Depression

a (Rationale: The client with depression must learn alternative ways of dealing with stress such as talking. The client has demonstrated that goal by discussing problems with another client. Refraining from self-harm during hospitalization is not a goal for discharge. The other statements demonstrate hopelessness or unrealistic assessments of personal strengths.)

The nurse determines that a client with depression is meeting a short-term goal when the client makes which statement? a "I made friends with another client and talked about my problems." b "I will not harm myself during hospitalization." c "I do not have much hope of getting my job back." d "I wish I was really good at enjoying myself at parties."

c,d,e

What are some of the clinical manifestations of​ depression? Select all that apply. a Euphoria b Excessive spending c Feelings of hopelessness d Guilt e Sleep disturbances

c

A client diagnosed with major depressive disorder is admitted to the mental health unit because of attempted suicide. The nurse identified the problem of impaired​ self-care. Upon​ evaluation, What data indicate that the client achieved the outcome identified for this​ problem? a Talks to nurse about suicidal ideations b Identifies the importance for​ cognitive-behavioral therapy​ (CBT) c Competes shower and brushes teeth independently d Attends yoga class

b

A client is admitted to a mental health unit for depression. After a​ week, the client continues to withdraw from others. Which statement by the nurse would most likely promote interaction with other​ clients? a "You will feel better if you participate in activities. b. "Come and play cards with me. c "It is important to participate in group activities. " d "I will put the television on for you to watch.

b (Rationale The presence of three symptoms on 1 day or one symptom for 3 days may signal serious depression and requires immediate referral to a mental health professional. The other referral options are not appropriate for this client.)

The nurse is assessing a client and asks how she is feeling. In response to the nurse​'s ​question, the postpartum client states she has been experiencing ongoing appetite​ changes, sleep​ deprivation, crying​ spells, anxiety, and poor concentration. The nurse determines that the client needs to be referred for evaluation. Which referral would be most appropriate for this​ client? a Hotline for postpartum mothers b Mental health professional c Support group d Clergy

d

The nurse is admitting a client to the mental health unit for possible persistent depressive disorder. What data should the nurse collect when completing the client​'s physical​ assessment? a Suicidal ideations b Medication use c Sleep disturbances d Vital signs

b (Women diagnosed with postpartum psychosis would benefit from lithium or antipsychotic medications. Pitocin is a medication administered to induce or enhance the progress of labor and delivery. Paxil and Zoloft are medications prescribed for postpartum depression.)

Madison Grange is a​ 27-year-old female with symptoms of​ hyperactivity, confusion,​ hallucinations, and delusions. The nurse determines that Ms. Grange is most likely experiencing postpartum psychosis. Which medication does the nurse anticipate will be ordered for Ms.​ Grange? a Paxil b Lithium c Zoloft d Pitocin

c (Miss Luke is at risk for suicidal ideations. You need to provide a​ safe, protective environment upon admission to assure her safety. A client who is experiencing severe anxiety would need to be placed in a​ safe, quiet environment away from other​ client's to prevent disturbance or threat to others. A client should never be left alone. You need to assist Miss. Luke in identifying personal​ strengths, not personal weaknesses. Negative feels should be allowed while setting limits on negative conversation.)

Miss Laura​ Luke, an​ 18-year-old client, is isolating herself from peers and refuses to go to school. She refuses to maintain her ADLs. Upon admission to a mental health​ unit, Miss Luke is diagnosed with major depressive disorder. Which intervention should you initiate upon admission to the​ unit? a Help the client identify personal weaknesses. b Isolate the client from others. c Provide a​ safe, protective environment. d Create an environment free of excessive stimulation.

a,b,d

What are the risk factors for the development of​ depression? Select all that apply. a Childhood sexual abuse b Family member with depression c Being Caucasian d Dysfunctional family relationship e Being male

b,e

What kinds of weather will cause symptoms related to seasonal affective disorder​ (SAD) to be more​ prominent? Select all that apply. a Windy b Cloudy c Cold d Sunny e Rainy

b,c,d,e

Which are alternative therapies used to treat mood​ disorders? Select all that apply. a Electroconvulsive therapy b Vitamin B c St. John​'s wort d Exercise e Acupuncture

a,b,c

Which classifications of medications are prescribed for mood​ disorders? Select all that apply. a Selective serotonin reuptake inhibitors b Monoamine oxidase inhibitors c Tricyclic antidepressants d Benzodiazepines ​e Carbonic-anhydrase inhibitors

a (Tricyclic doxepin is a medication that is contraindicated while breastfeeding.​ Nortriptyline, lithium, and SSRIs can be safely used while breastfeeding.)

Which medication is contraindicated for breastfeeding​ mothers? a Tricyclic doxepin b Lithium c Nortriptyline d Selective serotonin reuptake inhibitors

c (Rationale The nurse should anticipate that a client experiencing major depressive disorder would have insomnia. A client with major depressive disorder will experience psychomotor​ retardation, decreased​ libido, and feelings of worthlessness or excessive guilt.)

A client is being admitted for treatment of major depressive disorder. Which symptom should the nurse anticipate the client would experience during​ hospitalization? a Increased libido b Euphoria c Insomnia d Enhanced energy

d

A client with depression is admitted to the mental health unit because of attempted suicide. Which​ short-term goal should be given high priority for this​ client? a The client will establish healthy and mutually caring relationships. b The client will identify and discuss actual and perceived losses. c The client will learn strategies to promote relaxation and​ self-care. d The client will seek out the nurse when feeling​ self-destructive.

c

A client​'s spouse complains that his wife​'s depression isn​'t any better after taking an antidepressant medication for 1 week. What action should the nurse initially​ take? a Suggest that the client change antidepressant medication. b Question the husband about what response he expects. c Explain that it may take 1-3 weeks to see any improvement. d Tell him to contact the healthcare provider.

d

A nurse is making​ follow-up calls to postpartum clients. Which client should the nurse schedule to be seen​ immediately? a The client stating she has no appetite and wants to sleep all day b The client stating she needs a refill on her sertraline​ (Zoloft) next week c The client describing being sad all the time d The client reporting hearing voices talking about the baby

a,b,c,e (Rationale Clinical therapies for postpartum psychosis include lithium and antipsychotics. Support groups and​ short-term institutionalization may be​ required, as well as supervision when caring for the infant or other children. Mental health counseling is indicated for postpartum depression.)

A nurse is teaching a family about possible therapies for a client with postpartum psychosis. Which clinical therapy would the nurse state is used to treat the client experiencing this​ condition? Select all that apply. ​a Short-term institutionalization b Supervision when caring for infant or other children c Lithium and antipsychotics d Mental health counseling e Support groups

b (Rationale Following an​ ECT, the nurse can expect​ transient, short-term memory loss. Paralytic​ ileus, hypotension, and shallow respirations are not normal findings following an ECT.)

A severely depressed client received electroconvulsive therapy​ (ECT) this morning. Which finding would the nurse recognize as normal​ posttreatment? a Paralytic ileus b Memory loss c Hypotension d Shallow respirations

c (Rationale Support groups have proven to be successful. Support groups may help the couple feel that they are not alone in their experience. Support groups provide a place for exchanging​ information, improved​ self-esteem, and learning​ stress-reduction measures.​ ECT, removal of the​ infant, and the use of antipsychotics are interventions used for postpartum psychosis.)

A treatment program for clients with postpartum depression includes pharmacologic and nonpharmacologic approaches. The nurse suggests that which nonpharmacologic treatment provides couples with opportunities to share common experiences and​ concerns? a Antipsychotics b Removal of the infant c Support groups d ECT​ (electroconvulsive therapy)

a (Rationale Major depressive is evidenced by psychomotor​ retardation, impairment of​ self-care, inability to​ sleep, and a suicide attempt. Bipolar disorder is characterized by hyperactivity and euphoria that may become sarcasm or hostility. Adjustment disorder with depressed mood is a change in mood and affect following a​ stressor, such as the end of a relationship. It is also called situational depression. Dysthymic disorder has symptoms of normal moods for a period of​ weeks, followed by​ depression, insomnia/hypersomnia, loss of interest in​ activities, and social withdrawal.)

A​ 42-year-old was admitted to the mental health unit after a failed suicide attempt by drug overdose. The client sought help when her husband informed her of his decision to leave her and the children after 21 years of marriage. Upon initial contact with the​ nurse, the client looked​ exhausted, affect was​ sad, movements and responses were​ slowed, and​ self-care impairments were evident. What type of disorder would the nurse suspect the client is​ experiencing? a Major depressive disorder b Adjustment disorder with depressed mood c Bipolar disorder d Dysthymic disorder

b (Mrs. Jones is likely experiencing major depressive disorder and is at risk for suicidal ideations or recurring thoughts of death. To assure Mrs.​ Jone's safety, you need to identify if she is having any suicidal ideations. Once you have identified that Mrs. Jones is​ safe, you can determine if she is experiencing​ anhedonia, is drinking​ alcohol, and her medication history.)

Mrs.​ Jones, a​ 75-year-old client, lives alone in an apartment after the death of her husband. Her only child lives 225 miles away and visits every other month. She is complaining of memory​ loss, insomnia, loss of​ appetite, and irritability. Mrs. Jones indicates that the symptoms have persisted for the past 3 months. When completing a health history with Mrs.​ Jones, what data are essential for you to​ obtain? A. Medication history B. Suicidal ideations C. Alcohol use D. Anhedonia

c

Ms. Carla​ Simmons, age​ 26, is admitted to a mental health unit. She has been avoiding her family​ responsibilities, has not left the house for a​ month, and has not had a good appetite. During the past 2​ months, she has lost over 20 pounds. Ms. Simmons is diagnosed with severe depression. At an interdisciplinary​ conference, the recommendation is made for electroconvulsive therapy​ (ECT). When would the nurse start preparing the client for this​ procedure? a Immediately after the procedure is completed b The night before the ECT is planned to occur c When the client and her family are presented with the treatment plan by the healthcare provider d When the client is admitted to the mental health unit

c (Rationale: Older adults, especially women, have higher levels of monoamine oxidase, which deactivates neurotransmitters, resulting in decreased impulse transmission that can cause depression. The other explanations are inaccurate.)

The adult child of an elderly client with depression asks the nurse why elderly people are at higher risk for developing depression. Which response by the nurse is most appropriate? a "Older clients have a higher level of a thyroid hormone that can lead to depression." b "Older adults have higher levels of chemical messengers in the brain that result in depression." c "Older clients have higher levels of an enzyme that slows signals to the brain, causing depression." d "Older adults have enlarged ventricles of the brain, which can lead to depression."

b (Rationale: Older adults, especially women, have higher levels of monoamine oxidase, which deactivates neurotransmitters, resulting in decreased impulse transmission that can cause depression. The other explanations are inaccurate.)

The adult child of an elderly client with depression asks the nurse why elderly people are at higher risk for developing depression. Which response by the nurse is most appropriate? a "Older clients have a higher level of a thyroid hormone that can lead to depression." b "Older clients have higher levels of an enzyme that slows signals to the brain, causing depression." c "Older adults have enlarged ventricles of the brain, which can lead to depression." d "Older adults have higher levels of chemical messengers in the brain that result in depression."

a,c,d,e (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.)

The client states to the​ nurse, "I take citalopram​ (Celexa) 40 mg every​ day, and I have also been taking St. John​'s wort 750 mg daily for the past 2​ weeks." Which manifestations would lead the nurse to suspect that the client is developing serotonin​ syndrome? Select all that apply. a Confusion b Constipation c Ataxia d Diaphoresis e Headache

a (Rationale Postpartum blues is characterized by mild depression interspersed with happier feelings and is​ self-limiting. Crying for no reason is a frequent assessment finding. Postpartum depression is characterized by feelings of shame and​ guilt, among others. Postpartum psychosis is more severe and includes hallucinations and​ confusion, which are not represented in this situation. Postpartum infection is not suggested by this scenario.)

The home care nurse is providing care for a postpartum client. The client begins to cry during the assessment process and​ states, "I don​'t know why I am crying all the time. I am so in love with my baby. " Which postpartum disorder does the nurse suspect that the client is​ experiencing? a Postpartum blues b Postpartum infection c Postpartum psychosis d Postpartum depression

b (Rationale: The client with depression must learn alternative ways of dealing with stress such as talking. The client has demonstrated that goal by discussing problems with another client. Refraining from self-harm during hospitalization is not a goal for discharge. The other statements demonstrate hopelessness or unrealistic assessments of personal strengths.)

The nurse determines that a client with depression is meeting a short-term goal when the client makes which statement? a "I do not have much hope of getting my job back." b "I made friends with another client and talked about my problems." c "I will not harm myself during hospitalization." d "I wish I was really good at enjoying myself at parties."

b,c,d (Rationale Postpartum blues can manifest as​ fatigue, anxiousness,​ tearfulness, loss of​ appetite, and feelings of being overwhelmed and being​ "let down." Sleepiness is a normal occurrence during the postpartum period and is not a finding that supports postpartum blues. Irrational thoughts would support a diagnosis of postpartum​ psychosis, not postpartum blues.)

The nurse is assessing a client for postpartum blues. Which feelings​ voiced, or behaviors​ observed, might the nurse document regarding a client experiencing postpartum​ blues? Select all that apply. a Sleepiness b Fatigue c Tearfulness d Overwhelmed e Irrational thoughts

d (Rationale Clients who are diagnosed with dysthymic disorder demonstrate a depressed mood most of the time for 2 years​ (for adults), are unable to cope with​ responsibilities, and have thoughts of suicide and death. Other symptoms include​ self-pity, chronic​ fatigue, poor​ self-esteem, difficulty​ concentrating, and pessimism about the future. Seasonal affective disorder occurs when the individual experiences depression during the fall and winter seasons. Bipolar disorders are a group of mood disorders that include manic​ episodes, hypomanic​ episodes, and mixed episodes. Symptoms may include​ euphoria, inability to take time to​ eat, sleep​ disturbances, and possibly sexual disinhibition. Cyclothymic disorder symptoms include fluctuating mood disturbances involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms.)

The nurse is assessing a new client on the mental health unit. The client states that she has been depressed most of the time for the past 2​ years, is unable to cope with family​ responsibilities, and has frequent thoughts of suicide and death. Based on these​ data, which type of diagnosis does the nurse​ anticipate? a Bipolar disorder b Cyclothymic disorder c Seasonal affective disorder d Dysthymic disorder

c (Rationale: These symptoms are indicative of neuroleptic malignant syndrome (NMS), a potentially fatal idiopathic response to high-potency neuroleptic medications. The medication should be discontinued and the physician notified immediately. NMS is an emergency and must be reported immediately to the physician before charting)

The nurse is caring for a client 'who has developed symptoms associated with neuroleptic malignant syndrome (NMS). The priority of action for the nurse is to: a Continue the medications and perform more frequent assessments of the client. b Chart the assessment findings and report them to the primary nurse at change of shift. c discontinue the client's neuroleptic medication and report the symptoms to the physician immediately. d Discontinue the neuroleptic medication and document assessment findings as the cause for the action.

a (Rationale: These symptoms are indicative of neuroleptic malignant syndrome (NMS), a potentially fatal idiopathic response to high-potency neuroleptic medications. The medication should be discontinued and the physician notified immediately. NMS is an emergency and must be reported immediately to the physician before charting.)

The nurse is caring for a client 'who has developed symptoms associated with neuroleptic malignant syndrome (NMS). The priority of action for the nurse is to: a discontinue the client's neuroleptic medication and report the symptoms to the physician immediately. b Chart the assessment findings and report them to the primary nurse at change of shift. c Continue the medications and perform more frequent assessments of the client. d Discontinue the neuroleptic medication and document assessment findings as the cause for the action.

b (Rationale: The only option that can cause urinary retention and constipation is psychomotor retardation and medication. Medication therapy with tricyclic antidepressants is known to cause urinary retention and constipation. Psychomotor retardation is characterized by noticeably slowed body movements and a subsequent slowing of all body processes, which can lead to urinary retention and constipation. Inadequate dietary and fluid intake can lead to constipation. Lack of exercise and poor dietary choices also can cause constipation.)

The nurse is caring for a client who is experiencing a major depressive episode. The nurse monitors the client for signs of urinary retention and constipation, which are possible due to: a Lack of exercise b Psychomotor retardation and medication c Inadequate dietary and fluid intake d Poor dietary choices

a,c,d,e (Rationale The nurse caring for a client with postpartum depression should assess the client​'s emotional state using the Edinburgh Postnatal Depression Scale​ (EPDS). The nurse should discuss options and resources available to the mother and provide referrals as needed. The nurse should educate the mother on the​ signs/symptoms of postpartum blues versus PPD or psychosis as well as when she should seek help. The nurse should assist the mother in positively interacting with her newborn by explaining infant cues and their meanings. The nurse should assist family members in understanding what the mother is going through and provide opportunities for family to express their​ feelings/concerns, while assisting and encouraging the mother to care for the infant.)

The nurse is caring for a client with postpartum depression. Which intervention should the nurse include in the client​'s ​care? Select all that apply. a Use a depression scale to assess the client​'s status b Schedule an appointment with a therapist c Help facilitate bonding with the infant d Provide resources and referrals as needed e Educate the client and family about signs and symptoms of postpartum depression

d (Rationale ​Self-neglect is a manifestation of depression in an adolescent client. Whininess is a manifestation of depression in a preschool child. Boredom and threats to run away are manifestations of depression in a​ school-age client.)

The nurse is caring for an adolescent client diagnosed with depression. Which assessment findings support this​ diagnosis? a Boredom b Whininess c Threats to run away ​d Self-neglect

a,b,c,e (Rationale When completing a health history on a client with seasonal affective​ disorder, the nurse needs to obtain information regarding sleep​ disturbances, medical​ history, feelings of​ guilt, and anhedonia​ (decreased ability to experience​ pleasure). The client​'s sexual history is not pertinent when completing the health history on this client.)

The nurse is completing a health history on a client with seasonal affective disorder​ (SAD). What data should the nurse obtain during this​ interview? Select all that apply. a Sleep disturbances b Medical history c Anhedonia d Sexual history e Feelings of guilt

c (Rationale When caring for a client with major depressive​ disorder, the nurse should involve the client in recreational activities and conversation that provide distraction from​ self-absorption and negative thoughts. Playing a card game encourages participation in a nonthreatening activity while engaging with others. Reading a​ book, watching​ television, and listening to music are activities that can be completed independently and do not encourage conversation or activities with others.)

The nurse is planning care for a client diagnosed with major depressive disorder. Which activity should the nurse encourage the client to participate in based on the​ diagnosis? a Listening to music b Reading a book c Playing a card game d Watching television

d (Rationale When planning care for a client with situational​ depression, the nurse needs to teach the client assertiveness techniques. The client should be encouraged to express negative feelings while setting limits on negative talk. The nurse needs to provide positive reinforcement for accomplishments not negative reinforcements. The nurse also needs to engage the client in activities and not isolate.)

The nurse is planning care for a client diagnosed with situational depression. Which intervention is essential to include when planning​ care? a Provide negative reinforcement when needed. b Encourage the client to freely discuss negative feelings. c Isolate the client from others. d Teach assertiveness techniques.

b

The nurse is planning care for a client with seasonal affective disorder​ (SAD). After which intervention would the nurse expect to see improvement in emotional​ stability? a Electroconvulsive therapy b Phototherapy c Yoga d Massage therapy

b (Rationale The medication that is appropriate for a breastfeeding client diagnosed with postpartum depression is nortriptyline. The other medications are contraindicated for breastfeeding clients).

The nurse is providing care to a breastfeeding client diagnosed with postpartum depression. Which medication order is appropriate for this​ client? a Tricyclic doxepin b Nortriptyline c Fluoxetine d Atypical nefazodone

a (Rationale Family attachment to a new baby is important for all family members. The nurse would educate the new parents on the open visitation and​ rooming-in policy as a means of encouraging attachment between the new baby and the older sibling. The sibling should have access to the new baby. Ensuring that another family member takes care of the sibling decreases​ attachment, as does escorting the sibling to a playroom during visitation.)

The nurse is providing care to a postpartum mother who also has a​ child, age​ 3, at home. Which action by the nurse would facilitate bonding between the new baby and the​ sibling? a Educating the new parents on the open visitation and​ rooming-in policy at the hospital b Escorting the sibling to the playroom to allow the parents time alone with the new baby c Ensuring that another family member takes care of the sibling during visits d Encouraging sibling visitation during specified hours

d (Rationale The priority problem that the nurse needs to include when planning care for a client admitted for major depressive disorder is risk for violence directed at self. A client who is experiencing major depressive disorder may be experiencing suicidal ideations or have recurring thoughts of death. Problems addressing safety issues are priority. Although disturbed body​ image, impaired​ self-care, and risk for social isolation are pertinent​ problems, they are not priority problems.)

Which priority problem should the nurse include when planning care for a client diagnosed with major depressive​ disorder? a Disturbed body image b Risk for social isolation c Impaired​ self-care d Risk for violence directed at self

b (Feedback Rationale: The best response is a statement of empathy for the client. This response signifies that the nurse understands the feelings that are present in the client. Asking if the client feels abandoned and making assumptions about what the client thinks of the nurse puts the emphasis on the nurse and negates the client's feelings. "I understand how you feel" is patronizing and will not elicit further feelings from the client.)

Which response from the nurse is appropriate when a client expresses feelings of worthlessness? a "I understand how you feel." b "This must be a difficult time for you." c "Can you tell me why you think I have caused this?" d "Are you feeling that you have been abandoned?"

b (Rationale: The best response is a statement of empathy for the client. This response signifies that the nurse understands the feelings that are present in the client. Asking if the client feels abandoned and making assumptions about what the client thinks of the nurse puts the emphasis on the nurse and negates the client's feelings. "I understand how you feel" is patronizing and will not elicit further feelings from the client.)

Which response from the nurse is appropriate when a client expresses feelings of worthlessness? a "I understand how you feel." b "This must be a difficult time for you." c "Can you tell me why you think I have caused this?" d "Are you feeling that you have been abandoned?"

c

ou are taking a mental health assessment of Mrs.​ Castillo, a woman in her​ 30's. Mrs. Castillo tells you that she has been having feelings of deep sadness all summer and that she has never experienced this type of​ long-lasting sadness before. She tells you that she is usually optimistic and​ energetic, but in the past 4 months her mood has completely changed. Upon further​ questioning, you learn that Mrs. Castillo has two​ children, ages 2 and​ 5, and that a year ago she and her family moved to a new city where she has no friends or extended family members. Based on this​ information, which mood disorder is Mrs. Castillo most likely​ experiencing? a Seasonal affective disorder b Bipolar disorder c Major depressive disorder d Postpartum depression