Psych CH 17
The nurse is conducting an interview with an adult client who is being treated for major depression. What question should the nurse prioritize in an effort to determine the client's risk for suicide? "Do you feel like your antidepressant is helping your mood?" "What are your plans for the next few days?" "How would you describe your relationship with your parents?" "Do you ever feel like your situation is hopeless?"
"Do you ever feel like your situation is hopeless?" Hopelessness is a significant risk factor for suicide among persons who are depressed. For an adult client, relationships with parents are significant but not among the major risk factors for suicide. Similarly, the client's perception of medication effectiveness is important but not a key risk factor. It is common for depressed individuals to lack firm plans for their days, and a lack of planning does not necessarily indicate a heightened suicide risk.
A nursing instructor is teaching about different depressive disorders and identifies a need for further instruction when a student states what? "With dysthymic disorder, depressed mood exists for most days for at least 2 years." "Dysthymic disorder is less chronic than major depression." "Dysthymic disorder is milder than major depression." "Dysthymic disorder can significantly affect a patient's functioning."
"Dysthymic disorder is less chronic than major depression." Dysthymic disorder is milder but more chronic than major depression and is diagnosed when the depressed mood is present for most days for at least 2 years with two or more other symptoms present.
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'm so tired that all I ever want to do is sleep all the time." "I've been drinking about three or four more beers every night." "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'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." Warning signs for suicide include increased substance use (drinking three or four more beers every night), an inability to sleep or sleeping all the time, and feeling trapped. Social isolation or withdrawal (rather than going out with friends or looking for a new job) would suggest suicide.
While caring for a client in the hospital, the nurse becomes concerned that the client may be having thoughts of suicide. Which statement would be most therapeutic? "Have you tried taking medication?" "Are you feeling sad?" "Do you have support at home?" "I've noticed something is bothering you. Please share you thoughts with me."
"I've noticed something is bothering you. Please share you thoughts with me." Nurses start with expressing what the nurse is noticing. This type of communication communicates objectivity and helps minimize defensiveness or minimization. Then the nurse should follow with an invitation or an open-ended question that encourages clients to convey what is concerning them most at this particular time. Sensitivity and empathy allow nurses to gather information, engage clients, and develop the therapeutic relationship.
A client is to receive three treatments of electroconvulsive therapy (ECT) per week for 3 weeks. After the third treatment, the client is forgetful and confused. When the client's spouse arrives to take the client home, the nurse discusses the client's condition with the spouse. Which statement is best? "Some confusion after ECT is normal. Withhold the client's medications for today and call tomorrow to let us know how the client is doing." "Some confusion after ECT is normal. The client will regain memory in a few hours." "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." "Confusion after ECT is not expected. Though it will resolve, the client probably will not be a candidate for ECT in the future."
"Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." A frequent consequence of ECT is memory impairment, ranging from mild forgetfulness of details to severe confusion. This may persist for weeks or months after treatment but usually resolves.
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? "While bipolar disorders are genetic, the gene can only be passed on by a father." "Bipolar disorders have not been found to be genetic." "While bipolar disorders are genetic, there are other causes as well." "Genetics are a minor factor in bipolar; it is more heavily influenced by psychological factors."
"While bipolar disorders are genetic, there are other causes as well." 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 has experienced a first episode of major depression and has received medication and treatment, which has led to a complete remission of the symptoms. The client asks the nurse, "How much longer will I need to take the medication?" Which response by the nurse would be most appropriate? "You'll need to continue the medication for about 6 to 12 months to see how things go." "Since you have no more symptoms, you can stop taking the medications tomorrow." "The medication has eliminated your symptoms so you'll need to keep taking it for the rest of your life." "It's probably best to continue the medication for another month, gradually decreasing the dosage over that time."
"You'll need to continue the medication for about 6 to 12 months to see how things go." Even after the first episode of major depression, medication should be continued for at least 6 months to 1 year after the client achieves complete remission of symptoms. If the client experiences a recurrence after tapering the first course of treatment, the regimen should be reinstituted for at least another year, and if the illness reoccurs, medication should be continued indefinitely.
A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When monitoring the client's blood concentration of this drug, which level would alert the nurse to the need to change the dosage? 115 ng/mL 30 ng/mL 55 ng/mL 75 ng/mL
30 ng/mL Optimal blood concentrations seem to be in the range of 50 to 150 ng/mL. Thus, anything outside this range would indicate the need for a change in drug dosage.
Which sleep pattern is suggestive of a manic episode? A client takes multiple short naps at varied times throughout the day and night. A client experiences day-night reversal, sleeping until late in the afternoon and going to bed near dawn. A client stays awake for several days and nights before "crashing" and sleeping for a long period. A client reports having fitful sleep that is characterized by frequent awakenings and nightmares.
A client stays awake for several days and nights before "crashing" and sleeping for a long period. During a manic episode, an individual will typically go several nights without sleep before collapsing from exhaustion.
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 feminist viewpoint of depression. A biological explanation for the client's depressive disorder. A reason the client has become lesbian at the age of 23.
A psychodynamic interpretation of the client's major depressive disorder. 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.
A 34-year-old client with depression is admitted to an inpatient psychiatric unit. The nurse enters the client's room and initiates interaction with the client. When talking with the client, which approach would be least appropriate? Respectful, direct manner Quiet and empathetic manner Animated and cheerful manner Matter-of-fact manner
Animated and cheerful manner When communicating with clients who are depressed, the nurse should never use an overly enthusiastic approach. This approach can lead to irritation and block communication.
Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder? Spaghetti Steak Bananas Brocolli
Bananas For a client who is unable to sit long enough to eat, snacks and high-energy foods that can be eaten while moving should be provided.
A psychiatric-mental health nurse is conducting a refresher class for a group of psychiatric-mental health nurses returning to the field. After teaching about depressive disorders, the nurse determines a need for additional teaching when the class identifies which physical symptom as being associated with depression? Fatigue Catatonia Insomnia Worthlessness
Catatonia Catatonia is a state of motor or physical activity associated with manic states in bipolar illness. Catatonia is also seen in clients with schizophrenia who have periods of immobility interrupted by episodes of extreme agitation. Fatigue is a lack of energy common during a severely depressed state. Severely depressed clients frequently have difficulty falling asleep or wake early in the morning and are unable to go back to sleep as with insomnia. Feelings of worthlessness or excessive/inappropriate guilt are commonly associated with depression.
A client has just been admitted to the inpatient psychiatry unit following a suicide attempt. During the client's first 24 hours of care, what outcome should be identified? Client will express that the client feels safe on the unit Client will state that the client feels optimistic about the client's future Client will implement strategies for managing stress Client will participate actively in cognitive behavioral therapy
Client will express that the client feels safe on the unit The initial care of a client who has had a suicide attempt focuses on helping the client feel safe and instilling the beginnings of hope. It would be premature to expect the client to learn and apply new stress management strategies after only 24 hours. Cognitive behavioral therapy would not begin during the acute stage of recovery. A sense of overall optimism will likely require long-term therapy to achieve it.
Which is an anticonvulsant used as a mood stabilizer? Divalproex Phenelzine Venlafaxine Bupropion
Divalproex Divalproex is an anticonvulsant that may be used as a mood stabilizer. Venlafaxine, bupropion, and phenelzine are antidepressants.
Following the failure of a woman's recent in vitro fertilization (IVF), the nurse recognizes that she may be at risk of depression. Which intervention is considered a primary suicide prevention measure? Placing the woman on suicide precautions and establishing a no-suicide contract Beginning a course of therapy with a nurse-therapist or psychologist Beginning treatment with a selective serotonin reuptake inhibitor Establishing a support system for the woman and teaching her some coping measures
Establishing a support system for the woman and teaching her some coping measures Primary prevention involves the identification and elimination of factors that cause or contribute to the development of an illness or disorder that could lead to suicide. Medication management, psychotherapy, and suicide precautions are more aggressive measures that would not be classified as primary prevention.
Which antidepressant medication is classified as a selective serotonin reuptake inhibitor (SSRI)? Isocarboxazid Phenelzine Tranylcypromine Fluoxetine
Fluoxetine Fluoxetine is included among the SSRIs. Phenelzine, isocarboxazid, and tranylcypromine are monoamine oxidase inhibitors (MAOIs).
A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of what? Anorexia Anxiety Grandiosity Depression
Grandiosity Grandiosity is elevated self-esteem and may range from unusual self-confidence to grandiose delusions. Speech is pressured; the person is more talkative than usual and at times is difficult to interrupt. There is often a flight of ideas or racing thoughts.
Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder? Grandiose thinking and poor concentration Bizarre, colorful, inappropriate dress Insulting, provocative behavior directed at staff Hyperactivity, dismissing meals, and sleep disturbance
Hyperactivity, dismissing meals, and sleep disturbance Safety needs are always the first priority in care planning. A client who has not eaten or slept for several days and has been extremely hyperactive may be at risk for exhaustion and malnutrition and the implications of those states. Although thought disorder, expansive mood, and dress are important assessment information, priority interventions must center on the basic needs of hyperactivity, dismissing meals, and sleep disturbance.
A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition? Antidepressant therapy Electroconvulsive therapy Psychotherapy Light therapy
Light therapy Phototherapy has proven effective for clients with symptoms of depression associated with a seasonal pattern. This condition, called seasonal affective disorder, may be related to lack of light and decreased melatonin production.
A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy? Thyroid level Cardiac enzymes White blood cell (WBC) count Liver function
Liver function Baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy, and clients with known liver disease should not be given divalproex sodium. There is a boxed warning for hepatotoxicity. Thyroid level, WBC count, and cardiac enzymes do not have to be performed routinely before starting this medication.
The nurse is planning a presentation about suicide to a group of health professionals. Which should be included in the nurse's teaching plan? The most common method of committing suicide is the use of sleeping pills. Suicide rates for women are highest among women with children. Men are more likely to commit suicide than women are. Suicide tends to be most prevalent in the those in the age group of 30 to 40.
Men are more likely to commit suicide than women are. The nurse should include in the teaching plan that men are four times more likely to commit suicide than women are. Suicide rates are highest in the age group of 15 to 24. Firearms contribute to high rates of suicide among adolescents.
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? Hypersomnia Middle insomnia Terminal insomnia Initial insomnia
Middle insomnia 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).
A client has been diagnosed with major depression and placed on amitriptyline. Which is a side effect of amitriptyline? Orthostatic hypotension Weight loss Excessive salivation Diarrhea
Orthostatic hypotension Side effects of amitriptyline include orthostatic hypotension, constipation, weight gain, and dry mouth.
The nurse is caring for a client with major depressive disorder who has been admitted to a psychiatric-mental health facility. After assessing the client, the nurse has developed a nursing diagnosis of "risk for violence toward others related to agitation and low tolerance level." Which would be an appropriate intervention for this client? Encourage the client to engage in calming group activities. Remove all dangerous items from the client's room. Encourage the client to act on thoughts that are leading to aggression. Provide antianxiety medication to prevent an incident.
Remove all dangerous items from the client's room. Establishing geographic boundaries, such as room restriction or half-hall restriction, is part of ongoing monitoring. Also, clients likely will have "as-needed" medications ordered; nurses use them if aggressive or agitated behavior escalates. Other environmental approaches include reducing stimuli and opportunities for interaction with other clients in the milieu. Nurses remove all dangerous items from the client's room and monitor closely for use of any dangerous items. Nurses help clients learn to recognize what triggers violent thoughts and behaviors. They teach clients not to act on these thoughts but to leave the situation and find a staff member to talk to about them.
A client is receiving lithium carbonate for the treatment of mania. The nurse would reinforce which teaching component regarding lithium treatment? Give medication on an empty stomach. Schedule bloodwork for lithium levels. Decrease fluid intake to prevent edema. Watch for low urine output.
Schedule bloodwork for lithium levels. There is a narrow range between therapeutic lithium levels and lithium toxicity. It is important to obtain scheduled drug levels to prevent toxicity from occurring. The nurse should monitor for polyuria. Teaching includes taking the medication with food or milk after meals and ensuring an adequate daily intake of fluid (2,500 to 3,000 mL) daily.
A client with bipolar disorder has a plasma lithium concentration of 2.7 mE/L. Which finding would a nurse most likely assess in this client? Select all that apply. Incoordination Tinnitus Fasciculations Nystagmus Seizures
Seizures Nystagmus Fasciculations A plasma lithium concentration of 2.7mEq/L indicates severe toxicity manifested by seizures, nystagmus, and fasciculations. Tinnitus and incoordination are noted with moderate toxicity, with plasma drug concentration ranging from 1.5 to 2.5 mEq/L.
A client with major depression is prescribed paroxetine. The nurse develops an education plan for the client based on the understanding that this drug belongs to which class of drugs? Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors Tricyclic antidepressants Serotonin norepinephrine reuptake inhibitors
Selective serotonin reuptake inhibitors Paroxetine is a selective serotonin reuptake inhibitor. Serotonin norepinephrine reuptake inhibitors include venlafaxine, nefazodone, duloxetine, and desvenlafaxine. Amitriptyline is an example of a tricyclic antidepressant. Monoamine oxidase inhibitors include phenelzine, tranylcypromine, isocarboxazid, and selegiline.
A client hospitalized for uncontrolled manic behavior constantly belittles other clients on the general ward and is demanding special favors from the nurses. Which is the most effective nursing intervention for this client? Provide an antianxiety agent whenever the client's belittling or demanding behavior occurs. Offer a variety of stimulating activities to distract the client from others and from making demands on the nurses. Set limits with specific and consistent consequences for belittling or demanding behavior. Ask other clients and staff members to ignore the client's behavior.
Set limits with specific and consistent consequences for belittling or demanding behavior. The nurse will need to set limits and consequences for inappropriate behavior such as belittling and being demanding of others. Requiring that others ignore the client is likely to increase those behaviors. Offering stimulating activities would be counterproductive, and providing antianxiety medication, while useful at times, does not address the effects of or provide motivation to adjust behaviors.
Family education concerning the safe care of a client with a history of suicide attempts includes what? Select all that apply. Signs and symptoms that indicate a mood change that could indicate the client is suicidal Information regarding the stressors that trigger the client's suicidal ideations Techniques to help the client cope with known triggers Information on how to determine if the threat of suicide is legitimate List of emergency service telephone numbers
Signs and symptoms that indicate a mood change that could indicate the client is suicidal Information regarding the stressors that trigger the client's suicidal ideations Techniques to help the client cope with known triggers List of emergency service telephone numbers Family education should include information regarding recognizing changes in mood or behavior that could indicate a plan for self-injury (e.g., irritability, anger, agitation, withdrawal, or self-deprecating comments) and notify the client's health care provider. It should also include how to anticipate future stressors that trigger the client, along with information regarding how to assist the client with coping skills. Also important to family education is information regarding a 24-hour emergency hotline phone number—and the need to keep the information readily available.
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? Reality orientation Silence and active listening Projective identification Direct confrontation
Silence and active listening 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 is with an adolescent who reports nothing to live for and wishing to be dead. Which nursing action would be the priority? Ascertaining the client's beliefs about what happens when you die Staying with the client to explore more of the client's thoughts about suicide Putting the client in seclusion with a staff member assigned to watch the client at all times Going to the client's psychiatrist to report the suicidal ideation
Staying with the client to explore more of the client's thoughts about suicide A true psychiatric emergency exists when an individual presents with one or more symptoms associated with imminent risk for suicidal behavior. The first priority is to provide for the client's safety while initiating the least restrictive care possible. Staying with the client and further exploring the client's thoughts about suicide will enhance safety and allow the nurse to more thoroughly understand the extent of the client's suicidal risk. It would not be appropriate to leave the client alone while the nurse goes to talk with the psychiatrist. Seclusion would be used only as a last resort because it is a highly restrictive environment. Determining the client's beliefs about death would be a topic to be addressed much later in the process.
Trying to kill oneself and surviving the ordeal is identified as what? Suicide attempt Suicidal behavior Parasuicide Suicidal ideation
Suicide attempt An attempt of suicide can be characterized as living through an experience of suicide despite having expected or intended to die.
The nurse is assessing a client for warning signs of suicide. Which would be a concern? The client is reaching out to family and friends. The client has engaged in risky behaviors and tends to be impulsive. The client has forgiven those who have caused emotional pain. The client has decreased substance use.
The client has engaged in risky behaviors and tends to be impulsive. According to the "Is Path Warm" mnemonic, a risk factor for suicide is risk-taking behavior without thinking.
The nurse is assessing a client who has presented to the emergency department in emotional distress. What client data represents the greatest risk for suicide? The client sits silently after being asked several of the assessment questions The client has been treated with a variety of antidepressants over the years. The client overdosed on pills 2 years earlier The client states, "Everything just seems really dark right now."
The client overdosed on pills 2 years earlier The greatest predictor of suicide risk is a previous attempt. All of the other listed variables must be addressed, but none is as significant a risk factor as a previous suicide attempt.
A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis? The client will discuss the cause of the fatigue. The client will reframe negative thoughts in a more positive way. The client will identify factors that contribute to depression. The client will differentiate between reality and fantasy.
The client will reframe negative thoughts in a more positive way. An appropriate outcome for hopelessness would be for the client to reframe and redefine an event positively rather than negatively, which can help the client view the situation in an alternative way, thereby fostering hope. Discussing the cause of fatigue is unrelated to hopelessness. Identifying factors contributing to depression would reflect a knowledge deficit. The ability to differentiate reality from fantasy would be inappropriate for this client. There is nothing to support that the client is not focused in the here and now.
A client who has just been prescribed lithium for bipolar disorder is being given education from the nurse about this medication. Which is important for the nurse to include in teaching? The higher the sodium level, the lower the lithium level will be. Lithium has few interactions with other drugs. The higher the potassium level, the lower the lithium level will be. Changes in diet will not affect lithium levels.
The higher the sodium level, the lower the lithium level will be. Lithium is a salt, so the interaction between lithium and sodium levels in the body and between lithium level and fluid volume in the body are crucial issues to consider. The higher the sodium levels, the lower the lithium level will be and vice versa. The other options do not represent correct information.
During assessment of a client with depression, the client states, "I just feel so sad and hopeless. I just don't care anymore. I don't even enjoy doing the crossword puzzles like I used to." The nurse documents this finding as indicative of: psychosis. dysthymic disorder. anhedonia. delusion.
anhedonia. The client's statements reflect anhedonia, a loss of interest or pleasures such that the client does not experience any enjoyment in activities that were previously considered pleasurable. Dysthymic disorder is a milder but more chronic depression. Delusion is manifested as false, fixed beliefs. Psychosis is a state in which a person experiences symptoms such as hallucinations, delusions, or disorganized thoughts, speech, or behavior.
The nurse educates a class on factors that enhance the risk of suicide. The instructor determines the need for additional education when the class identifies what as one of these factors? loss family member committing suicide cautiousness delusions
cautiousness Impulsivity, rather than cautiousness, enhances suicide risk. Other factors include a family member having completed suicide, psychotic thoughts such as delusions, and loss.
A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the client will have to demonstrate specific symptoms. What are some of these symptoms? Select all that apply. disruption in appetite disruption in concentration disruption in sleep excessive guilt obsessive desire to exercise
disruption in sleep disruption in appetite disruption in concentration excessive guilt Four of seven symptoms must be present along with the episodes of depressed mood to qualify for a diagnosis of major depressive disorder. Symptoms include disruption in sleep, appetite, concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation.
