Chapter 17

In the past year, a client's parent reports the client has experienced six manic episodes, each lasting for 3 weeks. This is best described as what? a. Rapid cycling b. Cyclothymic disorder c. Hypomania d. Hypermania

a. Rapid cycling Rationale - In rapid cycling, clients have four or more manic episodes for at least 2 weeks in a single year. The episodes are marked by either partial or full remission for at least 2 months or a switch to an episode of opposite type.

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

c. Bipolar I Rationale - Bipolar I disorder is characterized by one or more manic episodes, usually alternating with major depressive episodes.

The major difference between bipolar I and bipolar II disorder is what? a. Clients with bipolar I have no symptoms of mania, but only depression. b. The prognosis for bipolar I is much better than for bipolar II. c. Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances. d. Both disorders are the same, except that clients with bipolar I disorders have a much higher incidence of suicide.

c. Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances. Rationale - Bipolar II disorder is characterized by a major depressive episode (either current or past) and at least one hypomanic episode. Bipolar II disorder differs from bipolar I in that the client has never had a manic or mixed episode but may have had an episode in which he/she experienced a persistently elevated, expansive, or irritable mood. The hypomanic symptoms are not severe enough to cause marked social or occupational dysfunction.

A nurse providing community education for parents regarding adolescent suicide should include in the teaching session that the most frequent cause or motive for suicide in this age group is what? a. Progressive failure to adapt b. Feelings of anger or hostility c. Reunion wish or fantasy d. Feelings of alienation or isolation

d. Feelings of alienation or isolation Rationale - In adolescent clients, the developmental task is of a sense of belonging. When adolescents feel alienated or isolated, suicidal thoughts may emerge. In adolescence, therefore, the most common motives are feelings of alienation or isolation.

The nurse provides medication teaching to a client who is newly prescribed a serotonin norepinephrine reuptake inhibitor (SNRI) for the treatment of depression. Which client statement indicates a need for additional teaching? a. "I might experience an increased appetite." b. "I can use sugar-free gum to treat dry mouth." c. "I should wear sunscreen due to photosensitivity." d. "I should change positions slowly to decrease my risk for falls."

a. "I might experience an increased appetite." Rationale - Side effects associated with SNRIs include abnormal dreams, anticholinergic effects, decreased appetite, dizziness, gastrointestinal distress, hypertension, insomnia or sedation, irritability, jitteriness, photosensitivity, and sexual dysfunction. Based on these side effects the client statement that indicates a need for additional teaching is, "I might experience an increased appetite." because this medication often decreases appetite. Sugar-free gum for dry mouth is appropriate because of the anticholinergic effects associated with this medication classification. Sunscreen should be encouraged due to the risk for photosensitivity, and position changes should be implemented slowly to decrease the risk for falls due to the dizziness that can occur with this medication classification.

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? a. "I need to notify my provider if I develop a skin rash." b. "I need to have my blood tested about once a month." c. "I have to watch how much salt I use every day." d. "This drug can affect my liver function." e. "The dose may need to be reduced if I'm started on valproic acid."

a. "I need to notify my provider if I develop a skin rash." e. "The dose may need to be reduced if I'm started on valproic acid." Rationale - 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). 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.

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? a. "I'm obliged to share what we talk about with the other people on your care team." b. "Why is it important to you that this be kept between you and I?" c. "In my experience, nothing good ever comes of keeping secrets." d. "What can I do to get your permission to share with the other members of the care team?"

a. "I'm obliged to share what we talk about with the other people on your care team." Rationale - 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.

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

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

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? a. "The hypothesis states it is gamma-aminobutyric acid (GABA)." b. "There is a lack of norepinephrine." c. "One of those neurotransmitters is serotonin." d. "Low levels of dopamine could be the cause."

a. "The hypothesis states it is gamma-aminobutyric acid (GABA)." Rationale - 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.

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? a. "You'll need to continue the medication for about 6 to 12 months to see how things go." b. "It's probably best to continue the medication for another month, gradually decreasing the dosage over that time." c. "Since you have no more symptoms, you can stop taking the medications tomorrow." d. "The medication has eliminated your symptoms so you'll need to keep taking it for the rest of your life."

a. "You'll need to continue the medication for about 6 to 12 months to see how things go." Rationale - 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.

Research has shown that risk of suicide increases within which time frame for initiation of antidepressant therapy? a. 14 days b. 28 days c. 35 days d. 42 days

a. 14 days Rationale - Studies have shown that the risk for suicide increases within the first 2 to 3 weeks after starting antidepressant medication, usually because the client's mood has not lifted as quickly as physical energy has returned.

Which sleep pattern is suggestive of a manic episode? a. A client stays awake for several days and nights before "crashing" and sleeping for a long period. b. A client experiences day-night reversal, sleeping until late in the afternoon and going to bed near dawn. c. A client reports having fitful sleep that is characterized by frequent awakenings and nightmares. d. A client takes multiple short naps at varied times throughout the day and night.

a. A client stays awake for several days and nights before "crashing" and sleeping for a long period. Rationale - During a manic episode, an individual will typically go several nights without sleep before collapsing from exhaustion.

The nurse is seeing a 43-year-old client whose spouse just died by suicide. Which is a common emotional response that the nurse should anticipate from this client? a. Anger toward the loved one who committed suicide b. The development of a panic disorder c. Turning toward alcohol or drugs d. Unpredictable behavior and a potential for risk-taking behaviors

a. Anger toward the loved one who committed suicide Rationale - Some of the emotional responses suicide survivors may experience include feelings of unreality, shock, disbelief, and emotional numbness; grief, sadness, and despair; confusion over not knowing why the loved one chose suicide; anger toward the mental health practitioner, another family member, or a friend for failing to prevent the suicide; self-anger and guilt for failing to prevent the suicide; feelings of anger toward and betrayal by the loved one who committed suicide; and social stigmatization and isolation.

A loss of pleasure or interest in a client diagnosed with depression would be documented as what? a. Anhedonia b. Flat affect c. Hopelessness d. Discouragement

a. Anhedonia Rationale - A person with depression has a sustained period of feeling depressed, sad, or hopeless and may experience anhedonia (loss of interest or pleasure). The client may report "not caring anymore" or not feeling any enjoyment in activities that were previously considered pleasurable. Flat affect is the complete or near absence of affective expression. Hopelessness and discouragement would not be the correct documentation for this symptom.

A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder? a. Anticonvulsants b. Antianxiety c. Anticoagulants d. Antibiotics

a. Anticonvulsants Rationale - Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness.

The policies and procedures at a community psychiatric-mental health center include an emphasis on case finding. How can a nurse at the center bestperform case finding? a. Assessing all clients carefully to identify those at risk for suicide b. Modifying the center's environment to maximize client safety c. Organizing the layout of the center to allow observation of clients d. Encouraging clients not to be ashamed of previous suicide attempts or suicidal thoughts

a. Assessing all clients carefully to identify those at risk for suicide Rationale - Case finding involves the identification of people who are at risk for suicide so that proper treatment can be initiated. Modifying the layout of the center would not be necessary in order to carry out the necessary assessments. Observation would not be a part of community-based care. The nurse should address the shame that often accompanies suicide, but this action is not a key component of case finding.

The nurse is planning the inpatient care of a client who has been admitted with major depression. The client's plan of care includes regular exercise, but the client is reluctant to participate due to a lack of energy and motivation. What is the nurse's best action? a. Collaborate with the client to choose a manageable amount of exercise and acknowledge the client's subsequent effort b. Arrange for the client to exercise approximately 1 hour after antidepressant administration c. Describe the benefits of exercise to the client and state that privileges will be lost if the client does not participate d. Teach the client isometric exercises that the client can complete while in bed

a. Collaborate with the client to choose a manageable amount of exercise and acknowledge the client's subsequent effort Rationale - In general, a good approach is to collaborate with the client to find an agreeable solution. Energy levels do not change in the short term following antidepressant administration. Threatening the loss of privileges is an inappropriate and unnecessary approach. The nurse should not accommodate the client's remaining in bed unless it is a necessity.

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? a. Ensuring a plan is in place for the client's community-based care b. Ensuring that the client has created a commitment to treatment statement c. Documenting the client's psychiatric advance directive d. Communicating with the pharmacy where the client will obtain prescribed medications

a. Ensuring a plan is in place for the client's community-based care Rationale - 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.

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? a. Establishing a support system for the woman and teaching her some coping measures b. Beginning treatment with a selective serotonin reuptake inhibitor c. Placing the woman on suicide precautions and establishing a no-suicide contract d. Beginning a course of therapy with a nurse-therapist or psychologist

a. Establishing a support system for the woman and teaching her some coping measures Rationale - 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.

A nurse is reviewing the history of a client with documented bipolar and seizure disorders and notes a change in therapy from lithium to carbamazepine. What information would alert the nurse to this change in therapy? Select all that apply. a. Lithium therapy was not effective. b. The client was not compliant with prior therapy. c. There are decreased cardiovascular effects. d. The client prefers carbamazepine. e. Carbamazepine has a clinical primary indication for seizures.

a. Lithium therapy was not effective. c. There are decreased cardiovascular effects. e. Carbamazepine has a clinical primary indication for seizures. Rationale - The client has documented bipolar and seizure disorders, and the primary clinical indication for carbamazepine is that of an anti-convulsant. Research has shown that this medication can be used if lithium therapy is not effective. The medication has also decreased cardiac effects as compared to lithium. There is no information present to suspect it is a client's preference and/or that the client was not compliant with prior therapy.

Limit setting is most appropriate in which client population? a. Manic b. Anxious c. Depressed d. Suicidal

a. Manic Rationale - Most of the time, anxious, depressed, and suicidal clients do not test the limits of the caregiver.

The nurse is planning a presentation about suicide to a group of health professionals. Which should be included in the nurse's teaching plan? a. Men are more likely to commit suicide than women are. b. Suicide rates for women are highest among women with children. c. Suicide tends to be most prevalent in the those in the age group of 30 to 40. d. The most common method of committing suicide is the use of sleeping pills.

a. Men are more likely to commit suicide than women are. Rationale - 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.

Which biogenic amines have been implicated in depression? a. Norepinephrine and serotonin b. Epinephrine and dopamine c. Dopamine and histamine d. Epinephrine and serotonin

a. Norepinephrine and serotonin Rationale - 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.

A depressed older adult client is being treated with a tricyclic antidepressant (TCA). For which clinical manifestations should the nurse monitor the client? a. Orthostatic hypotension and urinary retention b. Photosensitivity and skin rashes c. Pseudoparkinsonism and tardive dyskinesia d. Diarrhea and electrolyte imbalance

a. Orthostatic hypotension and urinary retention Rationale - Orthostatic hypotension and urinary retention are common side effects of TCAs. Photosensitivity, skin rashes, pseudoparkinsonism, and tardive dyskinesia are common side effects of older antipsychotics. Diarrhea and electrolyte imbalances are side effects of lithium.

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? a. Promptly act on, and document, the client's statement. b. Verbally communicate the client's statement to the psychiatrist immediately. c. Facilitate a prompt referral to the psychiatric-mental health advanced practice registered nurse. d. Inform a colleague about the client's statement as soon as possible.

a. Promptly act on, and document, the client's statement. Rationale - 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 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? a. Selective serotonin reuptake inhibitors b. Serotonin norepinephrine reuptake inhibitors c. Monoamine oxidase inhibitors d. Tricyclic antidepressants

a. Selective serotonin reuptake inhibitors Rationale - 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.

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? a. Substance use b. Inflated self-esteem or grandiosity c. Insomnia d. Overexcitment

a. Substance use Rationale - 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.

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? a. The client overdosed on pills 2 years earlier b. The client states, "Everything just seems really dark right now." c. The client has been treated with a variety of antidepressants over the years. d. The client sits silently after being asked several of the assessment questions

a. The client overdosed on pills 2 years earlier Rationale - 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.

For which client would the nurse be obligated to take immediate and focused action to prevent imminent death? a. The client with depression who has been using alcohol and owns a gun b. The client with depression who lives in poverty and has chronic pain c. The client with depression who is withdrawn and spends most of the time playing video games d. The client who is grieving is often tearful and does not want to be left alone

a. The client with depression who has been using alcohol and owns a gun Rationale - A true psychiatric emergency exists when an individual presents with one or more symptoms associated with imminent risk for suicidal behavior. Immediate and focused action is needed to prevent the patient's death. The client who is depressed, using alcohol and has access to the most lethal means to commit suicide is the highest risk and requires imminent intervention. The client who is depressed, lives in poverty and has chronic pain meets criteria for someone at risk, however, the risk in this case is not imminent and would not warrant immediate intervention. The client who is depressed, withdrawn and spending most of the time playing video games would certainly warrant assessment and therapeutic intervention, however, based on the information provided the client would not be deemed an imminent risk. The grieving client who is tearful and does not want to be left alone is experiencing a normative response to death and does not meet the criteria for imminent suicide intervention.

Which is an accurate statement regarding women and suicide? a. They are less likely to complete suicide than men. b. They are more likely to choose a more lethal method than men. c. They are more likely to die from attempted suicide than men. d. They attempt suicide less often than men.

a. They are less likely to complete suicide than men. Rationale - Women are less likely to complete a suicide than men, in part because they are more likely to choose a less lethal method. Women are less likely to die from an attempted suicide than men, but they attempt suicide more often.

When caring for a client with mania, which effect would a nurse most likely find during assessment? a. Unusual self-confidence b. Slow, repetitive speech c. Logical thinking d. Narrowed focus

a. Unusual self-confidence Rationale - Mania is easily recognized by the cognitive changes that occur. Elevated self-esteem is expressed as grandiosity (exaggerating personal importance) 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 (illogical connections between thoughts) or racing thoughts. Distractibility increases.

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 ... a. help the client to identify and explore other options. b. encourage the client to identify and attend outpatient support groups. c. provide distraction by organizing therapeutic recreation. d. organize a family meeting.

a. help the client to identify and explore other options. Rationale - 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.

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. a. illegal drug use b. writing about death c. insomnia d. wearing a seatbelt e. alcohol use f. assertive communication

a. illegal drug use b. writing about death c. insomnia e. alcohol use Rationale - 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 creating a plan of care for a client with depression and suicidal ideations. Which nursing action would be a protective factor in the prevention of suicide for this client? a. incorporating therapy along with antidepressant medications b. emphasizing medical interventions for depression c. counseling the client to avoid conflict and stress d. encouraging the client to spend more time alone reflecting on issues

a. incorporating therapy along with antidepressant medications Rationale - Protective factors buffer individuals from suicidal thoughts and behavior. Protective factors have not been studied as extensively as risk factors, but identifying and understanding them are very important. Protective factors include effective clinical care for mental, physical, and substance abuse disorders. Although medical interventions for depression are important, effective depression treatment is multitudinal and should incorporate psychosocial and spiritual care as well. Clients should not be told to avoid conflict; rather, the nurse should assist the client in building personal capacity to manage conflict in adaptive ways. Clients who are at risk for suicide would find social support to be a protective factor in mitigating or preventing self-harm. Client's should be encouraged to be connected to family and community support whenever possible.

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. a. lack of coping ability b. prior episode(s) of depression c. current substance use of abuse d. present of life and environmental stressors e. responsive support system f. family history of depressive disorder

a. lack of coping ability b. prior episode(s) of depression c. current substance use of abuse d. present of life and environmental stressors f. family history of depressive disorder Rationale - 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.

When assessing a client who reports mild symptoms of depression, the nurse expects that the diagnostic tests ordered will include: a. thyroid stimulating hormone (TSH). b. coagulation time. c. platelet count. d. liver function test

a. thyroid stimulating hormone (TSH). Rationale - 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.

The nurse is caring for a client with a previous suicide attempt. Which statement made by the nurse would indicate a need for further teaching? a. "My notes should reflect the client's judgment and ability to participate in care planning." b. "I only need to document suicidal ideations if the client is currently having them." c. "I will include the ongoing care plan for the client in my documentation." d. "My documentation will include any use of recent drugs, alcohol, or prescription medications."

b. "I only need to document suicidal ideations if the client is currently having them." Rationale - Documentation is very important when nurses are caring for clients who are potentially suicidal. The nurse should document the presence or absence of suicidal thoughts, intent, plan, and available means to illustrate the client's current and ongoing suicide risk. If the client denies any suicidal ideation, it is important that the denial is documented. Therefore, the nurse's statement, "I only need to document suicidal ideations if the client is currently having them" would need further teaching. The nurse's statements, "My notes should reflect the client's judgment and ability to participate in care planning," "I will include the ongoing care plan for the client in my documentation," and "My documentation will include any use of recent drugs, alcohol, or prescription medications" are correct statements.

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? a. "I stopped taking St. John's wort 4 weeks ago." b. "I started taking diet pills to assist with weight loss." c. "I stopped drinking red wine when I started taking my new prescription." d. "I used to enjoy taking ecstasy, but I know it isn't safe with my new medication."

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

A client recovering from the manic phase of bipolar disorder is distraught to realize all savings account money was spent during the episode. Which action would the nurse make a priority for this client? a. Consult social services. b. Assess for risk of suicide. c. Discuss medication side effects. d. Explain consequences of behavior.

b. Assess for risk of suicide. Rationale - During a manic episode, poor judgment and impulsivity lead to risk-taking behaviors that can have dire consequences for the client and family. As the client recovers from a manic episode, they may be so devastated by the consequences of their impulsive behavior and poor judgment that suicide seems like the only option. Assessing for suicide is the priority action at this time. Social services may need to be consulted if the client is facing financial issues. Discussing the side effects of medications would not be essential at this time. The client does not need to reminded of the consequences of behavior.

A client is admitted to the psychiatric-mental health unit for severe depression. Two days after being admitted, the client has more energy and appears happy. What is the nurse's priority intervention with the client? a. Complete a full head-to-toe assessment on the client. b. Assess the client for suicide risk. c. Evaluate the medication effects. d. Praise the client for overcoming their depression.

b. Assess the client for suicide risk. Rationale - Suicidality should be continually assessed with clients diagnosed with depression. During the depths of depression, clients may not have the energy to complete a suicide. As clients begin to feel better and have more energy, the client is at higher risk for suicide. If a previously depressed client appears to have become energized overnight, they may have decided to die by suicide and thus may be relieved that the decision is finally made. The client may be very intent on suicide and the nurse's priority is to assess the client's suicide risk. Praising the client for overcoming their depression is nontherapeutic and not appropriate for the situation. Completing a full head-to-toe assessment on the client and evaluating the medication effects may be appropriate but ensuring safety and assessing the client for suicide risk is priority with this client.

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. a. Medical comorbodity b. Current substance use or abuse c. Life and environmental stressors d. Lack of coping abilities e. History of depression

b. Current substance use or abuse c. Life and environmental stressors d. Lack of coping abilities Rationale - 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.

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? a. Suicide b. Dehydration c. Sleep disturbance d. Decreased energy

b. Dehydration Rationale - 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.

A nurse is preparing a presentation for family members of clients who have been diagnosed with depression. When describing the family response to depression, which would the nurse include? a. Family members typically can understand how disabling depression can be. b. Depression in one family member affects the entire family. c. Abuse of the depressed person is a rare occurrence in families. d. Families of women older than 55 years of age with depression experience the majority of problems.

b. Depression in one family member affects the entire family. Rationale - Depression in one member affects the whole family. Spouses, children, parents, siblings, and friends experience frustration, guilt, and anger when the family member is immobilized and cannot function. It is often hard for others to understand the depth of the mood and how disabling it can be. The lack of understanding and difficulty of living with a depressed person can lead to abuse. Women between the ages of 18 and 45 years constitute the majority of those experiencing depression, and thus their families experience the majority of problems.

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? a. Onset of depression is common in adolescence b. Depression is twice as common in women than in men c. Depression is correlated with low intellectual ability d. Onset of depression is most common in middle-aged persons

b. Depression is twice as common in women than in men Rationale - 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.

A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. The client's suicidal risk has lessened considerably, and the client currently denies having any desire to perform suicide. In addition, the client is able to identify reasons to be alive. Which nursing intervention is appropriate? a. Assigning nursing staff to stay with the client during the suicidal crisis b. Developing a personal plan for managing suicidal thoughts when they occur c. Advising the client to consider electroconvulsive therapy treatments d. Administering psychotropic drugs that decrease the client's serotonin levels

b. Developing a personal plan for managing suicidal thoughts when they occur Rationale - The client's immediate suicidal crisis has subsided, and it is now appropriate for the nurse to focus on working with the client on symptom management. Preventing suicidal behavior requires that clients develop crisis management strategies, generate solutions to difficult life circumstances other than suicide, engage in effective interpersonal interactions, and maintain hope. The nurse can help the client develop a written plan that can be used as a blueprint for action when the client feels like the client is losing control. The plan should include strategies that the client can use to self-soothe; friends and family members who could be called (including multiple phone numbers where they can be reached); self-help groups and services such as suicide hotlines; and professional resources, including emergency departments and outpatient emergency psychiatric services. Medications that increase serotonin levels may be prescribed. The role of electroconvulsive therapy to decrease suicidal behavior is under investigation.

A 35-year-old client with bipolar disorder has a history of discontinuing medication when feeling well and then becoming manic again. During the client's last episode of mania, the client lost several thousand dollars in risky investments. Which intervention will be most helpful in achieving medication adherence? a. Point out that each time the client stops taking medication, the client becomes manic again. b. During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. c. Ensure that a family member takes responsibility for administering medications. d. Remind the client that the client owes it to the client's spouse and children to stay well.

b. During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. Rationale - To help link the importance of taking medication with relapse prevention, the nurse lists target symptoms and identifies signs of imminent relapse. The nurse engages in problem solving with the client about early management of symptoms so severity does not increase.

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? a. Euthymic mood b. Emotional lability c. Manic episode d. Grandiosity

b. Emotional lability Rationale - 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.

On admission to the psychiatric unit, a client is dressed in a red leotard and exercise bra, with an assortment of chains and brightly colored scarves on the client's head, waist, wrists, and ankles. The client's first words to the nurse are, "I'll punch you, munch you, crunch you," as the client dances into the room, shadow boxing. The client shakes the nurse's hand and says cheerfully, "We need to become better acquainted. I have the world's greatest intellect, and you are probably an intellectual midget." How can the nurse document the client's mood? a. Belligerent and blunted. b. Expansive and grandiose c. Anxious and unpredictable. d. Suspicious and paranoid.

b. Expansive and grandiose Rationale - The client is demonstrating an expansive and grandiose mood state. Although the client also exhibits aspects of belligerence, the client does not have a blunted affect. The client is not demonstrating anxious or unpredictable behavior, suspicion, or paranoia.

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

b. Flight of ideas Rationale - Rapid "flights of ideas" lead to excessive and illogical rhyming, punning, and word associations, along with pressured speech.

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? a. Ask the client to sit alone and write a letter. b. Restrict the client to the client's room until the client can calm down. c. Encourage the client to participate in an activity with other clients. d. Tell the client that if the client is violent, the client will be sent home.

b. Restrict the client to the client's room until the client can calm down. Rationale - 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.

A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what? a. Toxic effect b. Side effect c. Desired effect d. Therapeutic effect

b. Side effect Rationale - Lithium has many side effects that can be handled with interventions. For diarrhea, the nurse can instruct the client to take the medication with meals and provide for fluid replacement. The nurse should tell the client to notify the prescriber if the diarrhea becomes severe—this development can be an early sign of lithium toxicity, which would warrant a change in medication. Diarrhea is not a toxic or desired effect. The therapeutic effect is the intended effect of a drug.

Before a client became depressed, the client was an active, involved parent with three children, often attending their school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals that the client feels like an unnecessary burden on the client's family. Which nursing diagnosis is most appropriate? a. Anxiety related to side effects of medication b. Situational low self-esteem c. Ineffective coping related to marital disagreements d. Ineffective activity planning related to depression

b. Situational low self-esteem Rationale - The client does not express anxiety, issues with marital disagreements, or problems with activity planning. Instead, the client has experienced a change from being an involved, interested parent to feeling as though the client is a burden, which would be reflective of a disturbance of self-esteem. The self-esteem changes the client is experiencing are related to feelings of worthlessness brought on by the depressive episode.

The nurse is assessing a 42-year-old client who is experiencing depression. The client's mother died by suicide 20 years ago. Which statement regarding this client's risk for suicide is correct? a. The client's risk is equivalent to that of the general population. b. The client has a greater risk for suicide than the general population. c. The client's risk for suicide will increase when the client reaches the age of 50. d. The client would have a greater risk for suicide if the client's father had died by suicide.

b. The client has a greater risk for suicide than the general population. Rationale - Risk for suicide increases when there is a family history of suicide. Risk of suicide is two to eight times higher in first-degree (parents, siblings, or children) relatives of people who died by suicide than in the general population.

A nurse is caring for a client diagnosed with depression. The provider believes the depression is caused by a deficiency or dysregulation with the client's neurotransmitters or in their receptor functions. Which theory supports the provider's beliefs on etiology of the client's depression? a. genetic theory b. neurobiological theory c. neuroendocrine theory d. psychoneuroimmunology

b. neurobiological theory Rationale - Neurobiological theories posit that major depression is caused by a deficiency or dysregulation in central nervous system (CNS) concentrations of the neurotransmitters norepinephrine, dopamine, and serotonin or in their receptor functions. Neuroendocrine theories hypothesize that major depressive disorder is associated with multiple endocrine alterations, specifically of the hypothalamic-pituitary-adrenal axis, the hypothalamic-pituitary-thyroid axis, the hypothalamic-growth hormone axis, and the hypothalamic-pituitary-gonadal axis. Psychoneuroimmunology is a recent area of research that hypothesizes increased cytokine levels are associated with depression and cognitive impairment indicating that inflammatory reactions are involved with the development of some mental health disorders such as depression. Genetic theory hypothesizes genetics influences a substantial role in the etiology of mood disorders. The provider believing the client's neurotransmitters are altered or dysregulated is utilizing the neurobiological theory.

The nurse has been asked to assess a client to determine if the client has a suicide plan. Which question would assist the nurse in assessing this area? a. "Are you a religious person?" b. "Do you have people in your life who are supportive of you?" c. "Are you thinking about killing yourself right now?" d. "How do you generally cope with problems in your life?"

c. "Are you thinking about killing yourself right now?" Rationale - Potential questions to assess a suicide plan include the following: Are you thinking about killing yourself right now? Are you feeling so badly that you have thought of taking your own life? Have things been so bad that you feel you can't go on? What have you thought about doing? Have you thought about a specific time or place? Do you have access to a firearm, pills, knife?

An adult client just got fired from their job and is crying to the nurse. The client states, "My work was my purpose in life." What priority question should be made by the nurse? a. "Having a stable job is good for your mental health; this seems like a big deal." b. "Have you started applying for other jobs?" c. "Have you been thinking about harming or killing yourself?" d. "Do you have a supportive family to help you in the meantime?"

c. "Have you been thinking about harming or killing yourself?" Rationale - Suicide assessment is always considered a priority by all health care disciplines. The client has had a risk factor for suicide—job loss—and is currently having sadness and a sense of purposelessness, which are possible warning signs for impending suicide. The nurse's statement, "Have you been thinking about harming or killing yourself?", is priority to assess the intent to die. The nurse's statement, "Having a stable job is good for your mental health; this seems like a big deal" is correct but does not address the safety issue of possible suicidal ideations in the client. The nurse's statement, "Have you started applying for other jobs?", is dismissive to the client's current feelings and is trying to solve the problem, which is not therapeutic at this time. The nurse's statement, "Do you have a supportive family to help you in the meantime?", is appropriate to ask but the presence of possible suicidal ideations needs to be ruled out first, due to the immediate safety risk.

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? a. "Some confusion after ECT is normal. The client will regain memory in a few hours." b. "Confusion after ECT is not expected. Though it will resolve, the client probably will not be a candidate for ECT in the future." c. "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." d. "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."

c. "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." Rationale - 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 psychiatric-mental health nurse is conducting an in-service education program about suicide for a group of nurses working at a community mental health center. The nurse determines that the teaching was successful based on which statement by the group? a. "Suicide is more of a concern in countries other than the United States." b. "Suicide does not occur in affluent neighborhoods, indicating poverty is a factor." c. "Suicide has profound effects on those connected to the individual." d. "Suicide rates among older adults are low."

c. "Suicide has profound effects on those connected to the individual." Rationale - Suicide is a major public health concern, both in the United States and around the world. Although certain factors may increase risk for suicide, suicide knows no bounds of person, age, class, race, or gender. It is an act that profoundly affects those left in its wake. Suicide among the older adult population has increased.

A 46-year-old client comes to the community mental health center because the client thinks they might be suffering from depression. When assessing this client, which symptom would the nurse identify as being necessary for the diagnosis of major depressive disorder to be made? a. Euphoria along with poor decision making ability b, Disregard for personal hygiene including cleanliness and appearance c. A loss of interest or inability to derive pleasure for previously enjoyed activities d. A stooped posture and nonverbal signs of a depressed mood

c. A loss of interest or inability to derive pleasure for previously enjoyed activities Rationale - Clients with major depressive disorder must have either a depressed mood or a loss of interest or inability to derive pleasure from previously enjoyed activities for diagnosis..

A 42-year-old client with major depression is in an inpatient psychiatric hospital. The client has been taking phenelzine, a monoamine oxidase inhibitor (MAOI), for depression. The therapist writes an order to discontinue the phenelzine and begin fluoxetine. Which action by the nurse is indicated? a. Begin educating the client about food restrictions when taking fluoxetine. b. Begin educating the client about selective serotonin reuptake inhibitors. c. Call the therapist to discuss the need for a washout period before starting fluoxetine. d. Note in the medication administration record to check the client's blood pressure for the first 2 days after starting fluoxetine.

c. Call the therapist to discuss the need for a washout period before starting fluoxetine. Rationale - If the client is switching from an MAOI to fluoxetine, the provider should allow a washout period of at least 5 weeks (half-life of MAOI). Conversely, if a client is switching from fluoxetine to an MAOI, providers should allow a "washout" period of at least 2 weeks (half-life of fluoxetine) before beginning the MAOI.

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? a. A dysregulation in the circadian rhythm, leading to sleep disturbance b. A single gene or sequence of genes causing pathologic changes c. Exposure to repetitive sub-threshold stressors at vulnerable times d. "Wear and tear" on the body from mood episodes leading to increased problems

c. Exposure to repetitive sub-threshold stressors at vulnerable times Rationale - 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.

When teaching prevention to the parents of a 15-year-old client who recently attempted suicide by taking an overdose of alprazolam, the nurse describes which behavioral clue? a. Angry outbursts at significant others b. Inquiry about doses of lethal drugs c. Giving away valued personal items d. Experiencing the loss of a boyfriend or girlfriend

c. Giving away valued personal items Rationale - The suicidal individual may exhibit behaviors that provide clues to his or her intent, including the following:• Talking about death, suicide, and wanting to be dead• Talking or thinking about punishment, torture, and being persecuted• Hearing voices and suddenly seeming very happy after being very depressed for some time• Being very aggressive or very impulsive, and acting suddenly and unexpectedly• Showing an unusual amount of interest in getting his or her affairs in order• Giving away personal belongings

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

c. Hallucinations Rationale - Perceptual disturbances include hallucinations and delusions, anxiety, and grandiose delusions involving power, wealth, fame, or knowledge. Increased motor activity is assessed in appearance and general behavior. Inappropriate affect is assessed in mood and affect. Limited insight is part of the judgment and insight assessment.

A nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the greatest risk for a suicide attempt? a. Man with bipolar I disorder b. Woman with acute stress disorder c. Man with major depressive disorder d. Woman with somatoform disorder

c. Man with major depressive disorder Rationale - Men have a higher suicide completion rate than women. For men, suicide occurs at a rate of 22.8 per 100,000, whereas in women it is 6.2 per 100,000. Men are more likely to use means that have a higher rate of success, such as firearms and hanging. Most suicide deaths occur in men with a psychiatric disorder, primarily depression, in many cases complicated by substance use disorders.

Which is a true statement regarding depressive disorders? a. They are more prevalent in men than women. b. Depression in older adults is easier to diagnose. c. The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated. d. It is the fourth leading cause of years lost because of disability.

c. The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated. Rationale - The neurotransmitters norepinephrine, dopamine, and serotonin have been associated with depression. Individuals between the ages of 18 to 29 years have a three times higher prevalence rate than those age 60 and older. The prevalence rates for females and males differ with females experiencing "a 1.5 - 3-fold higher rate than males beginning in early adolescence." Depressive symptomatology in older adults is more difficult to diagnose because it may be confused with symptoms of dementia or cerebrovascular accidents. Depression is the leading cause of years lost because of disability.

A nurse is implementing safety precautions on the psychiatric-mental health unit for clients at high risk for suicide. Which method of suicide does the nurse identify as the most common to happen on inpatient mental health units? a. smothering b. cutting wrists c. hanging d. overdosing on medications

c. hanging Rationale - Despite safety measures taken on inpatient mental health units, it is estimated that 50-65 hospital inpatient suicides occur each year in the United States. Most inpatient suicides happen in psychiatric facilities, and the method used in 70% of these events is hanging. The methods of smothering, cutting wrists, and overdosing on medications are far less likely to happen in an inpatient setting.

A nurse maintains a safe environment for a client who is suicidal by ... a. creating a stimulating environment. b. maintaining confidentiality at all times with the client. c. observing the client frequently. d. ensuring the client has access to all d. personal belongings to make the client feel at home.

c. observing the client frequently. Rationale - Maintaining a safe environment includes observing the client frequently for suicidal behavior, removing dangerous objects, and providing counseling opportunities for the client.

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? a. suicidal ideations b. hypertensive crisis c. serotonin syndrome d. anticholinergic syndrome

c. serotonin syndrome Rationale - 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 nurse is conducting a health fair in the community about preventing suicide. Which statement made by a resident of the community would require further teaching by the nurse? a. "Suicide accounts for thousands of deaths each year and that number keeps rising." b. "A parasuicide attempt is a suicidal gesture and the goal is not to kill themselves." c. "Suicidality is a term that encompasses all suicide-related behaviors and thoughts of attempting or completing suicide." d. "Suicide deaths are usually not preventable because the person desperately wants to alleviate their suffering."

d. "Suicide deaths are usually not preventable because the person desperately wants to alleviate their suffering." Rationale - Although people complete suicide to alleviate their suffering, suicides are a preventable death when immediate friends, family, and health care providers identify symptoms and use effective interventions. Therefore, the resident's statement, "Suicide deaths are usually not preventable because the person desperately wants to alleviate their suffering" would require further teaching. The resident's statements, "Suicide accounts for thousands of deaths each year and that number keeps rising," "A parasuicide attempt is a suicidal gesture and the goal is not to kill themselves," and "Suicidality is a term that encompasses all suicide-related behaviors and thoughts of attempting or completing suicide" are all true and would not require further teaching.

A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which is the nurse's priority intervention for this client? a. Exploring the grief and loss issues concerning the baby's death. b. Encouraging the client to express feelings of isolation following the recent immigration. c. Encouraging attendance at group cognitive-behavioral therapy on the unit. d. Ensuring that the client is not permitted to use anything that would be potentially dangerous.

d. Ensuring that the client is not permitted to use anything that would be potentially dangerous. Rationale - Although grief, loss, and isolation may be influencing the client's depressed state, the priority intervention is to prevent self-harm. All the interventions listed are appropriate, but ensuring safety from potential danger is the priority.

Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder? a. Bizarre, colorful, inappropriate dress b. Grandiose thinking and poor concentration c. Insulting, provocative behavior directed at staff d. Hyperactivity, dismissing meals, and sleep disturbance

d. Hyperactivity, dismissing meals, and sleep disturbance Rationale - 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 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? a. Initial insomnia b. Terminal insomnia c. Hypersomnia d. Middle insomnia

d. Middle insomnia Rationale - 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).

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? a. Direct confrontation b. Reality orientation c. Projective identification d. Silence and active listening

d. Silence and active listening Rationale - 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 reviewing the medical record of a young client to determine the client's risk for suicide. Which factor would alert the nurse to an increased risk for this client? a. fears of growing older b. diagnosed with an acute illness c. starting a new business with friends d. experiencing unemployment that has lasted a year

d. experiencing unemployment that has lasted a year Rationale - Social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among the younger population. Internal distress, low self-esteem, and interpersonal distress have long been associated with suicide. Cognitive risk factors include problem-solving deficits, impulsivity, rumination, and hopelessness. Impulsivity, anger, and reduced inhibition increase the risk of suicide. Fear of growing older is not a common concern for this population. With the likelihood of a positive outcome, acute illness is not generally viewed as being hopeless. Chronic medical illnesses increase the likelihood of chronic depression, which in turn contributes to the increased suicide rate of those older than the age of 65 years. While starting a new business may create a degree of anxiety, it is usually viewed with hopefulness and enthusiasm.

A client experiencing acute mania from bipolar disorder refuses hospitalization. Which type of treatment would the nurse anticipate being prescribed for this client? a. community clinic b. virtual health care c. primary care visits d. intensive outpatient program

d. intensive outpatient program Rationale - 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 was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client's feelings of sadness and hopelessness, the nurse would expect to assess what? a. Increased focus b. Decreased complaints of pain c. Psychomotor retardation d. Increased energy level

c. Psychomotor retardation Rationale - Associated signs and symptoms of depression include an inability to think or concentrate, increased complaints of pain, psychomotor retardation, and lack of energy and fatigue.

A nursing student is caring for an elderly client who is taking sertraline for depression. The instructor quizzes the student about the medication and its actions. To what classification of drugs should the student assign sertraline? a. Cyclic antidepressant b. Monoamine-oxidase inhibitor c. Selective serotonin reuptake inhibitor d. Serotonin 2 antagonist

c. Selective serotonin reuptake inhibitor Rationale - Sertraline is a selective serotonin reuptake inhibitor.

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? a. "Do you ever feel like your situation is hopeless?" b. "How would you describe your relationship with your parents?" c. "Do you feel like your antidepressant is helping your mood?" d. "What are your plans for the next few days?"

a. "Do you ever feel like your situation is hopeless?" Rationale - 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 reviewing a case study with students about a client with mania who was admitted to a mental health unit. The instructor asks the students what medical diagnosis is most likely responsible for the mania. Which would be the best answer by a student? a. Bipolar disorder b. Anxiety disorder c. Adolescent conduct disorder d. Many psychiatric disorders have symptoms of mania

a. Bipolar disorder Rationale - In most cases, mania is a symptom that manifests in people with underlying bipolar disorder. Mania is reflected in periods of euphoria, exuberant activity, grandiosity, and a false sense of well-being. There can be periods of mood instability and irritability as well.

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

a. "Can you tell me more about these symptoms?" Rationale - Additional assessment is needed for the bipolar client at this time. By asking an open-ended question, the nurse will be able to determine if the symptoms described by the client are examples of a depressive episode. Telling the client to continue taking medication as prescribed may be warranted, but telling the client that the symptoms are minor minimizes the expressed concern. Asking the client whether or not they have been taking their medication correctly may be needed but it is not the best response at the time because it can be construed as implicit bias. There may be a need for bloodwork, but more information is needed before an order should be obtained.

Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what? a. Anaclitic depression b. Moderate depression c. A mood disorder due to a general medical condition d. Postpartum psychosis

b. Moderate depression Rationale - 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.

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? a. "That shows an admirable level of perseverance on your part. Well done!" b. "Many people who are battling depression find that support groups are beneficial." c. "Excellent! This shows that you're nearly recovered from your depression." d. "You really showed that you're able to rise above your fear and anxiety."

a. "That shows an admirable level of perseverance on your part. Well done!" Rationale - 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.

When conducting a risk assessment for suicide, the nurse mostlikely identifies which client as having the greatest risk for completing suicide? a. A 50-year-old male client who lives on a farm outside the city b. A 30 year-old male client who is married with a new baby c. A 25-year-old female client who attends school full time d. A 30-year-old female client who had a baby three months prior

a. A 50-year-old male client who lives on a farm outside the city Rationale - 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 assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client? a. Confusion b. Long-term memory impairment c. Full of energy d. Numbness and tingling in the extremities

a. Confusion Rationale - 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.

Which is an anticonvulsant used as a mood stabilizer? a. Divalproex b. Venlafaxine c. Bupropion d. Phenelzine

a. Divalproex Rationale - Divalproex is an anticonvulsant that may be used as a mood stabilizer. Venlafaxine, bupropion, and phenelzine are antidepressants.

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? a. Explain to the client that untreated depression often becomes increasingly severe and frequent over time b. Document a nursing diagnosis of ineffective denial and choose interventions accordingly c. Assess the client's knowledge of depression and describe the risks of suicide d. Document a nursing diagnosis of noncompliance and educate the client about the benefits of treatment

a. Explain to the client that untreated depression often becomes increasingly severe and frequent over time Rationale - 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.

The nurse knows that the most dangerous time period following a previous suicide attempt is what? a. First 3 months b. First 6 months c. First 9 months d. First year

a. First 3 months Rationale - The first 2 years after a suicide attempt represent the highest risk period, especially the first 3 months.

A 32-year-old client is admitted to the inpatient unit for depression with suicidal thoughts. During the nursing assessment, why it is important for the nurse to assess and explore if there is any family member who has committed suicide? a. Genetic predisposition b. Disengagement of family c. Lack of conflict resolution skills d. Terminal illness

a. Genetic predisposition Rationale - Suicide rates tend to be higher in families in which suicide has occurred, which are genetic and familial factors. First-degree relatives of individuals who have completed suicide have a two- to eight-times higher risk for suicide than do individuals in the general population.

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? a. Identify a person to whom he or she can turn to for help after discharge. b. Understand the need for daily medications. c. Feel stigmatized by the hospitalization experience. d. Complete activities of daily living independently.

a. Identify a person to whom he or she can turn to for help after discharge. Rationale - 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.

To care for an acutely suicidal client, which is the most effective initial mode of treatment? a. Inpatient care b. Group therapy c. Behavioral therapy d. Outpatient care

a. Inpatient care Rationale - If a person is acutely suicidal, inpatient care is often the initial mode of treatment. Frequently, inpatient treatment is short term, focused on crisis intervention, and followed up with outpatient approaches when the immediate danger has subsided.

A client arrives on the psychiatric unit exhibiting restlessness, disorientation, incoherent speech, agitation, purposeless physical activity, and suicidal ideations. Which is the priority nursing diagnosis for this client? a. Risk for self-harm b. Ineffective individual coping c. Hopelessness d. Disturbed identity

a. Risk for self-harm Rationale - The client is experiencing severe hyperactivity, disorientation, and agitation as well as suicidal ideation. Therefore, the client's safety is the priority. The nurse's first action is to provide a safe environment and to address the client's risk for self-harm. The nursing diagnosis of risk for self-harm takes priority over any nursing diagnoses.

The nurse is working with an outpatient who has a history of depression and suicide attempts. What assessment finding should the nurse interpret as indicating a high degree of planning for a future attempt? a. The client recently purchased a large bottle of over-the-counter analgesics b. The client stopped attending a depression support group, despite initially benefiting from it c, The client told the nurse, "I just want to stop being a burden to my wife and kids." d. The client has told the nurse, "I'm pretty sure my meds aren't working."

a. The client recently purchased a large bottle of over-the-counter analgesics Rationale - Acquisition of a large amount of medication strongly suggests planning of a suicide attempt. The client's referral to being a burden suggests suicidality but does not directly indicate a specific plan. Withdrawing from a support group and expressing skepticism about psychopharmacology suggest a worsening of the client's condition but not necessarily a suicide plan.

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. a. disruption in sleep b. disruption in appetite c. obsessive desire to exercise d. disruption in concentration e. excessive guilt

a. disruption in sleep b. disruption in appetite d. disruption in concentration e. excessive guilt Rationale - 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.

The majority of suicides among men are attributed to: a. firearms. b. hanging. c. overdose. d. drowning.

a. firearms. Rationale - Men complete 79% of all suicides; 57.5% of these deaths are by firearms. The other means of suicide listed do not account for the majority of suicides in men.

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? a. "Bipolar disorders have not been found to be genetic." b. "While bipolar disorders are genetic, there are other causes as well." c. "While bipolar disorders are genetic, the gene can only be passed on by a father." d. "Genetics are a minor factor in bipolar; it is more heavily influenced by psychological factors."

b. "While bipolar disorders are genetic, there are other causes as well." Rationale - 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.

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? a. Fifty percent of all suicides occur as a result of major psychoses. b. Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. c. Suicidal tendencies are inherited. d. Suicide attempts are very common in teenage girls.

b. Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. Rationale - 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 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? a.. Find out the name of the client's pharmacy. b. Confirm baseline labs have been ordered prior to starting therapy. c. Monitor for weight loss. d. Draw weekly blood levels to monitor serum levels.

b. Confirm baseline labs have been ordered prior to starting therapy. Rationale - 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.

A client in an acute manic phase is pacing the halls and talking in a loud voice with pressured speech. The client is overly involved with coclients and frequently threatens and disrupts others on the unit. After administering lithium treatment for the client, the nurse can expect the plan of care to include which additional intervention? a. Monitoring phototherapy response. b. Monitoring blood levels of the medication. c. Teaching the client to avoid foods with tyramine. d. Assessing for post-electroconvulsive therapy disorientation and confusion.

b. Monitoring blood levels of the medication. Rationale - Lithium is the drug of choice for clients with bipolar illness and has a high antimanic effectiveness. Lithium decreases the intensity, frequency, and duration of manic and depressive episodes. Blood levels need to be monitored for therapeutic levels during the acute phase (1.0-1.5 mEq/L) and during longer term maintenance. Other treatments that could be expected for clients during mania include sedatives or antipsychotics. Electroconvulsive therapy, phototherapy, and monoamine oxidase inhibitors are not typically indicated during manic phases.

A parent of four small children lost a spouse in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since the spouse's death, the client's mood has been somber; until now, the client has refused treatment. What is this client at high risk for? a. Bipolar disorder b. Suicide c. Schizophrenia d. Dysthymic disorder

b. Suicide Rationale - If depression persists over time and is left untreated, it has a significant negative effect on quality of life and increases the risk of suicide.

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? a. The client will discuss the cause of the fatigue. b. The client will reframe negative thoughts in a more positive way. c. The client will identify factors that contribute to depression. d. The client will differentiate between reality and fantasy.

b. The client will reframe negative thoughts in a more positive way. Rationale - 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? a. The higher the potassium level, the lower the lithium level will be. b. The higher the sodium level, the lower the lithium level will be. c. Changes in diet will not affect lithium levels. d. Lithium has few interactions with other drugs.

b. The higher the sodium level, the lower the lithium level will be. Rationale - 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.

The nurse is providing emotional support and education to a client experiencing severe depression. Which statement made by the client indicates the teaching is effective? a. "This is something that will pass if I just try to see the good in life." b. "If I take medications, these behaviors will stop." c. "I know I can't help this behavior since it is an imbalance of chemicals." d. "I may have caused this when I started traveling out of town for work."

c. "I know I can't help this behavior since it is an imbalance of chemicals." Rationale - Neurobiologic theories posit that 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. The spouse did not cause these behaviors of depression by traveling, this is an internal neurotransmission alteration. The client is unable to just "get over it" without the help of therapy and medication. Medication alone is not the most effective method of treatment.

A client with major depression is admitted to the health facility and expresses feelings of worthlessness and abandonment by significant others. Which replies by the nurse would convey empathy? a. "I can understand what is going on with you." b. "Are you feeling like others have abandoned you?" c. "It sounds like this is a really difficult time for you." d. "Can you tell me what you are thinking right now?"

c. "It sounds like this is a really difficult time for you." Rationale - "It sounds like this is a really difficult time for you" is an empathetic response that signifies that the nurse understands the client's ideas and feelings. Stating "I can understand what is going on with you" blocks effective communication because the nurse is minimizing the client's feelings. It indicates that the nurse cannot empathize with the client. Asking about if the client feels abandoned names the feelings and does not convey empathy. Asking what the client is thinking is not an empathetic response but is a therapeutic technique called exploring.

A 30-year-old woman has been brought to the emergency department after causing a disturbance. She is wearing a pair of tight, pink yoga pants, high heels, a sports bra, and a bright-colored hat. The woman's care providers would recognize that the woman's dress may suggest what? a. Antisocial personality disorder b. Acute confusion c. Mania d. Chronic low self-esteem

c. Mania Rationale - Physical appearance is a factor that influences communication; the client with mania may dress in brightly colored clothes with several items of jewelry and excessive makeup.

A nurse is developing a presentation for families who have members diagnosed with bipolar disorders. When describing this condition to the group, which would the nurse most likely include? a. As the person ages, the episodes tend to decrease. b. Environmental stressors are a key cause of these disorders. c. The risk for suicide is high with either depression or mania. d. Risk-taking behaviors are more common during a depressive episode.

c. The risk for suicide is high with either depression or mania. Rationale - The risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may feel that life is not worth living. During a manic episode, the client may believe that they have supernatural powers, such as the ability to fly. As clients recover from a manic episode, they may be so devastated by the consequences of their impulsive behavior and poor judgment that suicide seems like the only option. Manic or depressive episodes tend to accelerate over time, with each episode leaving a trace and increasing the person's vulnerability (or sensitizing the person to have another episode with less stimulation). Environmental conditions contribute to the timing of an episode of the illness but are not a cause of the illness. During a manic episode, poor judgment and impulsivity lead to risk-taking behaviors.

After being diagnosed with a chronic disease, a client has been feeling depressed. Which diagnosis has the strongest association with an increased suicide risk? a. Chronic obstructive pulmonary disease b. Congestive heart failure c. Coronary heart disease d. Acquired immunodeficiency syndrome

d. Acquired immunodeficiency syndrome Rationale - The World Health Organization notes that chronic physical illness and certain physical illnesses contribute to higher suicide risk in some individuals. Neurologic diseases such as epilepsy and spinal and brain injury have been associated with increased suicide risk. HIV infection and AIDS also pose increased suicide risk, particularly at the time of diagnosis. Pain also has been identified as a significant contributing factor.

A nurse is caring for a middle aged male client whose spouse recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important? a. Refer the client for long-term psychotherapy. b. Determine the client's risk of psychosis. c. Determine whether anyone in the client's family has had depression. d. Ask the client whether they are thinking about killing themselves

d. Ask the client whether they are thinking about killing themselves Rationale - The nurse should first ask if the client is thinking about killing themself, because statistics show that recently widowed men is higher than that of married men. Social isolation and access to firearms play important roles in this group. Information related to psychosis, psychotherapy, or family history would be less of a priority at this time.

For which reason is depression in older adults often undiagnosed and untreated? a. Older adults are less likely to express their sadness. b. Older adults usually die prior to the onset of depression. c. Older adults do not enter the health care system as much as younger adults. d. Older adult depression is often seen as "normal aging."

d. Older adult depression is often seen as "normal aging." Rationale - 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.

A nurse is providing psycho-education to a client who has been admitted to the inpatient mental health unit for a manic episode. In order to ensure the teaching is effective, the nurse must first determine which regarding the client? a. Ability to concentrate and process the information b. Likelihood to assume responsibility for self-care c. Cognitive awareness and intellectual abilities d. Interest in learning about the disorder

a. Ability to concentrate and process the information Rationale - To best assure successful outcomes related to client education of an individual experiencing a manic episode, the nurse's initial assessment is focused on the client's ability to concentrate and process the information.

The nurse is providing care for a client who deliberately overdosed on acetaminophen several days ago. The nurse should assess the current severity of the client's suicidal ideation by asking what question? a. "How often are you having thoughts about suicide this morning?" b. "What caused you to take all those pills last week?" c. "Do you have access to any more pills that we don't know about?" d. "Do you see a way out from your depression apart from suicide?"

a. "How often are you having thoughts about suicide this morning?" Rationale - Asking the client about the quantity and persistence of suicidal thoughts addresses the severity of suicidal ideation. Exploring the previous suicide attempt does not help the nurse understand the client's current severity. Asking about access to pills addresses the client's degree of planning. Asking about a "way out" is a valid assessment of the client's hope, but not the severity of suicidal ideation.

Psychodynamic theory attributes the development of mood disorders to what? a. Unexpressed and unconscious anger b. Repressed sexuality c. Hardships in adulthood d. Loss of cultural identity

a. Unexpressed and unconscious anger Rationale - Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. They cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.

A 50-year-old client who has recently been diagnosed with a chronic degenerative illness has announced to the nurse the intention to commit suicide in order to prevent future suffering. Which fact should underlie the nurse's response to this client? a. The nurse is required to document the client's wishes and begin to facilitate an assisted suicide. b. The nurse is obliged to protect the client from self-harm. c. The nurse must refer the client to a physician who is authorized to assist the client with a suicide. d. The nurse is ethically obliged to inform law enforcement.

b. The nurse is obliged to protect the client from self-harm. Rationale - While the nurse is not obliged to inform law enforcement, he or she is ethically obligated to protect the client from self-harm. Participation or referral for assisted suicide has not been recognized as an acceptable component of nursing practice.

The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what? a. Assist him or her in the expression of sad and helpless feelings. b. Assess the cause of his or her depression. c. Develop rapport based on trust and understanding. d. Prevent self-destructive behavior.

d. Prevent self-destructive behavior. Rationale - Preventing self-destructive behavior is the primary nursing goal. Other important goals, such as assisting the client in expressing feelings, assessing for causes of depression, and developing rapport, may be important for intervention after the primary goal of maintaining safety is met.

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has priority? a. Hopelessness related to recent divorce b. Ineffective coping related to inadequate stress management c. Spiritual distress related to conflicting thoughts about suicide and sin d. Risk for suicide related to highly lethal plan

d. Risk for suicide related to highly lethal plan Rationale - Safety is the priority. The overall goals for the client who is suicidal is first to keep the client safe and later to help him or her develop new coping skills that do not involve self-harm. Hopelessness related to recent divorce, ineffective coping related to inadequate stress management, and spiritual distress related to conflicting thoughts about suicide and sin would not be the priority diagnosis for this client.