Mood, Adjustment, and Dementia Disorders
A man brings his wife to the facility. He reports that since the death of their 7-month-old daughter 8 weeks ago, his wife has been neglecting her housework and family, has lost 20 lb (9.1 kg) from not eating, and hasn't left the house. She is admitted to the psychiatric unit with a diagnosis of depression. The nurse helps the client settle in. While observing her unpack, the nurse expects her to exhibit: 1. fast movements. 2. slow movements. 3. a desire to initiate a conversation with her roommates. 4. a desire to unpack and arrange her belongings without assistance.
2. slow movements. RATIONALES: Typically, a depressed client exhibits slow movements and fatigue. Such a client also has difficulty interacting, making decisions, and initiating independent actions. Nursing interventions should be planned to assist and support the client, as needed, to meet needs. Although a client with agitated depression (depression with frantic pacing) may exhibit increased activity, this behavior is more common in a client with mania.
A client with a diagnosis of major depression is prescribed clonazepam (Klonopin) for agitation in addition to an antidepressant. Client teaching would include which statement? 1. "Clonazepam may interact with organ meats." 2. "The medications shouldn't be taken together." 3. "Clonazepam is a minor depressant and may aggravate symptoms of depression." 4. "Clonazepam therapy shouldn't interfere with any activities."
3. "Clonazepam is a minor depressant and may aggravate symptoms of depression." RATIONALES: Clonazepam is a central nervous system (CNS) depressant and can aggravate symptoms in depressed clients. It doesn't interact with organ meats and can be taken with antidepressant medication. Clonazepam causes sedation. The client should be cautioned about using hazardous machinery until the effects of the medication are known.
A client with diagnosis of major depression and a history of several suicide attempts tells a nurse, "I have no reason to live. Nobody cares about me." Which response by the nurse is most therapeutic? 1. "Do you have thoughts about harming yourself?" 2. "Depression commonly causes people to feel like this." 3. "How long have you been feeling like this?" 4. "You have everything to live for."
3. "How long have you been feeling like this?" RATIONALE: This client has been evaluated and resides in a safe environment; the most therapeutic response at this point would be to allow him to safely express his feelings. Asking if the client thinks about harming himself might provide useful information, but doesn't specifically address the client's current feelings. Telling the client that he has everything to live for discounts his subjective experience and blocks further communication. Telling the client that depression commonly causes the kind of feelings he's having provides accurate information that may be useful at another time, but this approach doesn't relate to the client's current needs.
A 40-year-old executive who was unexpectedly laid off from work 2 days ago complains of fatigue and an inability to cope. He admits drinking excessively over the last 48 hours. This behavior is an example of which condition? 1. Alcoholism 2. A manic episode 3. Situational crisis 4. Depression
3. Situational crisis RATIONALES: A situational crisis results from a specific event in a person's life. The person is overwhelmed by the situation and reacts emotionally. Fatigue, insomnia, and inability to make decisions are common signs and symptoms. The situational crisis may precipitate behavior that causes a crisis (alcohol or drug abuse). There isn't enough information to label this client an alcoholic. A manic episode is characterized by euphoria and labile affect. Symptoms of depression are usually present for 2 or more weeks. This client's symptoms have been present for only 48 hours.
Which classification of drugs is the most potentially fatal if the client takes an overdose? 1. Antihistamines 2. Dopaminergics 3. Phenothiazine antipsychotics 4. Tricyclic antidepressants
4. Tricyclic antidepressants RATIONALES: Tricyclic antidepressants can create fatal cardiac arrhythmias. Overdose of the other medications is rarely fatal.
