MHQ3

A client who has major depressive disorder states to the nurse that he and his family would be better off if he were gone. Which of the following is the nurse's priority response? Do you really think your family would be better off without you? Are you thinking of harming yourself? Tell me what is happening right now. When did you first start feeling this way.

Are you thinking of harming yourself?

A nurse in an acute mental health unit is caring for a client following a suicide attempt. The client states, "I need my family to forgive me." Which of the following is the priority action by the nurse? Contact a clergy member of the client's choosing Offer to call a member of the client's family Provide emotional support for the client Ask the client if she plans to harm herself

Ask the client if she plans to harm herself

A nurse asks a client who is suicidal to make a safety contract, but the client declines. Which of the following actions should the nurse identify as the priority? Lock the doors to the unit and secure windows so they cannot be opened Provide the client with plastic eating utensils for meals Remove any objects from the client's environment that could be used for self harm Assign a staff member to stay with the client at all times

Assign a staff member to stay with the client at all times

A charge nurse is conducting a staff education in-service about depressive disorders. Which of the following should the nurse identify as a risk factor for depression? Being married Pregnancy Male gender Chronic illness

Chronic illness

A nurse is assessing a client who is taking bupropion. The nurse should recognize which of the following findings as an indication that the medication is effective? Increased weight gain Increased urinary output Decreased sexual function Decreased urge to smoke

Decreased urge to smoke

A nurse in a dialysis center is caring for a client who has a new diagnosis of end-stage kidney disease. When he arrives for his first dialysis treatment, he tells the nurse, "I decided to come today, but I am not sure if I will need to come back again this week. I am feeling much better since my discharge from the hospital and I think my kidneys are working again." The nurse should identify that this client is demonstrating which of the following Kuble-Ross stages of grieving? Bargaining Denial Depression Anger

Denial

A nurse is planning care for a client newly admitted with major depressive disorder. Which of the following actions should the nurse plan to take? Ask the client to create her own schedule of daily activities Teach the client to use passive communication when interacting with others Determine the client's need for assistance with grooming Limit the client's involvement in unit activities

Determine the client's need for assistance with grooming

A nurse is caring for a client who has major depressive disorder and was prescribed citalopram 2 weeks ago with a planned dosage increase 1 week ago. The client reports having an improved appetite, but still feels very depressed and is still having trouble sleeping. Which of the following actions should the nurse take? Speak to the provider about adding an MAOI to the current medication regimen Explain that antidepressants often take several weeks to be fully effective Tell the client that the provider will need to change citalopram to a different medication Recommend a sleep study be done on the client

Explain that antidepressants often take several weeks to be fully effective

A nurse is caring for a new client who exhibits manifestations of a major depressive episode. The provider states that she wants to rule out medical conditions which could also be linked to findings. The nurse should expect diagnostic testing for which of the following medical conditions? Pancreatitis Cholecystitis Tuberculosis Hypothyroidism

Hypothyroidism

A nurse is caring for a client who is experiencing grief following the unexpected death of his spouse. Which of the following statements by the client indicates he is experiencing maladaptive grieving? I am only able to sleep 2 or 3 hours at night Its impossible for me to focus on my job I have lost 15 lbs since my wife died. I have started smoking again.

I have started smoking again.

A nurse is evaluating teaching for a client who has a newly diagnosed depression and new prescription for bupropion. Which of the following statements by the client indicates understanding of the teaching? I may develop a slow heartbeat while taking bupropion I can drink one glass of wine with dinner each day while taking bupropion I may not notice a lifting of my mood for at least 2 weeks I should watch for increased salivation and drooling while taking bupropion

I may not notice a lifting of my mood for at least 2 weeks

A nurse in an acute mental health facility is caring for a client who has major depressive disorder. Since her admission 3 days ago, she has not put on clean clothes, washed her hair, or participated in any of the unit activities. On this day, the nurse observes that she is wearing clean clothes, and has combed her hair. Which of the following responses should the nurse make? Oh im so pleased that you finally put on clean clothes Why did you wear clean clothes and comb your hair today? Your mood must be lifting because you have on clean clothes and have combed your hair I see that you have on clean clothes and have combed your hair

I see that you have on clean clothes and have combed your hair

A nurse is teaching a client who has depression about a new prescription for fluoxetine 20 mg daily. Which of the following statements by the client indicates understanding of the teaching? I should expect relief from depression within 3 to 4 days I will take my fluoxetine at bedtime so I can sleep better I should notify my provider if I develop a skin rash I will notice an improvement in my sex drive

I should notify my provider if I develop a skin rash

A nurse is working in suicide prevention is discussing suicide interventions with a newly hired nurse. Which of the following statements indicates that the newly hired nurse understands when a tertiary intervention is needed? I should perform screening to identify clients at risk for suicide I should recognize the lethality of the suicide plan I should provide counseling for the family following the suicide of the client I should provide a safe environment to prevent the client from committing suicide

I should provide counseling for the family following the suicide of the client

A nurse is reinforcing teaching with an older adult client who has major depressive disorder and a prescription for nortriptyline 25 mg daily. Which of the following client statements indicates understanding of the teaching? I should take my nortriptyline before breakfast I can no longer eat pepperoni pizza I will avoid drinking caffeinated beverages I should sit on the side of the bed before standing up in the morning

I should sit on the side of the bed before standing up in the morning

A nurse is discussing treatment of depressive disorders with a client who has major depression. Which of the following client statements indicates an understanding of the teaching? I need to make a voluntary choice to stop feeling depressed. I can cure my depression by thinking positive thoughts. I will attend psychotherapy to help manage my depression. I will plan on my antidepressant taking three to five days to be effective.

I will attend psychotherapy to help manage my depression.

A nurse is caring for a client who is dying. The client says, "My mother died in the hospital, but I did not get there before she died." Which of the following statements should the nurse make? We will call your family in time for them to get here I wonder if you are fearful of dying alone I will make sure a staff member is in your room at all times I will tell your family of your concern so that they can be here

I wonder if you are fearful of dying alone

A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching? I should expect to feel better after 24 hours of starting this medication I should not take this medication with grapefruit juice Ill take this medicine with food Ill take this medicine first thing in the morning

Ill take this medicine first thing in the morning

A nurse on a crisi hotline is speaking to a client who says, "I just took an entire bottle of amitriptyline." Which of the following responses should the nurse make? Im glad you called, and I want to send an ambulance to help you. You must have been feeling pretty depressed to do that. Do you know how many pills were in the bottle? Were you trying to kill yourself by taking an overdose?

Im glad you called, and I want to send an ambulance to help you.

A nurse is caring for a client who is experiencing a normal grief reaction following the loss of her spouse. Which of the following findings should the nurse expect? Chest pain Insomnia Hypertension Dry mouth

Insomnia

A nurse is assessing a parent who lost a 12 year old child in a car crash 2 years ago. Which of the following findings indicates the client is exhibiting manifestations of prolonged grieving? Leaves the child's room exactly as it was before the loss Volunteers at a local children's hospital Talks about the child in the past tense Visits the child's grave every week after worship services

Leaves the child's room exactly as it was before the loss

A nurse on an acute mental health unit is caring for a client who has major depressive disorder. Which of the following interventions is the nurse's priority? Monitor for risk of self-harm Administer prescribed antidepressants Encourage adequate fluid intake Assist with activities of daily living.

Monitor for risk of self-harm

A nurse in an acute care mental health facility is caring for a client who has depression. After 3 days of treatment, the nurse notices that the client suddenly seems cheerful and relaxed and there are no longer signs of a depressive state. Which of the following interventions is appropriate to include in the plan of care? Encourage family to take the client out of the facility for short periods of time Reward the client for her change in behavior Monitor the client's whereabouts at all times Ask the client why her behavior was changed

Monitor the client's whereabouts at all times

A nurse is caring for a client who is terminally ill and exhibiting signs of impending death. The client's medical record states that the client is a practicing Roman Catholic. Which of the following nursing actions is appropriate? Offer to make arrangements for the Sacrament of the Sick Prepare to stay with the client's body after death until family arrives Arrange for a member of the client's faith to bathe the body after death Post a sign on the client's door stating, "No talking."

Offer to make arrangements for the Sacrament of the Sick

A nurse is caring for a client who is taking amitriptyline. The nurse should monitor for which of the following adverse effects? Orthostatic hypotension Drooling Diarrhea Metallic taste in mouth

Orthostatic hypotension

A charge nurse is discussing suicide interventions with nursing staff. Which of the following should the nurse identify as an example of secondary intervention? Providing support for family and friends following a suicide Identifying individuals who are at higher risk for attempting suicide Recognizing the warning signs of suicide Performing life saving measures following a suicide attempt

Performing life saving measures following a suicide attempt

A nurse in an emergency department is caring for an adolescent following a suicide attempt. After reviewing the client's history, the nurse should determine that which of the following is the priority risk for suicide completion? Active psychiatric disorder previous suicide attempt loss of a parent history of substance abuse

Previous suicide attempt

A nurse is providing discharge teaching to a client with a new prescription for phenelzine. The nurse should instruct the client to avoid which of the following foods when taking this medication? Salami Cottage cheese Shellfish Frozen pes

Salami

A nurse is caring for a client who has major depressive disorder. Which of the following findings should the nurse expect? Significant change in weight Hyperexcitability Exaggerated response to stimuli Attention seeking behavior

Significant change in weight

A nurse is caring for a client who has major depressive disorder. Which of the following findings should the nurse expect? A dismissal of past failures Psychomotor agitation An increase in energy Sleep disturbances

Sleep disturbances

A nurse is providing a community health education class about suicide prevention. Which of the following should the nurse identify as risk factors for suicide? (Select all that apply) Substance use disorder Age greater than 45 years old Female gender Currently married Schizophrenia

Substance use disorder Age greater than 45 years Schizophrenia

A nurse is caring for a client whose partner died five years ago. Which of the following findings indicates that the client is experiencing maladaptive grief? The client joined a bowling league 2 months ago The client has kept his partner's closet untouched since her death The client exercises at a local health facility 3 days each week The client meets his daughter for dinner every week

The client has kept his partner's closet untouched since her death

A nurse is caring for a 48-year old client who is grieving following the death of her husband seven months ago. The client reports that she has lost 30 lbs, and is having difficulty sleeping. Which of the following factors indicate the client is experiencing maladaptive grieving? The client is 48 years old The client's husband died seven months ago the client has lost 30 lbs The client is having difficulty sleeping

The client's husband died seven months ago

A nurse is caring for a client who has been diagnosed with end-stage liver cancer. Which of the following responses is an indication the client is in the denial phase of the grief process? The doctor has been so good to me. I know he has tried everything he can. It is just my time. I can't believe the doctor graduated from medical school. He doesn't know a thing about treating cancer! The doctor says I only have a few months to live, but I know he is exaggerating to get me to take my medication Even though I am not hurting right now, I don't feel like I have the energy to get out of bed.

The doctor says I only have a few months to live, but I know he is exaggerating to get me to take my medication

A nurse is caring for a client who has major depressive disorder and is scheduled for electroconvulsant therapy (ECT). The client's spouse asks the nurse about the possible side effects of the ECT. Which of the following responses should the nurse make? The main side effects are temporary and may include mild confusion, a headache, and short term memory loss. Most clients have no adverse effects to this treatment but muscle cramping may result from induced seizure. Some clients have been known to have a myocardial infarction but we will monitor your spouse closely to be certain this does not happen The most common side effects are directly related to the use of anesthesia

The main side effects are temporary and may include mild confusion, a headache, and short term memory loss.

A nurse is providing teaching to the parents of an adolescent who has a depressive disorder and new prescription for trazodone. Which of the following information should the nurse include in the teaching? Trazodone can cause suicidal thoughts in adolescents Expect your child to lose weight while taking trazodone Your child's symptoms of depression should improve within one week Trazodone should be taken in the morning to prevent insomnia

Trazodone can cause suicidal thoughts in adolescents

A nurse is developing a plan of care for a client who has a depressive disorder and is taking amitriptyline. Which of the following actions should the nurse include in the plan of care? Weigh the client weekly Administer the medication before breakfast Monitor for frequent urination Withhold medication if client experiences blurred vision

Weigh the client weekly

A nurse is teaching a client who has depressive disorder about fluoxetine. Which of the following information should the nurse include in the teaching? You may experience a decreased sex drive while taking this medication. You will notice an improvement in your depressive symptoms in 2-3 days. You may notice that you have less appetite while taking this medication. You may experience drooling while taking this medication.

You may experience a decreased sex drive while taking this medication.

A nurse is providing medication teaching for a client who has a new prescription for phenelzine. Which of the following statements should the nurse include in the teaching? You should change positions slowly while taking this medication This medication is prescribed to help overcome alcohol addiction You should omit foods containing oxalates while taking phenelzine You should avoid drinking liquids after your evening meal

You should change positions slowly while taking this medication

A nurse is providing teaching for a client who has major depressive disorder and is seeking voluntary admission to an acute mental health facility. Which of the following statements should the nurse include? You will give up your right to refuse antidepressant medications upon admission Your provider is required to notify your employer of your admission You will still need to give informed consent after treatments after admission You cannot leave the facility until your provider completes a discharge summary

You will still need to give informed consent after treatments after admission

A nurse is caring for a client who has major depressive disorder and attempted suicide. The client tells the nurse, "I should have died because I am totally worthless." Which of the following responses should the nurse make? You have a great deal to live for Its not unusual for depressed people to feel that way Why do you feel you are worthless? You've been feeling that your life has no meaning.

You've been feeling that your life has no meaning.

A nurse is preparing a client who is a potential candidate for ECT and providing information about the treatments. The nurse may do which of the following? SATA. a) Encourage the client to express fears about getting ECT. b) Discuss with the client and family the possibility of short term memory loss c) Remind client and family that injury from the induced seizure is common d) Monitor for any cardiac alterations (current and past) to avoid possible negative outcomes e) Ensure the client that he will be awake during the entire procedure

a) Encourage the client to express fears about getting ECT. b) Discuss with the client and family the possibility of short term memory loss d) Monitor for any cardiac alterations (current and past) to avoid possible negative outcomes

A client has just been admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following behavioral manifestations might the nurse expect to assess? SATA. a) Slumped posture b) Delusional thinking c) Feelings of despair d) Feels best early in the morning and worse as the day progresses e) Anorexia

a) Slumped posture b) Delusional thinking c) Feelings of despair e) Anorexia

The nurse is preparing a patient for an electroconvulsive therapy treatment. About 30 minutes prior to the treatment the nurse administers atropine sulfate 0.4 mg IM. Rationale for this order is a) To decrease secretions and increase heart rate b) to relax muscles c) to produce a calming effect d) to induce anesthesia

a) To decrease secretions and increase heart rate

The physician orders sertraline 50 mg PO bid for Margaret, a 68-year-old woman with Major Depressive Disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? a) "Cheer up, Margaret. You have so much to be happy about." b) "Sometimes it takes a few weeks for the medicine to bring about an improvement of symptoms." c) "I'll report to the physician, Margaret. Maybe he will order something different." d) "Try to not dwell on your symptoms, Margaret. Why don't you join the others down in the dayroom?"

b) "Sometimes it takes a few weeks for the medicine to bring about an improvement of symptoms."

In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? SATA a) Don't eat chocolate while taking this medication b) Keep taking this medication, even if you don't feel it is helping. It sometimes takes awhile to take effect. c) Don't take this medication with the migraine drugs "triptans." d) Go to the lab each week to have your blood drawn for therapeutic level of this druge) This drug causes a high degree of sedation, so take it just before bedtime

b) Keep taking this medication, even if you don't feel it is helping. It sometimes takes awhile to take effect. c) Don't take this medication with the migraine drugs "triptans."

After receiving three ECT treatments, a client says to the nurse, "I feel so much better, but I'm having trouble remembering some things that happened last week." The nurses best response would be: a) "Don't worry about that. Nothing important happened." b) "Memory loss is just something you have to put up with in order to feel better." c) "Memory loss is a side effect of ECT, but it is only temporary. Your memory should return within a few weeks." d) "Forget about last week, Mr. C. You need to look forward from here."

c) "Memory loss is a side effect of ECT, but it is only temporary. Your memory should return within a few weeks."

ECT is thought to effect a therapeutic response by a) stimulation of the CNS b) decreasing the levels of acetycholine and monoamine oxidase c) increasing the levels of serotonin, norepinephrine, and dopamine d) altering sodium metabolism within nerve and muscle cells

c) increasing the levels of serotonin, norepinephrine, and dopamine

John is a client at the mental health clinic. He is depressed, has been expressing suicidal ideations, and has been seeing the psychiatric nurse every three days. He has been taking 100 mg of sertraline daily for about a month, receiving small amounts of the medication from the nurse each visit. Today he comes to the clinic in a cheerful mood, much different than he seemed just 3 days ago. How might the nurse assess this behavioral change? a) The sertraline is finally taking effect b) He is no longer in need of antidepressant medication c) He has completed the grief response over the loss of his wife d) He may have decided to carry out his suicidal plan

d) He may have decided to carry out his suicidal plan

Education for the client who is taking monoamine oxidase inhibitors (MAOIs) should include which of the following? a) Fluid and sodium replacement when appropriate, frequent blood drug levels, signs and symptoms of toxicity b) Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks c) Short term use, possible tolerance to beneficial effects, careful tapering of the drug at the end of treatment d) Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without notification

d) Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without notification

A depressed client is receiving ECT treatment. In the treatment room, the anesthesiologist administers methohexital sodium followed by IV succinylcholine. The purposes of these medications are to a) decrease secretions and increase heart rate b) prevent nausea and induce a calming effect c) minimize memory loss and stabilize mood d) induce anesthesia and relax muscles

d) induce anesthesia and relax muscles