Depression and Suicidal Thoughts/Behaviors and Practice Q's

Which client is displaying the use of cognitive distortion?

A client with major depression says, "No matter what I do, everything turns out bad." -Using overgeneralization and pessimism

Which feeling would be difficult for a client with major depression to express?

Anger toward others

Which conclusion would the nurse make about a depressed, suicidal client who greets the nurse cheerfully and states, "Everything is looking up, I'm not going to have problems for very long."?

Increased risk of suicide

While caring for a client who is on tricyclic antidepressant therapy, the nurse instructs the client to avoid taking long, hot showers. Which side effect of the medication is the nurse trying to minimize in the client?

Orthostatic hypotension -Hot water, standing for a long duration

A client reports decreased appetite, insomnia, anhedonia, and feelings of worthlessness. His job performance and relationships have been affected. Which question is the most important to assist the HCP in determining diagnosis of this mood disorder?

"When did symptoms first start" -Symptom start date is important cause client is describing symptoms of major depressive disorder (at least 2 weeks)

Which info would support the nurses decision to arrange for a staff member to remain with a depressed client continuously?

-Agitated pacing in the hall -History of suicide attempts -Statements that life is not worth living

Which side effect would the nurse monitor for when administering a SSRI?

-Anxiety -Nausea -Sedation -Restlessness -Suicidal ideation -Increased energy level Others: dry mouth, vomiting, constipation, diarrhea, anorexia, differences in taste, HA, tremor , sexual dysfunction, fatigue, increased sweating, visual disturbances, urinary problems

Which findings would support the nurse's conclusion that the depressed client is experiencing hopelessness?

-Bouts of crying -Self-destructive acts -Feelings of worthlessness

A client with depression presents with feelings of sadness and is having difficulty sleeping. Which additional S&S would the nurse monitor for?

-Diminished pleasure in activities -Alteration in appetite

Place these nursing assessment questions in the appropriate order to best ensure safety for a client with suicidal ideations?

1. "Are you thinking about hurting yourself?" 2. "Have you decided on a plan to harm yourself?" 3. "What is your plan for killing yourself?" 4. "How would yo get what you need to end your life?"

For a client with the diagnosis of major depression, which problem is the most common?

Decreased social interaction

The nurse is caring for a client with depression. What is be the primary nursing intervention in this client?

Develop a trusting relationship with the client

Which initial behavior would the nurse help a client with MDD complete?

Develop rapport with the nurse -Client with MDD doesn't have the impetus or energy to investigate new leisure activities

A client has been feeling "down in the dumps" because of the loss of a pet two years ago. Which condition would the nurse suspect in the client?

Dysthymia (persistent depressive disorder at least 2 years)

Which behavior by the client would best indicate to the nurse a trusting relationship is beginning to develop with a client who has major depressive disorder?

Establishes eye contact with the nurse

Which food item is safe to be consumed by a client who is on monoamine oxidase inhibitor (MAOI) therapy?

Grilled chicken

A client with major depressive disorder is most likely to experience which feeling?

Isolation

Which initial action would the nurse take for a depressed, suicidal client whose energy is returning and has been taking mood-elevating medications for several weeks?

Keep the client under close observation -^ risk of suicide that will be acted out

Which client has the greatest risk for a completed suicide?

Older single man diagnosed with pancreatic cancer -Older single men suffering chronic diseases are at highest risk, due to fewer social suports than women -Chronic health problems can lead to learned helplessness

Which activity would the nurse suggest for a moderately depressed client?

Participating in aerobic exercise -Physical activity in a noncompetitive environment can help ease depressive symptoms

While caring for a postpartum client, the nurse suspects the client to have postpartum melancholia. Which symptom in the client made the nurse suspect this condition?

Rejection of the baby

The nurse is caring for a client who has suicidal thoughts. What should be the primary intervention by the nurse?

The nurse should create a safe environment for the client

Which aspect would nurses have difficulty dealing with when caring for a client with MDD?

The pervasive quality of the depression -Depression is "contagious", clients offer no response

What is meant by "off-label use" of medications?

Use of a medication for a purpose other than what is approved by the FDA

A depressed, suicidal client is most likely to verbalize which feelings?

-Helplessness -Isolation -Hopelessness

Which rationale would be priority for recommending group activities for a client with persistent depressive disorder (longer than 2 years)?

A group can offer increased support

A client with depression tells the nurse, "I am a loser and have not achieved anything big in life. My family and friends think that I am worthless." Which therapy will the nurse anticipate from the primary health-care provider to help in changing the mood of the client?

Cognitive therapy (client has depression due to emotional status of feeling worthlessness -Antidepressants are helpful if there is a clear neurological condition

Which prescribed treatment would a nurse anticipate for a client with severe, persistent, intractable depression and suicidal ideation?

ECT

Which clinical manifestation would the nurse observe in an older client with major depressive disorder?

-Decreased appetite -Neglect of personal hygiene -"I don't know" answers to questions -"I can't remember answers to questions -Require little thought to decision making

Which therapeutic communication technique would be useful for a client with major depressive disorder?

-Reflecting -Offering self -Using silence -Paraphrasing -Asking open-ended questions -Encouraging compassion

Which client education info would the nurse give to a client who has suicidal ideations and is recently prescribed a tricyclic antidepressant to ease depression?

-There may not be a noticeable improvement for 2-3 weeks longer

A geriatric client who has developed tolerance to antidepressants was brought to the hospital after attempting suicide. What would be the best treatment approach for such a client?

ECT

For a client who has many self-inflicted nonlethal injuries over preceding month, which level of suicidal behavior is demonstrated?

Gestures

A client reports to the psychiatrist, "I feel very confident in the morning, but I get worse as the day progresses. I am unable to sleep at night due to headache, backache, chest pain, and abdominal pain. It all started after I broke up with my girlfriend." Which type of depression is the client experiencing?

Moderate depression -In the 2nd stage of depression > client experiences lack of sleep, chest pain, abdominal pain, HA, and backache

When managing care of an acutely depressed client, which approach would demonstrate that the nurse recognizes the client's fundamental mental health need?

Role modeling a hopeful attitude regarding life and the future -Molds adaptive behavior

Which type of setting would the nurse maintain for extremely depressed clients?

Simple daily routines -Least stressful and least anxiety producing -Client has limited interest, unable to make simple decisions, multiple stimuli increase anxiety

A woman who gave birth to a second child 3 weeks ago is depressed, crying, and having extreme difficulty caring for her children. Which approach would the nurse take when the husband calls the women's health clinic and asks what he should do?

Telling him that his wife may be suffering from depression and needs emergency care -Postpartum can occur within 4 weeks after birth

The nurse receives a phone call from an adolescent who expresses suicidal ideations. Which client response indicates that the nurse can safely terminate the call?

The adolescent formulates an action plan to control self-harm behaviors and decrease self-destructive thoughts and actions

A nurse is caring for a client with suicidal tendencies. Which client outcome would be the best indicator of the effectiveness of the nursing interventions?

The client has avoided self-harm

A client with major depressive disorder is hospitalized due to severe suicidal tendencies and is on antidepressant drugs. One day the nurse observes the client to be peaceful and confident. What might this dramatic clinical change indicate to the nurse?

The client may have set a suicidal plan