PrepU | Assignment 5 | Chapter 17: Mood Disorders and Suicide

The nurse has been asked to assess a client to determine if the client has a suicide plan. Which question would assist the nurse in assessing this area?

"Are you thinking about killing yourself right now?"

A bipolar client presents to the clinic with reports of headaches and feeling more irritable than usual. What is the best nursing response?

"Can you tell me more about these symptoms?"

The nurse is providing care for a client who deliberately overdosed on acetaminophen several days ago. The nurse should assess the current severity of the client's suicidal ideation by asking what question?

"How often are you having thoughts about suicide this morning?"

The nurse provides care for a client who is depressed and expresses hopelessness with the current situation. Which client statement indicates a need to implement safety precautions?

"I haven't been able to sleep for the past week because I am anxious."

The nurse reviews the medication list for a client who is newly prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which client statement indicates a need to assess the client for serotonin syndrome?

"I started taking diet pills to assist with weight loss." Serotonin syndrome is a potentially serious side effect caused by drug-induced excess of intrasynaptic serotonin, 5-hydroxytryptamine (5-HT). Combining medications that increase CNS serotonin levels, such as SSRIs + MAOIs, St. John's wort, diet pills, dextromethorphan, or alcohol (especially red wine) or an SSRI + street drugs (e.g., LSD, MMDA, or ecstasy). The client statement "I started taking diet pills to assist with weight loss." requires the nurse to assess the client for symptoms of serotonin syndrome, which include mental status changes, agitation, ataxia, myoclonus, hyperreflexia, fever, shivering, diaphoresis, and diarrhea. The other client statements do not indicate that the client is at risk for serotonin syndrome.

The nurse is interviewing a client with a diagnosis of depression and the client states, "Honestly, I know my family would be a lot better off if I wasn't around to be a burden on them. That's just between you and me, though, okay?" What is the nurse's best response?

"I'm obliged to share what we talk about with the other people on your care team."

A 52-year-old client with bipolar disorder tells the nurse, "I read that there are chemicals in my brain that can cause my symptoms." Knowing that the client is referring to neurotransmitters, which would be the best response by the nurse?

"Low levels of the neurotransmitter serotonin are associated with mania."

A client's physician has prescribed paroxetine for the treatment of the client's depression. Which teaching points should the nurse include in the client education related to this treatment?

"Make sure that you don't change the quantity or timing of your medication without first consulting your doctor."

A nurse is completing an admission assessment of a young adult client who has a history of depression, and who was brought to the hospital by a friend. In response to the nurse's question regarding suicidal ideation, the client discloses that they often think about attempting suicide. Which question is appropriate for the nurse to ask?

"What thoughts have you had about how you would kill yourself?"

A client has just been diagnosed with bipolar disorder and is upset with the diagnosis. The client tells the nurse, "It is probably my mother's fault, she has bipolar too." Which is the best response by the nurse?

"While bipolar disorders are genetic, there are other causes as well."

A 38-year-old client has been diagnosed with major depressive disorder. The client is being placed on an antidepressant and the nurse is providing medication teaching. Which would be appropriate information to provide to the client?

"You may not notice an improvement in your symptoms for 2 to 6 weeks."

A client has experienced a first episode of major depression and has received medication and treatment, which has led to a complete remission of the symptoms. The client asks the nurse, "How much longer will I need to take the medication?" Which response by the nurse would be most appropriate?

"You'll need to continue the medication for about 6 to 12 months to see how things go."

For maintenance therapy of mania, the therapeutic serum level of lithium is ...

0.6-1.2 mEq/L.

The mental health nurse appropriately provides education on light therapy to which client?

20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

Which sleep pattern is suggestive of a manic episode?

A client stays awake for several days and nights before "crashing" and sleeping for a long period.

A 46-year-old client comes to the community mental health center because the client thinks they might be suffering from depression. When assessing this client, which symptom would the nurse identify as being necessary for the diagnosis of major depressive disorder to be made?

A loss of interest or inability to derive pleasure for previously enjoyed activities

A client was abandoned by the parents at age 3, resulting in the client's perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of what?

A psychodynamic interpretation of the client's major depressive disorder.

A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what?

A significant decrease in appetite

The community mental health nurse is providing care for a large number of clients. What client should the nurse monitor most closely for the warning signs of suicide?

A young male with schizophrenia who is in danger of becoming homeless

A nurse is providing psycho-education to a client who has been admitted to the inpatient mental health unit for a manic episode. In order to ensure the teaching is effective, the nurse must first determine which regarding the client?

Ability to concentrate and process the information

The nurse is seeing a 26-year-old client and the client's family. The client's family describes the client as being "very, very different." The family describes a history of periods of unpredictable behavior and disregard for consequences occurring a few times each year. The client has recently been diagnosed with bipolar I disorder, a condition that is characterized by what?

An elevated mood that lasts for at least 1 week

A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder?

Anticonvulsants Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness.

A client is admitted to the unit in an acute manic episode. The client has had three major depressive episodes in the past 10 years and two other hospitalizations for mania. Which disorders would reflect the client's symptom profile?

Bipolar I Bipolar I disorder is characterized by one or more manic episodes, usually alternating with major depressive episodes.

What is the difference between depressive disorders and bipolar disorders?

Bipolar disorders involve mood swings ranging from depression to mania. The hallmark feature of depressive disorders is a disturbance in mood, in which the affected person feels dysfunctionally sad, gloomy, unhappy, or "down" more often than not. Bipolar disorders also are marked by a disturbance in mood. The difference is that these clients experience mood swings ranging from profound depression to extreme euphoria (mania). Symptoms during depressive episodes are consistent with those of major depression.

After presenting to a group on factors that enhance the risk of suicide, a nurse determines the need for additional education when the group identifies which item as a risk factor?

Cautiousness

A client has just been admitted to the inpatient psychiatry unit following a suicide attempt. During the client's first 24 hours of care, what outcome should be identified?

Client will express that the client feels safe on the unit

When assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client?

Confusion

Which is an anticonvulsant used as a mood stabilizer?

Divalproex Divalproex is an anticonvulsant that may be used as a mood stabilizer. Venlafaxine, bupropion, and phenelzine are antidepressants.

A 35-year-old client with bipolar disorder has a history of discontinuing medication when feeling well and then becoming manic again. During the client's last episode of mania, the client lost several thousand dollars in risky investments. Which intervention will be most helpful in achieving medication adherence?

During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse.

A 32-year-old client is admitted to the inpatient unit for depression with suicidal thoughts. During the nursing assessment, why it is important for the nurse to assess and explore if there is any family member who has committed suicide?

Genetic predisposition

The police bring a client to the hospital. They found the client in a hospital gown, swimming in a local creek. The client states that the client was "being baptized by Mother Nature, who loves and worships me." How would the nurse describe the client's current alterations in mental status?

Grandiose delusions

A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of what?

Grandiosity

Which is the priority nursing action to prevent suicide and promote mental health?

Identify a client who is thinking about suicide.

A nurse is preparing a client for discharge. As part of the discharge process, the nurse provides education to the client regarding safety from self-harm. Which intervention should the nurse employ?

Include family members to provide a better understanding of symptoms of the illness

Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension?

Increase hydration Increasing hydration and sitting or standing up slowly are nonpharmacologic interventions for orthostatic hypotension. Taking medications with food would counteract nausea and vomiting. Daily exercise and eating a nutritionally balanced diet would help with weight gain that occurs in clients taking antidepressants.

To care for an acutely suicidal client, which is the most effective initial mode of treatment?

Inpatient care

A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition?

Light therapy

A nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the greatest risk for a suicide attempt?

Man with major depressive disorder

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what?

Middle insomnia

Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what?

Moderate depression

Which medication classification is considered first-line drug therapy for bipolar disorder?

Mood stabilizers

Which biogenic amines have been implicated in depression?

Norepinephrine and serotonin

Which is a true statement regarding depressive disorders?

Norepinephrine, dopamine, and serotonin have been implicated.

A depressed older adult client is being treated with a tricyclic antidepressant (TCA). For which clinical manifestations should the nurse monitor the client?

Orthostatic hypotension and urinary retention

The nurse is caring for a client diagnosed with bipolar disorder. During a manic episode, which takes priority?

Safety

A client with major depression is prescribed paroxetine. The nurse develops an education plan for the client based on the understanding that this drug belongs to which class of drugs?

Selective serotonin reuptake inhibitors

A nurse is caring for a client diagnosed with bipolar disorder. The client is experiencing a manic episode. The nurse would be especially alert for signs indicating what?

Self-injury

In response to a change in the community health nurse, a client has recently discontinued use of lithium. As a result of the discontinuation of the medication, the client has began to exhibit early signs of mania. The client is brought to the emergency department at the hospital for assessment. Which is the best nursing approach for this client?

Setting limits, providing a low-stimulation environment, and maintaining a neutral attitude

The nurse is conducting an admission assessment for a client with major depressive disorder. Which is the priority assessment for the nurse?

Suicide risk assessment Explanation: Safety is a priority for clients suffering from depression. The focus of interventions may differ slightly depending on the client's specific problems. Suicide is a primary concern for all clients with depression.

A client with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation?

The client is experiencing catatonia. Explanation: Electroconvulsive therapy is an effective treatment for clients with severe depression. It is generally reserved for those whose disorder is refractory or intolerant to initial drug treatments and who are so severely ill that rapid treatment is required (e.g., clients with malnutrition, catatonia, or suicidality).

The nurse is assessing a client who has presented to the emergency department in emotional distress. What client data represents the greatest risk for suicide?

The client overdosed on pills 2 years earlier

The nurse is working with an outpatient who has a history of depression and suicide attempts. What assessment finding should the nurse interpret as indicating a high degree of planning for a future attempt?

The client recently purchased a large bottle of over-the-counter analgesics

A mental health nurse has formed a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. An appropriate outcome for this nursing diagnosis would include what?

The client will demonstrate improved ability to express self.

A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis?

The client will reframe negative thoughts in a more positive way.

Which is an accurate statement regarding women and suicide?

They are less likely to complete suicide than men.

A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the client will have to demonstrate specific symptoms. What are some of these symptoms? Select all that apply.

disruption in sleep disruption in appetite disruption in concentration excessive guilt

The majority of suicides among men are attributed to:

firearms

A client who is depressed tells the nurse, "If I'm honest, I really see suicide as the only way out." In order to challenge the client's belief, the nurse should ...

help the client to identify and explore other options.

A nurse maintains a safe environment for a client who is suicidal by ...

observing the client frequently.