Ch 17 - Mood Disorders and Suicide PrepU
"The hypothesis states it is gamma-aminobutyric acid (GABA)." According to the neurobiologic theories, major depression is caused by a deficiency or dysregulation in central nervous system concentrations of the neurotransmitters norepinephrine, dopamine, and serotonin, or in their receptor functions. GABA has not been implicated.
After reviewing with a group of new-hire nurses the neurobiologic theories of depression, the nurse determines the need for additional education when one of the new nurses identify which neurotransmitter as playing a role during the question-and-answer session?
Disruptive mood dysregulation disorder is characterized by severe irritability and outbursts of temper. The onset of disruptive mood dysregulation disorder begins before the age of 10 when children have verbal rages and/or are physically aggressive toward others or property. These outbursts are outside of the normal temper tantrums children display and typically occur two to three times a week. The behavior disrupts family functioning as well as the child's ability to succeed in school and social activities. The pediatric client in the scenario having frequent outbursts that interfere with their school functioning would likely be diagnosed with disruptive mood dysregulation disorder. Major depressive disorder is characterized by a persistent feeling of sadness or a lack of interest in outside stimuli. Persistent depressive disorder (dysthymia) is characterized by a chronic low-level depression that is not as severe as, but may be longer lasting than, major depressive disorder. Premenstrual dysphoric disorder is characterized by significant somatic and psychological manifestations (mood swings, feelings of sadness, or sensitivity to rejection) that occur consistently during the luteal pha
A 10-year-old client is being evaluated for severe physical and verbal outbursts that occur approximately three times a week. The rage outbursts are disruptive to the child's school performance and have been occurring for 2 years. What diagnosis would the client be evaluated for?
intensive outpatient program Intensive outpatient programs for several weeks of acute-phase care during a manic or depressive episode are used when hospitalization is not necessary or to prevent or shorten hospitalization. These programs are usually called partial hospitalization. Close medication monitoring and milieu therapies that foster restoration of a client's previous adaptive abilities are the major nursing responsibilities in these settings. Community clinic visits would be appropriate for the client whose condition is stable. The use of telemedicine can be very effective for persons with bipolar disorder during periods of remission. Telephone contacts are a useful strategy for monitoring medication adherence. Collaborative care of mental health with primary care increases the likelihood that a person would be screened for bipolar disorder, resulting in an early diagnosis and effective treatment; however, this is not the treatment that would be prescribed first.
A client experiencing acute mania from bipolar disorder refuses hospitalization. Which type of treatment would the nurse anticipate being prescribed for this client?
"Please speak more slowly, I am having trouble following what you are saying." The speech of manic clients may be pressured—rapid, circumstantial, rhyming, noisy, or intrusive with flights of ideas. Such disordered speech indicates thought processes that are flooded with thoughts, ideas, and impulses. The nurse must keep channels of communication open with clients, regardless of speech patterns. The nurse can say, "Please speak more slowly. I'm having trouble following you." This puts the responsibility for the communication difficulty on the nurse rather than on the client. This nurse patiently and frequently repeats this request during conversation because clients will return to rapid speech. Delaying the conversation can prevent the nurse from meeting the client's needs as well as the nontherapeutic response of "If you don't slow down..." This is a veiled threat. The client may have difficulty communicating the thoughts in writing and will be an ineffective tool in communication.
A client experiencing mania is talking with the nurse but speaking so rapidly, the nurse is unable to decipher what is being said. Which statement to the client will be most effective in facilitating communication between the nurse and client?
Promptly act on, and document, the client's statement. Prompt action and documentation are the best defenses against a future lawsuit. Verbal communication does not constitute proof of the nurse's due diligence. A referral may be needed, but this in itself does not prove the timeline of the nurse's actions.
A client has admitted to the nurse that the client is "tempted to end it all." How can the nurse prevent a future malpractice lawsuit if the client makes a suicide attempt?
Explain to the client that untreated depression often becomes increasingly severe and frequent over time Untreated depression tends to increase in severity and in the frequency of episodes. The client's statement does not necessarily indicate noncompliance, but rather the client's initial preference. Similarly, the client's statement does not necessarily suggest denial. Assessing the client's knowledge of depression is necessary, but describing the risks of suicide does not directly address the client's expressed preference.
A client has been diagnosed with depression and states that the client is reluctant to receive treatment, stating that the client "would prefer to just wait this out." What is the nurse's most appropriate action?
Side effects of amitriptyline include orthostatic hypotension, constipation, weight gain, and dry mouth.
A client has been diagnosed with major depression and placed on amitriptyline. Which is a side effect of amitriptyline?
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. The client reports of waking up during the night and has trouble returning to sleep. A nurse interprets this finding as suggesting what?
Ensuring a plan is in place for the client's community-based care Following a suicide attempt, it is imperative that a plan be in place for continuity of care in the community. Arrangements such as advance directives and commitment to treatment statements are optional, not mandatory. Communication with the pharmacy is just one component of a discharge plan and is not necessary in every circumstance.
A client has been successfully treated on the psychiatric mental health unit following a suicide attempt. In preparation for discharge, the nurse should prioritize what action?
Serotonin syndrome tends to develop within hours or days after starting or increasing the dose of serotonergic medication. Symptoms include altered mental status, autonomic dysfunction, and neuromuscular abnormalities. At least three of the following symptoms must be present for a diagnosis, including mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea. The client in the scenario who began an antidepressant prescription 3 days ago and is agitated, has a fever, and is shivering is likely experiencing serotonin syndrome. Suicidal ideations are not present in the client. The client symptoms are not characteristic with a hypertensive crisis or anticholinergic syndrome.
A client is being evaluated 3 days after beginning a new prescription for an antidepressant medication. Upon assessment, the client is agitated, has a fever, and is shivering. Which adverse reaction is the client experiencing?
Risk factors for the development of depression include a prior episode(s) of depression, family history of depressive disorder, lack of social support, lack of coping ability, presence of life and environmental stressors, current substance use of abuse, and medical and/or mental illness comorbidity. A responsive support system would be a protective factor, not a risk factor.
A client is being screened for risk factors of depression. Which risk factor(s) is associated with the development of depression? Select all that apply.
Escitalopram is classified as an SSRI. Venlafaxine is classified as a serotonin norepinephrine reuptake inhibitor. Maprotiline is a cyclic antidepressant. Phenelzine is a monoamine oxidase inhibitor.
A client is prescribed a selective serotonin reuptake inhibitor (SSRI) as treatment for depression. Which would the nurse most likely administer?
"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 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?
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.
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?
help the client to identify and explore other options. A client who is seriously considering suicide is doing so because the client sees it as their only option. The nurse should directly, but empathically, challenge this view. This client's high level of suicidality would preclude referral to outpatient support groups. Distraction is often beneficial but does not serve to challenge the client's beliefs. Similarly, a family meeting may or may not challenge the client's belief that suicide is the only option.
A client who is depressed tells the nurse, "If I'm honest, I really see suicide as the only way out." In order to challenge the client's belief, the nurse should ...
Risk factors for depression include prior history of depression, family history of depressive disorder, lack of social support, lack of coping abilities, presence of life and environmental stressors, current substance use or abuse, and medical comorbidity. This client's assessment findings include a recent life stressor in the form of divorce and excessive use of alcohol. In addition, the client's social isolation and heavy drinking indicate lack of healthy coping abilities. The client's data do not include a family history or prior history of depression or any other health issues.
A client who otherwise is healthy is admitted for depression and reports feeling "all alone." The client reports recently losing a spouse to 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.
Emotional lability is alterations in moods with little or no change in external events. It is a term used for the rapid shifts in moods that often occur in bipolar disorder.
A client with a diagnosis of bipolar disorder is described by a family member as "flip-flopping between being happy and loving to irritable and hostile." Which characteristic symptoms of this disorder is the family member referring to?
"That shows an admirable level of perseverance on your part. Well done!" Acknowledging the effort and perseverance that it took for the client to attend the support group is a good example of validation. Because the client has depression, the client likely had to battle hopelessness more than fear or anxiety. A statement about the benefits of support groups is irrelevant and does not validate the client. It is presumptuous to claim that the client has nearly recovered.
A client with a diagnosis of depression tells the nurse that the client's mood was especially bad this morning but that the client pushed through it to attend a support group. How can the nurse best validate the client?
Carbamazepine is an anticonvulsant with mood-stabilizing effects. Lithium is a mood stabilizer. Mannitol and methyldopa are not used in the treatment of bipolar disorder.
A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications?
Lamotrigine has a boxed warning for skin rash, which should be reported immediately if it develops. In most cases, the rash is benign, but it is not possible to predict whether the rash is benign or serious (Stevens--Johnson syndrome). The dose may need to be reduced if started on valproic acid. Blood testing is needed for other mood stabilizers such as lithium, divalproex, and carbamazepine. Salt is a concern with lithium therapy. Liver function can be affected by carbamazepine.
A client with bipolar disorder, having experienced a depressive episode, is prescribed lamotrigine. After educating the client on this medication, the nurse determines that the education was successful when the client makes which statement?
Possible decision to complete a suicide attempt In many cases, clients are admitted to the psychiatric hospital because of a suicide attempt. Suicidality should continually be evaluated, and the client should be protected from self-harm. During the depths of depression, clients may not have the energy to complete a suicide. As clients begin to feel better and have increased energy, they may be at a greater risk for suicide. If a previously depressed client appears to become energized overnight, he or she may have made a decision to commit suicide and thus may be relieved that the decision is finally made. The nurse may misinterpret the mood improvement as a positive move toward recovery; however, this client may be very intent on suicide. These individuals should be carefully monitored to maintain their safety. Antidepressants take several weeks to become effective.
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?
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 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?
Lethality refers to the probability that a person will successfully complete suicide. Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death (e.g., taking a sublethal drug). The term suicidality refers to all suicide-related behaviors and thoughts of completing or attempting suicide, and suicide ideation is thinking about and planning one's own death.
A group of nurses are reviewing information about suicide and associated concepts. The group leader believes understanding of the information has taken place when the leader asks, "What is the probability that a person will successfully complete suicide called?" Which is the appropriate response from the group?
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.
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?
"I will keep our conversation private." The nurse's statement, "I will keep our conversation private" demonstrates that the nurse is attempting to keep a secret, which is not allowed under any circumstance in case a client discloses their intentions to harm self or others. The nurse's statements, "What brought you in here?" and "Are you having current thoughts of harming yourself?" are appropriate assessment questions for the client interview. The nurse's statement, "This is a safe place; I am here to listen" is an appropriate statement to establish trust with the client.
A nurse is conducting a client interview on a psychiatric-mental health unit. Which statement made by the nurse would indicate the need for immediate intervention by the nurse manager?
Pharmacotherapy is essential to the successful management of bipolar disorder to achieve the goals of rapid control of symptoms and prevention of future episodes, or, at least, reduction in their severity and frequency.
A nurse is preparing to administer pharmacotherapy as part of the treatment plan for a client with bipolar disorder. The nurse understands that this therapy is designed to achieve which goal? Select all that apply.
Substance use disorders, aggression, hopelessness, emotion-focused coping, social isolation, and lack of purpose in life have been associated with suicidal behavior in men. In addition, suicide deaths among men involve firearms. The media, lack of conflict resolution skills, and parenting practices can play a role, but are not considered major factors.
A nurse is providing a presentation about suicide for a group of health professionals. Which element would the nurse include as a major contributor to the rising suicide rate among men?
Distress, anxiety, depression, fear of contagion, uncertainty, chronic stress, isolation, and economic hardship all contribute to a person being more vulnerable to negative impact.
A nurse working on the COVID-19 unit is inservicing a group of new staff to the unit. The nurse realizes that education has been effective when the staff identifies what element(s) contribute to a person being more vulnerable to the negative impact of COVID-19, which may lead to suicide? Select all that apply.
"Dysthymic disorder is less chronic than major depression." Persistent depressive disorder (dysthymic disorder) is a long duration mood disorder that has a lower intensity of depressive symptomatology. It may precede major depression.
A nursing instructor is teaching about depressive disorders and identifies a need for further instruction when a student states what?
"Psychiatrists are the primary discipline treating clients diagnosed with depression." Interdisciplinary treatment of depressive disorders, which are lifelong, needs to include a wide array of health professionals in all areas. The specific goals of treatment are reducing or controlling symptoms, and, if possible, eliminating signs and symptoms of the depressive syndrome; improving occupational and psychosocial functioning as much as possible; and reducing the likelihood of relapse and recurrence through recovery-oriented strategies. Therefore, the nurse's statements, "Symptoms are aimed to be reduced in the client", "Occupational and psychosocial functioning should increase for the client with treatment", and "A focus of treatment is to decrease the likelihood of a recurrence depressive event for the client" indicate effective teaching. The nurse's statement, "Psychiatrists are the primary discipline treating clients diagnosed with depression" indicates a need for further teaching.
A psychiatric-mental health nurse has learned about the treatment goals for clients diagnosed with depression. Which statement made by the nurse would indicate a need for further teaching?
Depression is twice as common in women than in men. The onset of depression can happen at any age; onset is more commonly seen in the 20s. Depression is not correlated with low intellectual ability.
After teaching a group of nursing students about major depression, the instructor determines that the education was successful when the group identifies which information is accurate?
When there is a significant wight loss in older adults with moderate to severe depression, they need to be assessed for dehydration as well as weight changes. They also need to be monitored for suicide, sleep disturbance, and decreased energy, but they are not related to nutrition and the weight loss.
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?
Obtain details about the client's suicide plan. The first action the nurse should take when using the nursing process is to assess the client's suicide plan fully by asking about details of the client's plan, lethality of the planned method, and the client's access to it.
ATI A nurse in an acute care mental health facility is caring for a newly admitted client who has major depressive disorder (MDD). The client tells the nurse, "My life is meaningless! I'm going to kill myself tonight." Which of the following actions should the nurse identify as the priority?
Give the client step-by-step instructions when performing ADLs. The client who has severe depression often has slowed thinking and lacks energy to perform ADLs. At the same time, daily routines of washing and dressing are important for the client's well-being. The nurse can assist the client by giving one direction at a time and staying with the client while activities are performed.
ATI A nurse is planning care for a client who has major depressive disorder and is experiencing loss of appetite, insomnia, and the inability to provide self-care. Which of the following interventions should the nurse include in the plan of care?
The nurse should identify muscle weakness as an early indication of lithium toxicity. Other early indications include diarrhea, nausea and vomiting, polyuria, thirst, lethargy, slurred speech, and fine hand tremors. The nurse should instruct the client and family to withhold lithium and notify the provider if these indicators of toxicity are present.
ATI A nurse is providing discharge teaching to the family of a client who has bipolar disorder and a prescription for lithium. The nurse should identify which of the following findings as an early indication of lithium toxicity?
"I will need to take this medication for at least 4 months after my symptoms go away." To prevent relapse, the client should expect to take an antidepressant, such as citalopram, an SSRI, for 4 to 9 months after manifestations of depression resolve.
ATI A nurse is providing teaching to a client who has major depressive disorder and a new prescription for citalopram. Which of the following statements by the client demonstrates an understanding of the teaching?
Promote rest in a quiet environment with decreased client stimulation. The greatest risk to this client is injury and exhaustion resulting from manic behavior due to increased stimulation. Therefore, the priority intervention is to encourage frequent rest periods and sleep in a quiet environment with decreased client stimulation from noise or other clients
ATI A nurse on an acute mental health unit is planning care for a client who has bipolar disorder and is experiencing acute mania. Which of the following interventions should the nurse identify as the priority?
Exposure to repetitive sub-threshold stressors at vulnerable times The kindling theory posits that as genetically predisposed individuals experience repetitive, subthreshold stressors at vulnerable times, mood symptoms of increasing intensity and duration occur. Eventually, a full-blown depressive or manic episode erupts. Each episode leaves a trace and increases the person's vulnerability, or sensitizes the person to have another episode with less stimulation. Chronobiologic theories suggest that circadian dysregulation underlies the sleep-wake disturbances of bipolar disorder. Research related to genetic factors suggests that bipolar disorder is highly heritable, although no one gene or sequence of genes is responsible for the pathology of bipolar disorders. The allostatic load (or "wear and tear" on the body model) bipolar disorder is viewed as a disorder where the allostatic load increases as the number of mood episodes increases, leading to an increase in physical and mental health problems.
After educating a client's family on the etiology of bipolar disorders, a nurse determines that the education was successful when the family describes the kindling theory as involving what?
Restrict the client to the client's room until the client can calm down. If clients are determined to be at risk for violence, establishing geographic boundaries, such as room or half-hall restriction, is part of ongoing monitoring. Other environmental approaches include reducing stimuli and opportunities for interaction with other clients. Nurses remove all dangerous items from client rooms and monitor closely for use of any dangerous items. A pen or pencil that is used to write a letter can be a dangerous object.
After observing a bipolar client on the mental health unit, the nurse determines that the client is at risk for violence. Which would be an appropriate intervention?
"Inpatient settings focus on utilizing technology for the client psychotherapy sessions." Nurses working on inpatient units provide a wide range of direct services, including administering and monitoring medications and target symptoms; conducting psychoeducational groups; and structuring and maintaining a therapeutic environment. Therefore, the nurse's statements, "In this setting, nurses will be administering medications and closely monitoring the client's symptoms," "Nurses are responsible for conducting psychoeducational groups with clients and their families," and "An important aspect of the inpatient setting is to structure and maintain a therapeutic environment for the client" would indicate accurate information. Televideo (the use of video and audio formats) can closely mimic in-person interactions and psychotherapy sessions and are utilized in virtual mental health care or telehealth settings. Therefore, the nurse's statement, "Inpatient settings focus on utilizing technology for the client psychotherapy sessions" would indicate a need for further teaching in the nurse.
An inpatient psychiatric-mental health nurse was recently hired to work on the inpatient unit. Which statement made by the nurse would indicate a need for further teaching about the nurse's inpatient-setting client responsibilities?
Moderate depression Cognitive psychotherapy is as effective as antidepressant medication in the treatment of mild to moderate depression. It is less likely to address depression that has a demonstrated medical etiology. The primary treatment for postpartum psychosis is medication. Therapy is not relevant in cases of anaclitic depression since the problem occurs in infants.
Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what?
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.
Family education concerning the safe care of a client with a history of suicide attempts includes what? Select all that apply.
Older adult depression is often seen as "normal aging." Depression is often considered normal in light of the multiple losses common to aging. Older clients, their families, or health care providers mistakenly confuse signs and symptoms of depression with "normal aging." Older adults are not less likely to express sadness or die prior to the onset of depression. Older adults enter the health care system more than do younger adults.
For which reason is depression in older adults often undiagnosed and untreated?
On admission, the client should be assessed for current risk factors that indicate suicide may be a possibility. Determine the content of any suicidal thoughts or ideations. If the client has a plan, this usually indicates that the client is more serious about committing suicide. Determine the lethality of the method. A more lethal method usually indicates an increased likelihood of an attempt. It is also important to ask when the client intends to carry out the plan. Asking the client about whether the family knows is not an appropriate question and can violate HIPAA. Calling a chaplain or someone to talk to is also not appropriate for the same reason. Counseling should be done by professionals, and safety assessments should be performed continuously during admission.
The client is being admitted with suicidal thoughts. Which question(s) should the nurse ask the client? Select all that apply.
To diagnose MDD, the client must present with either (1) depressed mood or (2) loss of interest or pleasure for a 2-week period in addition to five (or more) specific symptoms, including weight loss or gain or an increase or decrease is appetite nearly every day, insomnia or hypersomnia nearly every day, psychomotor changes (either increased or decreased) nearly every day, fatigue or loss of energy nearly every day, feelings of worthlessness or inappropriate/excessive guilt nearly every day, diminished ability to think or concentrate or indecisiveness nearly every day, and recurrent thoughts of death and/or suicidal ideation without a specific plan or a suicide attempt or a specific plan for committing suicide. Based on this information, the questions the nurse asks to determine if the client meets the criteria for MDD include "Are you experiencing insomnia every day?" and "Have you recently loss weight without dieting?" and "Have you experienced difficulty with concentration when working?" The remaining questions are not appropriate because the client must have recurrent thought of death and not just a fear of dying and an increase in energy does not support a diagnosis of MDD.
The nurse assesses a client who reports being depressed for over 2 weeks. Which question does the nurse include in the interview portion of the assessment process to determine if the client meets the criteria for major depressive disorder (MDD)? Select all that apply.
a 32-year-old male living in a rural area with feelings of hopelessness Suicide is the second leading cause of death for people ages 10-34 and the fourth leading cause of death for adults aged 35-54. Males have a suicide completion rate nearly four times that of females. Men living in rural areas have a much higher risk of suicide than those in urban areas. Other risk factors include serving in the military, feelings of hopelessness, and increased substance use. The lesbian, gay, bisexual, transgender, queer, questioning, intersex, and allies community (LGBTQIA) is at increased risk for suicide. Protective factors include having a supportive family and belonging to a culture that discourages suicide. The 32-year-old male living in a rural area with feelings of hopelessness has four risk factors for suicide, which makes them the highest risk for suicide. The 48-year-old female military veteran living in an urban area with intimate partner problems has three risk factors. The 18-year-old transgender female living in an urban area with increased use of substances has three risk factors. The 55-year-old male living in a rural area belonging to a culture that discourages suicide has two risk
The nurse is assessing a group of clients. Which client would be at the highest risk for suicide?
"I'm obliged to share what we talk about with the other people on your care team." The nurse has a binding obligation to communicate information suggesting a suicide risk to other members of the care team. The nurse should certainly assess the motivations for the client's desire for secrecy, but the priority is clearly communicating to the client that this is not possible. The nurse should avoid trite advice ("Nothing good ever comes ..."). The client's permission is not required to share this information, though the nurse should make efforts to preserve rapport and trust.
The nurse is interviewing a client with a diagnosis of depression and the client states, "Honestly, I know my family would be a lot better off if I wasn't around to be a burden on them. That's just between you and me, though, okay?" What is the nurse's best response?
Identify a person to whom he or she can turn to for help after discharge. The priority assessment for the nurse to make is whether or not the client can identify a person or, ideally, persons to whom he or she can turn to for help after discharge. Inability of the client to name any significant others portends a poor outpatient course.
The nurse is preparing to discharge a client from the inpatient facility where the client was treated following an unsuccessful suicide attempt. The priority assessment for the nurse to make is to assess whether or not the client can do what?
Confirm baseline labs have been ordered prior to starting therapy. Prior to the initiation of divalproex sodium therapy, baseline CBC with differential and liver function tests should be taken. Because this medication can lead to hepatotoxicity, it is important to both establish a baseline and continue to monitor on a weekly basis to verify therapeutic levels. Finding out the name of the client's pharmacy may be needed to fill the prescription. Weight gain is an associated side effect of therapy, not weight loss.
The nurse is providing client education to an individual who has recently been diagnosed with bipolar disorder and is starting divalproex sodium therapy. What priority information should the nurse include in the plan of care?
Bipolar I disorder is the classic manic-depressive disorder with mood swings alternating from depressed to manic. Although the depression component is similar to that experienced in a major depressive disorder, in this disorder there is also a distinct period (of at least 1 week or less if hospitalized) of abnormally and persistently elevated, expansive, or irritable mood with abnormally increased goal-directed behavior or energy. In bipolar II disorder, the client is mostly depressed and experiences hypomania, a mild form of mania. A rapid change in moods is not associated with a personality disorder. In cyclothymic disorder, hypomanic symptoms occur alternating with numerous periods of depression that are less severe. The symptoms have to be present for at least 2 years to be diagnosed with cyclothymic disorder.
The nurse is reviewing the chart for a 20-year-old female client being admitted for a new onset of a rapid change in mood. For which condition would the nurse plan care for this client?
Warning signs to suicide include talking or writing about death, dying, or suicide; increased drug or alcohol use; sense of purposelessness; anxiety, agitation, insomnia, or hypersomnia; feeling trapped; hopelessness; social isolation from friends and family; anger, rage, or seeking revenge; and recklessness. Therefore, illegal drug use, writing about death, insomnia, and alcohol use would be included in the educational session about warning signs of suicide. Wearing a seatbelt and assertive communication are healthy behaviors and do not indicate possible warning signs of suicide.
The nurse is teaching about suicide prevention at the local high school. Which warning sign(s) of suicide would the nurse include in the education session? Select all that apply.
The client will experience a safe environment. The most desirable treatment outcome is the client's recovery with no future suicide attempts. Short-term outcomes include maintaining the client's safety, averting suicide, and mobilizing the client's resources. Whether the client is hospitalized or cared for in the community, their emotional distress must be reduced. Long-term outcomes must focus on maintaining the client in psychiatric treatment, enabling the client and family to identify and manage suicidal crises effectively, and widening the client's support network.
The nurse plans care for a client who is hospitalized due to a suicide attempt. Which short-term outcome does the nurse include in the client's plan of care?
Encourage the client to start with easy tasks, such as talking to a friend. A diagnosis of depression, in addition to the pharmacologic therapy, often cause a lack of energy and sadness. Strategies to address this wellness challenge include starting with something easy, such as talking to a friend or taking a walk after dinner. Encouraging the client to consider meditation is an appropriate strategy to address stress management. Encouraging the client to track dietary intake through journaling addresses the wellness challenge of recognizing the need for physical activity, healthy foods, and sleep.
The nurse provides education to a client who is experiencing wellness challenges due to a diagnosis of depression in which the client reports of lack of energy and sadness. Which strategy is appropriate to enhance coping with a lack of energy and sadness?
"I can take this with a meal." Divalproex sodium (Depakote), an anticonvulsant, has a broader spectrum of efficacy and has about equal benefit for clients with pure mania as for those with other forms of bipolar disorder. The client should be instructed to take the medication with food. The client should be instructed to avoid alcohol while taking this medication. This medication should not be stopped abruptly and should not be taken with herbal supplements before discussing the supplements with the health care provider.
The nurse provides medication teaching to a client with bipolar disorder. Which statement indicates that teaching about divalproex sodium was effective?
"There is no sense discouraging suicidal thoughts because it doesn't help." It is essential that the nurse teach the client and family about suicide and its prevention. Once the teaching is complete, it is important to evaluate understanding. The family member statement that indicates a need to provide additional teaching is, "This is no sense discouraging suicidal thoughts because it doesn't help." It is essential that suicidal ideation, rumination, and self-harm behaviors be discouraged. The other family member statements indicate a correct understanding of the teaching provided.
The nurse provides teaching to the family of a client who is hospitalized after a suicide attempt. Which family member statement indicates a need for additional teaching?
"I started taking diet pills to assist with weight loss." Serotonin syndrome is a potentially serious side effect caused by drug-induced excess of intrasynaptic serotonin, 5-hydroxytryptamine (5-HT). Combining medications that increase CNS serotonin levels, such as SSRIs + MAOIs, St. John's wort, diet pills, dextromethorphan, or alcohol (especially red wine) or an SSRI + street drugs (e.g., LSD, MMDA, or ecstasy). The client statement "I started taking diet pills to assist with weight loss." requires the nurse to assess the client for symptoms of serotonin syndrome, which include mental status changes, agitation, ataxia, myoclonus, hyperreflexia, fever, shivering, diaphoresis, and diarrhea. The other client statements do not indicate that the client is at risk for serotonin syndrome.
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?
Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. It is important to teach survivors of suicide and those with a family member who is suicidal that depression, or feelings of unhappiness, is most often associated with suicidal thoughts and behaviors. The mentally ill group, or "crazy people," is not the primary group that commits suicide, and individuals who are suicidal are not necessarily "crazy."
The parent of a suicidal adolescent is concerned that "only crazy people commit suicide." When helping the parent understand a daughter's suicidal behavior, the nurse would explain what?
thought stopping and positive self talk Cognitive interventions include measures such as thought stopping and positive self-talk can dispel irrational beliefs and distorted attitudes and in turn reduce depressive symptoms during the acute phase of major depression. Social skills training and activity scheduling are behavioral interventions. Interpersonal therapy is used to recognize, explore, and resolve the interpersonal losses, role confusion and transitions, social isolation, and deficits in social skills.
The plan of care for a client diagnosed with depression includes cognitive interventions. A nurse expects to assist with which technique(s)? Select all that apply.
Substance use The effects of illicit substance use can mimic the symptoms of mania. The use of substances must be ruled out through the use of blood and urine diagnostics. Once determined that the signs and symptoms are not the result of substances, the client can be further investigated for mania.
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?
confusion After ECT treatment, the client may be mildly confused or briefly disoriented. He or she is very tired and often has a headache. The client will have some short-term memory impairment. Numbness and tingling in the extremities is not an expected symptom of ECT.
When assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client?
thyroid stimulating hormone (TSH). Mood is also affected by the thyroid gland. Approximately 5% to 10% of clients with abnormally low levels of thyroid hormones may suffer from a chronic mood disorder. Clients with a mild, symptom-free form of hypothyroidism may be more vulnerable to depressed mood than the average person. Thus, diagnostic testing will likely include TSH, not coagulation times, platelet counts, or liver function tests.
When assessing a client who reports mild symptoms of depression, the nurse expects that the diagnostic tests ordered will include:
A 50-year-old male client who lives on a farm outside the city Males have a higher suicide completion rate four times more than females. Rural men have a much higher risk of suicide than urban men, and that gap is widening, perhaps attributable to the higher rates of gun ownership in rural areas. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk for committing suicide. The 50-year-old client living on a rural farm is the most likely in this list of clients to complete suicide. The 30-year-old male client with the new baby does not fit the profile of a client most likely to complete suicide. Females are more likely to attempt suicide but not kill themselves as a result of the attempt.
When conducting a risk assessment for suicide, the nurse most likely identifies which client as having the greatest risk for completing suicide?
Bipolar I disorder is often more disruptive than bipolar II disorder. Bipolar I disorder is often more severe, thus symptoms tend to create more disruption in functioning compared to bipolar II disorder. Bipolar I disorder is characterized by one or more manic or mixed episodes in which the individual experiences rapidly alternating moods accompanied by symptoms of a manic mood and a major depressive episode.
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?
Fluoxetine is included among the SSRIs. Phenelzine, isocarboxazid, and tranylcypromine are monoamine oxidase inhibitors (MAOIs).
Which antidepressant medication is classified as a selective serotonin reuptake inhibitor (SSRI)?
Norepinephrine, dopamine, and serotonin have been implicated. The monoamines that have been implicated in depression are norepinephrine (NE), dopamine (DA), and serotonin (5-HT). Disturbances in mood may result when absolute concentrations of NE, 5-HT, or both are deficient. Depressive disorders are more prevalent in women than in men. Depression in older adults may be difficult to diagnose because many older people have comorbid diseases. It is currently the leading cause of U.S. disability in clients 15 to 44 years of age.
Which is a true statement regarding depressive disorders?
Divalproex is an anticonvulsant that may be used as a mood stabilizer. Venlafaxine, bupropion, and phenelzine are antidepressants.
Which is an anticonvulsant used as a mood stabilizer?
Signs of serotonin syndrome include mental status changes (hallucinations, agitation, coma), autonomic instability (tachycardia, hyperthermia, changes in blood pressure), neuromuscular problems (hyperreflexia, incoordination), and gastrointestinal disturbance (nausea, vomiting, diarrhea). Constipation and hyporeflexia would not be expected.
Which signs would a nurse expect in a client diagnosed with serotonin syndrome? Select all that apply.
