Mood Disorders Lippy
The nurse is conducting an intake interview with an Asian American female who reports sadness, physical and mental fatigue, anxiety, and sleep disturbance. Prior to the client's time with the physician, it is important for the nurse to obtain information about the client's use of which of the following? Select all that apply. 1. Tea. 2. Herbal medicine. 3. Breathing exercise. 4. Massage. 5. Folk healer.
ANS: 1. Tea 2. Herbal medicine 5. Folk healer It is important for the nurse to obtain information about the client's use of tea, herbal medicine, and a folk healer because the information is critical to the safe prescription of psychotropic medication. Breathing exercises, massage, and acupuncture are also traditional therapies used by the Asian American population, but do not interfere with the use of medications.
Which statement by the nurse reflects the best understanding about suicide in an individual with depression? 1. "The more severe the depression, the greater the probability for suicidal behavior." 2. "The person who talks about suicide is less likely to try it." 3. "Every client with depression is potentially suicidal." 4. "Suicide is less likely when the individual is receiving antidepressant therapy."
ANS: 3. "Every client with depression is potentially suicidal." Statistics do not apply when you are focused 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 his or her 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.
The nurse is distinguishing between delusions experienced by a client diagnosed with major depression with psychotic features and the delusions of a client diagnosed with schizophrenia. The essential difference is: 1. Major depression delusions are more likely to be negative than schizophrenic delusions. 2. Major depression delusions clear up less quickly than schizophrenic delusions. 3. Major depression delusions are more likely than schizophrenic delusions to require longacting depot antipsychotic medication given intramuscularly. 4. Major depression delusions are more mood congruent than schizophrenic delusions.
ANS: 4. Major depression delusions are more mood congruent than schizophrenic delusions. Delusions occurring in schizophrenia tend to be more mood incongruent and more bizarre than delusions experienced with depression. Schizophrenic delusions clear up less quickly and are more likely to require depot antipsychotic medication, which are administered intramuscularly. Delusions in major depression match the client's mood, are somewhat more reality based, and tend to resolve once the client is properly medicated.
The client with bipolar disorder states to the nurse, "I guess the medication does help me after all. When I stopped taking it, I started to have trouble sleeping and my thoughts were racing." The nurse should tell the client: 1. "I'm happy you realize that you started to get symptoms when you stopped your medication." 2. "Although it took a long time, you fi nally do understand that you need your medication." 3. "Why didn't you go to the community mental health center for help?" 4. "Didn't your family tell you that you were getting sick again?"
1. "I'm happy you realize that you started to get symptoms when you stopped your medication." The statement, "I'm happy you realize that you started to get symptoms when you stopped your medication," praises the client for realistic self-appraisal and development of insight. Positive reinforcement by the nurse strengthens insight and promotes good judgment in the client. The statements, "Although it took a long time, you fi nally do understand that you need your medication" and "Why didn't you go to the community mental health center for help?" blame the client and diminish the client's self-worth. When clients begin to experience symptoms of relapse, they may not realize what is happening to them and may not have the judgment to seek help. The statement, "Didn't your family tell you that you were getting sick again?" blames the family and makes an unfair assumption.
A client with major depressive disorder has independently showered, dressed, and washed her hair for the first time since her admission to the inpatient unit 4 days ago. In an interaction with the nurse, she still stresses her faults. She states "I'm just no good; I can't do anything right." The nurse's best response would be: 1. "You look very nice today." 2. "You were able to shower, wash your hair, and dress today." 3. "I'll get out the craft project that you wanted to complete." 4. "What is your goal for today?"
ANS: 2. "You were able to shower, wash your hair, and dress today." An objective reflection by the nurse based on actual behavior is the best affirmation for the client to help boast self-esteem. Depressed persons tend to reject positive opinions from others. Picking a project for such a client is also likely to bring a negative response and/or foster dependence. Antipsychotics are sometimes prescribed for clients with bipolar disorder and would not pose a special concern.
A client with bipolar disorder, manic phase, is scheduled for a chest radiograph. Before taking the client to the radiology department, the nurse should: 1. Give a thorough explanation of the procedure. 2. Explain the procedure in simple terms. 3. Call security to be on standby for possible problems. 4. Cancel the appointment until the client can go unescorted.
ANS: 2. Explain the procedure in simple terms. The nurse needs to explain the procedure in simple terms because the client in a manic phase has difficulty concentrating, is easily distracted, and can misinterpret what the nurse states. Giving a thorough explanation of the procedure is not helpful and can confuse the client. Calling security to be on standby is inappropriate. If the nurse judges that the client might elope or become agitated, the nurse should schedule the appointment for another time. Canceling the appointment until the client can go unescorted is impractical and may not follow unit or hospital policy and the client's treatment plan.
A client who is acutely manic and very anxious begins to pace, bump into furniture, and preach loudly. The nurse should: 1. Walk with the client until he calms down. 2. Tell the client to go to his room. 3. Ask the client to sit in on a group therapy session. 4. Administer haloperidol (Haldol) ordered p.r.n.
ANS: 4. Administer haloperidol (Haldol) ordered p.r.n. The nurse should administer haloperidol ordered p.r.n. to the acutely manic and anxious client to help calm him and reduce the risk of violent or destructive behavior. The manic client is beginning to exhibit behaviors that may escalate and lead to loss of control, thereby causing the client to be a danger to self or others. Walking with the client is not helpful because his current anxiety is too high and his pacing is not helping him. Telling the client to go to his room is not helpful, because the client is exhibiting a high level of anxiety and hyperactivity and will be unable to stay in his room. Asking the client to sit in on a group therapy session is not helpful because the client cannot sit for a period of time. The client would be disruptive to the members of the group and his behavior could lead to increased anxiety in the other clients.
A client comes to the mental health clinic saying that he feels so down and lacking in energy with "loss of interest in everything." He tells the nurse that he received some samples of a new medication from his primary care physician last week to relieve his depression. The nurse recalls that this client has a history of bipolar I disorder with hospitalization for a significant manic episode. With this knowledge, the nurse would have special concern if he is taking which of the following categories of medication? 1. Atypical antipsychotics. 2. Mood stabilizers/antimanics. 3. Antianxiety agents (benzodiazepines). 4. Selective serotonin reuptake inhibitor (SSRI) antidepressant.
ANS: 4. Selective serotonin reuptake inhibitor (SSRI) antidepressant. The most urgent consideration for intervention and for teaching is the fact that for individuals with a history of bipolar disorder, antidepressants when taken alone can push the person into mania. Antipsychotics are sometimes prescribed for clients with bipolar disorder and would not pose a special concern. Individuals with bipolar disorder are typically treated with mood stabilizers, and benzodiazepines are sometimes used in the short term to give a client relief before the mood stabilizers can take effect.
Which of the following would be helpful in preventing suicide for clients about to be discharged from a psychiatric inpatient unit? Select all that apply. 1. At discharge give all depressed clients a card containing the crisis phone line number for their area. 2. Have all clients who have expressed suicidal ideation just prior to or during hospitalization make a written personal suicide prevention plan. 3. Require that all clients who have had previous suicidal ideation, plans, or attempts refill their medication every 2 weeks rather than monthly. 4. Educate family and friends of previously suicidal clients in ways to help clients remain safe after discharge. 5. Suggest that family and friends of previously suicidal clients know the client's whereabouts at all times.
ANS: 1, 2, 4. 1. At discharge give all depressed clients a card containing the crisis phone line number for their area. 2. Have all clients who have expressed suicidal ideation just prior to or during hospitalization make a written personal suicide prevention plan. 4. Educate family and friends of previously suicidal clients in ways to help clients remain safe after discharge. Having resources such as a crisis phone line number and a specific prevention plan helps clients know what to do if they begin to feel they want to harm themselves. Likewise, having support people educated about how to help the client stay safe also improves the client's safety. Not all medications are lethal enough that access to a month's supply of medication should be limited. Further, such a limitation is likely to increase costs for the clients, which may increase the client's stress. It is unrealistic and potentially distressing to the client and family/friends to have the client under constant surveillance.
A high school student tells a nurse in an outpatient clinic the reason he is depressed and suicidal is that he is being bullied at school. While discussing the circumstances of the bullying, the student indicates he is gay, which he thinks contributes to his being bullied. He tells the nurse his sexual orientation in confidence, stating that his parents do not know and that he does not want that information revealed to them. Which of the following actions should the nurse take? Select all that apply. 1. Give him the crisis phone line number and contact information for a support group for gay teens. 2. Notify the student's parents despite his objections because of the risk to him. 3. Question him about the bullying and his current status regarding suicidal thoughts/plans. 4. Help him develop a safety plan regarding suicidal thoughts/plans. 5. Notify the school about the bullying without identifying the specific student.
ANS: 1, 3, 4, 5. 1. Give him the crisis phone line number and contact information for a support group for gay teens. 3. Question him about the bullying and his current status regarding suicidal thoughts/plans. 4. Help him develop a safety plan regarding suicidal thoughts/plans. 5. Notify the school about the bullying without identifying the specific student. Exploring the bullying and giving the student resources as well as planning for his safety will help the client remain safe. Notifying the school is essential to ensuring the safety of other students in the community. Notifying the parents against the client's wishes destroys trust and could make him feel more desperate. A better action would be to help the student prepare to reveal his sexual orientation to his parents
Which of the following statements made by an adolescent who has just begun taking an antidepressant would indicate the need for further teaching about the action of antidepressants in treating depression? 1. "Now that I have been taking my antidepressant for a week, I'm going to feel better about myself." 2. "A week ago when I started my antidepressant, I didn't care about eating, but now I want to eat a bit more." 3. After a week of taking my antidepressant, I can sleep a little better— 6 hours or so each night." 4. "Now that I've had a week of my antidepressant, it is a little easier to get up in the morning."
ANS: 1. "Now that I have been taking my antidepressant for a week, I'm going to feel better about myself." In the first week or so of taking an antidepressant, the vegetative symptoms of depression (poor sleep, appetite, and energy level) improve. However, it takes 3 to 4 weeks for improvement in self-concept/self-esteem to take place.
A health care provider has prescribed valproic acid for a client with bipolar disorder who has achieved limited success with lithium carbonate. The nurse should instruct the client about which of the following? 1. Follow-up blood tests are necessary while on this medication. 2. The extended-release tablet can be crushed if necessary for ease of swallowing. 3. Tachycardia and upset stomach are common side effects. 4. Consumption of a moderate amount of alcohol is safe if the medication is taken in the morning.
ANS: 1. Follow-up blood tests are necessary while on this medication. 1. Valproic acid can cause hepatotoxicity, so regular liver function tests are needed. Other side effects include nausea and drowsiness. Extended-release tablets should not be split or crushed; doing so changes their absorption. Alcohol should never be mixed with this medication. There will be medication in the client's body at all times.
When developing the teaching plan for the family of a client with severe depression who is to receive electroconvulsive therapy (ECT), which of the following information should the nurse include? 1. Some temporary confusion and disorientation immediately after a treatment is common. 2. During an ECT treatment session, the client is at risk for aspiration. 3. Clients with severe depression usually do not respond to ECT. 4. The client will not be able to breathe independently during a treatment.
ANS: 1. Some temporary confusion and disorientation immediately after a treatment is common. The family needs to be informed that some confusion and disorientation will occur as the client emerges from anesthesia immediately after ECT, to lessen their fear and anxiety about the procedure. The nurse will assist the client with reorientation (time, person, and place) and will give clear, simple instructions. The client may need to lie down after ECT because of the effects of the anesthesia. Informing the family that there is a danger of aspiration during ECT is inappropriate and unnecessary. The risk of aspiration occurring during ECT is minimal because food and fl uids are withheld for 6 to 8 hours before the treatment. In addition, the client receives atropine to inhibit salivation and respiratory tract secretions. Telling the family that the client will not be able to breathe independently during ECT may frighten them unnecessarily. If asked, the nurse should inform the family that the anesthesiologist mechanically ventilates the client with 100% oxygen immediately before the treatment. The client with severe depression responds to ECT. Usually, ECT is used for those who are severely depressed and not responding to pharmacotherapy and for those who are highly suicidal.
A client who experienced sleep disturbances, feelings of worthlessness, and an inability to concentrate for the past 3 months was fired from her job a month ago. The client tells the nurse, "My boss was wonderful! He was understanding and a really nice man." The nurse interprets the client's statement as representing the defense mechanism of reaction formation. Which of the following would be the best response by the nurse? 1. "But, I don't understand, wasn't he the one who fired you?" 2. "Tell me more about having to work while not being able to sleep or concentrate." 3. "It must have been hard to leave a boss like that." 4. "It sounds like he would hire you back if you asked."
ANS: 2. "Tell me more about having to work while not being able to sleep or concentrate." Option 1 casts doubt on the client's perception, which is likely to increase the client's anxiety and make the client feel defensive. Options 3 & 4 further the client's unrealistic perception of the situation. Option 2 focuses on the client and her feelings which is the most effective approach to help her realistically consider her situation and decrease the anxiety that led the client to use the defense mechanism of reaction formation.
A client exhibiting euphoria, hyperactivity, and distractibility cannot remain seated at mealtimes long enough to eat an adequate amount of food. When developing the client's plan of care, the nurse anticipates providing the client with "finger food" to eat while moving about the unit. Which of the following foods should the nurse include in the client's plan of care? 1. Bacon, lettuce, and tomato sandwich. 2. Cheeseburger. 3. Ice cream cone. 4. Cut-up vegetables.
ANS: 2. Cheeseburger. The nurse needs to provide the client who cannot sit long enough to eat adequate amounts of "finger foods," or food that can be held and eaten while moving. High-protein and high-carbohydrate foods, such as a cheeseburger or peanut butter sandwich, are best for the hyperactive client to help maintain body weight. A bacon, lettuce, and tomato sandwich would not provide the client with adequate protein and carbohydrates. Additionally, this type of sandwich is difficult to carry around and can be dropped easily. An ice cream cone, although high in calories, would not provide the client with adequate protein. Cut-up vegetables are a poor selection because, although they are high in vitamins, they are low in protein, which is necessary for building and repairing body cells and tissues, and low in carbohydrates, which are needed for energy.
During an interaction with the nurse, a client states, "My husband has supported me every time I've been hospitalized for depression. He'll leave me this time. I'm an awful wife and mother. I'm no good. Nothing I do is right." Based on this information, which of the following nursing diagnoses should the nurse identify when developing the client's plan of care? 1. Impaired social interaction related to unsatisfactory relationships as evidenced by withdrawal. 2. Chronic low self-esteem related to lack of selfworth as evidenced by negative statements. 3. Risk for self-directed violence related to feelings of guilt as evidenced by statements of suicidal ideation. 4. Ineffective coping related to hospitalizations as evidenced by impaired judgment
ANS: 2. Chronic low self-esteem related to lack of selfworth The client's negative thinking and statements are directly related to the psychopathology of depression. The client's views and feelings about herself reflect low self-esteem. Although Impaired social interaction, Risk for self-directed violence, and Ineffective coping are possible nursing diagnoses, there are insufficient data to support these diagnoses. Further assessment is needed to identify supportive data.
The client with bipolar disorder is approaching discharge after being hospitalized with her first episode of acute mania. The client's husband asks the nurse what he can do to help her. Which of the following recommendations for the husband should the nurse anticipate including in the teaching plan? 1. Help the client to be free from worry and anxiety. 2. Communicate openly and offer support. 3. Relieve the client of all responsibilities. 4. Remind the client to control her symptoms
ANS: 2. Communicate openly and offer support. The nurse should encourage the husband to support and communicate openly with his wife to maintain effective family-client interactions. During any illness, open communication and support helps the relationship between husband and wife. It is unrealistic for any individual to be free from anxiety or worry and impossible for the husband to be able to control what his wife may think or feel. Relieving the client of all responsibilities is unrealistic and not helpful. The client needs to resume activities as soon as she can manage them. Reminding his wife to control her symptoms is not appropriate and indicates that the husband needs further teaching about this condition.
In a predischarge program to educate clients with bipolar disorder and their family members, the nurse emphasizes that the most significant indicators for the onset of relapse include which of the following symptoms? 1. A sense of pleasure and motivation for new endeavors. 2. Decreased need for sleep and racing thoughts. 3. Self-concern about increase in energy. 4. Leaving a good job to start a new business.
ANS: 2. Decreased need for sleep and racing thoughts. Decreased need for sleep and racing thoughts are the most prominent hallmarks of mania. Feelings of pleasure, motivation, and increased energy, within reason, are desired experiences. Also leaving a job to start a new business is not, in itself, a sign of impending illness.
A young woman comes to the mental health clinic for her routine medication follow-up. She has been married for 2 years and reports that she and her husband are ready to start a family. She has a diagnosis of bipolar I disorder and has been well managed on divalproex sodium (Depakote) for at least 3 years. What is the most essential counsel for the nurse to give her? 1. "Schedule an appointment for a complete gynecological exam if you have not had one in the past year." 2. "Pay careful attention to eating healthy from this point on in order to maximize the health of both mother and baby." 3. "Check with your prescriber today as Depakote carries an increased risk for birth defects, especially during the first 3 months of pregnancy." 4. "It is very important for you to take steps to reduce your stress and this will help you to stay in balance during your pregnancy and reduce your chances of developing post-partum depression."
ANS: 3. "Check with your prescriber today as Depakote carries an increased risk for birth defects, especially during the first 3 months of pregnancy." All of these options need to be addressed. However, it is vital that this young woman receive counseling about the serious birth defects that have an increased incidence with the taking of Depakote during the first trimester of pregnancy. These problems include craniofacial abnormalities (cleft palate), organ malformations (holes in the heart and urinary tract problems), limb deficiencies, and developmental delays. The chances of preeclampsia and premature labor are also increased.
A client comes to the mental health clinic for a follow-up visit for a diagnosis of major depressive disorder. He says that he has been taking his escitalopram oxalate as prescribed since his second hospitalization 3 months ago. He tells the nurse that he is feeling "like my old self again." Now he wants to stop taking medication. "I don't want to be dependent on meds like my father." What is the nurse's best initial response to him? 1. "After another 3 months of stability, it might be safe for you to go off the escitalopram." 2. "After two significant episodes, you will need to take an antidepressant indefinitely." 3. "Research indicates that individuals who have had two major depressive episodes have a 70% chance of having a third episode." 4. "It is likely that you can learn to manage your depression with a regular exercise regime and a healthy diet."
ANS: 3. "Research indicates that individuals who have had two major depressive episodes have a 70% chance of having a third episode." After two episodes of a major depressive disorder, the likelihood of a third episode increases to 70%. This information would be useful to convey prior to discussing the importance of continuing his medication. This client also has a family history of depression. A healthy diet and exercise are very significant adjuncts to the therapeutic plan but may not be sufficient as stand-alone therapy.
A client states, "I'm so tired of living and just want to end it all." Which of the following responses is most therapeutic? 1. "I'll walk with you to your room so that you can get some rest." 2. "Perhaps after your son visits you'll feel better about things." 3. "You're in a lot of pain now but you will feel better. I'm here to help you." 4. "You are very depressed right now and want to die but you need to focus on life."
ANS: 3. "You're in a lot of pain now but you will feel better. I'm here to help you." The most therapeutic response is for the nurse to state, "You're in a lot of pain now but you will feel better and I'm here to help you." The client with active suicidal ideation believes that the solution to his problems is suicide. This statement by the nurse conveys empathy and hope to the client that he will get better and offers the nurse's help in doing so. The statement, "I'll walk with you to your room so that you can get some rest," is inappropriate because it focuses only on the client's use of the word tired, not the underlying feeling or intent of the statement. The statement about feeling better after the client's son visits is inappropriate because the nurse does not recognize the client's suicidal behavior and does not convey an understanding of the psychopathology of depression. The statement, "You are very depressed right now and want to die but you need to think about life," is inappropriate because it will not change the way the client is thinking or feeling. It also minimizes the client's feelings.
A client who has had three episodes of recurrent endogenous depression within the past 2 years states to the nurse, "I want to know why I'm so depressed." Which of the following statements by the nurse is most helpful? 1. "I know you'll get better with the right medication. 2. "Let's discuss possible reasons underlying your depression." 3. "Your depression is most likely caused by a brain chemical imbalance." 4. "Members of your family seem very supportive of you."
ANS: 3. "Your depression is most likely caused by a brain chemical imbalance." Endogenous depression (depression coming from within the person) is biochemical in nature. The biologic theory of depression indicates a neurotransmitter imbalance involving serotonin, norepinephrine, and possibly dopamine. Reactive depression is caused by the occurrence of something happening outside the body, such as the death of a loved one or another significant loss. Stating that the client will improve with the right medication or that family members seem supportive does not address the client's immediate concerns of not knowing the cause of the depression. Discussing possible reasons for the client's depression is nontherapeutic because the depression is endogenous and biochemically based.
A client experiencing acute mania has been taking lithium carbonate 600 mg P.O. three times daily for 14 days. The client's serum lithium level is 1.8 mEq/L. The nurse should: 1. Call the health care provider, hold next dose of lithium and push fluids. 2. Call the health care provider, start an IV and put client on bed rest. 3. Call the health care provider, then transfer client to a medical intensive care unit. 4. Inform the client that the lithium level is within normal limits.
ANS: 3. Call the health care provider, then transfer client to a medical intensive care unit. Bipolar disorder is a biochemical disorder caused by an imbalance of neurotransmitters in the brain. Manic episodes seem to be related to excessive levels of norepinephrine, serotonin, and dopamine. Psychopharmacologic therapy aims to restore the balance of neurotransmitters. In the past, it was thought that bipolar disorder may have been caused by early psychodynamics or disturbed families, but the current view emphasizes the role of biology. Bipolar disorder could be genetic or inherited from someone in the family, but it is best for the client and family to understand the disease concept related to neurotransmitter imbalance. This understanding also helps them to refrain from placing blame on anyone. Siblings and close relatives have a higher incidence of bipolar disorder and mood disorders in general when compared with the general population.
The nurse is caring for a client with bipolar disorder who was recently admitted to an inpatient unit and is experiencing a manic episode. What is a priority nursing intervention for this client? 1. Order and administer all medications in a liquid form. 2. Base permission for family visits on the client's attendance at therapy groups. 3. Closely monitor the client's eating and sleeping habits. 4. Encourage the client to keep a journal about feelings and emotions.
ANS: 3. Closely monitor the client's eating and sleeping habits. Distraction and disorganization may prevent clients from eating or sleeping. Monitoring for needed intervention can prevent exhaustion and malnutrition. Liquid medications are indicated only if the client cannot or will not swallow tablets. Manic clients tend to disrupt group therapy, so this treatment usually is not for them. Family visits should not be tied to compliance with treatment. The client is unlikely to be able to concentrate and complete a journal at this time.
A client is suicidal and not responding to the antidepressants prescribed to him over the last 2 months. This morning, after talking to his wife, the client verbally agrees to electroconvulsive therapy (ECT), but refuses to sign the consent form saying it is "evil." The nurse should: 1. Proceed with treatment because he has given verbal consent. 2. Have his wife sign the consent form as next of kin. 3. Inform his wife that his refusal to sign means treatment must be withheld unless the client later signs the document or a court hearing is held. 4. Tell the client that he will not be released from the hospital as soon as originally promised due to his refusal.
ANS: 3. Inform his wife that his refusal to sign means treatment must be withheld unless the client later signs the document or a court hearing is held. 3. As long as the client is not judged to be incompetent, he can refuse to sign the consent form. The only way to force treatment would be a court hearing in which a judge could order the treatment to proceed. The treatment cannot proceed merely on a verbal consent or the written consent of the spouse. The client's release cannot be held hostage to force him to sign the consent.
A client is brought to the hospital by police and admitted involuntarily. She is diagnosed as having bipolar disorder, manic phase. The physician orders lithium 300 mg by mouth three times a day. The client refuses her morning dose of lithium. The nurse should next: 1. Force the client to take the lithium because of the client's involuntarily admission status. 2. Contact the physician to change the lithium order to be given intramuscularly. 3. Inform the client that she retains the right to refuse medication despite her involuntary admission. 4. Tell the client that certain privileges will be revoked if she does not take the medication.
ANS: 3. Inform the client that she retains the right to refuse medication despite her involuntary admission. The only right the client loses because of her involuntary admission is the right to leave the hospital whenever she wishes. Forcing the client to take medication and revoking privileges are punitive and coercive. Lithium is not given intramuscularly.
The intake nurse is making an assessment of a client who has just arrived at the emergency department. Which of the following comments from this client who is taking Nardil (phenelzine), a monoamine oxidase (MAO) inhibitor, for treatment-resistant depression should be given top priority? 1. "My bowels haven't moved in the last 2 days." 2. "What was my temperature? I'm feeling warm." 3. "My legs feel stiff after I sit in the chair for a while." 4. "I have a throbbing headache."
ANS: 4. "I have a throbbing headache." A serious, life-threatening reaction to MAO inhibitors is hypertensive crisis. Although this medication is inclined to reduce blood pressure, in combination with too much tyramine (present in other drugs and foods), blood pressure can rise to a dangerous level. A throbbing headache could be a significant indicator of an impending crisis.
A client has just been admitted to the hospital for medication adjustment after outpatient treatment failure of his bipolar disorder and returning mania. He tells his primary nurse about his medications and treatment. Which of his following statements would raise the most urgent need for more medication instruction about his lithium therapy? 1. "My doctor tells me that my lithium level is 1.0 so I don't have to worry about my levels." 2. "I've been getting a lot of good exercise playing on a local soccer team." 3. "I'm trying hard to watch my diet and eat healthy." 4. "I have learned to take my lithium even when I'm not feeling well, like when I had the stomach flu."
ANS: 4. "I have learned to take my lithium even when I'm not feeling well, like when I had the stomach flu." The therapeutic serum level for lithium is 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L). Levels due fluctuate with fluid intake and output, however. Therefore, the most urgent matter for teaching is the client's comment about taking his lithium during excessive loss of fluids during an episode of "stomach flu" with diarrhea. Exercising is only concerning if the client becomes dehydrated. A healthy diet is indicated while taking lithium.
A client who is depressed states, "I'm an awful person. Everything about me is bad. I can't do anything right." Which of the following responses by the nurse is most therapeutic? 1. "Everybody around here likes you." 2. "I can see many good qualities in you." 3. "Let's discuss what you've done correctly." 4. "You were able to bathe today."
ANS: 4. "You were able to bathe today." By saying, "You were able to bathe today," the nurse is pointing out a visible accomplishment or strength, thereby increasing the client's feelings of self-worth and self-esteem. Stating that "everybody around here likes you" or discussing what the client has done correctly is inappropriate because although the client may agree with the nurse, the client still may be depressed. Stating that the nurse sees many good qualities in the client is not helpful because a person's feeling of self-worth is generally determined by accomplishments. Intellectual understanding does not help the client with severe depression. Additionally, the nurse cannot talk a client out of depression because major depression is endogenous and biochemical in nature. Medication should restore the neurotransmitter balance and relieve the depression.
Which of the following is the best predictor of a client's favorable response to the choice of an antidepressant? 1. The drug's side effect profile. 2. The client's age at diagnosis. 3. The cost of the medication. 4. A favorable response by a family member.
ANS: 4. A favorable response by a family member. A favorable response by a family member to a medication and a previous response to medication are good predictors of a favorable client response to a medication because the illness is genetic and hereditary. Although the side effects of the drug, the client's age at diagnosis, and the cost of the medication are important factors to consider when choosing antidepressant therapy, this information does not necessarily predict how a client will respond to a specific drug.
When developing staff assignments for the unit, the nurse manager should determine that which of the following clients needs one-to-one staff supervision? 1. The client who is sometimes preoccupied with death. 2. The client who tries to elope from the unit but is ambivalent about suicide. 3. The client who is impulsive and holds her breath until she faints. 4. The client who cannot sign a no-harm contract because of hallucinations.
ANS: 4. The client who cannot sign a no-harm contract because of hallucinations. 4. One-to-one staff supervision is needed for the client who is unwilling or cannot sign a no-harm contract because of an impairment in reality testing due to hallucinations, delusions, dementia, or delirium. Other high-risk clients include those with constant suicidal thoughts, past attempts with high lethality, high risk of elopement, available access to a planned method, and severe depression. The client who is sometimes preoccupied with death or who tries to elope but is ambivalent about suicide is not at high risk for suicide and therefore does not need one-to-one supervision, nor does the client who is impulsive and holds her breath until she faints. This client may be seeking attention and not intending self-harm in the form of suicide. Furthermore, fainting is not a lethal method of suicide.
The nurse is assessing the outcomes of care for a client who has an Axis I diagnosis of major depression. Following the initiation of treatment, arrange the symptoms in chronological order from the one that improves first to the one that improves last. 1. Self-esteem. 2. Sleep. 3. Energy level. 4. Appetite.
ANS: In chronological order: 2. Sleep. 4. Appetite. 3. Energy level. 1. Self-esteem. When beginning medication treatment, the client will initially notice an improvement in sleep, followed by an improvement in appetite which leads to an increase in energy level. Behavioral treatment is most likely to affect self-esteem and since the decline in self-esteem generally occurs over months or years, it will likely take longer than a few days to improve.
