WEEK 11 [ADN240] "DEPRESSION, POSTPARTUM, MOOD & AFFECT"

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The nurse on the postpartum unit demonstrates techniques to the mother to feed the newborn. The nurse then observes the mother following her technique. The patient is exhibiting which stage of maternal role attainment

Anticipatory

Which term describes affect that is congruent with the immediate​ situation?

Appropriate

A client experiencing situational depression after losing a good job tells the​ nurse, "I am tired of always having to start​ over." What can the nurse do to assist this​ client?

Ask what the client has done in the past to make​ "starting over" so successful. Encourage the client to maintain a consistent exercise plan. Encourage the client to take the time to rest and relax.

The client states to the nurse, "I take citalopram (Celexa) 40 mg every day, and I have also been taking St. John 's wort 750 mg daily for the past 2 weeks." Which manifestations would lead the nurse to suspect that the client is developing serotonin syndrome? (Select all that apply.)

Ataxia Headache Diaphoresis

The nurse is conducting a follow-up interview with a client using alternative therapy to aid in the treatment of depression. Which observations indicate that yoga therapy has been helpful for this client? (Select all that apply.)

Attentive during the interview Motivated to return to work Expressed satisfaction with treatment

The nurse is providing medication teaching with Harold​ Jackson, a​ 22-year-old male client who is prescribed a monoamine oxidase inhibitor. What should the nurse emphasize when teaching Harold about this​ medication?

Avoid foods containing tyramine

The nurse is preparing an educational seminar on depression for a community health fair. Which strategies should the nurse include to reduce depressive episodes? (Select all that apply.)

Be aware of family risk factors Obtain adequate rest Have regular visits with the healthcare provider Build a strong support system

Danial Kvitkova is an​ 85-year-old Caucasian male client who has been receiving hemodialysis for several years for chronic renal failure. The nurse notes a change in​ Danial's affect over the last several hemodialysis treatments. Which would be the most appropriate assessment of Danial by the​ nurse?

Change in​ spouse's health status or loss of spouse

During a health​ interview, 38-year-old female​ client, Doreen​ Macintyre, does not directly answer any of the​ nurse's questions and demonstrates despondency. How should the nurse document​ Doreen's affect during the​ interview?

Client has a depressed affect.

The nurse is visiting the home of a new mother and full-term infant. During the course of the visit, the nurse suspects that the mother is experiencing early signs of postpartum depression. How did the nurse come to this conclusion?

Client scored 13 on the Edinburgh Postnatal Depression Scale

What kinds of weather will cause symptoms related to seasonal affective disorder​ (SAD) to be more​ prominent?(Select all that apply.)

Cold Rainy Cloudy

During the morning report, the nurse learns that a client 's affect is flat. What should the nurse expect when interacting with this client?

Complete lack of emotional response

A client diagnosed with major depressive disorder is admitted to the mental health unit because of attempted suicide. The nurse identified the problem of impaired self-care. Upon evaluation, What data indicate that the client achieved the outcome identified for this problem

Completes shower and brushes teeth independently

What are the risk factors for the development of​ depression?(Select all that apply.)

Dysfunctional family relationship Family member with depression Childhood sexual abuse

The nurse is assessing a new client on the mental health unit. The client states that she has been depressed most of the time for the past 2 years, is unable to cope with family responsibilities, and has frequent thoughts of suicide and death. Based on these data, which type of diagnosis does the nurse anticipate?

Dysthymic disorder

Stephanie Willard is a​ 33-year-old woman who comes to the health clinic for her​ follow-up postpartum appointment. She admits that she has felt overwhelming sadness since the birth of her infant. Which screening tool should the nurse use to assess her emotional​ status?

Edinburgh Postnatal Depression Scale​ (EPDS)

The nurse is providing care to a postpartum mother who also has a child, age 3, at home. Which action by the nurse would facilitate bonding between the new baby and the sibling?

Educating the new parents on the open visitation and​ rooming-in policy at the hospital

A nurse is performing research on the​ etiology, pathophysiology, and treatment of adjustment disorder with depressed mood. What research will the nurse most likely find regarding exercise and this​ disorder?

Evidence suggests that physical exercise is as effective as​ cognitive-behavioral therapy​ (CBT) or medication in reducing depression.

Which are cognitive characteristics of a manic​ state?Select all that apply.

Experiences hallucinations Believes self is unusually beautiful Grandiose​ self-beliefs

A client's spouse complains that his wife 's depression isn't any better after taking an antidepressant medication for 1 week. What action should the nurse initially take?

Explain that it may take 1-3 weeks to see any improvement.

The nurse is assessing a client for postpartum blues. Which feelings voiced, or behaviors observed, might the nurse document regarding a client experiencing postpartum blues? (Select all that apply.)

Fatigue Tearfulness Overwhelmed

The nurse is completing a health history on a client with seasonal affective disorder (SAD). What data should the nurse obtain during this interview? (Select all that apply.)

Feelings of guilt Medical history Anhedonia Sleep disturbances

Mrs. Harper gave birth 12 hours ago and successfully bonded with her newborn. What activity would the nurse recommend to best encourage attachment between mother and​ infant?

Fingertipping

The spouse of a client who passed away a few moments ago is sitting in the room staring into space. When asked if there is anything that can be done at this time, the spouse begins to laugh. Which terms should the nurse use to describe the spouse's affect at this time? (Select all that apply.)

Flat Inappropriate

The mother of twin toddler girls asks the nurse to separate them at the time of annual inoculations because they will both"fly off the handle" at the same time, making it difficult to control the situation. Which information about affect is this mother describing to the nurse?

Genetic influence

A nurse is caring for a client with an adjustment disorder with depressed mood. The nurse wants to perform interventions that will promote hope for the client. What intervention best promotes hope in this​ client?

Help clients to identify ways in which they have control of their lives.

The nurse is caring for a client with postpartum depression. Which intervention should the nurse include in the client's care? (Select all that apply.)

Help facilitate bonding with the infant Use a depression scale to assess the client​'s status Educate the client and family about signs and symptoms of postpartum depression Provide resources and referrals as needed

A client experiencing situational depression over the loss of a spouse is overwhelmed with having to close the​ spouse's business, settle​ finances, and figure out a way to survive financially. What can the nurse do to help this​ client?

Help the client prioritize things that need to be accomplished Help the client focus on strengths

During a routine physical​ examination, a client tells the​ nurse, "I​ don't know what to do anymore since my husband died and left me​ alone." Which nursing diagnosis would be appropriate for the client at this​ time?

Helplessness

The nurse is caring for a client in whom postpartum depression is suspected. Which question is most appropriate for the nurse to ask this client during the diagnostic process?

How many hours of sleep are you getting each ​night?

During a health history assessment, the nurse first believed that a client was experiencing manifestations of grief until a specific comment was made. What did the client state that helped the nurse determine that the client is experiencing depression?

I am a complete failure.

A client is being admitted for treatment of major depressive disorder. Which symptom should the nurse anticipate the client would experience during hospitalization?

Insomnia

Which terms do healthcare professionals use to describe​ affect?Select all that apply.

Intensity Congruence Stability Range

At the conclusion of an appointment with a behavioral therapist, a client with anger management issues asks the nurse why the therapist believes the client needs to start taking serotonin. Which response should the nurse make to the client?

It is associated with aggressive behavior.

Madison Grange is a​ 27-year-old female with symptoms of​ hyperactivity, confusion,​ hallucinations, and delusions. The nurse determines that Ms. Grange is most likely experiencing postpartum psychosis. Which medication does the nurse anticipate will be ordered for Ms.​ Grange?

Lithium

A client, who usually demonstrates an appropriate affect, becomes irritated and angry after learning that a community health clinic is closing and care will need to be obtained 20 miles away. What should the nurse suspect as being the reason for this client's change in affect?

Location of the clinic 20 miles away

A 42-year-old was admitted to the mental health unit after a failed suicide attempt by drug overdose. The client sought help when her husband informed her of his decision to leave her and the children after 21 years of marriage. Upon initial contact with the nurse, the client looked exhausted, affect was sad, movements and responses were slowed, and self-care impairments were evident. What type of disorder would the nurse suspect the client is experiencing?

Major depressive disorder

You are taking a mental health assessment of Mrs.​ Castillo, a woman in her​ 30's. Mrs. Castillo tells you that she has been having feelings of deep sadness all summer and that she has never experienced this type of​ long-lasting sadness before. She tells you that she is usually optimistic and​ energetic, but in the past 4 months her mood has completely changed. Upon further​ questioning, you learn that Mrs. Castillo has two​ children, ages 2 and​ 5, and that a year ago she and her family moved to a new city where she has no friends or extended family members. Based on this​ information, which mood disorder is Mrs. Castillo most likely​ experiencing?

Major depressive disorder

A severely depressed client received electroconvulsive therapy (ECT) this morning. Which finding would the nurse recognize as normal posttreatment?

Memory loss

The nurse is assessing a client and asks how she is feeling. In response to the nurse's question, the postpartum client states she has been experiencing ongoing appetite changes, sleep deprivation, crying spells, anxiety, and poor concentration. The nurse determines that the client needs to be referred for evaluation. Which referral would be most appropriate for this client?

Mental health professional

Which type of antidepressant requires the client to follow a​ tyramine-free diet?

Monoamine oxidase inhibitor​ (MAOI)

Which are theories used to explain mood​ disorders?Select all that apply.

Neurobiological Biological rhythms Cognitive Intrapersonal

The nurse is providing care to a breastfeeding client diagnosed with postpartum depression. Which medication order is appropriate for this client?

Nortriptyline

The nurse is planning care for a client with seasonal affective disorder (SAD). After which intervention would the nurse expect to see improvement in emotional stability?

Phototherapy

The nurse is planning care for a client diagnosed with major depressive disorder. Which activity should the nurse encourage the client to participate in based on the diagnosis?

Playing a card game

The home care nurse hears the spouse of an older client say​ "You have been so sick but you insist on living in this huge home that you cannot maintain but expect me​ to." The client engages in an argument with the spouse. What does the home care nurse identify as occurring with this​ couple?

Possible situational depression for both client and spouse

The home care nurse is providing care for a postpartum client. The client begins to cry during the assessment process and states,"I don 't know why I am crying all the time. I am so in love with my baby."Which postpartum disorder does the nurse suspect that the client is experiencing

Postpartum blues

A postpartum client returns to the clinic for her scheduled appointment 3 weeks after delivery. She reports extreme fatigue, feelings of sadness, and insomnia. Based on these assessment findings, which diagnosis does the nurse anticipate for this client?

Postpartum depression

A nurse is providing a workshop about nursing care for clients experiencing a postpartum illness. Which discharge teaching strategy suggested by the nurse would be inappropriate?

Prioritizing tasks

Miss Laura​ Luke, an​ 18-year-old client, is isolating herself from peers and refuses to go to school. She refuses to maintain her ADLs. Upon admission to a mental health​ unit, Miss Luke is diagnosed with major depressive disorder. Which intervention should you initiate upon admission to the​ unit?

Provide a​ safe, protective environment.

Which are symptoms of​ depression?Select all that apply.

Psychomotor retardation Feeling apathetic Changes in sleep Experiences anhedonia

Discharge teaching is being conducted by the charge nurse to a client with postpartum depression. Which resource option would be inappropriate for the nurse to provide to the client?

Referrals to public health nursing services

A client experiencing situational depression after the traumatic death of the spouse tells the​ nurse, "Since I started taking a walk every​ day, I've been feeling​ better." How has exercise impacted this​ client?

Relieved stress Elevated the​ client's mood

A client informs the​ nurse, "My mother keeps telling me to get over the death of my​ spouse, but​ I'm having a hard time doing​ that." What should the nurse do to assist the client and​ family?

Remind the client and family that the grief process is different for​ everyone, and that no time limit can be set.

Which priority problem should the nurse include when planning care for a client diagnosed with major depressive disorder?

Risk for violence directed at self

The nurse is assessing a client for risk factors associated with postpartum depression. Which data item found in the health history is not associated with postpartum depression?

Second pregnancy

The nurse sees a client crying after being dropped off for a​ physician's appointment in the clinic. The client tells the nurse that not being able to drive anymore is making the client a burden to her daughter. What should the nurse realize the client is at risk for​ developing?

Situational depression

What are some of the clinical manifestations of​ depression?(Select all that apply.)

Sleep disturbances Guilt Feelings of hopelessness

Which alternative therapy for depression cannot be safely combined with prescription​ antidepressants?

St. John​'s wort

Which are alternative therapies used to treat mood​ disorders?(Select all that apply.)

St. John​'s wort

At the conclusion of a health history, the nurse is concerned that a middle-aged client is experiencing physical manifestations of depression. What did the nurse assess to come to this conclusion? (Select all that apply.)

States a considerable loss of energy Inability to recall the last time ingested food Clothing​ rumpled; hair not washed or combed

Mrs.​ Jones, a​ 75-year-old client, lives alone in an apartment after the death of her husband. Her only child lives 225 miles away and visits every other month. She is complaining of memory​ loss, insomnia, loss of​ appetite, and irritability. Mrs. Jones indicates that the symptoms have persisted for the past 3 months. When completing a health history with Mrs.​ Jones, what data are essential for you to​ obtain?

Suicidal ideations

A treatment program for clients with postpartum depression includes pharmacologic and nonpharmacologic approaches. The nurse suggests that which nonpharmacologic treatment provides couples with opportunities to share common experiences and concerns?

Support groups

A nurse is teaching a family about possible therapies for a client with postpartum psychosis. Which clinical therapy would the nurse state is used to treat the client experiencing this condition? (Select all that apply.)

Support groups Supervision when caring for infant or other children Lithium and antipsychotics ​ Short-term institutionalization

A client with depression is prescribed an omega-3 fatty acid supplement. What should the nurse suggest when the client takes this supplement?

Take with orange juice

he nurse is planning care for a client diagnosed with situational depression. Which intervention is essential to include when planning care?

Teach assertiveness techniques.

The nurse learns that a client experiencing situational depression after the death of the​ client's mother has returned to​ work, is caring for her​ family, and spends quiet time reflecting on her life and future. What is this client​ demonstrating?

The ability to work through the grief process

A nurse is making follow-up calls to postpartum clients. Which client should the nurse schedule to be seen immediately?

The client reporting hearing voices talking about the baby

A client with depression is admitted to the mental health unit because of attempted suicide. Which short-term goal should be given high priority for this client?

The client will seek out the nurse when feeling​ self-destructive.

The mother of an adolescent diagnosed with depression was hoping that the child would not have the problem even though both she and her spouse struggle with depression every day. Which is the best response by the nurse to the mother?

The genetic risk for children to be diagnosed with depression is greatest if both parents have the disorder.

The nurse is caring for several clients on a postpartum unit. Which client is at the greatest risk for developing postpartum​depression?

The​ first-time mom

The nurse is reviewing orders written for a client demonstrating signs of depression. Which diagnostic test should the nurse expect to be prescribed for this client?

Thyroid function

A client is prescribed electroconvulsive therapy as treatment for depression. What should the nurse review with the client about these treatments?

Treatments will be 3 times a week for 12 treatments

While reviewing previous documentation, the nurse notes that a client is described as demonstrating passive behavior. What should the nurse expect when communicating with this client? (Select all that apply.)

Unexpected explosions of anger Avoiding conflict or confrontation

The nurse is admitting a client to the mental health unit for possible persistent depressive disorder. What data should the nurse collect when completing the client's physical assessment

Vital signs

Ms. Carla​ Simmons, age​ 26, is admitted to a mental health unit. She has been avoiding her family​ responsibilities, has not left the house for a​ month, and has not had a good appetite. During the past 2​ months, she has lost over 20 pounds. Ms. Simmons is diagnosed with severe depression. At an interdisciplinary​ conference, the recommendation is made for electroconvulsive therapy​ (ECT). When would the nurse start preparing the client for this​ procedure?

When the client and her family are presented with the treatment plan by the healthcare provider

A client is admitted to a mental health unit for depression. After a week, the client continues to withdraw from others. Which statement by the nurse would most likely promote interaction with other clients?

come and play cards.

Shavona Wilson is a​ 36-year-old client who had a normal vaginal delivery of a healthy 8​ lb, 4 oz female infant 4 days ago. During her initial​ follow-up check, she tells the nurse that she has been crying at times during the​ day, is sleeping a​ lot, and has no appetite. She​ asks, "What is wrong with me when I should be so happy right​ now? I have two beautiful​ children!" Which response by the nurse would be most appropriate while assessing Ms.​ Wilson?

​"Do you have a history of depression or​ anxiety?

The adult daughter of Zora​ Koskovich, an​ 80-year-old client being treated for a foot​ wound, is concerned that her mother is depressed. What is the best response by the nurse to the​ daughter's concern?

​"That is possible since over​ 10% of people over the age of 80 have symptoms of​ depression."

The nurse is caring for an adolescent client diagnosed with depression. Which assessment findings support this diagnosis?

​Self-neglect


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