PrepU Videbeck Ch 17 Mood Disorders & Suicide

Which activity should the nurse include in the plan of care for a client with mania who is experiencing psychomotor agitation? Playing checkers with members of the staff Reading in a quiet, low-stimulus environment Engaging in a card game with other clients on the unit Attending a clay-molding class that is scheduled for today

Attending a clay-molding class that is scheduled for today

A client is admitted to the unit in an acute manic episode. The client has had three major depressive episodes in the past 10 years and two other hospitalizations for mania. Which disorders would reflect the client's symptom profile? Bipolar I Cyclothymic disorder Euthymic state Bipolar II

Bipolar I

When teaching a client who is recently diagnosed bipolar I disorder, the nurse correctly tells the client that the difference between bipolar I disorder and bipolar II disorder is what? Bipolar I disorder involves altered moods of anger and paranoia. Bipolar I disorder more often effects women. Bipolar I disorder is characterized by hypomanic episodes. Bipolar I disorder is often more disruptive than bipolar II disorder.

Bipolar I disorder is often more disruptive than bipolar II disorder.

Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply. Communicate expected behaviors to the client. Ensure that the client knows that they are not in charge of the nursing unit. Assist the client in identifying ways of setting limits on personal behaviors. Follow through about the consequences of behavior in a nonpunitive manner. Enforce rules by informing the client that he/she will not be allowed to attend therapy groups. Have the client state the consequences for behaving in ways that are viewed as unacceptable.

Communicate expected behaviors to the client. Assist the client in identifying ways of setting limits on personal behaviors. Follow through about the consequences of behavior in a nonpunitive manner. Have the client state the consequences for behaving in ways that are viewed as unacceptable.

A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment findings would support this suspicion? Select all that apply. Headache Agitation Hallucinations Orthostatic hypotension Confusion

Confusion Hallucinations Agitation

An elderly client is admitted to the hospital with fatigue and weight loss of 20 pounds in 1 month. Upon further assessment, the client is diagnosed with depression. What other thing should the nurse assess this client for based on the weight loss? Sleep disturbance Suicide Dehydration Decreased energy

Dehydration

The nurse is describing the medication side and adverse effects to a client who is taking amitriptyline. Which information should the nurse incorporate in the discussion? Consume a low-fiber diet. Increase fluids and bulk in the diet. Rest if the heart begins to beat rapidly. Walk if you have difficulty urinating because this is a normal side effect.

Increase fluids and bulk in the diet.

A client who has a recent diagnosis of bipolar I disorder is scheduled to begin therapy with lithium. Which instruction should the nurse provide to this client? "Try to limit your fluid intake to no more than four to six glasses per day." "If you don't feel substantially different in a few days, increase your dose by 50%." "Avoid exercise at the hottest times of the day." "Try to adapt to a low-salt diet as soon as possible."

"Avoid exercise at the hottest times of the day."

A bipolar client presents to the clinic with reports of headaches and feeling more irritable than usual. What is the best nursing response? "Can you tell me more about these symptoms?" "Continue to take your medication because the symptoms are minor." "Let's get some bloodwork done." "Have you been taking your medication correctly?"

"Can you tell me more about these symptoms?"

The nurse reviews the medication list for a client who is newly prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which client statement indicates a need to assess the client for serotonin syndrome? "I stopped taking St. John's wort 4 weeks ago." "I used to enjoy taking ecstasy, but I know it isn't safe with my new medication." "I stopped drinking red wine when I started taking my new prescription." "I started taking diet pills to assist with weight loss."

"I started taking diet pills to assist with weight loss."

The nurse is discussing discharge and outpatient follow-up plans with a client hospitalized for depression. Which statement demonstrates the client's use of a defense mechanism and would indicate the need for follow-up treatment? "I don't think I can do this on my own. I still need help coping with things. I know I need to keep working with staff, even now that I'm going home." "This has been the hardest thing I've ever had to deal with. I've made progress in learning how to communicate, especially with my family. It's hard to tell them when I need help." "I really tried to listen to what people said in the group sessions. Sometimes it was hard, but I think we really helped each other. I think I've learned it's all right to get disappointed sometimes." "I was really depressed about not getting the promotion I was promised. Looking back on it, the pay raise wouldn't have been worth the huge increase in responsibility. It's just as well; it all worked out in the end."

"I was really depressed about not getting the promotion I was promised. Looking back on it, the pay raise wouldn't have been worth the huge increase in responsibility. It's just as well; it all worked out in the end."

A client comes to the clinic for an evaluation of headache, fatigue, and an overall feeling of being "down." When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply. "I've been going out with my friends about once or twice a week." "Most times, I feel like I'm trapped with no way out." "I've been drinking about three or four more beers every night." "I'm so tired that all I ever want to do is sleep all the time." "I'm looking for a new job because my job is so stressful."

"I've been drinking about three or four more beers every night." "I'm so tired that all I ever want to do is sleep all the time." "Most times, I feel like I'm trapped with no way out."

The nurse is assessing a client with depression and a colleague suggests that the client be encouraged to sign a no-suicide contract. What is the nurse's best response to the colleague? "Yes, there are some benefits to no-suicide contracts, but they're ethically questionable." "It's best to let the client bring up the issue of no-suicide contracts rather than us suggesting them." "There's no demonstrated benefit of no-suicide contracts, though they're not believed to be harmful." "The most recent evidence suggests that these contracts can actually provoke a suicide attempt."

"There's no demonstrated benefit of no-suicide contracts, though they're not believed to be harmful."

A depressed client on an inpatient unit says to the nurse, "My family would be better off without me." Which is the nurse's best response? "Have you talked to your family about this?" "Everyone feels this way when they are depressed." "You will feel better once your medication begins to work." "You sound very upset. Are you thinking of hurting yourself?"

"You sound very upset. Are you thinking of hurting yourself?"

A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? Encouraging quiet reading and writing for the first few days Identification of physical activities that will provide exercise No socializing activities until the client asks to participate in milieu A structured program of activities in which the client can participate

A structured program of activities in which the client can participate

The nurse is creating a plan of care for a client diagnosed with depression whose food intake is poor. The nurse should include which interventions in the plan of care? Select all that apply. Assist the client in selecting foods from the food menu. Offer high-calorie fluids throughout the day and evening. Allow the client to eat alone in the room if the client requests to do so. Offer small high-calorie, high-protein snacks during the day and evening. Select the foods for the client to be sure that the client eats a balanced diet.

Assist the client in selecting foods from the food menu. Offer high-calorie fluids throughout the day and evening. Offer small high-calorie, high-protein snacks during the day and evening.

A client who otherwise is healthy is admitted for depression and reports feeling "all alone" following a recent divorce. The client admits to drinking at least 12 beers every day. The client has which risk factors for the depression? Select all that apply. Family history of depression Lack of coping abilities Current substance use or abuse Life and environmental stressors Medical comorbidity

Current substance use or abuse Life and environmental stressors Lack of coping abilities

A client recently admitted to the hospital in the manic phase of bipolar disorder is unkempt, taking antipsychotic medications, and complaining of abdominal fullness and discomfort. Which intervention addresses the priority sign/symptom? Teach self-grooming skills. Reward cleanliness with unit privileges. Monitor the adequacy of the antipsychotic dosage. Encourage frequent fluid intake and a high-fiber diet.

Encourage frequent fluid intake and a high-fiber diet.

The nurse is conducting an admission assessment with a 45-year-old client who has been demonstrating signs of bipolar disorder. While conducting the assessment, the client starts speaking in illogical rhymes and using word associations. What is the name for this thought pattern? Delusions of grandeur Excessive euphoric speech Flight of ideas Expansive ideas

Flight of ideas

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine. Which information would be important for the nurse to obtain during this client visit regarding the side and adverse effects of the medication? Cardiovascular symptoms Gastrointestinal dysfunctions Problems with mouth dryness Problems with excessive sweating

Gastrointestinal dysfunctions

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

Hallucinations

The nurse is preparing a client with depression for electroconvulsive therapy, which is scheduled for the next morning. Which interventions would be included in the preprocedural plan? Select all that apply Have the client void. Obtain an informed consent. Administer tap water enemas. Avoid discussing the procedure. Remove dentures and contact lenses. Withhold food and fluids for 6 hours.

Have the client void. Obtain an informed consent. Remove dentures and contact lenses. Withhold food and fluids for 6 hours.

A depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as "I'm such a failure. I can't do anything right." How should the nurse plan to respond to the client's statement? Reassure the client that things will get better. Tell the client that this is not true and that we all have a purpose in life. Identify recent behaviors or accomplishments that demonstrate the client's skills. Remain with the client and sit in silence; this will encourage the client to verbalize feelings.

Identify recent behaviors or accomplishments that demonstrate the client's skills.

A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." Based on the client's behavior and statement, which intervention should the nurse include in the plan? Suggesting a reduction of medication Allowing increased "in-room" activities Increasing the level of suicide precautions Allowing the client off-unit privileges as needed

Increasing the level of suicide precautions

A client taking lithium therapy has a serum therapeutic level of 0.8 mEq/L. What priority dietary instruction should the nurse include in the teaching plan? Limit fluid intake to 6-8 oz (180-340 mL) glasses a day. Monitor weight pattern. Maintain daily sodium intake. Switch to a DASH diet.

Maintain daily sodium intake.

A mental health nurse is caring for a depressed client, whose spouse passed away 2 months ago. The client sates, "I'm going to kill myself." Which is a behavioral sign of suicide? Guilt Hopelessness Isolation Making a will

Making a will

The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. Which client symptoms require the nurse's immediate action? Incessant talking and sexual innuendoes Grandiose delusions and poor concentration Outlandish behaviors and inappropriate dress Nonstop physical activity and poor nutritional intake

Nonstop physical activity and poor nutritional intake

The primary health care provider is planning to prescribe a medication for a client with major depression. Which medication should the nurse expect to be prescribed? Diazepam Lorazepam Phenobarbital Paroxetine hydrochloride

Paroxetine hydrochloride

A client diagnosed with depression has a prescription for sertraline. The nurse should withhold the medication and question the prescription if the client has a history of which disorder? Diabetes mellitus Myocardial infarction Phenelzine sulfate use Irritable bowel syndrome

Phenelzine sulfate use

Police officers bring a client to the mental health unit for admission. The client had been directing traffic on a busy city street, shouting rhymes such as "to work, you jerk, for perks" and making obscene gestures at cars that came close to the client. When the client's spouse is contacted at work, the spouse reports that the client stopped taking lithium 3 weeks ago and has not slept or eaten for 3 days. With which two features characteristic of the manic phase of bipolar disorder can the nurse identify? Poor judgment and hyperactivity Vegetative signs and poor grooming Disinhibition and elevated mood Increased muscle tension and anxiety

Poor judgment and hyperactivity

A client with major depression and a suicide attempt is admitted to the inpatient facility. The client is started on antidepressant therapy. The next day, the client demonstrates significantly higher energy and says, "I'll feel much better." The nurse would interpret this behavior as suggesting what? A typical response to the medication Possible decision to complete a suicide attempt An act to cover up the client's true feelings Effectiveness of the drug therapy

Possible decision to complete a suicide attempt

A client with which psychiatric disorder is at high risk for suicide? Anxiety disorders Eating disorders Personality disorders Schizophrenia

Schizophrenia

In response to a change in the community health nurse, a client has recently discontinued use of lithium. As a result of the discontinuation of the medication, the client has began to exhibit early signs of mania. The client is brought to the emergency department at the hospital for assessment. Which is the best nursing approach for this client? Allowing the client maximum opportunity for freedom and self-expression Setting limits, providing a low-stimulation environment, and maintaining a neutral attitude Insisting that the client remain active throughout the day so the client will sleep Offering high-calorie meals and insisting the client finish all meals

Setting limits, providing a low-stimulation environment, and maintaining a neutral attitude

To confirm that a client is experiencing a manic episode, the nurse must eliminate the possibility that the client's symptoms are related to which problem? Insomnia Overexcitment Inflated self-esteem or grandiosity Substance use

Substance use

A hospitalized client is started on a monoamine oxidase inhibitor (MAOI) for the treatment of depression. The nurse should instruct the client that which foods are acceptable to consume while taking this medication? Select all that apply. Figs Yogurt Crackers Aged cheese Tossed salad Oatmeal raisin cookies

Tossed salad Crackers

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client? Chess Writing Board games Group exercise

Writing