Mood & Affect Test

A client receiving pain medication for abdominal discomfort reports no relief of pain and continues to describe multiple somatic complaints. The client also describes feelings of discouragement and hopelessness related to the pain, because the healthcare team has not yet found a cause for the pain. Which action by the nurse is appropriate? A) Assessing the client for depression B) Obtaining an order for different pain medication C) Contacting the family to talk to the client D) Reviewing of the client's lab values

A) Assessing the client for depression

A client prescribed an antidepressant tells the nurse that the pill causes dizziness upon standing or changing position too quickly. This is a common side effect of which antidepressant medication? A) Atypical antidepressant B) Monoamine oxidase inhibitor (MAOI) C) Selective serotonin reuptake inhibitor (SSRI) D) Lithium

A) Atypical antidepressant *Ortho Hypotension

A client with depression is receiving electroconvulsive therapy (ECT). Which interventions should the nurse plan when caring for this client? Select all that apply. A) Maintain nothing-by-mouth status until fully awake. B) Administer intravenous fluids for 8 hours postprocedure. C) Place in the lateral recumbent position. D) Provide oral fluids immediately after the procedure. E) Place in the supine position with the head flat.

A) Maintain nothing-by-mouth status until fully awake C) Place in the lateral recumbent position

A patient with a diagnosis of depression and suicidal ideation was started on an antidepressant 1 month ago. When the patient comes to the community health clinic for a follow-up appointment he is cheerful and talkative. What priority assessment must the nurse consider for this patient? a. The medication dose needs to be decreased. b. Treatment is successful, and medication can be stopped. c. The patient is ready to return to work. d. Specific assessment for suicide plan must be evaluated.

D.Energy levels increase as depression lifts; this may increase the risk of completing a suicide plan. An increase in mood would not indicate a decrease or discontinuation of prescribed medication. The patient may be ready to return to work, but assessment for suicide risk in a patient who has had suicidal ideation is the priority assessment.

Persistent Depressive Disorder:

Depressed mood present most of the day, more days than not, for ≥2 years (may be similar to MDD but less severe)

Major Depressive Disorder:

Diagnosed when patient experiences either depressed mood or loss of interest most of the day, almost every day, for 2 weeks *Anhedonia plus four other depression symptoms

Mania Symptoms:

Distractibility, Racing Thought, Psychomotor Agitation, Pressured Speech, Disordered Sleep Patterns (Last most of the day for 1 wk)

Congruent:

Does this persons affect make sense for this situation?

A person was online continuously for over 24 hours, posting rhymes on official government websites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident? a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficits and paranoia

C Hyperactivity (activity without sleep) and poor judgment (posting rhymes on government websites) are characteristic of manic episodes. The distracters do not specifically apply to mania.

A nurse working on a psychiatric unit is caring for a client who has been diagnosed with major depressive disorder (MDD). Upon assessment of the client, which clinical manifestations does the nurse recognize as consistent with this diagnosis? A) Depressed mood or loss of interest occasionally for at least 1 week B) Depressed mood sporadically for at least 2 years C) Restlessness, fatigue, suicidal ideation, feelings of guilt D) Anxiety, change in appetite, grief, altered nutrition

C) Restlessness, fatigue, suicidal ideation, feelings of guilt

Which statement about bipolar disorder is true? A) The client will exhibit functional impairment at work during remission periods. B) Episodes associated with bipolar disorder tend to decrease in frequency with age. C) Some clients with bipolar disorder do not experience remission periods. D) Bipolar disorders typically appear between the ages of 25 and 50.

C) Some clients with bipolar disorder do not experience remission periods.

A patient has been resistant to treatment with antidepressant therapy. The care provider prescribes a monoamine oxidase inhibitor (MAOI) medication. What teaching is critical for the nurse to give the patient? a. Serum blood levels must be regularly monitored to assess for toxicity .b. To prevent side effects, the medication should be administered as an intramuscular injection .c. Eating foods such as blue cheese or red wine will cause side effects. d. This medication class may only be used safely for a few days at a time.

C. MAOIs have serious food interactions when ingested with tyramine-containing foods such as aged or processed foods. Serum levels are routinely monitored when mood stabilizers such as lithium carbonate are prescribed. It is not necessary to administer this class intramuscularly. This medication takes several weeks to show effectiveness and should not be stopped abruptly; short-term use will not be effective.

Consider these three anticonvulsant medications: divalproex, carbamazepine, and gabapentin. Which medication also belongs to this classification? a. clonazepam b. risperidone c. lamotrigine d. aripiprazole

C. The three drugs in the stem of the question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs.

Anticonvulsants

Carbamzaepine, Divalproex/Depakote, Gabapentin/Neurontin, Lamotigine/Lamictal -Monitor mood & symptoms during medication treatment; -Use with caution in liver & renal impairment -Monitor drug levels - Pt's will take these meds long term / can be on atypical & antidepressants meds as well; ---S/E: Dizziness, Drowsiness, Dry Mouth, Headache

Depression:

disorder characterized by sad or despondent mood or loss of interest in usual activities

Rapid Cycling:

four or more mood episodes in 12-month period *At least 2 months between episodes or with alternating mania and depressive episode

Mood:

like emotions but last longer, less focused on object/event, less intense (subjective, self-reported)

Postpartum Blues:

mood swings, tearfulness, sleep disruptions, anxiety *usually occur within 2-3 days postpartum, last up to 2 weeks

Postpartum Psychosis:

psychotic features associated with peripartum or (more commonly) postpartum depression

Postpartum Depression:

symptoms more severe, lasting longer; begins during pregnancy and/or up to a year after giving birth *Higher risk: those who have given birth to multiple children and/or preterm births

Mixed:

symptoms of depression experienced during mania or hypomania

Therapeutic Communication Tips

· Ask them how they prefer to be addressed · Be mindful of your own non-verbal communication · Smile and make appropriate eye contact · Don't judge · Don't give unsolicited advice · If asked for advice instead of saying "If I were you, I'd...", say "Have you considered doing...?" or "I'm wondering if you ..." · Practice active listening. Listen with the intent to understand instead of thinking of what you are going to say next. · Validate client's feelings · Empathize, don't sympathize. Sympathize example: "I went through an ugly divorce too." · Don't overshare. Oversharing is a boundary issue. · Avoid questions that invite a one-word answer. · Drill down with your questions once you have established a connection. "What was that like for you?", "What has helped you in the past?", "Tell me more..." · Use silence when appropriate and learn to become comfortable with silence. Sometimes clients need to reflect before responding. Or sometimes you want to just be with the client, letting them know you are there for them. · Look at the client's non-verbal communication. What is the client saying with their non-verbals? Is it congruent with the content that they are expressing?

Suicide Influencing Factors

· Family hx of someone who suicided higher chance of having suicide ideation · Early trauma (changes our brain) · Neurobiology (how much serotonin you can make/depression) · Interpersonal: hx of abuse, loneliness, no social support, GRIEF, hopelessness, situations that take away a persons control (abuse victim, lose ability to drive or live alone, leg amputated) · Comorbid: Other mental illnesses 90% of people have comorbid disorders (bipolar, borderline/emotional regulation , conduct disorder, drug & alcohol) Highest Risk: Rapid Mood Cycles · Social Factors: Systemic Issues (LBTQIA = stigma), People of Different Races, Discrimination

Manifestations of Suicide

· May mention feeling helpless in face of stress · May discuss life after death · Verbal cues such as "It won't matter for long" or "I can't take this much longer" · Giving away possessions · Withdrawing from relationships · Obtaining means to end life · Some individuals demonstrate no overt behaviors · Mnemonic for short-term indications of suicidal attempt: > IS PATH WARM Ideation, Substance abuse, Purposelessness, Anxiety, Trapped, Hopeless, Withdrawal, Anger, Recklessness, Mood changes · Unusually rigid thinking · Dichotomous thinking · Magnification · Overgeneralization · Externalization of self-worth · Predicting negative outcomes without considering possible positive ones · Alienation from family, friends · Difficulty adapting to demands of new social roles · Loss of loved one · Unemployment · Loss of autonomy · Feeling like a burden to others

Suicide Nursing Care

· Pharmacologic Intervention (antidepressants, mood stabilizers, antipsychotics) · Group Therapy/Individual/Family/CBT/Writing · Appropriate Nonjudgmental Care · Safety · Observation/Interview (HX,Mood & Affect) · Assess Risk Level · Teaching · Safety Plan

Suicide Risk Factors

· Recent loss of significant relationship · Feelings of failure, hopelessness · Access to lethal means · History of trauma or abuse · Chronic physical illness, including chronic pain · Gender · Age · Social isolation, lack of support systems*

Protective Factors (suicide)

· Strong family connections · Community support · Access to mental health providers · Young children to care and provide for · Strong ties to religion that denounces suicide · Caring for pets · Use of healthy coping and decision-making skills

Etiology of Suicide

· · Ambivalent: Cutting selves · Lethal Meds: Why men are likely to succeed (gun, hanging self, jumping from building) · Ambivalence: looks more like testing (take a few pills) · Lethal: Tells that they are going to shoot themselves with a gun in their garage · Command Auditory Hallucinations: the voices are telling me to jump off that bridge

A client in the manic phase of bipolar disorder is prescribed lithium and has a current lithium blood level of 0.4 mEq/L. Which clinical manifestation does the nurse anticipate when assessing this client? A) A decrease in manic behavior B) Hyperactivity and pressured speech C) A return to baseline behavior, calm and rational D) Signs and symptoms of depression

B) Hyperactivity and pressured speech

Which intervention is a primary prevention strategy for depression? A) Regular screening for depression B) Provide education about stress management C) Counseling clients about their risk for mood disorders D) Developing community-based mental health programs

B) Provide education about stress management

Hypomania Symptoms:

(less extreme form of mania) does not impair functioning or require hospitalization, pts feel on top of the world/don't recognize change in selves, people who know them may see changes

Ketamine

-Nasal Spray in Adolescents in Clinics -Very expensive - Effective within 24 hrs in some patients -Tranquilizer -Helps w/ depression symptoms

MAOIs

-Rarely used due to severe food & med interactions - Other antidepressants must be d/c'd before MAOI use op hypertensive crisis could occur- -Hypoglycemic Crisis could also occur if diabetic, wear medical alert bracelet -Avoid Cheese/Meat Plate, Pickled Foods, Alcohol - S/E: Anticholinergic, Hyper & Hypo Tension, Sexual Dysfunction, Muscle Spasms, Weakness

A nurse educator is teaching a group of student nurses regarding depression, its pathophysiology, and the theories related to the disorder. What statements will the nurse instructor include about the theories of depression? Select all that apply. A) Sociocultural theory emphasizes the role that social stressors play in the development of depression. B) The sociocultural factor theory states that those who are depressed focus on negative messages in the environment and ignore positive experiences. C) The learning theory states that individuals learn to be depressed in response to a self-perception of a lack of control over their life experiences. D) The sociocultural factor theory suggests that all people have an inborn need for interpersonal relationships. E) The learning theory states that individuals with depression typically experience little success in achieving gratification and little positive reinforcement in coping with negative incidents

A) Sociocultural theory emphasizes the role that social stressors play in the development of depression. C) The learning theory states that individuals learn to be depressed in response to a self-perception of a lack of control over their life experiences. E) The learning theory states that individuals with depression typically experience little success in achieving gratification and little positive reinforcement in coping with negative incidents

A nurse at a psychiatrist's office is reviewing the medication prescribed to several new clients for mood disorders. Which order would the nurse question? A) A prescription for paroxetine for a 15-year-old boy with depression B) A prescription for fluoxetine for a 14-year-old girl with depression C) A prescription for sertraline for a 10-year-old boy with obsessive-compulsive disorder D) A prescription for sertraline for an 11-year-old girl with depression

A) The FDA does not recommend paroxetine to treat depression in children and adolescents because of an increased risk in suicidal thinking and behavior during initial treatment. All other prescriptions are appropriate for the age and disorder

The nurse is providing care for a client who is experiencing situational depression after the death of her mother. During the assessment, the nurse learns that the client has returned to work, is caring for her family, and spends quiet time reflecting on her life and future. Which conclusion by the nurse is most appropriate? A) The client is working through the grief process. B) The client is experiencing denial regarding the death of a parent. C) The client is exhibiting ineffective coping. D) The client is experiencing anxiety.

A) The client is working through the grief process.

A client is scheduled for electroconvulsive therapy (ECT) for the treatment of depression. Which instructions should the nurse include regarding this therapy? Select all that apply. A) You will need to remove all jewelry before beginning the therapy session. B) These treatments will cure the depression. C) Long-term memory loss often occurs after receiving ECT. D) The treatments are known to help some but not all people with depression. E) You will need to stop eating and drinking 4 hours prior to the therapy session.

A) You will need to remove all jewelry before beginning the therapy session. D) The treatments are known to help some but not all people with depression. E) You will need to stop eating and drinking 4 hours prior to the therapy session

A patient who has been diagnosed with depression is scheduled for cognitive therapy in addition to receiving prescribed antidepressant medication. The nurse understands that the goal of cognitive therapy will be met when what is reported by the patient? a. "I will tell myself that I am a good person when things don't go well at work." b. "My medications will make my problems go away." c. "My family will help take care of my children while I am in the hospital." d. "This therapy will improve my response to neurotransmitter impulses."

A. Cognitive therapy helps patients restructure their patterns of thinking to various events or thoughts in a more healthy way. Medication alters neurotransmitters but does not make problems go away. Family support is important but is not the goal of cognitive therapy. Neurotransmitters are affected by medication and brain stimulation therapy, not by cognitive therapy.

A patient diagnosed with bipolar disorder is dressed in a red leotard and bright scarves. The patient twirls and shadow boxes. The patient says gaily, "Do you like my scarves? Here they are my gift to you." How should the nurse document the patient's mood? a. Euphoric b. Irritable c. Suspicious d. Confident

A. The patient has demonstrated clang associations and pleasant, happy behavior. Excessive happiness indicates euphoria. Irritability, belligerence, excessive happiness, and confidence are not the best terms for the patient's mood. Suspiciousness is not evident.

A student nurse is assisting in the care of a client with bipolar disorder. The student nurse researches the disorder further, focusing on the pathophysiology and etiology of the disorder. Which are true regarding the pathophysiology and etiology of bipolar disorder? Select all that apply. A) No definitive cause or specific pathophysiology has been identified for bipolar spectrum disorders. B) Bipolar disorders, anxiety disorders, and personality disorders share biological susceptibility and inheritance patterns. C) Immunologic abnormalities may contribute to the pathophysiology of mania and bipolar disorder. D) Children of parents with bipolar disorder have an increased risk of developing the disorder. E) Stressful life events and an emotionally overinvolved, hostile, and critical communication pattern are factors associated with heritability of the disorder. Answer: A, C, D, E

ALL but b

Which molecule has been implicated in the pathophysiology of depression? A) Brain natriuretic peptide B) Dopamine C) Epinephrine D) Calcitonin

B) Dopamine

Atypical Antipsychotics

Ariprazole, Olanzapine; -Used often for rapid de-escalation of manic symptoms -Given with other medications for mood stabilization

A client in the manic phase of bipolar disorder is unable to sleep during the night. Which interventions could be helpful to this client? Select all that apply. A) Engage in conversation. B) Extend daytime naps. C) Encourage the client to watch television. D) Assist the client with a warm bath and provide a light snack. E) Encourage the client to listen to soothing music.

D) Assist the client with a warm bath and provide a light snack. E) Encourage the client to listen to soothing music.

1) The nurse is caring for a client with a chronic health condition. Which condition should the nurse identify as a common complication associated with reduced role function? A) Osteoporosis B) Congestive heart failure C) Diabetes D) Depression

D) Depression

) The nurse understands that bipolar disorders affect clients differently across the lifespan. Which is true regarding bipolar disorder and lifespan considerations? A) Children with bipolar disorders present with mood changes only. B) Children with bipolar disorders rarely exhibit violent tempers. C) Suicide risk does not increase in adolescents and teenagers who are diagnosed with bipolar disorders. D) Lifetime prevalence of bipolar disorders in adolescents is 0-3%.

D) Lifetime prevalence of bipolar disorders in adolescents is 0-3%.

A client being treated for severe depression reports feeling better and having more energy. Which is a priority nursing diagnosis for the client at this time? A) Social Isolation B) Hopelessness C) Situational Low Self-Esteem D) Risk for Self-Directed Violence

D) Risk for Self-Directed Violence *The one risk that occurs with successful treatment of a client with depression is that once the depression begins to resolve, the underlying thought of suicide could prevail. With treatment, the client may begin to have more energy to make a plan regarding suicide. The nurse should further assess this client's statement about making plans. The client is not demonstrating low self-esteem, hopelessness, or social isolation.

A nurse is caring for a client who displays symptoms associated with seasonal affective disorder (SAD). Which treatment would the nurse question as inappropriate for this client? A) Cognitive-behavioral therapy B) Light therapy C) Bupropion extended-release D) Selective serotonin reuptake inhibitor (SSRI)

D) Selective serotonin reuptake inhibitor (SSRI)

A patient who is taking prescribed lithium carbonate is exhibiting signs of diarrhea, blurred vision, frequent urination, and an unsteady gait. Which serum lithium level would the nurse expect for this patient? a. 0 to 0.5 mEq/L b. 0.6 to 0.9 mEq/L c. 1.0 to 1.4 mEq/L d. 1.5 or higher mEq/L

D.Diarrhea, blurred vision, ataxia, and polyuria are all signs of lithium toxicity, which generally occurs at serum levels above 1.5 mEq/L. Serum levels within the normal range of 0.8 to 1.4 mEq/L are not likely to cause signs of toxicity.

Symptoms of Bipolar:

Down: Same symptoms as depression Up: Mania, Hypomania

SNRI

Duloxetine and Venlafaxine; -Treats Anxiety & Depression -Monitor for serotonin syndrome- -Monitor bp due to increase -Must be tapered - Assess for suicidality -Takes one month for therapeutic levels -S/E: Insomnia, Anxiety, Decreased Appetitie, Increased BLEEDING (NSAIDS & Warfarin), Elevated Cholesterol

ECT:

Electric current passed through brain to induce seizure. Given over 2-3 times a wk for 3-4 wks with rapid results. General anesthesia. 2nd Line Therapy (after meds) for MDD & Bipolar. *Skip Am Meds Day of ECT. Can cause mild confusion and memory loss.

SSRI's

End in Tine & Pram; Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline; - Take in am to prevent insomnia and gi issues -Avoid herbals to prevent serotonin syndrome -Don't stop abruptly - taper -Assess for suicidality -1 month to reach therapeutic level - S/E: N/V/D, HA, Dry Mouth, Insomnia, Dizziness, Sexual Dysfunction

Stimulus

Ex/ Lunch in 5 min late and their reaction is to freak out that is dysfunctional

Antidepressants

SSRI, SNRIs, Aytpical Antidepressants, Tricyclic, MAOIs, Ketamine

Symptoms of Depression:

Sadness, Emptiness, Anhedonia (Disinterest), Sleep Disturbances, Fatigue, Irritability, Somatic Symptoms (Physical Pain)

Nursing Care for Depression

Screening ,Antidepressants, Psychotherapy (CBT), ECT, Assess Safety, Teaching importance to adhering to treatment, Observation, Interview (hx), Physical Exam (somatic, sexual), Suicide Assessment " are you having thoughts of suicide", Assess for comorbidities

Situational Depression:

Maladaptive reaction to identified psychosocial stressor(s) that occurs within 3 months after stressor occurs, persists ≤6 months after termination of stressor (similar to other depressive disorder but less severe, may have higher levels of anxiety)

Atypical Antidepressants

Mirtazapine & Bupropion -Bupropion also tobacco cessation -Use w/ caution w/ seizure disorder & renal & liver impairment -1 month for therapeutic level; -Less sexual side effects S/E: Nausea, Dizziness, Changes in appetite & weight

Bipolar:

Mood alternates between extremes of depression and mania or hypomania interspersed with periods of normal mood

Depression Risk Factors

Family HX, Female Gender, HX of Child Abuse/Trauma, Unemployment, Poverty, Lower Educational Level, Lack of Social Supports

Risk Factors for Bipolar:

Family Hx, Drug Abuse, Periods of High Stress, Major Life Altering Event

Cognitive Behavioral Therapy:

Focuses on challenging and changing thought distortions and improving behavior/thought patterns. Also uses mindfulness. Weekly Sessions. Used in depression. Goal Oriented. Short Term.

Depression Prevention

Healthy Diet, Reg Exercise, Avoid Smoking, Adequate Sleep, Education on Stress Mgmnt, Meaningful Social Relationships, Support for Life Altering Events, Regular Screen

Tricyclic Antidepressants

Imipramine & Amitriptyline -Caution in use in elderly, urinary retention, glaucoma, enlarged prostate - Contraindicated in acute mi or dysrhythmias - Lowers seizures threshold -S/E: CANT SEE CANT PEE CANT POOP *Ami has a seizure and trips over her tricycle in the desert*

Mood Stabilizers

Lithium Carbonate, Anticonvulsant, Atypical Antipsychotics

TMS:

Magnetic Field passes thru skull & causes cerebral cortex cells to fire. Left prefrontal for depression & right prefrontal for mania. Less invasive. Changes neurotransmitters. Have shorter duration of effect than ect. Fewer side effects.

Nursing Care for Bipolar:

Observe/Recognize Manifestations, Understand how Pts respond, Provide Teaching about symptoms/treatment, Encourage pt to track feelings/behaviors, side effects, physical side effect, drug test, pharmacologic therapy:aytpical antipsychotics and anti seizure meds

Bipolar II Disorder:

One or more hypomanic episodes, one or more depressive episodes

Bipolar I Disorder:

One or more manic episodes, one or more depressive episodes

Lithium Carbonate

Prescribed for Bipolar I disorder (mania); - Therapeutic level 0.6-1.2 mEq/L; -Monitor for toxicity symptoms (tremulousness, N,V, lethargy, fatigue are early symptoms) -Client should drink 8-10 glasses of water per day due to dehydration leading to toxicity -Can stop taking to prevent toxicity -Contraindicated in kidney and CV disease - Monitor weight, yearly EKG, thyroid studies, creatinine, electrolytes, WBC, glucose; -Increased sodium intake will increase renal excretion of lithium; -S/E: Dizziness, Drowsiness, Dry Mouth, N/V, Blurred Vision, Loss of Appetite -Think Lithium=LEVEL

Stability:

Stable/Normal Labile/Over-reactive to Flat in no time at all

Restricted/Flat:

Stays the same

Seasonal Affective Disorder:

Symptoms of sadness and low energy in winter when days are shorter, due to less exposure to natural light, bupropion or ssri or light therapy is a treatment

Suicide attempt

act is not fatal but intent of act was to cause death

Suicide:

act of inflicting self-harm that results in death

Affect:

an individual's automatic reaction to an event or situation (unconscious

Emotions:

an individual's feeling responses to a wide variety of stimuli (intense/brief/conscious)

Suicidal ideation:

constantly considering, planning, or thinking about suicide