PrepU - Chapter 17 - Depression/Suicide

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

Correct response: Identify a person to whom he or she can turn to for help after discharge. Explanation: 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.

A family member of an adolescent who has expressed a desire to commit suicide asks the nurse, "What might predict the possibility of future suicide attempts?" Which would the nurse include in the response? Previous suicide attempt Unemployment Polydrug use Death of a spouse

Correct response: Previous suicide attempt Explanation: Although factors such as unemployment, death of a spouse, and polydrug use can contribute to depression and suicidal ideation, one of the best predictors for suicide during adolescence is a previous attempt.

Trying to kill oneself and surviving the ordeal is identified as what? Suicide attempt Parasuicide Suicidal behavior Suicidal ideation

Correct response: Suicide attempt Explanation: An attempt of suicide can be characterized as living through an experience of suicide despite having expected or intended to die.

A 42-year-old client has been prescribed a monoamine oxidase inhibitor (MAOI). The client should be informed to avoid foods containing what? Sodium Arganine Tyramine Calcium

Tyramine Explanation: MAOIs increase levels of tyramine. Therefore, if the client overdoses, takes other medications that interact with MAOIs, or eats foods that contain tyramine, Norepinephrine will accumulate, leading to hypertensive crisis.

Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? Increase hydration Eat a nutritionally balanced diet Get daily exercise Take medication with food

Correct response: Increase hydration Explanation: Increasing hydration and sitting or standing up slowly are nonpharmacologic interventions for orthostatic hypotension. Taking medications with food would counteract nausea and vomiting. Daily exercise and eating a nutritionally balanced diet would help with weight gain that occurs in clients taking antidepressants.

A client is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also reports having felt unhappy most of the time for "as long as I can remember." Which diagnosis should the nurse anticipate for this client? Bipolar disorder Mild depressive disorder Persistent depressive disorder Rapid cycling disorder

Correct response: Persistent depressive disorder Explanation: Persistent depressive disorder, or dysthymic disorder, is relatively mild compared to major depressive disorder but is chronic. It is diagnosed when the depressed mood exists for most days for at least 2 years with two or more of the following symptoms: poor appetite or overeating, insomnia or oversleeping, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.

Living through a traumatic experience and unintentionally killing oneself The voluntary and intentional act of killing oneself The engagement of suicidal behavior where death has occurred The primary motivating force of action when one is not trying to kill oneself

Correct response: The voluntary and intentional act of killing oneself Explanation: The definition of suicide is the voluntary and intentional act of killing oneself.

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

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

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? "Do you see a way out from your depression apart from suicide?" "How often are you having thoughts about suicide this morning?" "Do you have access to any more pills that we don't know about?" "What caused you to take all those pills last week?"

Correct response: "How often are you having thoughts about suicide this morning?" Explanation: 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.

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

Correct response: "I started taking diet pills to assist with weight loss." Explanation: 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.

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

Correct response: "I'm obliged to share what we talk about with the other people on your care team." Explanation: 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.

When conducting a suicide risk assessment with a client, the nurse should identify the client as a high imminent risk if which statement is made? "My son is really the only reason I stick around." "I just need someone to talk to" "There are no solutions to my problems." "I think about starving myself to death sometimes"

Correct response: "There are no solutions to my problems." Explanation: Hopelessness is the pervasive belief that undesirable events are likely to occur coupled with the belief that one's situation is unlikely to improve. A significant evidence base has been established linking hopelessness, loneliness, and other cognitive symptoms to suicide ideation. Depressed persons who are hopeless are more likely to consider suicide than those who are depressed but hopeful about the future. Furthermore, it appears that lack of positive thoughts about the future is more likely to predict suicidal behavior than negative thoughts even though both contribute to hopelessness. The statement, "There are no solutions to my problems" is consistent with the risk that the client has lost hope; therefore, the risk of suicide is high and possibly imminent. The nurse should ensure the suicide risk assessment and associated interventions are a high priority. Having a child can be a protective factor against suicide. Stating one is not going to engage in the act of suicide because of a family member lowers the risk of an imminent attempt. The client who states he or she thinks about starving sometimes has made a vague statement with a plan that is not highly lethal. The risk is likely low with this client but support should be provided, nonetheless. The client who reaches out by asking for someone to talk to is calling for help and being proactive before getting to the point of making the decision to commit suicide.

The nurse is assessing a client with depression and a colleague suggests that the client be encouraged to sign a no-suicide contract. What is the nurse's best response to the colleague? "It's best to let the client bring up the issue of no-suicide contracts rather than us suggesting them." "The most recent evidence suggests that these contracts can actually provoke a suicide attempt." "Yes, there are some benefits to no-suicide contracts, but they're ethically questionable." "There's no demonstrated benefit of no-suicide contracts, though they're not believed to be harmful."

Correct response: "There's no demonstrated benefit of no-suicide contracts, though they're not believed to be harmful." Explanation: No-suicide contracts have not been shown to be an effective means of preventing suicide. They are not, however, shown to be harmful, and there are no problematic ethical issues with their use beyond the fact that they do not benefit the client's safety.

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

Correct response: "You'll need to continue the medication for about 6 to 12 months to see how things go." Explanation: 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

Which individual has the greatest number of risk factors for the development of depression? A 42-year-old woman who has experienced depression before but has a strong support system A 50-year-old woman who just lost her spouse and has a family history of depression A 62-year-old man who has had depression in the past and abuses alcohol A 32-year-old man who has been diagnosed with cancer and has been abusing alcohol

Correct response: A 50-year-old woman who just lost her spouse and has a family history of depression Explanation: The risk factors for depression include gender, with a higher incidence in women than in men; prior episode of depression; family history; stressful life event; current substance abuse; medical illness; and few social supports. The woman who has just lost her spouse and has a family history of depression has three risk factors listed (gender,

Which client is most likely to benefit from electroconvulsive therapy (ECT)? A client whose recent strange behavior has been attributed to cyclothymic disorder A client with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy A client whose major depression has not responded appreciably to antidepressants

Correct response: A client whose major depression has not responded appreciably to antidepressants Explanation: While ECT is used to treat an increasing range of psychiatric-mental health problems, individuals with major depression are often among the best candidates for the treatment. ECT would not be used as a response to noncompliance, and a person who is currently experiencing a manic episode is less commonly treated with ECT. Cyclothymic disorder is less severe than bipolar II disorder and is consequently less likely to warrant ECT.

A client was abandoned by the parents at age 3, resulting in the client's perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of what? A reason the client has become lesbian at the age of 23. A psychodynamic interpretation of the client's major depressive disorder. A feminist viewpoint of depression. A biological explanation for the client's depressive disorder.

Correct response: A psychodynamic interpretation of the client's major depressive disorder. Explanation: Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. Such anger begins in childhood when basic developmental needs are not met. Clients cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.

A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what? Demonstrated examples of unwise decisions A significant decrease in appetite Claims by family, friends, or coworkers that the client is depressed Self-report of being sad after a break up

Correct response: A significant decrease in appetite Explanation: Among the nine clinical symptoms of a major depressive episode is a significant increase or decrease in appetite. Failures may precipitate or exacerbate decisions and others may confirm the client's depression, but these are not diagnostic criteria. Unwise decision making is not a hallmark of depression, but indecisiveness is a diagnostic criterion.

x The community mental health nurse is providing care for a large number of clients. What client should the nurse monitor most closely for the warning signs of suicide? A young male with schizophrenia who is in danger of becoming homeless An adult female who is mourning the death of her husband 5 months ago An older adult client who has recently been diagnosed with early stage Alzheimer disease A middle-aged female client who is receiving treatment for obsessive-compulsive disorder

Correct response: A young male with schizophrenia who is in danger of becoming homeless Explanation: Being a young male, having a mental illness, and facing a situational crisis are all significant risk factors for suicide. This constellation of factors is likely to create a greater risk for suicide than a client with a new diagnosis of dementia, a bereaved client, or a client with obsessive-compulsive disorder.

The nurse is told by a client that the client is having suicidal thoughts. Which intervention has lowest priority? Determining the client's concerns and if the client has a plan Administering a mental status exam to assess for psychosis Maintaining a safe, secure environment Assessing the client for past history of suicidal attempts

Correct response: Administering a mental status exam to assess for psychosis Explanation: About 50% to 80% of people who commit suicide have previously attempted suicide; the more violent and lethal the plan, the higher the potential for suicide. Assessment of past attempts and current plan (not psychosis) as well as maintaining client safety would be priorities. Maintaining a safe, secure environment is an important intervention by the nurse to prevent a suicide attempt

The nurse conducts a seminar regarding suicide at the community center. Which fact about suicide should the nurse include in the teaching session? An active suicidal ideation is often short term and specific to the situation. Suicide only affects people who are diagnosed with a mental health condition. Suicide should not be spoken about of because this encourages it. Most cases of suicide happen very suddenly with no warning signs.

Correct response: An active suicidal ideation is often short term and specific to the situation. Explanation: There are many myths about suicide that must be clarified with factual information; this is essential to decreasing the stigma associated with suicide. A fact about suicide that the nurse should include in the seminar is that active suicidal ideation is often short term and specific to the situation that individual is currently facing. The other statements regarding suicide are myths.

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? The development of a panic disorder Turning toward alcohol or drugs Unpredictable behavior and a potential for risk-taking behaviors Anger toward the loved one who committed suicide

Correct response: Anger toward the loved one who committed suicide Explanation: 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? Hopelessness Discouragement Flat affect Anhedonia

Correct response: Anhedonia Explanation: 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 client's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action? Perform a Mini Mental Status Examination (MMSE) Assess the client's blood pressure Assess the client's jugular venous pressure Call an emergency code

Correct response: Assess the client's blood pressure Explanation: Combining phenelzine with beer can precipitate a hypertensive crisis. There is no immediate indication that an emergency code is needed. The client's jugular venous pressure is less likely to be affected and is not a priority for assessment. Performing the MMSE is not a short-term priority.

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

Correct response: Assessing all clients carefully to identify those at risk for suicide Explanation: 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.

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? Begin educating the client about food restrictions when taking fluoxetine. Call the therapist to discuss the need for a washout period before starting fluoxetine. Note in the medication administration record to check the client's blood pressure for the first 2 days after starting fluoxetine. Begin educating the client about selective serotonin reuptake inhibitors.

Correct response: Call the therapist to discuss the need for a washout period before starting fluoxetine. Explanation: 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. Reference:

A psychiatric-mental health nurse is conducting a refresher class for a group of psychiatric-mental health nurses returning to the field. After teaching about depressive disorders, the nurse determines a need for additional teaching when the class identifies which physical or psychological symptom as being associated with depression? Fatigue Insomnia Worthlessness Catatonia

Correct response: Catatonia Explanation: Catatonia is a state of motor or physical activity associated with manic states in bipolar illness. Catatonia is also seen in clients with schizophrenia who have periods of immobility interrupted by episodes of extreme agitation. Fatigue is a lack of energy common during a severely depressed state. Severely depressed clients frequently have difficulty falling asleep or wake early in the morning and are unable to go back to sleep as with insomnia. Feelings of worthlessness or excessive/inappropriate guilt are commonly associated with depression.

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? Depression in one family member affects the entire family. Families of women older than 55 years of age with depression experience the majority of problems. Abuse of the depressed person is a rare occurrence in families. Family members typically can understand how disabling depression can be.

Correct response: Depression in one family member affects the entire family. Explanation: 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? Onset of depression is common in adolescence Depression is twice as common in women than in men Depression is correlated with low intellectual ability Onset of depression is most common in middle-aged persons

Correct response: Depression is twice as common in women than in men Explanation: Depression is twice as common in women than in men. The onset of depression can happen at any age; onset is more com

A client on the psychiatric mental health unit completed suicide. A nurse who cared for the client has been experiencing insomnia and anxiety attacks since the event. What is the nurse's first action? Dialogue with a trusted colleague about these feelings Interact with other clients in order to witness improvements in their condition Confide in one of the psychiatrists who gives care on the unit Take a leave of absence until the symptoms have stopped

Correct response: Dialogue with a trusted colleague about these feelings Explanation: A nurse who has experienced secondary trauma may benefit from talking about his or her experience. It would be inappropriate to seek informal care from a psychiatrist on the unit, however. The nurse should likely try talking about the event and seeking outpatient treatment before taking a leave of absence. Interacting with other patients is unlikely to bring the nurse relief.

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

Correct response: Ensuring a plan is in place for the client's community-based care Explanation: 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.

During an interview, the nurse has asked a client with depression about any hopes or plans for the future. In response, the client silently made a gesture of drawing the index finger from one side of the client's throat to the other. The nurse has informed the client that this must be communicated to the care team. What is the main rationale for the nurse's action? Ensuring continuity of care Ensuring the client's safety Promoting collaborative practice Promoting the client's autonomy

Correct response: Ensuring the client's safety Explanation: Plans of suicide must be communicated in order to protect clients' safety. Even though this action is consistent with collaborative practice and continuity of care, safety is the priority rationale. This is a justifiable violation of the client's autonomy and privacy.

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

Correct response: Establishing a support system for the woman and teaching her some coping measures Explanation: 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 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? Explain to the client that untreated depression often becomes increasingly severe and frequent over time Document a nursing diagnosis of noncompliance and educate the client about the benefits of treatment Document a nursing diagnosis of ineffective denial and choose interventions accordingly Assess the client's knowledge of depression and describe the risks of suicide

Correct response: Explain to the client that untreated depression often becomes increasingly severe and frequent over time Explanation: 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.

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? Genetic predisposition Terminal illness Lack of conflict resolution skills Disengagement of family

Correct response: Genetic predisposition Explanation: 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.

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? Giving away valued personal items Angry outbursts at significant others Inquiry about doses of lethal drugs Experiencing the loss of a boyfriend or girlfriend

Correct response: Giving away valued personal items Explanation: 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

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

Correct response: Men are more likely to commit suicide than women are. Explanation: 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 is a true statement regarding depressive disorders? Depression in older adults is easier to diagnosis. Norepinephrine, dopamine, and serotonin have been implicated. They are more prevalent in men than women. It is the leading cause of U.S. disability in clients older than 44 years of age.

Correct response: Norepinephrine, dopamine, and serotonin have been implicated. Explanation: 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. Depressive disorders are more prevalent in women than in men. Depression in older adults may be difficult to diagnose because many older people have comorbid diseases. It is currently the leading cause of U.S. disability in clients 15 to 44 years of age.

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

Correct response: Older adult depression is often seen as "normal aging." Explanation: 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 client with major depression and a suicide attempt is admitted to the inpatient facility. The client is started on antidepressant therapy. The next day, the client demonstrates significantly higher energy and says, "I'll feel much better." The nurse would interpret this behavior as suggesting what? Effectiveness of the drug therapy An act to cover up the client's true feelings Possible decision to complete a suicide attempt A typical response to the medication

Correct response: Possible decision to complete a suicide attempt Explanation: In many cases, clients are admitted to the psychiatric hospital because of a suicide attempt. Suicidality should continually be evaluated, and the client should be protected from self-harm. During the depths of depression, clients may not have the energy to complete a suicide. As clients begin to feel better and have increased energy, they may be at a greater risk for suicide. If a previously depressed client appears to become energized overnight, he or she may have made a decision to commit suicide and thus may be relieved that the decision is finally made. The nurse may misinterpret the mood improvement as a positive move toward recovery; however, this client may be very intent on suicide. These individuals should be carefully monitored to maintain their safety. Antidepressants take several weeks to become effective.

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? Decreased complaints of pain Psychomotor retardation Increased energy level Increased focus

Correct response: Psychomotor retardation Explanation: 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.

The nurse is caring for a client with major depressive disorder who has been admitted to a psychiatric-mental health facility. After assessing the client, the nurse has developed a nursing diagnosis of "risk for violence toward others related to agitation and low tolerance level." Which would be an appropriate intervention for this client? Remove all dangerous items from the client's room. Encourage the client to engage in calming group activities. Encourage the client to act on thoughts that are leading to aggression. Provide antianxiety medication to prevent an incident.

Correct response: Remove all dangerous items from the client's room. Explanation: Establishing geographic boundaries, such as room restriction or half-hall restriction, is part of ongoing monitoring. Also, clients likely will have "as-needed" medications ordered; nurses use them if aggressive or agitated behavior escalates. Other environmental approaches include reducing stimuli and opportunities for interaction with other clients in the milieu. Nurses remove all dangerous items from the client's room and monitor closely for use of any dangerous items. Nurses help clients learn to recognize what triggers violent thoughts and behaviors. They teach clients not to act on these thoughts but to leave the situation and find a staff member to talk to about them.

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? Monoamine oxidase inhibitors Selective serotonin reuptake inhibitors Tricyclic antidepressants Serotonin norepinephrine reuptake inhibitors

Correct response: Selective serotonin reuptake inhibitors Explanation: 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.

According to the biochemical theory of mood disorders, a client with a diagnosis of depression is likely to have alterations in the levels and function of which neurotransmitters? Aspartate, gamma-Aminobutyric acid (GABA), and serine Acetylcholine, adenosine, and glutamate Serotonin, norepinephrine, and dopamine Epinephrine, histamine, and melatonin

Correct response: Serotonin, norepinephrine, and dopamine Explanation: Monoamines such as serotonin, norepinephrine, and dopamine have been implicated in the etiology of mood disorders such as depression.

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? Reality orientation Silence and active listening Direct confrontation Projective identification

Correct response: Silence and active listening Explanation: 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.

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? Ineffective coping related to marital disagreements Anxiety related to side effects of medication Ineffective activity planning related to depression Situational low self-esteem

Correct response: Situational low self-esteem Explanation: 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.

A client with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation? The client is tolerating the initial drug therapy. The client is experiencing catatonia. The level of depression is mild to moderate. Suicidality is of little concern.

Correct response: The client is experiencing catatonia. Explanation: Electroconvulsive therapy is an effective treatment for clients with severe depression. It is generally reserved for those whose disorder is refractory or intolerant to initial drug treatments and who are so severely ill that rapid treatment is required (e.g., clients with malnutrition, catatonia, or suicidality).

A client has been treated following a suicide attempt. When providing anticipatory guidance during the client's discharge education, the nurse should teach the client that: The client is likely to experience stigma around the suicide attempt from some people. A subsequent suicide attempt will likely cause the client to be declared legally incompetent. The client's long-term recovery will be primarily dependent on the adherence to group therapy. The client's commitment to treatment statement will be in effect for the next 6 months.

Correct response: The client is likely to experience stigma around the suicide attempt from some people. Explanation: Clients should be made aware that they are likely to face stigma from individuals who are uncomfortable with the topic of suicide. A commitment to treatment statement is not a binding document that is in effect for a fixed period of time. Determination of legal competence is made on the basis of numerous factors and variables. Many clients benefit from group therapy, but this is not considered to be the primary variable in long-term recovery.

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? The client has told the nurse, "I'm pretty sure my meds aren't working." The client told the nurse, "I just want to stop being a burden to my wife and kids." The client recently purchased a large bottle of over-the-counter analgesics The client stopped attending a depression support group, despite initially benefiting from it

Correct response: The client recently purchased a large bottle of over-the-counter analgesics Explanation: 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 client is hospitalized on a psychiatric unit secondary to a suicide attempt. The client has been diagnosed with depression and is consistently depressed. When assessing the client, which finding would alert the nurse that the client's suicidal risk has increased? The client is lethargic, remaining isolated from other clients. The client tells the nurse that the client feels as depressed as ever. The client says the client feels better, with more energy to interact with others The client's energy level and degree of depression remain the same.

Correct response: The client says the client feels better, with more energy to interact with others Explanation: During the depths of depression, clients may not have the energy to complete a suicide. As clients begin to feel better and have increased energy, they may be at a greater risk for suicide. If a previously depressed client appears to become energized overnight, he or she may have made a decision to commit suicide and thus may be relieved that the decision is finally made. The nurse may misinterpret the mood improvement as a positive move toward recovery; however, this client may be very intent on suicide. These individuals should be carefully monitored to maintain their safety.

A client with major depression has been prescribed escitalopram. The nurse should address what topic in client education? The possibility of gastrointestinal upset The possibility of weight loss Strategies for preventing orthostatic hypotension The need to avoid food containing tyramine

Correct response: The possibility of gastrointestinal upset Explanation: Gastrointestinal upset is the most common adverse effect of a selective serotonin reuptake inhibitor (SSRI). There is no need to avoid foods with tyramine. Weight gain is more likely than weight loss, and SSRIs do not cause orthostatic hypotension.

Which statement most accurately describes the relationship between psychiatric illness and suicide risk? According to the DSM-5, suicide is considered to be a psychiatric diagnosis in and of itself. The vast majority of people who commit suicide have a diagnosed mental disorder. Psychiatric-mental health clients are stereotyped as being at high risk of suicide, but this is untrue. Clients with depression are at increased risk of suicide, but suicide rates among persons with schizophrenia equal those of the general population.

Correct response: The vast majority of people who commit suicide have a diagnosed mental disorder. Explanation: Approximately 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder. These disorders are varied and include schizophrenia. Suicide is not a recognized diagnosis.

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

Correct response: They are less likely to complete suicide than men. Explanation: 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 completing a baseline assessment of a client with depression, which diagnostic tests would the nurse anticipate? Renal function tests Abdominal ultrasound Thyroid function tests Coagulation profile

Correct response: Thyroid function tests Explanation: A physical examination is recommended with baseline vital signs and baseline laboratory tests, including a comprehensive blood chemistry panel, complete blood counts, liver function tests, thyroid function tests, urinalysis, and electrocardiograms. These physical examinations can help to rule out any underlying medical conditions that may be causing or exacerbating an existing depression. The other diagnostic tests indicated in the options are not related to identifying underlying medical conditions that are commonly found comorbid to depression.

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

Correct response: Unexpressed and unconscious anger Explanation: 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.

The nurse is screening clients in the community for major depressive disorder (MDD). Which client has the greatest risk for developing MDD? a young adult male client of Hispanic heritage with a current diagnosis of substance use disorder an older adult male client of Native American/First Nations heritage who is diagnosed with diabetes mellitus an older adult female client of African descent with a personal history of depression a young adult White female client with a family history of depressive disorder

Correct response: a young adult White female client with a family history of depressive disorder Explanation: Risk factors for developing MDD include being a young adult between the ages of 18 and 29 years, female gender, and being White or of Native American/First Nations heritage. Additional risk factors include a prior episode of depression, a family history of depressive disorder, a lack of social support and coping abilities, the presence of environmental and life stressors, current substance use or abuse, and a medical or mental illness comorbidity. Based on this information, the young adult While female client with a family history of depressive disorder has four risk factors for MDD including age, gender, ethnicity, and family history of depressive disorder. The young adult male client of Hispanic heritage has two risk factors: age and current substance use disorder. The older adult male client of Native American/First Nations heritage has two risk factors for MDD: ethnicity and a personal history of depression, whereas the older adult female client of African descent also has two risk factors for MDD: gender and a medical comorbidity of diabetes mellitus.

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? fears of growing older diagnosed with an acute illness starting a new business with friends experiencing unemployment that has lasted a year

Correct response: experiencing unemployment that has lasted a year Explanation: 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 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? Encouraging attendance at group cognitive-behavioral therapy on the unit. Ensuring that the client is not permitted to use anything that would be potentially dangerous. Encouraging the client to express feelings of isolation following the recent immigration. Exploring the grief and loss issues concerning the baby's death.

Ensuring that the client is not permitted to use anything that would be potentially dangerous. Explanation: 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.

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

"Do you ever feel like your situation is hopeless?" Explanation: 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.

Which question by a depressed, inpatient, psychiatric-mental health client should the nurse interpret as a potential suicide clue? "When do you think the doctor will let me get my street clothes back?" "Are clients allowed to keep drugstore medications at their bedside?" "When is my next scheduled electroconvulsive therapy session?" "Are we allowed to use the client kitchen whenever we want?"

Correct response: "Are clients allowed to keep drugstore medications at their bedside?" Explanation: Asking whether medications can be kept at the bedside is a suspicious question if a client is depressed and may precede an attempted overdose. The other questions are not necessarily suggestive of suicidal ideation.

Which question should the nurse ask to assess the client's degree of suicide planning when the client states, "Everyone would be better off without me. I will just use my gun to end it all!"? "Is there anyone who might keep you from doing this?" "Do you have access to a firearm?" "How often do you have these thoughts?" "Is this thought increasing in frequency?"

Correct response: "Do you have access to a firearm?" Explanation: Questions to ask when assessing a client's suicidal episode are placed into three categories: intent to die, severity of ideation, and degree of planning. A question to ask when assessing the client's degree of suicide planning is, "Do you have access to a firearm?" The other questions assess the intent to die and the degree of planning.

A nursing instructor is teaching about depressive disorders and identifies a need for further instruction when a student states what? "Dysthymic disorder is milder than major depression." "Dysthymic disorder is less chronic than major depression." "It is also known as persistent depressive disorder." "Major depression may be preceded by dysthymic disorder."

Correct response: "Dysthymic disorder is less chronic than major depression." Explanation: Persistent depressive disorder (dysthymic disorder) is a long duration mood disorder that has a lower intensity of depressive symptomatology. It may precede major depression.

The nurse who is developing a suicide prevention strategy would need to ensure which step is included? Select all that apply. Following up with interventions to prevent suicide in the future Using assertive interventions if there is a threat of suicide Consulting with family members about risk for suicide Figuring out who is at risk for suicide Determining imminent risk of suicide

Figuring out who is at risk for suicide Determining imminent risk of suicide Using assertive interventions if there is a threat of suicide Following up with interventions to prevent suicide in the future Explanation: The beginning evidence points to four steps in preventing suicide and promoting long-term mental health: identification of those thinking about suicide (case finding), assessment to determine an imminent suicidal threat, intervening to change suicidal behavior associated with a specific suicidal threat, and institution of effective interventions to prevent future episodes of suicidal behavior. Consulting with family members about the risk for suicide is not one of the four steps that have been identified in the research as evidence to support actions of health care providers in intervening and preventing suicide.

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

Inpatient care Explanation: 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 newly admitted client's history includes multiple suicide attempts. How can the nurse on the psychiatric-mental health unit best protect the client's safety? Performing vigilant assessment and close observation Facilitating a referral for cognitive behavioral therapy Administering the client's prescribed selective serotonin reuptake inhibitor Establishing a no-suicide contract with the client

Performing vigilant assessment and close observation Explanation: Assessment and observation are among the core nursing actions to prevent suicide. Medication is a cornerstone of treatment but does not prevent suicide in and of itself. No-suicide contracts have not been shown to be effective. Therapy is not always indicated for all clients and does not supersede assessment and observation as a safety measure.

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

Promptly act on, and document, the client's statement. Explanation: 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 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? The client will identify factors that contribute to depression. The client will reframe negative thoughts in a more positive way. The client will differentiate between reality and fantasy. The client will discuss the cause of the fatigue.

The client will reframe negative thoughts in a more positive way. Explanation: 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.

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? "Are you thinking about killing yourself right now?" "Do you have people in your life who are supportive of you?" "How do you generally cope with problems in your life?" "Are you a religious person?"

orrect response: "Are you thinking about killing yourself right now?" Explanation: 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?

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

orrect response: Moderate depression Explanation: 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.

The nurse provides care for a client who is depressed and expresses hopelessness with the current situation. Which client statement indicates a need to implement safety precautions? "I decided that I should stop drinking alcohol for a while." "I just started my new medication and I hope to feel better soon." "I just started a new job so at least I have that." "I haven't been able to sleep for the past week because I am anxious."

Correct response: "I haven't been able to sleep for the past week because I am anxious." Explanation: Identification of clients who are considering suicide is a priority nursing action. The nurse can use the mnemonic IS PATH WARM to assess the client for warning signs for suicide. The A in this mnemonic stands for anxiety and may be manifested by an inability to sleep; therefore, the statement that indicates a need to explore the implementation of safety precautions is, "I haven't been able to sleep for the past week." Starting a new antidepressant and stating, "I hope I feel better soon; I decided that I should stop drinking alcohol for a while; I just started a new job so at least I have that." do not correspond with any of the warning signs for suicide.

A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition? Electroconvulsive therapy Antidepressant therapy Psychotherapy Light therapy

Correct response: Light therapy Explanation: Phototherapy has proven effective for clients with symptoms of depression associated with a seasonal pattern. This condition, called seasonal affective disorder, may be related to lack of light and decreased melatonin production.

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

Correct response: "Some people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer." Explanation: 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 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? "Excellent! This shows that you're nearly recovered from your depression." "That shows an admirable level of perseverance on your part. Well done!" "Many people who are battling depression find that support groups are beneficial." "You really showed that you're able to rise above your fear and anxiety."

Correct response: "That shows an admirable level of perseverance on your part. Well done!" Explanation: 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.

A 38-year-old client has been diagnosed with major depressive disorder. The client is being placed on an antidepressant and the nurse is providing medication teaching. Which would be appropriate information to provide to the client? "The antidepressant's ability to affect the neurons in your brain will take between 2 to 6 weeks." "If you do not notice an improvement in your symptoms in 1 to 2 weeks, a different antidepressant will be prescribed." "You may not notice an improvement in your symptoms for 2 to 6 weeks." "You should notice an immediate improvement in your mood."

Correct response: "You may not notice an improvement in your symptoms for 2 to 6 weeks." Explanation: In general, all antidepressants act at the level of the neuron. Their effects include changing the receptor itself, altering metabolism and breakdown of the neurochemical, or blocking reuptake of the neurochemical at the presynaptic receptor. These changes occur soon after the medication is administered; however, reduction in depressive signs and symptoms usually takes between 2 to 6 weeks, depending on the drug.

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

Correct response: 14 days Explanation: 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.

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? Euphoria along with poor decision making ability A stooped posture and nonverbal signs of a depressed mood Disregard for personal hygiene including cleanliness and appearance A loss of interest or inability to derive pleasure for previously enjoyed activities

Correct response: A loss of interest or inability to derive pleasure for previously enjoyed activities Explanation: 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..

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

Correct response: Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. Explanation: 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."

A client has just been admitted to the inpatient psychiatry unit following a suicide attempt. During the client's first 24 hours of care, what outcome should be identified? Client will participate actively in cognitive behavioral therapy Client will express that the client feels safe on the unit Client will state that the client feels optimistic about the client's future Client will implement strategies for managing stress

Correct response: Client will express that the client feels safe on the unit Explanation: The initial care of a client who has had a suicide attempt focuses on helping the client feel safe and instilling the beginnings of hope. It would be premature to expect the client to learn and apply new stress management strategies after only 24 hours. Cognitive behavioral therapy would not begin during the acute stage of recovery. A sense of overall optimism will likely require long-term therapy to achieve it.

When assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client? Long-term memory impairment Full of energy Confusion Numbness and tingling in the extremities

Correct response: Confusion Explanation: 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.

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? Suicide Sleep disturbance Dehydration Decreased energy

Correct response: Dehydration Explanation: 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

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

Correct response: First 3 months Explanation: The first 2 years after a suicide attempt represent the highest risk period, especially the first 3 months.

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what? Initial insomnia Hypersomnia Terminal insomnia Middle insomnia

Correct response: Middle insomnia Explanation: 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). Reference:

Which biogenic amines have been implicated in depression? Dopamine and histamine Epinephrine and serotonin Norepinephrine and serotonin Epinephrine and dopamine

Correct response: Norepinephrine and serotonin Explanation: 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? Diarrhea and electrolyte imbalance Pseudoparkinsonism and tardive dyskinesia Orthostatic hypotension and urinary retention Photosensitivity and skin rashes

Correct response: Orthostatic hypotension and urinary retention Explanation: 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.

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

Correct response: Prevent self-destructive behavior. Explanation: 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 has attempted suicide has an underlying diagnosis of depression. Which medication would the nurse anticipate being ordered for the client? Mood stabilizer Atypical antipsychotic Selective serotonin reuptake inhibitor Tricyclic antidepressant

Correct response: Selective serotonin reuptake inhibitor Explanation: Medication management focuses on treating the underlying psychiatric disorder. For depression, a nonlethal antidepressant (e.g., selective serotonin reuptake inhibitor) usually is prescribed. For clients with schizophrenia and schizoaffective disorder, antipsychotics may be used; however, only clozapine, an atypical antipsychotic, has been shown to be effective.

A mental health nurse has formed a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. An appropriate outcome for this nursing diagnosis would include what? The client will identify factors that reduce activity tolerance. The client will demonstrate improved ability to express self. The client will differentiate between reality and fantasy. The client will discuss the cause of the fatigue.

Correct response: The client will demonstrate improved ability to express self. Explanation: An appropriate outcome would include demonstrating improved ability to express self.

The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should ... assess for depression in the client's family history. encourage the client to seek genetic counseling before considering a pregnancy. prepare the client for diagnostic genetic testing to confirm the diagnosis. educate the client regarding the symptoms of related physical disorders.

Correct response: assess for depression in the client's family history. Explanation: The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should assess for depression in the client's family history.

Family education concerning the safe care of a client with a history of suicide attempts includes what? Select all that apply. Signs and symptoms that indicate a mood change that could indicate the client is suicidal List of emergency service telephone numbers Techniques to help the client cope with known triggers Information regarding the stressors that trigger the client's suicidal ideations Information on how to determine if the threat of suicide is legitimate

Signs and symptoms that indicate a mood change that could indicate the client is suicidal Information regarding the stressors that trigger the client's suicidal ideations Techniques to help the client cope with known triggers List of emergency service telephone numbers Explanation: Family education should include information regarding recognizing changes in mood or behavior that could indicate a plan for self-injury (e.g., irritability, anger, agitation, withdrawal, or self-deprecating comments) and notify the client's health care provider. It should also include how to anticipate future stressors that trigger the client, along with information regarding how to assist the client with coping skills. Also important to family education is information regarding a 24-hour emergency hotline phone number—and the need to keep the information readily available.

The mental health nurse appropriately provides education on light therapy to which client? 58-year-old showing signs of early Alzheimer's disease 45-year-old lawyer whose medication therapy needs an additional treatment 50-year-old farmer whose major depression has not responded to any treatment modality 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

Correct response: 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term Explanation: Phototherapy—or the exposure to bright artificial light—can markedly reverse the symptoms of seasonal affective disorder, which occurs in the fall and winter. Phototherapy would be most appropriate for a 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term.

A high risk for suicide would be assessed as what? Adequate sleep pattern Feelings of self-worth Support systems available Previous suicidal behavior

Correct response: Previous suicidal behavior Explanation: Previous suicidal behaviors increase the risk of suicide.

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 likely assess which physiologic symptoms of depression? Guilt, indecisiveness, and poor self-concept Meticulous attention to grooming and hygiene Anxiety, unconscious anger, and hostility Psychomotor retardation and poor appetite

Correct response: Psychomotor retardation and poor appetite Explanation: Psychomotor retardation or agitation, often accompanies depression. The incorrect answers are not physiologic or somatic but psychological or functional symptoms of depression. Usually in depressive illness, grooming and hygiene are not tended to.

A nurse is providing a presentation about suicide for a group of health professionals. Which would the nurse address as a major contributor to the rising suicide rate among men? Substance abuse Lack of conflict resolution skills Parenting practices Media influences

Correct response: Substance abuse Explanation: Substance abuse, aggression, hopelessness, emotion-focused coping, social isolation, and lack of purpose in life have been associated with suicidal behavior in men. In addition, just under 50% of suicide attempts among men between the ages of 42 and 77 years involve firearms. The media, lack of conflict resolution skills, and parenting practices can play a role but are not considered major factors.

A nurse is with an adolescent who reports nothing to live for and wishing to be dead. Which nursing action would be the priority? Going to the client's psychiatrist to report the suicidal ideation Ascertaining the client's beliefs about what happens when you die Staying with the client to explore more of the client's thoughts about suicide Putting the client in seclusion with a staff member assigned to watch the client at all times

Staying with the client to explore more of the client's thoughts about suicide Explanation: A true psychiatric emergency exists when an individual presents with one or more symptoms associated with imminent risk for suicidal behavior. The first priority is to provide for the client's safety while initiating the least restrictive care possible. Staying with the client and further exploring the client's thoughts about suicide will enhance safety and allow the nurse to more thoroughly understand the extent of the client's suicidal risk. It would not be appropriate to leave the client alone while the nurse goes to talk with the psychiatrist. Seclusion would be used only as a last resort because it is a highly restrictive environment. Determining the client's beliefs about death would be a topic to be addressed much later in the process.