Sem 3 - Unit 1 - Mood and Affect - NCO

The nurse is providing instructions to a client who is on isocarboxazid for depression. Which statements made by the client indicate effective learning? Select all that apply. 1 "I will include yogurt in my diet." 2 "I will avoid soy sauce in my diet." 3 "I will avoid pepperoni in my diet." 4 "I will include cream cheese in my diet." 5 "I will avoid fermented bean curds in my diet."

1 "I will include yogurt in my diet." 4 "I will include cream cheese in my diet." 5 "I will avoid fermented bean curds in my diet." Isocarboxazid is a monoamine oxidase (MAO) inhibitor used to treat depression. Clients on MAOIs should avoid foods containing high amounts of tyramine. Yogurt and cream cheese are foods containing low to no tyramine content. Fermented bean curds are high tyramine-containing foods that should be avoided. Soy sauce and pepperoni are high tyramine foods that should be avoided.

A newly immigrated older Chinese adult is brought to a mental health clinic when family members become concerned that their parent is depressed. In an attempt to conduct a culturally competent assessment interview, the nurse asks certain questions. Which questions does the nurse ask? Select all that apply. 1 "What brought you here for treatment today?" 2 "What do you believe is the cause of your depression?" 3 "Does religion have a role in your perception of health and wellness?" 4 "Do you have insurance that includes coverage of mental health issues?" 5 "Have you ever sought treatment for a mental health problem previously?"

1 "What brought you here for treatment today?" 2 "What do you believe is the cause of your depression?" 3 "Does religion have a role in your perception of health and wellness?" 5 "Have you ever sought treatment for a mental health problem previously?" Determining the client's perception of the problem is an appropriate question that allows cultural factors to be included. Encouraging the client to discuss the problems will facilitate a clearer understanding of the factors involved. Religion often plays a significant role in a client's view of health, wellness, and recovery. Knowing whether a client has ever undergone treatment for a mental health problem reveals mental health history and how previous issues were addressed. Insurance coverage is not pertinent to the issue and is an inappropriate topic of questioning by the nurse.

When working with a client who is depressed, what should the nurse do initially? 1 Accept what the client says. 2 Attempt to keep the client occupied. 3 Keep the client's surroundings cheery. 4 Try to prevent the client from talking too much.

1 Accept what the client says. Because clients cannot be argued out of their feelings, it is best to initially accept what they say; it also encourages communication. Attempting to keep the client occupied delays discussing the client's feelings, and the client's low energy level may prevent involvement in activities. Keeping the client's surroundings cheery has little effect on the depressed client; it can increase depression. The depressed client does very little talking and needs to be encouraged to communicate.

A female client is admitted to the hospital after attempting suicide. She reveals that her desire for sex has diminished since her child's birth 3 years ago. What is most directly related to the client's loss of interest in sex? 1 Depression 2 Dependency 3 Marital stress 4 Identity confusion

1 Depression Decreased sexual desire is a major symptom of clinical depression. Other vegetative signs of depression include changes in bowel elimination, eating habits, and sleeping patterns. Although depression is often related to unmet dependency needs, the decreased sexual desire is associated with the depression, not the unmet dependency needs. The sexual difficulties are associated with the depression, and the depression, not the sexual difficulties, may be the major cause of marital stress. Also, there are no data indicating marital stress. Role confusion, not identity confusion, is usually associated with depression.

A hospitalized, depressed, suicidal client has been taking a mood-elevating medication for several weeks. The client's energy is returning, and the client no longer talks about suicide. What should the nurse do in response to this client's behavior? 1 Keep the client under close observation. 2 Arrange for the client to have more visitors. 3 Engage the client in preliminary discharge planning. 4 Observe the client for side effects of the medication.

1 Keep the client under close observation. As the client's motivation and energy return, the likelihood that suicidal ideation will be acted out increases. There are no data regarding visitation rights; the priority concern is the greater risk for suicide. Although engaging the client in preliminary discharge planning eventually will be done, the priority is determining the potential for suicide. Although the client should be observed for side effects of the medication, the greater risk of suicide takes precedence.

During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. 1 Lethargy 2 Ambivalence 3 Emotional lability 4 Increased appetite 5 Long periods of sleep

1 Lethargy 2 Ambivalence 3 Emotional lability Lethargy reflects the lack of physical and emotional energy that is associated with depression. Ambivalence, the coexistence of contradictory feelings about an object, person, or idea, is associated with postpartum depression. Emotional lability is associated with postpartum depression. Anorexia, rather than increased appetite, is associated with postpartum depression; the client lacks the physical and emotional energy to eat. Insomnia, rather than long periods of sleep, is also associated with postpartum depression.

When the nurse is managing the care of an acutely depressed client, which intervention demonstrates that the nurse recognizes the client's fundamental mental health need? 1 Role modeling a hopeful attitude regarding life and the future 2 Sharing that life has presented depressing situations for all of us at times 3 Devoting time with the client and trying to focus on happy, positive memories 4 Identifying the client's personal weaknesses and designing interventions to strengthen them

1 Role modeling a hopeful attitude regarding life and the future Role modeling has been shown to be an excellent tool in molding adaptive behavior. Depression affects the individual's ability to see hope in the future, and role modeling will help provide adaptation to similar feelings. Affirming that everyone has depressive situations in their lives does not foster a positive response in the depressed client. Reminiscing about happier times and events is likely to highlight the client's current loss of happiness rather than foster positive feelings. The depressed client generally has low self-esteem and is often too tired to engage in physical activities. When a client is depressed, the nurse should identify the client's personal strengths, not weaknesses, and focus on interventions to reinforce those strengths. Focusing on a client's weaknesses when the client is already depressed may initiate a deeper depression.

A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client? 1 Sertraline 2 Fluoxetine 3 Amphetamine 4 Carbamazepine

1 Sertraline Sertraline is considered safe in lactating females. Dosing immediately after breast-feeding can reduce the risk of the drug excreted in the breast milk by the next feeding time. Fluoxetine and amphetamine are not recommended for breast-feeding clients. Carbamazepine is not used to treat depression.

Which symptoms of depression, often overlooked in the older adult client, should the nurse include in the assessment process? Select all that apply. 1 Anxiety 2 Insomnia 3 Weight loss 4 Weight gain 5 General fatigue

2 Insomnia 5 General fatigue Insomnia and general fatigue are symptoms of depression that are often overlooked for the older adult client. Anxiety, weight loss and weight gain are all symptoms of depression; however, these symptoms are not often overlooked for the older adult client.

What characteristics are commonly associated with adolescent depression? Select all that apply. 1 Exercising daily 2 Having suicidal ideation 3 Exhibiting tearfulness 4 Having poor muscle tone 5 Avoiding previously enjoyed activities and relationships

2 Having suicidal ideation 3 Exhibiting tearfulness 5 Avoiding previously enjoyed activities and relationships Having suicidal ideation, exhibiting tearfulness, and avoiding previously enjoyed activities and relationships are characteristic features of depression. Having poor muscle tone and performing physical exercise routine are uncommon in depressed adolescents.

A nurse is concerned when an 11-month-old infant is brought to the pediatric clinic weighing 9 lb 3 oz (4167 g). The nurse suspects that the infant is suffering from physical and emotional neglect. What observations lead the nurse to suspect maltreatment? Select all that apply. 1 Stranger anxiety 2 Inappropriate clothing 3 Social unresponsiveness 4 Frequent rocking motions 5 Adequate personal hygiene

2 Inappropriate clothing 3 Social unresponsiveness 4 Frequent rocking motions Stranger anxiety begins around 5 to 6 months, when infants become responsive to the caregivers who have met both physical and emotional needs. When strangers speak to them or reach out to hold them they seem fearful, cling to the caregiver, and cry. Infants whose needs have not been met adequately have no reason to be fearful of others. A typical sign of physical neglect is the wearing of dirty clothes or clothing that is not suitable to the environment. The infant who has not experienced social responsiveness from the caregiver has not learned how to be socially responsive to others. Infants who experience emotional deprivation resort to self-stimulating behaviors in an effort to meet their emotional needs. Infants who experience physical neglect are more likely to be unclean, with signs of unattended skin lesions such as diaper rash or bruises.

A primary healthcare provider prescribes an antidepressant for a hospitalized client who has been severely depressed. Eight days later the nurse notes that the client is neatly dressed and well groomed. The client smiles at the nurse and says, "Things sure look better today." What nursing response is appropriate in light of the client's statement? 1 Complimenting the client's appearance 2 Starting preparations for the client's discharge 3 Arranging for constant supervision of the client 4 Adding privileges to the client's plan of care as a reward

3 Arranging for constant supervision of the client A change in behavior that seems positive may actually indicate that the client has worked out a plan for suicide; the potential for suicide increases when physical energy returns. Increased supervision is needed. Complimenting the client's appearance may increase the client's feelings of inadequacy, because it implies that the client did not look good before. It is inappropriate to consider discharge simply because of a change in behavior. Many factors should be considered in the decision to discharge a client. The addition of privileges is not indicated at this time.

A client comes to the clinic for a 6-week postpartum check-up. She confides that she is experiencing exhaustion that is not relieved by sleep and feelings of failure as a mother because the infant "cries all of the time." When asked whether she has a support system, she replies that she lives alone. Which response would provide the most accurate information? 1 Providing information about a local support group 2 Explaining that it is normal to feel depressed after childbirth 3 Asking the client questions, using a postpartum depression scale 4 Suggesting that the client find someone who can take care of the baby for 24 hours

3 Asking the client questions, using a postpartum depression scale A postpartum depression scale is a validated tool for identifying women who might be experiencing postpartum depression. The most widely used and validated tools are the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale. Although providing community resources of a local support group may be helpful, it is not useful in assessing the client's current emotional status. Although postpartum blues caused by hormonal changes soon after pregnancy might be common, feelings of depression and fatigue 6 weeks after childbirth is a matter of concern. The client may not have anyone else who can provide child care, or the client may not follow through on the recommendation. In addition, this intervention does not provide any information on the client's current emotional status.

A nurse spends time in individual sessions helping a depressed, suicidal client verbalize feelings. For what themes should the nurse particularly listen? Select all that apply. 1 Anger 2 Control 3 Isolation 4 Dominance 5 Hopelessness 6 Indecisiveness

3 Isolation 5 Hopelessness Feelings of isolation compound feelings of hopelessness and helplessness and may provide the client with the impetus to act on suicide ideation. The main factor leading to acting on suicidal impulses is the feeling of hopelessness, that there is nothing to live for. Anger may be associated with depression; however, a depressed person usually does not have the energy to act out suicidal ideation. The struggle for control or dominance is not an important risk factor for suicide. Indecisiveness may be associated with depression, but an indecisive individual is usually unable to make the decision to commit suicide.

An older client who lost a spouse 20 years ago comes to the community health center with a vague list of complaints and a brief life history. The couple's only child died at birth. The client lives alone and is able to perform all the activities of daily living. The client has had an active social life in the past but has outlived many friends and family members. What is an important question for the nurse to ask when taking this client's health history? 1 "Are you all alone?" 2 "How did your son die?" 3 "Do you still miss your spouse?" 4 "How do you feel about your life now?"

4 "How do you feel about your life now?" The answer to "How do you feel about your life now?" will provide the nurse with an idea of the client's hopes and frustrations without being threatening or probing. "Are you all alone?" is probing and provides little information for the nurse to use in planning care. "How did your son die?" and "Do you still miss your spouse?" are both probing, disregard the client's present situation, and provide little information for the nurse to use in planning care.

On the third postpartum day, the nurse enters the room of a client who had an unexpected cesarean birth and finds her crying. The client says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" What should the nurse consider when responding? 1 The client's feelings will pass after she has bonded with her infant. 2 The client is probably suffering from postpartum depression and needs special care. 3 A cesarean birth may be a traumatic experience, but most women know that it is a possible outcome. 4 A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this.

4 A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this. The client's response is appropriate to the situation, reflecting disappointment in not achieving her goal; in addition, this is the time when "postpartum blues" occurs. The client's feelings may or may not pass after she has bonded with her infant; there is no indication that the feeling will pass or that bonding is involved. The client's statement is not indicative of depression. With rising cesarean rates across the United States, most women know that a cesarean birth is a real possibility. However, knowing this does not negate the disappointment a client may feel over not reaching her goal.

The registered nurse instructed the nursing student to care for a client who suffers from depression. During a follow up visit, the registered nurse finds that the client's symptoms have not improved. Which activity of the nursing student would the registered nurse relate this to? 1 Modifying the environment 2 Limiting the client's choices of diet and clothing 3 Encouraging fluid intake 4 Discouraging social interaction to avoid the client's distraction from outside environment

4 Discouraging social interaction to avoid the client's distraction from outside environment The nursing student's act of discouraging interactions due to fear of the client's distraction may result in a lack of improvement. Social interactions should be encouraged instead. Modifying the environment may help to provide better healthcare. The nurse should limit the client's choices of food and clothing to relieve any decision-making stress. The nurse should also encourage fluid intake.

An older adult who is undergoing follow-up treatment for mild depression at a local walk-in mental health clinic reports the onset of nausea, headache, and episodes of double vision during the past few weeks. In light of the assessment information, what is the nurse's priority? 1 Performing an in-depth cardiac assessment 2 Arranging for an ophthalmic consultation immediately 3 Initiating a conversation about the son's cancer diagnosis 4 Inquiring when the client began therapy for hypertension

4 Inquiring when the client began therapy for hypertension Calcium channel blockers such as diltiazem can cause neurotoxin symptoms like the ones the individual is describing when taken in combination with a selective serotonin reuptake inhibitor (SSRI) such as citalopram. Although the client is taking a calcium channel blocker for hypertension, there is no indication that there is a cardiac cause of the symptoms. Diplopia (double vision) is an abnormal condition and will require further attention but is not the priority at this point in time. The son's cancer diagnosis is a potential source of anxiety and depression, but the physical symptoms are not classically seen in either of those emotional states.

A client with recurrent episodes of depression comes to the mental health clinic for a routine follow-up visit. The nurse suspects that the client is at increased risk for suicide. What is a contributing factor to the client's risk for suicide? 1 Psychomotor retardation 2 Decreased physical activity 3 Deliberate thoughtful behavior 4 Overwhelming feelings of guilt

4 Overwhelming feelings of guilt Overwhelming feelings of guilt contribute to the client's risk for suicide. The client may ruminate over past or current failings, and extreme guilt can assume psychotic proportions. Psychomotor retardation and decreased physical activity are clinical findings associated with depression and usually do not lead to suicide because the client does not have the energy for self-harm. Impulsive behaviors, not deliberate thoughtful behaviors, contribute to the client's risk for suicide.

After a child's visit to a healthcare provider, the parent tells the nurse, "I'm so upset! The doctor prescribed an antidepressant!" What is the best response by the nurse? 1 "Tell me more about what's bothering you." 2 "Weren't you told why your child needs an antidepressant?" 3 "You need to speak with the healthcare provider about your concerns." 4 "Are you sure it's an antidepressant and not a drug for attention deficit disorder?"

Correct 1 "Tell me more about what's bothering you." "Tell me more about what's bothering you" provides an opportunity to explore the parent's feelings. It is the nurse's responsibility, not the healthcare provider's, to assess the parent's concerns before planning further interventions. "Weren't you told why your child needs an antidepressant?" is a confrontational response that may put the parent on the defensive. "Are you sure it's an antidepressant and not a drug for attention deficit disorder?" is a judgmental, nontherapeutic response that may worsen the parent's concerns.