What did the nurse assess in this client? A) Client in casual wear, holding baby while rocking in a chair B) Spouse making dinner, client in bed asleep, baby in rocker in the kitchen C) Dirty dishes in the sink, beds unmade, and client wearing clothing for sleep D) Client watching television in the living room while the baby is in the crib crying

Answer: A Explanation: The nurse who observes the client in casual wear, holding the baby while rocking in a chair, should determine that treatment for postpartum depression has been effective because these are signs the client is improving. The other choices would indicate disinterest in child care and care of the home. The client who is sleeping while the spouse is making dinner and watching the baby would indicate treatment has not been effective at all. Page Ref: 1827

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? SATA A) Elevated the client's mood B) Relieved stress C) Provided a short-term diversion to the pain of losing the spouse D) Given the client something to do E) Improved the client's oxygenation to keep the brain stimulated

Answer: A, B Explanation: Exercise has been known to improve the status of clients diagnosed with situational depression by elevating mood, relieving stress, and helping with focus so that other tasks and responsibilities can be completed. Exercise does more than give someone something to do. Exercise does improve body oxygenation; however, that is not the reason why it has been effective for this client. Exercise should not be seen as a short-term diversion for this client because it is a habit that should be maintained in the future. Page Ref: 1806

A client with depression is receiving electroconvulsive therapy. Which intervention(s) should the nurse plan when caring for this client? SATA A) Maintain nothing-by-mouth status until fully awake. B) Administer intravenous fluids for 8 hours post procedure. C) Place in the lateral recumbent position. D) Provide oral fluids immediately after the procedure. E) Place in the supine position with the head flat.

Answer: A, C Explanation: Care of the client recovering from electroconvulsive therapy includes placing in the lateral recumbent position to facilitate drainage and to prevent aspiration and to maintain nothing by mouth until fully awake. The supine with head flat position can lead to aspiration. The client does not need intravenous fluids for 8 hours after the procedure. Providing oral fluids when not fully awake can lead to aspiration. Page Ref: 1796

A student nurse is assisting in the care of a client with bipolar disorder. The student nurse researches the disorder further, focusing on the pathophysiology and etiology of the disorder. What is true regarding the pathophysiology and etiology of bipolar disorder? SATA A) No definitive cause or specific pathophysiology has been identified for bipolar spectrum disorders. B) Bipolar disorders, anxiety disorders, and personality disorders share biological susceptibility and inheritance patterns. C) Immunological abnormalities may contribute to the pathophysiology of mania and bipolar disorder. D) Children of parents with bipolar disorder have an increased risk of developing the disorder. E) Stressful life events and an emotionally overinvolved, hostile, and critical communication pattern are factors associated with heritability of the disorder.

Answer: A, C, D, E Explanation: Bipolar disorders, schizophrenia, and major depressive disorders share biological susceptibility and inheritance patterns. All other choices are correct. Page Ref: 1809

A nurse instructor is teaching a group of student nurses regarding depression, its pathophysiology, and the theories related to the disorder. What statement(s) will the nurse instructor include about the theories of depression? SATA A) Intrapersonal theory focuses on the theme of loss, either real or symbolic. B) The sociocultural factor theory states that those who are depressed focus on negative messages in the environment and ignore positive experiences. C) The learning theory states that individuals learn to be depressed in response to a self-perception of a lack of control over their life experiences. D) The sociocultural factor theory suggests that gender socialization differences may be a factor in the higher rate of depression in women. E) The learning theory states that individuals with depression typically experience little success in achieving gratification and little positive reinforcement in coping with negative incidents.

Answer: A, C, E Explanation: Among the theories of depression, the intrapersonal theory focuses on the theme of loss, either real or symbolic. Also, the learning theory states that individuals learn to be depressed in response to a self-perception of a lack of control over their life experiences. The learning theory also states that individuals with depression typically experience little success in achieving gratification and little positive reinforcement in coping with negative incidents. The cognitive theory states that those who are depressed focus on negative messages in the environment and ignore positive experiences. The gender bias theory suggests that gender socialization differences may be a factor in the higher rate of depression in women. Page Ref: 1781

An older client, unable to tolerate most antidepressant medications because of adverse effects, is scheduled for electroconvulsive therapy. What should the nurse instruct this client? SATA A) Participation in psychotherapy with some medication therapy often needs to be continued after the treatments. B) These treatments will cure the depression. C) Learn to write everything down, because repeated treatments can cause long-term memory loss. D) The treatments are known to help some but not all people with depression.

Answer: A, D Explanation: The nurse should instruct the client to expect to participate in psychotherapy with some medication therapy after the treatments because electroconvulsive therapy does not cure depression. The client may experience memory loss after treatment; however, it is transient. The nurse does not need to instruct the client to write everything down because of permanent memory loss. Because of other health conditions and intolerance to antidepressant medications, electroconvulsive therapy is very helpful for the older client with depression. Page Ref: 1795

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? SATA A) Ask what the client has done in the past to make "starting over" so successful. B) Suggest the client talk with the physician about medications to help his mood. C) Remind the client that an alcoholic beverage with the evening meal could help with stress. D) Encourage the client to take the time to rest and relax. E) Encourage the client to maintain a consistent exercise plan.

Answer: A, D, E Explanation: The nurse needs to assess the client's resiliency by finding out what he was able to do in the past, in similar situations, to be successful. Exercise has been shown to improve cognitive function, elevate mood, and relieve stress and anxiety. Suggesting that the client needs medication is inappropriate without further assessment. The nurse should not encourage the client to rest and relax because this could lead to a major depressive episode. The nurse should not encourage the client to ingest alcohol because this can be a self-destructive behavior. Page Ref: 1805

The home care nurse is planning care for a client with a history of postpartum depression with previous children. What should be included in this plan of care? SATA A) Take advantage of those who want to help and maintain outside interests. B) Contact the physician to ensure the client is prescribed medication for postpartum depression. C) Encourage as much sleep as possible. D) Focus on the care the other children need. E) Instruct to eat a healthful diet with limited alcohol intake.

Answer: A, E Explanation: Because the client has a history of postpartum depression with other children, the nurse needs to plan prevention strategies for the client. By taking advantage of those who want to help and maintaining outside interests, the client may prevent the onset of postpartum depression. Instructing to eat a healthful diet with limited alcohol intake is another strategy to prevent postpartum depression. The other interventions would not help prevent postpartum depression. Page Ref: 1826

A client with a history of depression says that since taking yoga classes, the depressive episodes have decreased. What should the nurse explain about yoga? SATA A) Promotes alertness and enthusiasm B) Raises levels of endorphins C) Stimulates the production of serotonin D) Increases blood flow to the brain E) Improves physical energy

Answer: A, E Explanation: Yoga has been found to improve wellness and prevent disorders such as depression. The gentle nature of the exercises allows its use by people in almost any condition. Those who practice yoga on a regular basis report improved life satisfaction, alertness, enthusiasm, and mental and physical energy, all of which are the opposite of the symptoms of depression. Yoga does not specifically increase blood flow to the brain. Yoga does not stimulate the production of serotonin. Short periods of aerobic exercise or longer periods of anaerobic exercise over a period of weeks will raise the level of endorphins, which enhance the feeling of well-being. Page Ref: 1796

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? A) Help caregivers acknowledge clients' dependency and assume appropriate responsibility. B) Help clients to identify ways in which they have control of their lives. C) Provide families with a list of community resources and encourage them to participate in support groups. D) Provide the families with information about clients'condition in accordance with client preferences.

Answer: B Explanation: A nurse who is promoting hope for a client with an adjustment disorder with depressed mood will help clients identify ways in which they have control of their lives. The other choices are correct interventions for supporting family function, not providing hope. Page Ref: 1807

A client in the manic phase of bipolar disorder is being provided with lithium and has a current level of 0.4. What will the nurse assess in this client? A) A decrease in manic behavior B) Hyperactivity and pressured speech C) A return to baseline behavior, calm and rational D) Signs and symptoms of depression

Answer: B Explanation: A therapeutic lithium level is 1.0-1.5 mEq/L. Because this client's level is low, behaviors will indicate mania, that is, hyperactivity and pressured speech. There will be no decrease in manic behavior because the lithium level is too low. The client will not exhibit signs and symptoms of depression, but will continue in the manic phase until the lithium level is within a therapeutic range. The client will not return to baseline behavior, but will continue in the manic phase until the lithium level is within a therapeutic range. Page Ref: 1812-1813

The family member of a client diagnosed with bipolar disorder asks the nurse what that is. What should the nurse respond to the family? A) "Bipolar disorder is a type of depression that includes attention deficit disorder symptoms." B) "Bipolar disorder means there are cycles of depression as well as hyperactivity, or mania." C) "Bipolar disorder just means that the mood alternates with the seasons, and it becomes worse in the winter." D) "Bipolar disorder is just another type of depression, except depression occurs in cycles."

Answer: B Explanation: Clients with bipolar disorder may shift from emotions of extreme depression to extreme rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions. Bipolar disorder must include either mania or hypomania, not just depression. Bipolar disorder must include depression with either mania or hypomania, not attention deficit disorder. A mood change that becomes worse in the winter is called seasonal affective disorder. Page Ref: 1809

An older client with cardiac disease describes a decline in the amount of sleep and difficulty falling asleep at night. What should the nurse consider is occurring with this client? A) Normal signs of cardiac disease B) Signs of anxiety and depression C) Normal signs of aging D) Normal signs of respiratory disease

Answer: B Explanation: Drastic changes in sleep patterns may be early signs of underlying anxiety and depression and should be investigated and not written off as normal changes of aging. Pain, respiratory disease, and cardiac disease can also interfere with sleep, but sleep pattern disturbances need to be assessed further to determine if there is an underlying psychiatric problem. Page Ref: 1799

A nurse manager working in labor and delivery is providing educational material to staff nurses regarding postpartum depression and the maternal role attainment (MRA) process. What information is true regarding the MRA process? A) Maternal role attainment occurs in five stages. B) During the formal stage of the MRA process, the woman is still influenced by the guidance of others and tries to act as she believes others expect her to act. C) During the formal stage of the MRA process, the woman looks to role models, especially her own mother, for examples of how to mother. D) The personal stage of the MRA process begins when the mother starts making her own choices about mothering.

Answer: B Explanation: Maternal role attainment occurs in four stages. During the formal stage of the MRA process, the woman is still influenced by the guidance of others and tries to act as she believes others expect her to act. During the anticipatory stage of the MRA process, the woman looks to role models, especially her own mother, for examples of how to mother. The informal stage of the MRA process begins when the mother starts making her own choices about mothering. Page Ref: 1817

The postpartum client states that she cannot understand why she does not enjoy being with her baby. What should cause the nurse concern? A) Postpartum infection B) Postpartum depression C) Postpartum psychosis D) Postpartum blues

Answer: B Explanation: Postpartum depression is characterized by feelings of failure and self-accusation, among others. Postpartum psychosis is more severe, and includes hallucinations and irrationality, which are not represented in this situation. Postpartum infection has nothing to do with this situation. Postpartum blues is characterized by mild depression interspersed with happier feelings, and is self-limiting. Page Ref: 1817

A client was widowed 3 years ago and has nothing to do except visit with acquaintances at the neighborhood bar. Of which health problem is this client demonstrating manifestations? A) Bipolar disorder B) Depression C) Sadness D) Extended grief

Answer: B Explanation: Risk factors for the development of depression include a history of the loss of a close family member and substance abuse. Bipolar disorder is characterized by periods of mania with periods of depression. The client is not describing or demonstrating these periods. The client may or may not be experiencing extended grief. There is not enough information to determine if the client is demonstrating sadness. Page Ref: 1799

A client being treated for depression reports the desire to get out of bed, shower, eat, and contact friends and family for socialization. What should the nurse realize this client is demonstrating? A) Risk factors for self-harm B) Improvement in depression C) Denial of the diagnosis of depression D) The need for assistance with activities of daily living

Answer: B Explanation: The client reports the desire to get out of bed and is showering, eating, and contacting friends and family members. These are all indications that the client's depression is improving. This is not an indication of risk for harm, denial of the diagnosis, or the need for assistance with activities of daily living. Page Ref: 1803

The nurse caring for a postpartum client would consider the nursing diagnosis of ineffective individual coping when the client demonstrates which behavior? A) Reading material on care of a newborn B) Lying in bed, lights dim, and refusing to spend time with the baby C) Cuddling the new infant D) Talking with friends and family on the phone

Answer: B Explanation: The postpartum client who is lying in bed in a darkened room and not wanting to spend time with the new baby is demonstrating signs of ineffective individual coping. The other behaviors would not indicate ineffective copying but rather effective coping and are incorrect. Page Ref: 1825

The spouse of a client being treated for depression believes the client is not responding to prescribed medication. What should the nurse respond to the spouse? SATA A) "Stop the medication immediately." B) "A trial-and-error period is the best way to determine which medication is the most effective." C) "A trial of 4 to 6 weeks is usually done to see how people respond to the medication." D) "Stay on the medication for 6 months to see if there is a response." E) "Learn to live with the depression."

Answer: B, C Explanation: A trial-and-error period may be needed to determine what medication is best for the individual. About 30% of clients do not respond to their antidepressant in a trial of 4 to 6 weeks. Do not stop medications without notification of the prescriber. Antidepressant medication is often prescribed for clients with depression symptoms. Stating that the spouse will have to learn to live with the depression is inappropriate. Page Ref: 1801

A client with a 2-month-old child is experiencing insomnia, mood swings, and crying. From what would this client most likely benefit? SATA A) Electroconvulsive therapy B) Psychosocial interventions C) Antidepressants D) Time management and exercise therapy E) Cognitive-behavioral therapy

Answer: B, C Explanation: The client is demonstrating signs of postpartum depression as evidenced by the mood swings, insomnia, and crying. Treatment for this disorder includes antidepressants and psychosocial interventions. Electroconvulsive therapy would be indicated for some cases of depression but not for postpartum depression. Cognitive-behavioral therapy would be indicated for depression but not postpartum depression. Time management and exercise therapy would not be beneficial for a client experiencing postpartum depression. Page Ref: 1780

A nurse working in a psychiatric hospital is performing a suicide assessment on a client diagnosed with major depressive disorder (MDD). What is true regarding the suicide assessment? SATA A) Assess all clients for suicide risk by using indirect questioning. B) Ask if the client has any thought of suicide. C) Asking about suicide will "plant the idea" in the client's mind. D) Assess the lethality of the suicide plan, if one exists. E) If the client has suicidal thoughts, assess whether or not the client would act on them.

Answer: B, D, E Explanation: When performing a suicide assessment, the nurse should always use direct, not indirect, questioning. The nurse should ask if the client has any thought of suicide and assess the lethality of the suicide plan, if one exists, and whether or not the client will act on these thoughts. Asking about suicide will not "plant the idea" in the client's mind. Page Ref: 1802

The nurse suspects a client is at risk for experiencing bipolar disorder. What did the nurse assess in this client? SATA A) Blood pressure 120/80 mmHg B) Recent major life-altering event C) Works out at the gym every week D) Currently employed E) Mother diagnosed with bipolar disorder

Answer: B, E Explanation: Bipolar disorders typically appear between the ages of 15 and 30. Risk factors include a family history of bipolar disorders, drug abuse, periods of very high stress, and a major life-altering event. Women and men are at equal risk of having bipolar disorders. A blood pressure of 120/80 mmHg does not put a client at risk for bipolar disorders. Being employed and working out regularly are not risk factors for bipolar disorders. Page Ref: 1810

A client in the manic phase of bipolar disorder will not sit down to eat. What can the nurse do to ensure adequate nutrition and improved self-care of this client? SATA A) Provide a sedative before meals. B) Discuss finger-food options with the dietitian. C) Use a jacket restraint at meal times. D) Ask the physician if intravenous feedings would be applicable. E) Provide frequent nutritious snacks.

Answer: B, E Explanation: The client who is unable to sit down and eat is most likely to consume frequent small snacks that can be eaten "on the go." The nurse should discuss with a dietitian to ensure that high-calorie finger foods and nutritious liquids are available on the nursing unit until the client is able to attend regular meals. Sedating, restraining, and providing intravenous therapy are not appropriate interventions and should not be done. Page Ref: 1815

A nurse working in labor and delivery is aware of the risk for postpartum clients to develop postpartum depression. What is a risk factor for the development of postpartum depression? A) Multiparity (multiple pregnancies) B) Overwhelming family support C) History of bipolar disorder D) History of anxiety disorder

Answer: C Explanation: A history of bipolar disorder is a risk factor for the development of postpartum depression. Primiparity (first pregnancy) is a risk factor, not multiparity. A lack of family support, not overwhelming family support, is a risk factor for the development of postpartum depression. Page Ref: 1820-1821

A client is experiencing symptoms of depression. Which laboratory or diagnostic test would be used to determine if depression is being caused by another health problem? A) Electrocardiogram B) MRI of the brain C) Thyroid function tests D) Cerebral angiogram

Answer: C Explanation: Heart disorders are not associated with the diagnosis of mood disorders. Cerebral MRI is not used to differentiate mood disorders from physical disorders. Thyroid function tests would be prescribed because thyroid disorders may mimic depression or hypomania. A cerebral angiogram is not used to differentiate mood disorders from physical disorders. Page Ref: 1788

The nurse, who has been calling postpartum clients, learns that one client reports having no appetite and wants to sleep all day. What does this information suggest to the nurse? A) The client is feeling blue, which is normal. B) The client's sleep-wake cycle is disrupted. C) The client may be experiencing postpartum depression. D) The client is developing postpartum psychosis.

Answer: C Explanation: Lack of appetite and the desire to sleep are symptoms of developing postpartum depression. The client could be developing postpartum depression and not just "the blues." The client would need to have more acute symptoms such as hearing voices to consider postpartum psychosis. The nurse has no way of knowing what the client's sleep-wake cycle is, so this choice is incorrect. Page Ref: 1817

A nurse working on a psychiatric unit is caring for a client who has been diagnosed with major depressive disorder (MDD). Upon assessment of the client, what clinical manifestations will the nurse expect to find? A) Depressed mood or loss of interest occasionally for at least 1 week B) A depressed mood sporadically for at least 2 years C) Restlessness, fatigue, suicidal ideation, feelings of guilt D) Anxiety, change in appetite, grief, altered nutrition

Answer: C Explanation: MDD is diagnosed when the client experiences either depressed mood or loss of interest most of the day, almost every day, for at least 2 weeks. The depression must be accompanied by at least four symptoms, including: sleep disturbance, fatigue, feelings of guilt or worthlessness, restlessness or psychomotor agitation, and suicidal ideation or attempt. Page Ref: 1778

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? A) Evidence of low blood glucose levels B) Financial struggles within the family C) Possible situational depression for both client and spouse D) Spousal abuse

Answer: C Explanation: Manifestations associated with situational depression in the older client include irritability and poor work performance. One spouse is irritable because of overwork and the other spouse is irritable because of the inability to perform household work. The nurse cannot determine if the family is having financial struggles. There is no evidence of spousal abuse at this time. The nurse cannot determine that the arguing is due to low blood glucose levels. Page Ref: 1805

The nurse is planning to assess a client demonstrating signs of depression. What should the nurse use to assess this client? A) More time talking with the client B) The client's family members, for answering the assessment questions C) Beck Depression Inventory D) Glasgow Coma Scale

Answer: C Explanation: The Beck Depression Inventory is a series of 21 questions that the client answers in order to self-rate the level of depression. It takes approximately 10 minutes for the client to complete. The nurse can use it to help with the assessment of this client. The Glasgow Coma Scale is not used to assess depression but rather level of responsiveness for neurological conditions. The nurse should not ask family members to answer assessment questions for the client. Assessment of clients with depression is often done in 15- to 20-minute increments because the client usually does not have the energy to talk much longer. For that reason, the nurse should not plan more time with the client to complete the assessment. Page Ref: 1785

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? A) Depression B) Cardiac disease C) Situational depression D) Bipolar disorder

Answer: C Explanation: The client is experiencing a loss of independence with the inability to drive. This loss is causing tension between the client and daughter, and the client feels like a burden. This situation places the client at risk for the development of situational depression. The client is not demonstrating signs of bipolar disorder or depression. This type of situation is not linked to the development of cardiac disease. Page Ref: 1805

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? A) The nurse should not get involved with a family conflict. B) Tell the client that arguing with a parent never ends in a good way. C) Remind the client and family that the grief process is different for everyone, and that no time limit can be set. D) Agree with the mother.

Answer: C Explanation: The client's mother is urging the client to "get over" the death of a spouse. The nurse should remind both the client and family that the grief process is individual and that there is no set time limit for the process to end. Agreeing with the mother would be ignoring the client's feelings. The nurse should not avoid getting involved with the family conflict if the client is experiencing an alteration from a healthy state, because that would be ignoring the client's need. Telling the client that arguing with a parent never ends in a good way is inappropriate. Page Ref: 1805

The nurse is caring for an adolescent with bipolar disorder experiencing suicidal ideation. What would be a priority nursing concern? A) Powerlessness related to mood instability B) Impaired Social Interaction C) Risk for Suicide D) Social Isolation related to disorder

Answer: C Explanation: The priority for an adolescent with bipolar disorder and suicidal ideas is safety. Risk for Suicide is the nursing diagnosis that would address safety for the client. The other diagnoses have a lower priority and can be addressed once safety has been ensured. Page Ref: 1813

A client of Eastern European descent who gave birth to her third child on the previous shift tells the nurse that she wants to get cleaned up and have something to eat so that she can be ready to go home in the morning. What should the nurse do to assist this client? A) Suggest that the client take advantage of the rest since she has other children at home who will also need her care. B) Instruct the client to pace herself and that there is no hurry rush to go home. C) Assist the client with self-care requests and check on when the meals will be delivered. D) Suggest that her plans to go home depend upon her physician.

Answer: C Explanation: To provide culturally sensitive care, the nurse should assist the client with self-care requests and check on when the meals will be delivered because clients of European descent often want to ambulate, shower, dress, and plan to go home quickly. The nurse should not suggest that the discharge is dependent upon the physician. Telling the client to pace herself or to take advantage of rest because she has other children at home who will also need her care does not allow for cultural differences surrounding childbirth. Page Ref: 1819

A client who is breastfeeding has been diagnosed with postpartum depression after delivering a first child. Which medications might be prescribed for this client? SATA A) Diazepam B) Phenytoin C) Paroxetine D) Fluoxetine E) Sertraline

Answer: C, E Explanation: Sertraline is recommended to be the first-line treatment for postpartum depression. Paroxetine is the alternative first-line treatment for postpartum depression. Fluoxetine is not recommended for lactating women because of the long half-life and the risk of the medication crossing into the breast milk. Diazepam and phenytoin are not used to treat postpartum depression. Page Ref: 1822

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? A) Many studies specifically investigate the role of exercise in adjustment disorder with depressed mood or situational depression. B) Evidence indicates that exercise is effective in reducing symptoms of depression; however, exercise must be aerobic and for 60 minutes or more per day. C) Resistance exercise is less effective in reducing symptoms of depression than aerobic exercise alone. D) Evidence suggests that physical exercise is as effective as cognitive-behavioral therapy (CBT) or medication in reducing depression.

Answer: D Explanation: Although there are no studies that specifically investigate the role of exercise in adjustment disorder with depressed mood or situational depression, evidence suggests that physical exercise is as effective as CBT or medication in reducing depression. The exercise performed should be aerobic combined with resistance to get the most antidepressant effect. Page Ref: 1806

A new graduate nurse is working in a behavioral health hospital and desires to learn more about bipolar disorders. The nurse understands that bipolar disorders affect clients differently across the lifespan. What is true regarding bipolar disorders and lifespan considerations? A) Children with bipolar disorders present with mood changes only. B) Children with bipolar disorders are usually diagnosed quickly, preventing years of undiagnosed mental illness. C) Suicide risk does not increase in adolescents and teenagers who are diagnosed with bipolar disorders. D) Lifetime prevalence of bipolar disorders in adolescents is 0%-3%.

Answer: D Explanation: Lifetime prevalence of bipolar disorders in adolescents is 0%-3%. Children with bipolar disorders present with mood and behavioral changes. Children with bipolar disorders are often misdiagnosed with ADD or ADHD, causing years of undiagnosed and untreated mental illness. Suicide risk is increased among all age groups with bipolar disorders. Page Ref: 1811

The nurse overhears a client apologize to the spouse about being ill and leaving tasks at home uncompleted. In addition to this client's reason for hospitalization, the nurse realizes this client is at risk for developing which of the following? A) Musculoskeletal disorder B) Heart disease C) Diabetes D) Depression

Answer: D Explanation: People who are unusually sensitive to failure to achieve their goals are said to have self-critical traits. These cognitive-personality features increase the likelihood that stressors will lead to depression. There is not enough information to determine if the client will develop heart disease, a musculoskeletal disorder, or diabetes. Page Ref: 1778

The nurse is planning care for an adolescent client experiencing the manic phase of bipolar disorder. Which intervention would address hallucinations? A) Encourage spending time with others. B) Discuss a homework assignment. C) Keep isolated in a quiet room. D) Explain that hallucinations are not real.

Answer: D Explanation: The adolescent client in the manic phase of bipolar disorder experiencing hallucinations should not be left alone in a quiet room but rather should be talked with and explained that the hallucinations are not real. The nurse should not discuss homework assignments or encourage the client to spend time with others. The hallucinations need to be addressed. Page Ref: 1813

A client prescribed an antidepressant tells the nurse that the pill causes dizziness upon standing or changing position too quickly. The nurse realizes the client is experiencing a side effect of which medication? A) Serotonin-norepinephrine reuptake inhibitor B) Monoamine oxidase inhibitor C) Selective serotonin reuptake inhibitor D) Tricyclic antidepressant

Answer: D Explanation: The most common side effect of tricyclic antidepressants is orthostatic hypotension, due to alpha1 blockade on blood vessels. Orthostatic hypotension is not associated with the other medications. Page Ref: 1790

A nurse is caring for a client who displays symptoms associated with seasonal affective disorder (SAD). What healthcare provider order would the nurse question as inappropriate for this client? A) Cognitive-behavioral therapy B) Light therapy C) Bupropion extended-release D) Selective serotonin reuptake inhibitor (SSRI)

Answer: D Explanation: The nurse would question the order for a selective serotonin reuptake inhibitor (SSRI). This medication is used in the treatment of major depressive disorder (MDD) and dysthymic disorder, not seasonal affective disorder (SAD). All the other orders are appropriate for a client with SAD. Page Ref: 1800

A client being treated for depression reports feeling better and has started to make plans. What is a priority nursing concern? A) Social Isolation B) Hopelessness C) Situational Low Self-Esteem D) Risk for Self-Directed Violence

Answer: D Explanation: The one risk that occurs with successful treatment of a client with depression is that once the depression begins to resolve, the underlying thought of suicide could prevail. With treatment, the client may begin to have more energy to make a plan regarding suicide. The nurse should further assess this client's statement about making plans. The client is not demonstrating low self-esteem, hopelessness, or social isolation. Page Ref: 1802

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? SATA A) Ask if the client can move in with parents. B) Suggest that the client attend group therapy with a grief counselor. C) Investigate whether the spouse had life insurance and what income the client can expect. D) Help the client focus on strengths. E) Help the client prioritize things that need to be accomplished.

Answer: D, E Explanation: The client is demonstrating powerlessness. The nurse should help the client problem-solve by strategizing what needs to be accomplished. The nurse should not suggest group therapy with a grief counselor because the client is not demonstrating signs of dysfunctional grieving. The nurse should not suggest the client move in with parents nor investigate whether the spouse had life insurance to help with the client's income because the client has not yet determined the priority of issues that need to be addressed. These suggestions might be beneficial after the client has prioritized the things that need to be accomplished. Page Ref: 1807

The nurse is instructing a new mother on the strategies to prevent the development of postpartum depression. What should the nurse include in these instructions? SATA A) Restricting fluids and eating a low-fat diet help to avoid the onset of postpartum depression. B) Realize that feeling depressed after delivering a baby is normal and can last for months. C) The only way to avoid postpartum depression is to not have children. D) Encourage the client to plan how to manage the baby's care needs at home to help adjust to motherhood. E) Instruct the client to recognize the signs and symptoms of postpartum depression and phone the health care provider if these occur.

Answer: D, E Explanation: The nurse should instruct the client on the signs and symptoms of postpartum depression with the direction to phone her health care provider if this occurs. The nurse should also encourage the client to plan how to manage the baby's care needs at home to help adjust to motherhood. It is not normal to feel depressed for months after delivering a baby. Not having children is not the only way to avoid postpartum depression. Restricting fluids and eating a low-fat diet will not prevent postpartum depression and could harm the new mother's physiological status. Page Ref: 1826

A client in the manic phase of bipolar disorder is unable to sleep during the night. What intervention(s) could be helpful to this client? SATA A) Engage in conversation. B) Extend daytime naps. C) Encourage the client to watch television. D) Assist the client with a warm bath and provide a light snack. E) Encourage the client to listen to soothing music.

Answer: D, E Explanation: To promote sleep during the night, the nurse should decrease lighting and noise, encourage pre-sleep routines like a warm bath, and provide a snack. Listening to soothing music also helps to promote sleep. Stimulation such as watching television and long conversations should be avoided. To promote nighttime sleeping, daytime naps should be limited and not extended. Page Ref: 1812