Mood and Affect

the nurse is assessing a client with a history of depression to determine imminent risk for attempting suicide. which statement made by the client indicates a need for immediate intervention?

"everyone would be better off if i wasnt here"

which comment by the suicidal college student would indicate relief from suicidal thinking?

"i plan to go to school next semester"

which s/s would the nurse find in a client who is in the depressive phase of bipolar 1 disorder?

- apathy - loss of appetite - sleep disturbances

which findings would the nurses 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 signs and symptoms would the nurse monitor for?

- diminished pleasure in activities - alteration in appetite

which emergency treatments are the priority for a client who intentionally took an overdose of TCAs?

- gastric lavage with activated charcoal - support of physiological function - cardiac monitoring for arrhythmias or electrocardiogram (ECG) changes

the nurse educator is presenting to a group of nurses about the use of de-escalatory techniques. which actions would the nurse include in the presentation?

- identify client needs - determine stressors and triggers - refrain from arguing with the client

which statement accurately describes nortriptyline?

- overdosage is often lethal - constipation and urinary retention may occur - weight gain is a common side effect

which action would the nurse take for a withdrawn client who suddenly screams, burst into tears, and runs from the room to the far end of the hallway?

walk to the end of the hallway where the client is standing

which long0term outcome would the nurse add to the plan of care for a client experiencing a major depressive episode?

will verbalize realistic perceptions of self and others

an older adult living in a long-term care facility has been receiving 600 mg of lithium twice a day for 3 weeks to ease manic behavior. the client is experiencing n/v, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. which intervention is appropriate?

withholding the next dose of lithium and drawing blood for a lithium level

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

anxiety nausea sedation restlessness suicidal ideation increased energy level

which action would the nurse take for a client taking an antidepressant for 8 days, who smiles at the nurse and says, "things sure look better today"?

arrange for constant supervision of the client

which statement would the nurse make when discharging a depressed client from the mental health unit?

call the contact number we gave you if you have an emergency

during an admission interview, a client is expansive and distractible and demonstrates a fragmented, pressures, nonsequential pattern of speech. which communication technique would the nurse use?

closed questions

which strategy would the nurse use to help a depressed, withdrawn client who exhibits sadness through nonverbal behavior?

cope with painful feelings by sharing them

which problem is the MOST common for a client with the diagnosis of major depression?

decreased social interaction

which initial behavior would the nurse help a client with major depressive disorder complete?

develop rapport with the nurse

a health care provider prescribes divalproex for a client with the diagnosis of bipolar 1 disorder, manic episode. which side effects of this medication might the client report during a follow-up visit?

dizziness, nausea, and vomiting

which symptom indicates a possible drug interaction in a client taking monoamine oxidase inhibitors (MAOIs) for depression?

dry mouth

which term describes the disturbance in mood and affect seen in clients who are depressed?

dysphoric

which initial action would the nurse plan to take for a newly admitted client diagnosed with bipolar 1 disorder, manic episode?

encourage increased nutritional intake

which factor would likely be the reason a woman with bipolar disorder, manic episode, rarely eats?

excessive physical activity

the nurse is assessing the hospital room for items that the client can use to inflict self-harm and commit suicide. which finding indicates a need to modify the clients environment for safety?

fresh flowers in glass vase

which response would the nurse make to a depressed client who says, "i dont get out of bed most morning because i dont feel like it"?

getting up and involved in an activity might help lift your mood"

which feeling would the nurse anticipate a manic client with bipolar 1 disorder is likely experiencing?

grandeur

which conclusion would the nurse make about a client who has been taking antidepressants for 3 weeks and says, "im really feeling better; my energy level is up and i would like to have my favorite jacket"?

has an increase risk for suicide

a 65 yo client is receiving amitriptyline. which recommendation will the nurse make to the client concerning this medication?

have an eye examination to check for glaucoma

which characteristic is commonly associated with adolescent depression?

having suicidal ideation exhibiting tearfulness avoiding previously enjoyed activities and relationships

which approach would the nurse use to help a severely depressed adolescent client accept the realities of daily living?

helping the client fulfill personal hygiene needs

which complication can occur if a client receiving isocarboxazid fails to adhere to necessary dietary restrictions?

hypertensive crisis

after reviewing the lab results, which priority action would the nurse take for a client who is taking medications for bipolar disorder, type 2 diabetes, and peripheral vascular disease? - INR:2.6 - troponin t: negative - lithium: 2.5 mmol/L - A1c: 8.2%

implement seizure precautions immediately

which essential, initial interventions would be included in the plan of care for a client admitted to the psychiatric unit during the first episode of an acute psychotic disorder?

instituting psychopharmalogical prescriptions and offering supportive communication

a school-aged child with seizure disorder has been on long-term carbamazepine therapy. which intervention would the nurse incorporate into the plan of care?

monitoring the childs complete blood cell count

in which room would the nurse manager place a client with bipolar disorder, manic episode?

one that has basic simple furnishing

which biophysical need is the priority in the acute phase of bipolar disorder, manic episode?

physical

which activity would be appropriate for the nurse to introduce to a depressed client during the early part of hospitalization?

project involving drawing

which action would be priority for a client diagnosed with major depression who is experiencing psychotic features and who says "all of my relatives have been killed because ive been sinful and need to be punished"?

protecting the client against any suicidal impulses

which clinical manifestation is associated with depression?

psychomotor retardation

which nursing intervention would be the priority for an older adult client with depression who is prescribed a tricyclic antidepressant?

requesting that the hcp change the medication

a woman with bipolar disorder, manic episode, spent thousands of dollars on clothing and makeup; then she started going to bars every night and rarely sleeps or eats. which concept is the priority in planning care for this client?

safety

a high school student says that the prescribed antidepressant is no longer needed and should be discontinued. which action would the nurse take?

seek further information from the student

which rationale described the nurses behavior for sitting with a severely depressed client and making non demands on the client?

spending time with a depressed client demonstrates that they are worthy of attention

a school-age child with a seizure disorder is prescribed divalproex. the nurse would include which instruction when teaching the parent about administering this medication?

take the child for regularly scheduled blood tests

which precaution will the nurse consider when initiating treatment with fluoxetine?

the blood level may not be sufficient to cause noticeable improvement for 2-4 weeks

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

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

which reply by the nurse is appropriate when a client asks how psychotic medications work?

these meds affect the chemicals used in communication between nerve cells

which action would the nurse take to establish trust in a depressed client?

visit frequently for short periods with the client each day