prep u chapter 69

A client who attempted suicide 5 years ago is brought to the emergency department (ED) by a friend. The client states, "I just don't feel like living anymore. No one would care if I lived or died." What question should the nurse ask next?

"Do you have a plan for suicide at this time?"

A client with mania is demonstrating hypersexual behavior: blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which of the following interventions is indicated at this time?

"Let's go to the conference room and talk for a while."

The nurse is interviewing a client with major depression. Which of the following statements by the client would most indicate to the nurse that the client is at risk for suicide?

"Life has lost its meaning for me."

A client has recently lost her spouse and has been experiencing depression as a result. Which of the following statements from the nurse about the client's condition is most accurate?

"Usually, the kind of depression you are experiencing resolves with time."

A client is not coping well because of feelings of depression and hopelessness. What interventions would be helpful to use in caring for this client?

All choices are correct.

The nurse is caring for a patient who is taking amitriptyline for depression. What nursing intervention would be most appropriate if this patient developed orthostatic hypotension?

Ask the patient to sit on the side of the bed for 1 minute before getting up

The mobile crisis unit of a large city receives an emergency call from a client who states, "My life is worthless. I do not want to live anymore." The mobile crisis unit is on the way to the home. The nurse's best first response would be which of the following?

Attempt to calm and support the client.

A client has been prescribed phenelzine sulfate, an MAO inhibitor. Which of the following foods should the nurse caution the patient to avoid eating?

Cheddar cheese and bratwurst

A nurse is caring for a client who will undergo electroconvulsive therapy (ECT) for treatment of depression. When assessing a client immediately following ECT, the nurse expects which of the following?

Confusion

A 24-year-old woman taking lithium carbonate is allowed a 3-day pass from the mental health unit to go home. What is the best health teaching the nurse should advise this client?

Continue to maintain normal sodium intake while at home.

A client with depression is admitted to an inpatient psychiatric unit. The nurse provides a unit orientation. While observing the client's unpacking, the nurse can expect the client to exhibit:

Decelerated movements and flat affect.

Earl is admitted to the acute psychiatric unit with a history of bipolar disorder. He asks the nurse about early indications of lithium toxicity. What would be the nurse's response to Earl?

Diarrhea may occur, and please speak to the nurse about this side effect.

A client with long-standing depression has been on medications that either have not helped or have produced adverse effects. The client continues to have suicidal thoughts. The physician has suggested electroconvulsive therapy (ECT) as a treatment option. Why is this a good option for this client? Select all that apply.

ECT is reserved for clients who have not responded to drug therapy. ECT is reserved for clients who are intolerant of the side effects of antidepressant medications.

Which instructions should a nurse provide a client who depends on lithium to control bipolar disorder?

Emphasize the importance of maintaining adequate salt intake.

Which communication guideline should the nurse use when talking with a client experiencing mania?

Focus and redirect the conversation as necessary.

Which intervention should be of primary importance to the nurse working with a client to modify the client's negative expectations?

Have the client identify positive aspects of self.

A client has been undergoing transcranial magnetic stimulation to treat his depression. Which of the following complications would the nurse most expect the client to report?

Headache

A lack of dietary salt intake can have which effect on lithium levels?

Increase

A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse she has been taking fluoxetine 20 mg PO daily for the past 3 weeks and that she has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take?

Inform the patient that a decrease in weight is normal with this medication.

A client who is on long-term lithium therapy is considering pregnancy. What would the nurse explain to the client?

Lithium crosses the placental barrier; therefore, its use is contraindicated in pregnant women.

Which psychotropic medication is administered based on an individualized dosage according to blood levels of the drug?

Lithium.

A client hospitalized in an acute manic phase of bipolar disorder is pacing the halls and talking in a loud voice and with pressured speech. The client is overly involved with co-clients and frequently threatens and disrupts them. Providing medication treatment, the nurse can expect the plan of care to include:

Monitoring blood lithium levels.

An older adult client is admitted to the medical division after a fall. At home he is taking amitriptyline 25 mg three times per day. What adverse effect could be related to the patient's fall?

Orthostatic hypotension

A client arrives at the psychiatric unit exhibiting extreme agitation, disorientation, and incoherence of speech with frantic and aimless physical activity and grandiose delusions. Which of the following concerns takes highest priority in planning your nursing interventions?

Risk for injury.

A client has been receiving treatment for depression for 3 weeks. Which behavior suggests that the client is less depressed?

Talking about the difficulties of returning to college after discharge

A client is taking lithium. Which of the following drugs would the nurse caution the client about potentially increasing his serum lithium level? Select all that apply.

Tetracycline Loop diuretics Nonsteroidal anti-inflammatory drugs (NSAIDs)

A client is experiencing psychotic depression. Which of the following findings would the nurse understand as distinguishing this mood disorder from others?

The client experiences hallucinations and delusions.

A client with major depression asks why he is taking mirtazapine (Remeron), a serotonin reuptake inhibitor, instead of imipramine (Tofranil), a tricyclic antidepressant. Which explanation is most accurate?

The serotonin reuptake inhibitors have few adverse effects.

Which is not a category of drugs that relieves the symptoms of depression?

beta-adrenergic blockers

To elevate mood for a client with depression, the nurse should recommend high intake of:

carbohydrates.

What is the clinical definition of a mood disorder?

extreme moods that interfere with social relationships

Which nursing intervention is necessary after administering medications to a client who is at risk for suicide?

inspecting the client's mouth

Within the theory of monoamine hypothesis, depression results from imbalances in one or more of the monoamine neurotransmitters. What imbalance of serotonin is proposed within the theory?

lower

Following unsuccessful electroconvulsive therapy (ECT), a health care provider is talking with a client about alternative treatments that could be attempted. Which treatment is not an alternative to ECT?

neurologic ablation

Low levels of norepinephrine help explain why some depressed people develop:

psychomotor retardation.

A nurse is assessing a client's suicide risk level using the mnemonic SLAP as a guide. What does SLAP stand for?

specificity, lethality, availability, proximity

A client with bipolar disorder has abruptly stopped taking prescribed medication. Which behavior would indicate the client has experienced a manic episode?

Thoughtless spending

A client with depression mentions to the nurse that he has gained about 5 lbs recently. He says, "I'm always craving sugary and starchy foods—pasta, cakes, cereals." How would the nurse most accurately explain this symptom to the client?

"Carbohydrates stimulate a temporary increase in serotonin production, and serotonin levels are often decreased in clients with depression."

At 1 am, the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. Which response by the nurse would be the most therapeutic?

"I can't call the psychiatrist now, but you and I can talk about your request for a pass."

A client taking a monoamine oxidase inhibitor (MAOI) is attending a follow-up appointment. During the interview, the client says to the nurse, "I'm starting to become really discouraged. I've been on this medicine for 4 weeks now, and nothing has changed." Which would be the best response from the nurse?

"It can take up to 6 weeks before symptoms improve when taking your type of medication."

A client presents to the emergency department with the following symptoms: nausea, vomiting, sudden headache, and stiff neck. Vital signs are temperature 98.8 F; pulse 120; respirations 12; and blood pressure 220/148. Currently the client is taking an MAOI antidepressant. Which of the following conditions should the nurse suspect?

Hypertensive crisis

A client with major depression has been prescribed amitriptyline. Which of the following teaching points about the drug regimen would the nurse include in the client's education plan? Select all that apply.

Inform the client that maximum relief may not occur for 2 to 4 weeks or longer. Caution the client to rise slowly from a lying or sitting position. Discuss the increased potential for suicide as energy increases before depression resolves.

A client has been diagnosed with major depression. Which of the following affective manifestations would the nurse expect the client to display? Select all that apply.

Looking gloomy Showing decreased initiative Being insensitive to others' feelings

A client with depression is admitted to the hospital following a suicide attempt. Which nursing diagnosis would be most appropriate at this time?

Risk for self-directed violence related to depression

What acronym is helpful in remembering the multiple physiologic and thought changes of major depression?

SAD IMAGES

Which type of antidepressants is rarely fatal in overdose?

SSRIs

A client with mania hospitalized on a general unit constantly belittles other clients and is demanding special favors from the nurses. The most appropriate nursing intervention is:

Set limits with specific and consistent consequences for belittling or demanding behavior.

A 65-year-old client seeks crisis intervention in a community senior citizen center. She states she has very few financial resources, and her children never call or visit. She is sobbing and states, "I can't take it anymore. My life is so lonely and hard. I am living too long and shouldn't be here anymore." What is the most important assessment data for the nurse to further assess?

The meaning of the statement "I cannot take it anymore."

Seasonal affective disorder (SAD) is a mood disorder that has its onset during darker winter months and spontaneously disappears in the spring. Clients feel sleepy, fatigued, and lethargic. What would not be part of what you would teach a client with SAD?

Use eyeglasses or contact lenses that are coated to shield ultraviolet radiation.

A client reports to the emergency department with suicidal ideation and feelings of worthlessness. He has a family history of suicide. In assessing the client to determine treatment recommendations, the most important factor for the nurse to consider is:

an active suicide plan and the means to carry it out

A nurse is teaching the family of a client with dysthymia about the continuum of mood. Identify on the accompanying figure where the nurse would likely outline the client's mood when reviewing information with the family.

elated

A client has been diagnosed with bipolar disorder. Which classification of drugs could not be used treat the client with bipolar disorder?

phosphodiesterase inhibitors

A physician is switching a client from a tricyclic antidepressant (TCA) to a monoamine-oxidase inhibitor (MAOI). How much time would the nurse instruct the client to let pass as a minimum before stopping the TCA and beginning the MAOI?

14 days

A client who is recently widowed is unable to sleep, is without an appetite, and has trouble focusing on any topic. This client's condition can be attributed to:

reactive depression.

Serotonin syndrome is a potentially life-threatening condition that results from elevated levels of serotonin in the blood secondary to drug therapy. What factors place a client at risk for serotonin syndrome?

All answers are correct.

A client's health care provider suspects the client is suffering from depression. What other conditions mimic depression?

All options are correct.

What do social theories suggest to be contributors to depression?

All options are correct.

A 40-year-old man has been prescribed fluoxetine. The client states he has not continued the prescribed therapy even though his depression improved. What assessment is most important for the nurse to make?

Assess for sexual dysfunction

A client is extremely depressed and expresses increasing suicidal ideation to the primary nurse. The priority nursing intervention should be:

Ensuring that the client is not permitted to use anything that would be potentially dangerous.

A client, age 79 years, tells the home visiting nurse, "I've been feeling down for the last few days. I don't have much to live for. My family and friends are all dead. My money's running out, and my health is failing." The nurse should assess this as:

Evidence of high suicide potential.

A depressed older adult client is being treated with a tricyclic antidepressant (TCA). The nurse should observe the client carefully for:

Orthostatic hypotension and urinary retention.

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale?

Other clients need to be protected from the intrusive behavior.

The mental health nurse knows that limit setting is most appropriate in which client population?

Manic

A client with bipolar disorder has been taking lithium, as prescribed, for the past 3 years. Today, family members brought this client to the hospital because the client hadn't slept, bathed, or changed clothes for 4 days; had lost 10 lb (4.5 kg) in the past month; and woke the entire family at 4 a.m. with plans to fly them to Hawaii for a vacation. Based on this information, what may the nurse assume?

The lithium level should be measured before the client receives the next lithium dose.

A client is taking lithium and asks for explanations for why regular blood tests are needed. The nurse explains that it is to detect lithium toxicity. The nurse can best explain lithium toxicity as which of the following?

Too much medication in the blood serum.