Mood and affect PrepU

A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response? "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." "Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous." "It's very important that you not take the St. John's wort at the same time of day as your antidepressant." "It's very important that you comply with your prescribed treatment."

Correct response: "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." Explanation: The nurse should explain why this combination is not recommended rather than simply telling the client to comply without providing a rationale. It is true that many herbal remedies contain inconsistent doses, but this is not the primary risk of combining SSRIs with St. John's wort. Taking them at different times of day does not mitigate the risks of an unsafe reaction.

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? "Bipolar disorders have not been found to be genetic." "While bipolar disorders are genetic, there are other causes as well." "While bipolar disorders are genetic, the gene can only be passed on by a father." "Genetics are a minor factor in bipolar; it is more heavily influenced by psychological factors."

Correct response: "While bipolar disorders are genetic, there are other causes as well." Explanation: Although a single definitive cause has not been pinpointed, scientists agree that a combination or interaction of genes, neurobiology, environment, life history, and development can result in bipolar disorders. Bipolar disorders are highly inheritable.

A client with bipolar disorder is receiving lithium therapy. The nurse is reviewing the client's serum plasma drug levels and determines that the client's level is therapeutic based on what? 1.0 mEq/L 1.6 mEq/L 2.0 mEq/L 2.6 mEq/L

Correct response: 1.0 mEq/L Explanation: Serum plasma lithium levels should range from 0.6 to 1.2 mEq/L. Levels above that suggest toxicity (moderate toxicity for levels 1.5 to 2.5 mEq/L; severe toxicity for levels greater than 2.5 mEq/L).

The physician has placed a client who has suffered the loss of a child on a selective serotonin reuptake inhibitor (SSRI) for depression. The nurse is aware that the greatest risk for suicide would be: 10 to 14 days after the initial medication regime is implemented. once the client is discharged home with family. on the 1-year anniversary of the child's death. when the nurse sees the client visiting with other clients on the nursing unit.

Correct response: 10 to 14 days after the initial medication regime is implemented. Explanation: Ten to fourteen days is the normal response time for antidepressant medications to take effect and subsequent return of energy levels to perform the suicide act. There is no information about problems with the family that would precipitate suicide. The 1-year anniversary could be a stimulus, but a lower priority. Visiting with other clients is a positive interaction with elevation of mood.

The nurse is monitoring a postpartum client who says she's concerned because she feels mildly depressed. The nurse recognizes that she is most likely experiencing "postpartum blues," and reassures the client that this symptom is experienced by approximately what percentage of women? 25% 40% 85% 100%

Correct response: 85% Explanation: Postpartum blues, or mild depression during the first 10 days after giving birth, affects up to 85% of women who give birth. More intense depression during this period is referred to as postpartum depression, which affects approximately 10% to 15% of postpartum clients. Postpartum depression can be severe with negative implications for maternal and neonatal well-being.

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 reason the client has become lesbian at the age of 23. A biological explanation for the client's depressive disorder. A feminist viewpoint of depression.

Correct response: A psychodynamic interpretation of the client's major depressive disorder. Explanation: Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. Such anger begins in childhood when basic developmental needs are not met. Clients cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.

Which term is used to describe an activity used to release anger? Catharsis Hostility Anger Physical aggression

Correct response: Catharsis Explanation: Catharsis includes activities that provide a release of the anger. Hostility is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior. Anger is a strong, uncomfortable, emotional response to a real or perceived provocation. Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property

The major difference between bipolar I and bipolar II disorder is what? Clients with bipolar I have no symptoms of mania, but only depression. The prognosis for bipolar I is much better than for bipolar II. Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances. Both disorders are the same, except that clients with bipolar I disorders have a much higher incidence of suicide.

Correct response: Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances. Explanation: Bipolar II disorder is characterized by a major depressive episode (either current or past) and at least one hypomanic episode. Bipolar II disorder differs from bipolar I in that the client has never had a manic or mixed episode but may have had an episode in which he/she experienced a persistently elevated, expansive, or irritable mood. The hypomanic symptoms are not severe enough to cause marked social or occupational dysfunction.

A depressed client on a psychiatric unit asks the nurse to call the hospital lawyer to discuss writing out a will. What is the nurse's priority intervention? Call a lawyer as requested by the client. Discuss thoughts and explore intent for suicide with the client. Inform the physician first, and place the client on suicide watch. Offer the client medication for anxiety.

Correct response: Discuss thoughts and explore intent for suicide with the client. Explanation: Exploration of thoughts and intent are a priority based on lethality of plan for suicide. Calling the lawyer is incorrect because it does not explore the intent of the client's question. The nurse would discuss the intent with the client prior to calling the physician. Administering anxiety medication does not address the problem.

Which would be a finding related to perceptual disturbances during the mental status exam in the client with mania? Increased motor activity Inappropriate affect Hallucinations Limited insight

Correct response: Hallucinations Explanation: Perceptual disturbances include hallucinations and delusions, anxiety, and grandiose delusions involving power, wealth, fame, or knowledge. Increased motor activity is assessed in appearance and general behavior. Inappropriate affect is assessed in mood and affect. Limited insight is part of the judgment and insight assessment.

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? Initial insomnia Terminal insomnia Hypersomnia Middle insomnia

Correct response: Middle insomnia Explanation: The most common sleep disturbance associated with major depression is insomnia, which is categorized according to three categories: initial insomnia (difficulty falling asleep), middle insomnia (waking up during the night and having difficulty returning to sleep), and terminal insomnia (waking too early and being unable to return to sleep). Less frequently, the sleep disturbance is hypersomnia (prolonged sleep episodes at night or increased daytime sleep).

Dietary modifications are most likely necessary when a client is being treated with which antidepressant? Selective serotonin reuptake inhibitors(SSRIs) Monoamine oxidase inhibitors (MAOIs) Tricyclic antidepressants Atypical antidepressants

Correct response: Monoamine oxidase inhibitors (MAOIs) Explanation: MAOIs are antidepressants that are well known for their multiple drug and food interactions. As such, dietary modifications are necessary. Such modifications are not normally necessary when a client is receiving SSRIs, tricyclic antidepressants, or atypical antidepressants.

The nurse is caring for a client who has begun to lose hair from chemotherapy treatment. The client appears withdrawn and answers questions in one-word statements, which is a change from previous behavior. What is the nurse's priority response? Assess the client's feelings about current body image. Perform a depression screening assessment with the client. Share options for coping with ongoing hair loss with the client. Reassure the client that this phase of the treatment is temporary.

Correct response: Perform a depression screening assessment with the client. Explanation: This client may be experiencing clinical depression, which is common in clients undergoing treatment for cancer. The client is withdrawn and minimizes interaction with the nurse, which can indicate depression. The nurse should assess the client using a validated depression screening tool, including assessing for suicidality. Offering reassurance about the temporary nature of the hair loss or sharing options does not address the change in the client's mood. While exploring the client's feelings about body image may be appropriate, the priority is determining if depression is present and if so how it needs to be addressed.

Which is an important function of serotonin? Coordination of impulses Prevention of over-excitability Prevents depression Promotion of motivation

Correct response: Prevents depression Explanation: Serotonin, which is found in the limbic system, is important to arousal and sleep, as well as in preventing depression and promoting motivation. Dopamine is involved in the coordination of impulses and responses, both motor and intellectual. Gamma-aminobutyric acid is important in preventing over-excitability or stimulation such as a seizure.

An admitting nurse on a rehabilitation unit notices that an elderly client with a fractured hip and severe hypothyroidism is dirty and disheveled and that their personal hygiene is very poor. As the nurse gathers admission data, the nurse further notes that the client has few personal connections, is depressed, and doesn't seem to care about personal appearance. How should the nurse improve the client's performance of self-care activities? Offer to take the client to the shower and help them fix their hair. Provide complete hygienic care and make an appointment for the client to see the hospital barber. Ask the physician to refer the client to social services for a full evaluation and follow-up. Provide initial and routine hygienic care, then evaluate the client daily as treatment progresses.

Correct response: Provide initial and routine hygienic care, then evaluate the client daily as treatment progresses. Explanation: Low thyroid levels can cause depression, which can explain many of this client's symptoms. Rather than assuming the client doesn't care about their appearance, the nurse should provide supportive hygienic care and observe for mood changes as the client's thyroid levels improve. Offering to escort the client to the shower and help with their hair, providing complete hygienic care and making an appointment with the hospital barber, and asking the physician to refer the client to social services are appropriate interventions to take if the client's behavior doesn't improve as thyroid level improves

Which would be the priority diagnosis for the client in the manic phase of bipolar disorder who is exhibiting aggressive behavior? Ineffective health maintenance Risk for other-directed violence Disturbed thought processes Impaired social interaction

Correct response: Risk for other-directed violence Explanation: The priority nursing diagnosis is risk for other-directed violence. The other diagnoses are utilized for the client in the manic phase of bipolar disorder but are not the priority in this situation.

The nurse is working with a 50-year-old client admitted for a major depressive episode. The client has remained isolated and withdrawn since admission and is reluctant to speak. Which therapeutic communication skill is most likely to encourage the client to verbalize the client's feelings? Direct confrontation Reality orientation Projective identification Silence and active listening

Correct response: Silence and active listening Explanation: Silence and active listening are powerful tools for use with a client who is depressed and withdrawn. Direct confrontation can lead to feelings of shame or embarrassment. The client who is not psychotic does not need reality orientation, and projective identification is a primitive subconscious ego defense mechanism.

A nurse documents that "the client describes the recent breakup of a dating relationship with an emotionless tone and a flat facial expression." In which section of the mental status exam would the nurse have documented this statement? blocking feelings affect mood

Correct response: affect Explanation: Affect refers to a person's emotional expression (in this case, the manner in which the client talks about the client's experiences). Feelings are emotional states or perceptions. Blocking is the interruption of thoughts. Moods are prolonged emotional states expressed by the affect.

Which result is an expected outcome when unipolar and bipolar disorders are treated with an SRI antidepressant? Inhibiting the reuptake of serotonin Blocking the degradation of norepinephrine Inhibiting the reuptake of norepinephrine Blocking the degradation of serotonin

Correct response: Inhibiting the reuptake of serotonin Explanation: The result of SRI therapy is the delayed reuptake of the neurotransmitter serotonin. The other options do not accurately describe the outcome of SSRI therapy.

Which is an anticonvulsant used as a mood stabilizer? Divalproex Venlafaxine Bupropion Phenelzine

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

Which statement by the nurse reflects the best understanding about suicide in an individual with depression? "The more severe the depression, the greater the probability for suicidal behavior." "The person who talks about suicide is less likely to try it." "Every client with depression is potentially suicidal." "Suicide is less likely when the individual is receiving antidepressant therapy."

Statistics do not apply when focusing on one individual and every depressed client is potentially suicidal. During the most severe symptom period, the individual often does not have the energy to act on their suicidal ideation. The majority of people who complete suicide have talked about it or left clues to their intention. During the initial treatment period, the risk for suicide may be higher due to the delay of therapeutic onset.

somatic symptom disorder

psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause

The nurse is caring for a client with schizophrenia. The client tells the nurse, "My dead mother is calling me, I will finally be with her tonight. Please do not tell anyone." What is the most appropriate nursing response? "Don't worry; I will keep this secret to myself." "Who has influenced you with these ideas?" "I will speak with the health care provider about the possible use of physical restraints for you tonight." "I cannot keep this a secret. I will ensure that the staff helps keep you safe."

Correct response: "I cannot keep this a secret. I will ensure that the staff helps keep you safe." Explanation: The nurse is not supposed to keep secrets, especially if the information relates to the client inflicting self-harm. The nurse should inform the client that they will be closely monitored. Asking the client who has influenced the client with these ideas indicates a poor understanding of the nature of the client's illness. For client's with schizophrenia, stimuli are internally generated and can cause emotional dysfunction. The nurse should not exhibit anger, as the nurse is supposed to be accepting of the client in any circumstances. Stating that the client will be restrained may be perceived as threatening.

The following statements are heard in a group: "You can't say that because you don't really know me." "I wonder if the therapist is going to leave?" and "I'm not sure whether or not I can really talk freely." These best reflect which group theme? Guilt and punishment Fear for safety Trust and belonging Loss and abandonment

Correct response: Trust and belonging Explanation: The theme expressed in these statements represents the latent lack of trust in the leader or other group members. These statements are not related to guilt and punishment, fear for safety, or loss and abandonment.

After teaching a client who is prescribed imipramine about the drug, the nurse determines that the education was effective when the client states: "I need to be careful because the drug can make me sleepy." "I don't have to worry about getting dizzy when I get up from lying down." "I might notice some excess saliva in my mouth at different times." "I need to avoid foods with fiber because diarrhea can occur."

Correct response: "I need to be careful because the drug can make me sleepy." Explanation: Imipramine is a tricyclic antidepressant and is associated with sedation, orthostatic hypertension, and anticholinergic effects such as dry mouth and constipation. The client needs to be careful with activities because the drug is sedating. The client should change positions slowly to minimize orthostatic hypotension. Sugarless candies, good oral hygiene, and frequent rinsing of the mouth are helpful to combat dry mouth. A high fiber intake would be appropriate to decrease possible constipation.

A nurse is caring for a 14-year-old adolescent who states, "No one understands me." Which statement by the nurse bestdemonstrates empathy? "Explain why you think no one understands you. How can adults help?" "Tell me about a time you felt your parents were understanding." "Let's talk about your future plans and which courses you enjoy." "It's difficult to be a teenager. Tell me more about your experiences."

Correct response: "It's difficult to be a teenager. Tell me more about your experiences." Explanation: Empathy is the ability to put oneself in another's place and experience a feeling as that person is experiencing it. The correct answer acknowledges the adolescent's feelings and conveys an understanding without intimidating the client. Asking how adults can help and reflecting on parental understanding or favorite coursework is helpful overall but does not demonstrate empathy for the client.

The nurse is working on a psychiatric unit with new admissions with suicidal ideation. What characteristic is being described by a client who states, "I want to live, but maybe the answer is to die"? psychosis remorse frustration ambivalence

Correct response: ambivalence Explanation: One of the characteristics most commonly shared by suicidal persons is ambivalence, an internal struggle between self-preserving and self-destructive forces. These doubts are expressed when a person threatens or attempts suicide and then tries to get help to save their life. When the possible consequences of suicide are discussed, such persons commonly describe life-related outcomes such as relief from an unhappy situation. Many people consider suicide an alternative to present circumstances, but they may not have considered the implications of no longer being alive. A psychotic person may or may not have suicidal tendencies. Remorse and anger may be associated with depression but aren't universally present in suicidal persons. Frustration isn't specifically associated with suicidal ideation.

In assessing an adolescent client at an outpatient clinic, the nurse is able to recognize that depression in adolescents is often what? similar in symptomology to that of adult clients often masked by aggressive behaviors situational and not as serious as that of adult clients a sign that the teenager needs to be admitted to the hospital

Correct response: often masked by aggressive behaviors Explanation: Depression in adolescents is often masked by anger or aggressive behaviors. Symptoms are usually different from adults in that adolescent exhibit intense mood swings.