Mood Disorders and Suicide
A nurse in a mental health clinic is taking a medical history on a client. The nurse should identify that which of the following factors in the client's history increases their risk for mental illness?
Early exposure to violence
not sleeping
is consistent with mania, not depression.
substance/medication-induced depressive disorder
occurs soon after a client begins taking or withdrawing from a substance, with the most common occurrences when the client is using alcohol, phencyclidine, hallucinogens, inhalants, opioids, and amphetamines.
TCM treatment
lasts about 30 min.
a client who states they feel worthless
is likely experiencing depression. Clients who are in a manic episode usually exhibit overconfidence.
a client who sleeps excessive hours
is likely experiencing depression. Clients who are in a manic episode usually experience a lack of sleep.
ethnicity
is not a risk factor that can be modified to decrease the incidence of suicide.
being raised by a single parent
is not, by itself, indicative of being a risk factor for mental illness. It is abuse and neglect in childhood that can increase a client's risk for mental illness.
The nurse should identify that being in a family with numerous siblings
is not, by itself, indicative of being a risk factor for mental illness. It is early exposure to violence, abuse, and neglect in childhood that can increase a client's risk for mental illness.
Bipolar I disorder
is the most severe form of bipolar disorder and is characterized by shifts in mood, energy, and functioning.
no anesthesia
is used during TMS treatment, and they will remain awake.
The nurse should identify that
living in a rural area is not, by itself, indicative of being a risk factor for mental illness. It is early exposure to violence, abuse, and neglect in childhood that can increase a client's risk for mental illness.
a client talking about revenge
may be part of a murder-suicide plan, or at least indicates unresolved feelings of anger that warrant follow-up.
all items, including blinds,
that could be potentially dangerous and used to complete a suicide attempt should be removed from the client's room.
10 to 34 years of age
The nurse should inform the attendees that, according to the CDC, suicide is the second leading cause of death for people 10 to 34 years of age.
postpartum depression
occurs in 8% to 20% of clients during the postpartum period. While this is an important topic to include, educating this group about risk factors for suicide is the priority.
The nurse should identify that substance/medication-induced depressive disorder
occurs soon after a client begins taking or withdrawing from a substance, with the most common occurrences when the client is using alcohol, phencyclidine, hallucinogens, inhalants, opioids, and amphetamines.
clients who are at high risk for suicide
should be monitored at least every 15 min. The client should never be left alone and should always be in view of staff.
a client who has experienced suicidal ideation
should not have access to a gun.
A nurse is discussing findings of depression with a group of clients. Which of the following client statements indicates an understanding of the information?
"Thyroid problems can cause depression."
The nurse should assess
a client who is giving away their possessions for suicidal tendencies.
A school nurse is preparing a presentation about suicide prevention for high school. Which of the following should the nurse include as modifiable risk factors for suicide?
Access to firearms
A nurse is creating a presentation about depression for a community health fair. The nurse should plan to report that depression is more prevalent among which of the following demographics?
Adult females
Bipolar disorder is
characterized by alternating episodes of both mania and depression.
Dysthymic disorder
is a milder form of bipolar disorder characterized by difficulty sleeping and experiencing a mild level of depression.
The nurse should inform the attendees that
according to the CDC, suicide is the fifth leading cause of death for people 45 to 54 years of age.
A nurse on an inpatient mental health unit is teaching a newly licensed nurse about suicide prevention. Which of the following statements made by the newly licensed nurse indicates an understanding of the information presented?
"All sharp objects should be removed from the client's room."
To be effective
TCM treatments are usually required several times each week for 6 weeks.
The nurse should inform the attendees that
according to the CDC, suicide is the fourth leading cause of death for people 35 to 44 years of age.
A nurse is caring for a client who is hyperactive, pacing down the hallway, and exhibiting poor concentration during group therapy. Which of the following is characteristic of the client's manifestations?
Mania
Adult females
The nurse should identify that the prevalence of depression in U. S. adults aged 18 or older in 2017 was estimated at 17.3 million, with higher prevalence among females.
Access to firearms
The nurse should identify that firearms are one of the most common means of suicide. The family or client can modify the risk of suicide by removing access of firearms.
Does the client have a suicide plan?
Using the safety/risk reduction priority framework, the first information the nurse should try to obtain is whether the client has a definite suicide plan.
transcranial magnetic stimulation
is an outpatient procedure that lasts about 30 min.
The nurse should explain to the client that
they will need to remain NPO for several hours prior to the procedure.
A nurse is caring for a client who has persistent depressive disorder. When educating the client about their illness, which of the following statements should the nurse make?
"Persistent depressive disorder is a mild chronic form of depression."
A nurse on an inpatient mental health unit is evaluating a client who was admitted for suicidal ideation for readiness for discharge. Which of the following statements by the client indicates they may be ready for discharge?
"When I get home, I will reach out to my friends if I start feeling down."
a client who has major depressive disorder
to have experienced significant unintentional weight loss or weight gain or a decrease or increase in appetite.
the client is exhibiting manifestations of mania,
which include overactivity, overeating, overspending, poor sleeping habits, and speaking rapidly.
the client is exhibiting manifestations of mania
which include overactivity, overeating, overspending, poor sleeping habits, and speaking rapidly. The client's manifestations are not consistent with delusions.
the client is exhibiting manifestations of mania
which include overactivity, overeating, overspending, poor sleeping habits, and speaking rapidly. The client's manifestations are not consistent with depression.
The nurse should inform the attendees that,
according to the CDC, suicide is as high as 48.7/100,000 in White men over the age of 65.
during the transcranial magnetic stimulation procedure
the client may feel a slight tapping on the head, scalp contraction, and tightening of the jaw.
Bipolar Il disorder
is characterized hypomanic episodes, which are lower level and less dramatic manic shifts in mood.
A nurse is caring for a client who is scheduled for transcranial magnetic stimulation. When preparing the client for the procedure, which of the following statements should the nurse make?
"This procedure is effective when combined with psychotherapy."|
A nurse is providing teaching to a client who is to undergo transcranial magnetic stimulation (TMS) for depression. Which of the following information should the nurse provide?
"You may experience a mild headache following the procedure."
A nurse is providing teaching to a client who is to undergo electroconvulsive therapy (ECT) for depression. Which of the following information should the nurse provide?
"Your provider will likely schedule you for several treatments over a period of weeks."
A public health nurse is preparing a suicide prevention program for patrons of the local library. The nurse should inform the attendees that suicide is the second leading cause of death in which of the following age groups?
10 to 34 years of age
A nurse on a mental health unit is using the SAD PERSONS scale to assess the risk of suicide among several clients. Which of the following clients should the nurse identify as having the highest risk?
A 15-year-old male client
A school nurse is preparing a presentation for high school students on the relationship between substances and depression. Which of the following substances should the nurse plan to include as a contributing factor in the development of substance-induced depressive disorder?
Amphetamines
"Persistent depressive disorder is a mild chronic form of depression."
The nurse should identify that persistent depressive disorder is also known as dysthymia and is characterized as a less severe form of depression.
A nurse is reviewing the medical record of a client who has major depressive disorder. Which of the following assessment findings should the nurse expect for a client who has major depressive disorder?
Client reports having thoughts of death
A nurse is caring for a client who was admitted with suicidal ideation. The client tells the nurse they have several guns in their home. Which of the following types of interventions is the priority for the nurse to initiate?
Create a protective environment
A nurse is caring for a child who is exhibiting tantrums, dysfunction in school, trouble with peers, and suicidal ideation. Which of the following should the nurse identify as being consistent with the client's findings?
Disruptive mood dysregulation disorder
A nurse in an outpatient clinic is caring for a client who has major depressive disorder and has reported suicidal thoughts. Which of the following is the first information the nurse should try to obtain from the client?
Does the client have a suicide plan?
A school nurse is creating a presentation about mental health for a group of middle school students. Which of the following topics should the nurse prioritize when preparing this presentation?
Factors that contribute to suicide
The nurse should analyze cues when using Maslow's hierarchy of needs to meet the client's need for safety.
Suicidal ideation is an emergent need requiring immediate intervention. The nurse should address the client's support system because they mentioned they lacked interest in seeing them and being with their family. The nurse should address the client's medication regimen and noncompliance. It is important to instruct the client about how long it takes to expect a decrease in manifestations of depression.
A nurse is assessing a client who has a diagnosis of mania related to bipolar disorder. Which of the following behaviors should the nurse expect the client to exhibit?
The client is demonstrating risky behavior.
Client reports having thoughts of death
The nurse should expect a client who has major depressive disorder to report experiencing recurrent thoughts of death (not just fear of dying), suicidal ideation, or suicide attempts.
The client is demonstrating risky behavior.
The nurse should expect a client who is experiencing mania to exhibit risky behavior. Other behaviors of mania include impulsivity, overactivity, pacing, sleeplessness, fast speech, and being overconfident.
"All sharp objects should be removed from the client's room."
The nurse should identify that all items, including sharp objects or potential weapons, that could be potentially dangerous and used to complete a suicide attempt should be removed from the client's room.
A 15-year-old male client
The nurse should identify that clients who are less than 19 years of age and older than 45 years of age have an increased risk of suicide. Clients who are male also have an increased risk of suicide.
"Thyroid problems can cause depression."
The nurse should identify that depression can be induced by medical conditions, such as Parkinson's disease, Huntington's disease, Alzheimer's disease, and hypothyroidism.
Disruptive mood dysregulation disorder
The nurse should identify that disruptive mood dysregulation disorder is a disorder diagnosed in children who exhibit extreme irritability, tantrums, and trouble in school.
Early exposure to violence
The nurse should identify that early exposure to violence, abuse, and neglect in childhood can have long-term effects on clients, as shown in the Adverse Childhood Experiences Study done by the CDC. The CDC has therefore advocated for early and intensive intervention when children display mood disorders related to trauma.
Amphetamines
The nurse should identify that substance/medication-induced depressive disorder occurs soon after a client begins taking or withdrawing from a substance, with the most common occurrences when the client is using alcohol, phencyclidine, hallucinogens, inhalants, opioids, and amphetamines.
Mania
The nurse should identify that the client is exhibiting manifestations of mania, which include overactivity, overeating, overspending, poor sleeping habits, and speaking rapidly.
Factors that contribute to suicide
The nurse should identify that the greatest risk to these clients is suicide. Suicide is the second leading cause of death in clients ages 10 to 34. Assessing for and educating about risk factors for suicide is a task that should be prioritized to maintain client safety. By educating this group about factors that can contribute to suicide, the nurse is providing information that can help prevent self-harm.
"When I get home, I will reach out to my friends if I start feeling down."
The nurse should identify that this statement by the client indicates future planning and a solution to problems. Clients who are experiencing suicidal ideation do not make future plans and feel trapped without solutions to problems.
"This procedure is effective when combined with psychotherapy."|
The nurse should identify that transcranial magnetic stimulation has been proven to be very effective in the treatment of depression when coupled with psychotherapy.
"You may experience a mild headache following the procedure."
The nurse should inform the client that it is common to experience a headache following the procedure. The headaches are usually mild and pass without incident.
"Your provider will likely schedule you for several treatments over a period of weeks."
The nurse should inform the client that, to be effective, ECT usually requires several treatments over a period of several weeks.
When taking actions, including educating clients, the nurse will also evaluate client understanding of the information. The nurse understands that the client needs further instructions if the client states they can drink imported beer, eat overripe bananas, and should expect an increase in blood pressure.
The nurse should reiterate the risk of adverse hypertensive reaction and elevated levels of tyramine. Elevated blood pressure may indicate a high level of tyramine, which can cause cerebral and death. Eating foods such as overripe bananas and consuming beer and wine can cause the tyramine level to rise, causing an adverse hypertensive reaction.
When evaluating outcomes, the nurse should recognize that altered mental status and blurred vision are associated with lithium toxicity and require immediate follow-up.
Tremor is one of the earliest findings of lithium intoxication and nurses should be vigilant to recognize this finding. Dry mucous membranes and poor skin turgor are signs of dehydration and can raise lithium levels to toxic levels. The nurse should recognize the patient's use of ibuprofen as a nonsteroidal anti-inflammatory drug three times a day can cause changes in lithium concentrations. The elevated BUN and creatinine suggest altered fluid balance and altered renal function. The lithium value is elevated. Bradycardia with these other symptoms is indicative of lithium toxicity and warrants further follow-up.
Create a protective environment
Utilizing the safety/risk reduction priority framework, the nurse should identify that it is important for a client who has suicidal ideation to have reduced access to lethal means of self-harm. The nurse may need to recruit the help of others, such as a social worker or the client's family, to create a protective environment for the client by removing the guns from their home.
The nurse should identify that findings associated with depression include
a mood characterized by hopelessness, increased fatigue, weight changes, and loss of interest in activities. Hyperactivity is characteristic of mania, not depression.
The nurse should identify that persistent depressive disorder is
also known as dysthymia and is characterized as a less severe form of depression. Delusions and hallucinations typically occur in psychotic depression.
The nurse should identify that
clients who are less than 19 years of age and older than 45 years of age have an increased risk of suicide. Clients who are male also have an increased risk of suicide.
The nurse should identify that
educating clients who are prescribed MAOls about food-medication interactions is important. However, for this group, educating about risk factors for suicide is the priority.
The nurse should identify that
findings associated with depression include a mood characterized by hopelessness, increased fatigue, weight changes, and loss of interest in activities. Impulsiveness is characteristic of mania, not depression.
transcranial magnetic stimulation
is an outpatient procedure that lasts about 30 min. The client usually comes for treatment 5 days a week for 4 to 6 weeks.
sexual orientation
is not a risk factor that can be modified to decrease the incidence of suicide.
Rather than instructing family members to search for information regarding the warning signs indicating the client may be at increased risk for suicide,
the nurse should provide education to family members of the client about the warning signs of potential suicidal behaviors as well as important contact information that they may need if they need to call for immediate help.
The nurse should identify that
the prevalence of depression in U.S. adults aged 18 or older in 2017 was estimated at 17.3 million, with higher prevalence among females.
a client who has major depressive disorder
to experience sleep disturbances of insomnia or hypersomnia nearly every day. Sleeping 8 hr nightly is within the expected range of sleep.
