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Psych Prep U Mood Disorders and Suicide

Terms in this set (100)

Limit setting is most appropriate in which client population?
Manic

Most of the time, anxious, depressed, and suicidal clients do not test the limits of the caregiver.
Which statement regarding gender and suicide is correct?
Females engage in suicidal behaviors more frequently than males.

While females engage in suicidal behaviors approximately three times more frequently than males, males are at least four times more likely to die from suicide. This outcome may be because men generally tend to choose more violent methods. In the United States, two thirds of male suicide victims die by firearm. The most common cause of death by suicide in women is overdose or poisoning.
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 demonstrate improved ability to express self.

An appropriate outcome would include demonstrating improved ability to express self.
Which question by a depressed, inpatient, psychiatric-mental health client should the nurse interpret as a potential suicide clue?
"Are clients allowed to keep drugstore medications at their bedside?"

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 is an accurate statement regarding women and suicide?
They are less likely to complete suicide than men.

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.
Which antidepressant medication is classified as a selective serotonin reuptake inhibitor (SSRI)?
Fluoxetine

Fluoxetine is included among the SSRIs. Phenelzine, isocarboxazid, and tranylcypromine are monoamine oxidase inhibitors (MAOIs).
A client who otherwise is healthy is admitted for depression and reports feeling all alone. The client says the client recently lost the client's spouse to divorce. The client admits to drinking at least 12 beers every day. The client is at risk for which problem?
Medical comorbidity

Risk factors for depression include prior history of depression, family history of depressive disorder, lack of social support, lack of coping abilities, presence of life and environmental stressors, current substance use or abuse, and medical comorbidity. This client's assessment findings do not include a family history or prior history of depression or any other health issues.
A nursing student is caring for an elderly client who is taking sertraline for depression. The instructor quizzes the student about the medication and its actions. To what classification of drugs should the student assign sertraline?
Selective serotonin reuptake inhibitor

Sertraline is a selective serotonin reuptake inhibitor.
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?
"There's no demonstrated benefit of no-suicide contracts, though they're not believed to be harmful."

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'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?
Assess the client's blood pressure

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.
When assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client?
Confusion

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.
Which statement about bipolar disorders and gender is correct?
Bipolar I and II occur almost equally in men and women.

Bipolar I disorder affects men and women equally. Women are more likely to experience mixed mania and manic switches during treatment with antidepressants.
Which sleep pattern is suggestive of a manic episode?
A client stays awake for several days and nights before "crashing" and sleeping for a long period

During a manic episode, an individual will typically go several nights without sleep before collapsing from exhaustion.
Which statement most accurately describes the relationship between psychiatric illness and suicide risk?
The vast majority of people who commit suicide have a diagnosed mental disorder.

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.
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?
Establishing a support system for the woman and teaching her some coping measures.

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 nurse is caring for a group of hospitalized clients with various psychiatric diagnoses. The nurse identifies which client as having the highest risk for a suicide attempt?
Man with major depressive disorder

Men have a higher suicide completion rate than women. For men, suicide is the eighth leading cause of death, with a rate of 17.5 per 100,000—more than four times the rate in women. White men complete 73% of all suicides; 80% of these deaths are by firearms. Men are more likely to use means that have a higher rate of success, such as firearms and hanging. Most suicide deaths occur in men with a psychiatric disorder, primarily depression, in many cases complicated by substance abuse.
During assessment of a client with depression, the client states, "I just feel so sad and hopeless. I just don't care anymore. I don't even enjoy doing the crossword puzzles like I used to." The nurse documents this finding as indicative of what?
Anhedonia

The client's statements reflect anhedonia, a loss of interest or pleasures such that the client does not experience any enjoyment in activities that were previously considered pleasurable. Dysthymic disorder is a milder but more chronic depression. Delusion is manifested as false, fixed beliefs. Psychosis is a state in which a person experiences symptoms such as hallucinations, delusions, or disorganized thoughts, speech, or behavior
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?
Ensuring that the client is not permitted to use anything that would be potentially dangerous.

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.
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?
"You'll need to continue the medication for about 6 to 12 months to see how things go."

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 indefinitely
Which is a true statement regarding depressive disorders?
The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated.

The neurotransmitters norepinephrine, dopamine, and serotonin have been associated with depression. Individuals between the ages of 18 to 29 years have a three times higher prevalence rate than those age 60 and older. The prevalence rates for females and males differ with females experiencing "a 1.5 - 3-fold higher rate than males beginning in early adolescence." Depressive symptomatology in older adults is more difficult to diagnose because it may be confused with symptoms of dementia or cerebrovascular accidents. Depression is the leading cause of years lost because of disability.
The major difference between bipolar I and bipolar II disorder is what?
Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances.

Bipolar II disorder is characterized by a major depressive episode (either current or past) and at least one hypomanic episode. Bipolar II disorder differs from bipolar I in that the client has never had a manic or mixed episode but may have had an episode in which he/she experienced a persistently elevated, expansive, or irritable mood. The hypomanic symptoms are not severe enough to cause marked social or occupational dysfunction.
Which would be the priority diagnosis for the client in the manic phase of bipolar disorder who is exhibiting aggressive behavior?
Risk for other-directed violence

The priority nursing diagnosis is risk for other-directed violence. The other diagnoses are utilized for the client in the manic phase of bipolar disorder but are not the priority in this situation.
A 46-year-old client thinks he or she might be suffering from depression. Which must be present for a diagnosis of major depressive disorder to be made?
A loss of interest or inability to derive pleasure for previously enjoyed activities

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
The nurse is told by a client that the client is having suicidal thoughts. Which intervention has lowest priority?
Administering a mental status exam to assess for psychosis

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.
Which mental health disorder has the most significant risk factor for suicide?
Depression

Depression is a major risk factor of suicide. Anxiety, schizophrenia, and mania are significant risk factors but to a lesser degree than depression.
A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. The client's suicidal risk has lessened considerably, and the client currently denies having any desire to kill himself or herself. In addition, the client is able to identify reasons why the client wants to be alive. Which nursing intervention would be most appropriate at this time?
Developing a personal plan for managing suicidal thoughts when they occur

The client's immediate suicidal crisis has subsided, and it is now appropriate for the nurse to focus on working with the client on symptom management. Preventing suicidal behavior requires that clients develop crisis management strategies, generate solutions to difficult life circumstances other than suicide, engage in effective interpersonal interactions, and maintain hope. The nurse can help the client develop a written plan that can be used as a blueprint for action when the client feels like the client is losing control. The plan should include strategies that the client can use to self-soothe; friends and family members who could be called (including multiple phone numbers where they can be reached); self-help groups and services such as suicide hotlines; and professional resources, including emergency departments and outpatient emergency psychiatric services. Medications that increase serotonin levels may be prescribed. The role of electroconvulsive therapy to decrease suicidal behavior is under investigation.
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

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.
A client in an acute manic phase is pacing the halls and talking in a loud voice with pressured speech. The client is overly involved with coclients and frequently threatens and disrupts others on the unit. After administering lithium treatment for the client, the nurse can expect the plan of care to include which additional intervention?
Monitoring blood levels of the medication.

Lithium is the drug of choice for clients with bipolar illness and has a high antimanic effectiveness. Lithium decreases the intensity, frequency, and duration of manic and depressive episodes. Blood levels need to be monitored for therapeutic levels during the acute phase (1.0-1.5 mEq/L) and during longer term maintenance. Other treatments that could be expected for clients during mania include sedatives or antipsychotics. Electroconvulsive therapy, phototherapy, and monoamine oxidase inhibitors are not typically indicated during manic phases
A client who has just been prescribed lithium for bipolar disorder is being given education from the nurse about this medication. Which is important for the nurse to include in teaching?
The higher the sodium level, the lower the lithium level will be.

Lithium is a salt, so the interaction between lithium and sodium levels in the body and between lithium level and fluid volume in the body are crucial issues to consider. The higher the sodium levels, the lower the lithium level will be and vice versa. The other options do not represent correct information.
A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what?
Side effect

Lithium has many side effects that can be handled with interventions. For diarrhea, the nurse can instruct the client to take the medication with meals and provide for fluid replacement. The nurse should tell the client to notify the prescriber if the diarrhea becomes severe—this development can be an early sign of lithium toxicity, which would warrant a change in medication. Diarrhea is not a toxic or desired effect. The therapeutic effect is the intended effect of a drug.
When conducting a suicide risk assessment, the nurse understands that which method has the least lethality?
Wrist slashing

The least lethal of the options is wrist slashing. Hanging, overdose of benzodiazepines, and jumping are more lethal methods of suicide.
Which medication classification has been effective in stabilizing moods in people with bipolar disorder?
Anticonvulsants

Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness
Nursing interventions for the depressed person should include which approach?
Acceptance, honesty, empathy, and patience

When working with depressed individuals, it is most therapeutic to maintain an attitude of acceptance, honesty, empathy, and patience. Being too cheerful can convey a nongenuine approach. Being too businesslike can convey the attitude of not having time to care for the client, and confrontation is not necessary under the condition of depression.
The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what?
Prevent self-destructive behavior.

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.
Which is the greatest predictor of a future suicide attempt?
Previous attempt

The greatest predictor of a future suicide attempt is a previous attempt, in part because that individual already has broken the "taboo" around suicidal behavior. Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, and suicide planning.
Which psychotropic medication is administered based on an individualized dosage according to blood levels of the drug?
Lithium carbonate

The doses of lithium (an antimania drug) are individualized, based on a standardized safe level of 0.6 to 1.2 mEq/L. The other doses are not based on blood levels but by other standards, individual responses, and tolerance.
A client receiving lithium therapy has a plasma blood concentration of 2.2 mEq/L. Which would the nurse expect to assess?
Slurred speech

A plasma lithium concentration of 2.2 mEq/L indicates moderate toxicity, which would be evidenced by slurred speech, lack of coordination, mild to moderate ataxia, and severe diarrhea. A fine resting hand tremor, loose stools, and muscular weakness are mild side effects which are seen with plasma concentrations less than 1.5 mEq/L.
A psychiatric nurse's colleague has expressed a reluctance to assess a client's risk for suicide, stating, "The last thing I want to do is to plant the thought in the client's head and bring on a suicide attempt." What is the nurse's best response?
"Evidence shows that talking about suicide with clients doesn't cause suicide attempts."

It is untrue that asking clients about suicide provokes suicide attempts. However, it not true that nurses are powerless to influence clients' thoughts and actions around suicide in general. The colleague's reluctance is likely motivated by incorrect knowledge, not countertransference.
Environmental factors may be associated with suicidal behavior. Which is an environmental factor?
Job loss
Which is an anticonvulsant used as a mood stabilizer?
Divalproex

Divalproex is an anticonvulsant that may be used as a mood stabilizer. Venlafaxine, bupropion, and phenelzine are antidepressants.
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?
"You may not notice an improvement in your symptoms for 2 to 6 weeks."
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.

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.
After observing a bipolar client on the mental health unit, the nurse determines that the client is at risk for violence. Which would be an appropriate intervention?
Restrict the client to the client's room until the client can calm down.

If clients are determined to be at risk for violence, establishing geographic boundaries, such as room or half-hall restriction, is part of ongoing monitoring. Other environmental approaches include reducing stimuli and opportunities for interaction with other clients. Nurses remove all dangerous items from client rooms and monitor closely for use of any dangerous items. A pen or pencil that is used to write a letter can be a dangerous object.
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

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
A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the client will have to demonstrate specific symptoms. The nurse knows that some of these symptoms include what? Select all that apply
Disruption in sleep
Disruption in appetite
Disruption in concentration
Excessive guilt

Four of seven symptoms must be present along with the episodes of depressed mood to qualify for a diagnosis of major depressive disorder. Symptoms include disruption in sleep, appetite, concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation.
When caring for a client with mania, which would the nurse most likely assess?
Unusual self-confidence

Mania is easily recognized by the cognitive changes that occur. Elevated self-esteem is expressed as grandiosity (exaggerating personal importance) and may range from unusual self-confidence to grandiose delusions. Speech is pressured; the person is more talkative than usual and at times is difficult to interrupt. There is often a flight of ideas (illogical connections between thoughts) or racing thoughts. Distractibility increases.
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?
"I'm obliged to share what we talk about with the other people on your care team."

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.
Which medication classification is considered first-line drug therapy for bipolar disorder?
Mood stabilizers

Mood stabilizers are first-line drugs for bipolar disorders. They stabilize depressive and manic cycles.
A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy?
Liver function

Baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy, and clients with known liver disease should not be given divalproex sodium. There is a boxed warning for hepatotoxicity. Thyroid level, WBC count, and cardiac enzymes do not have to be performed routinely before starting this medication.
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've been drinking about three or four more beers every night."
"Most times, I feel like I'm trapped with no way out."
"I'm so tired that all I ever want to do is sleep all the time.
A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of what?
Grandiosity

Grandiosity is elevated self-esteem and may range from unusual self-confidence to grandiose delusions. Speech is pressured; the person is more talkative than usual and at times is difficult to interrupt. There is often a flight of ideas or racing thoughts.
A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications?
Carbamazepine

Carbamazepine is an anticonvulsant with mood-stabilizing effects. Lithium is a mood stabilizer. Mannitol and methyldopa are not used in the treatment of bipolar disorder.
A nurse is caring for a client diagnosed with bipolar disorder. The client is experiencing a manic episode. The nurse would be especially alert for signs indicating what?
Self-injury

During a manic episode, client safety is a priority. Risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may believe that life is not worth living. During a manic episode, the client may believe that he or she has supernatural powers, such as the ability to fly. Although changes in sleep, fluid balance (such as dehydration), and inadequate nutrition manifested by weight loss would be important to assess, safety and prevention of self-injury are the priority.
After educating a class on the etiology of bipolar disorders, a nursing instructor determines that the education was successful when the class describes the kindling theory as involving what?
Exposure to repetitive subthreshold stressors at vulnerable times

The kindling theory posits that as genetically predisposed individuals experience repetitive, subthreshold stressors at vulnerable times, mood symptoms of increasing intensity and duration occur. Eventually, a full-blown depressive or manic episode erupts. Each episode leaves a trace and increases the person's vulnerability, or sensitizes the person to have another episode with less stimulation. Chronobiologic theories suggest that circadian dysregulation underlies the sleep-wake disturbances of bipolar disorder. Research related to genetic factors suggests that bipolar disorder is highly heritable, although no one gene or sequence of genes is responsible for the pathology of bipolar disorders. The allostatic load (or "wear and tear" on the body model) bipolar disorder is viewed as a disorder where the allostatic load increases as the number of mood episodes increases, leading to an increase in physical and mental health problems.
Following a change in job position, a minister asks a client how the client likes the new job. The client states, "Oh everything is great. I can really see myself going far in this new position." However, the client's voice is monotone and the client's face is nearly absent of affective expression. The minister is worried about this client and describes this facial expression as what?
Flat

Several terms are used to describe affect. Flat refers to an absent or nearly absent affective expression. Inappropriate describes a discordant affective expression accompanying the content of speech or ideation. Blunted refers to a significantly reduced intensity of emotional expression. Restricted or constricted indicates that there is a mild reduction in the range and intensity of emotional expression.
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 psychodynamic interpretation of the client's major depressive disorder.

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

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 client has been diagnosed with major depression and placed on amitriptyline. Which is a side effect of amitriptyline?
Orthostatic hypotension

Side effects of amitriptyline include orthostatic hypotension, constipation, weight gain, and dry mouth.
A nurse is giving a presentation on mental health promotion at a community center. A participant states, "My friend tells me I'm depressed because I don't have a lot of energy and have trouble concentrating. I had to quit my full-time job because I don't seem to have the energy to manage it. But I don't want to kill myself or anything like that." Although more data are needed for diagnosis, the nurse suspects that the client may have what?
Dysthymic disorder

Dysthymia is a mild depressive illness in which symptoms, such as poor appetite or overeating, insomnia or excessive sleep, low energy, fatigue, low self-esteem, poor concentration, and difficulty making decisions, are chronic but less severe than with major depression. Diagnostic criteria include depressed or irritable mood most of the day, occurring more days than not for at least 2 years.
A 30-year-old woman has been brought to the emergency department after causing a disturbance. She is wearing a pair of tight, pink yoga pants, high heels, a sports bra, and a bright-colored hat. The woman's care providers would recognize that the woman's dress may suggest what?
Mania

Physical appearance is a factor that influences communication; the client with mania may dress in brightly colored clothes with several items of jewelry and excessive makeup.
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
Silence and active listening

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.
A nurse is developing an education plan for a client who is prescribed escitalopram. Which side effect would the nurse include in this plan? Select all that apply.
Weight gain
Decreased sexual interest

Escitalopram is a selective serotonin reuptake inhibitor. Common side effects include weight gain, diminished sexual interest and performance, headaches, gastrointestinal symptoms, insomnia, and agitation. Sedation, blurred vision, urinary retention, and dry mouth are more commonly associated with tricyclic antidepressants.
During assessment of a client with depression, the client states, "I just feel so sad and hopeless. I just don't care anymore. I don't even enjoy doing the crossword puzzles like I used to." The nurse documents this finding as indicative of what?
Anhedonia

The client's statements reflect anhedonia, a loss of interest or pleasures such that the client does not experience any enjoyment in activities that were previously considered pleasurable. Dysthymic disorder is a milder but more chronic depression. Delusion is manifested as false, fixed beliefs. Psychosis is a state in which a person experiences symptoms such as hallucinations, delusions, or disorganized thoughts, speech, or behavior.
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 reframe negative thoughts in a more positive way.

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.
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?
Light therapy

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 35-year-old client with bipolar disorder has a history of discontinuing medication when feeling well and then becoming manic again. During the client's last episode of mania, the client lost several thousand dollars in risky investments. Which intervention will be most helpful in achieving medication adherence?
During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse.

To help link the importance of taking medication with relapse prevention, the nurse lists target symptoms and identifies signs of imminent relapse. The nurse engages in problem solving with the client about early management of symptoms so severity does not increase.
The nurse is seeing a 26-year-old client and the client's family. The client's family describes the client as being "very, very different." The family describes a history of periods of unpredictable behavior and disregard for consequences occurring a few times each year. The client has recently been diagnosed with bipolar I disorder, a condition that is characterized by what?
An elevated mood that lasts for at least 1 week

During manic episodes that characterize bipolar disorder, the individual exhibits an abnormal, persistently elevated, or irritable mood that lasts for at least 1 week. Failure to respond to treatment, the presence of signs of depression without anhedonia, and the client's admission of a mood disorder are neither diagnostic nor typical of bipolar disorder
Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what?
Moderate depression

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.
A client who has attempted suicide has an underlying diagnosis of depression. Which would the nurse anticipate being ordered for the client?
Selective serotonin reuptake inhibitor

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 nurse is preparing to assess a middle-aged client who was brought to the emergency department by the client's spouse. The spouse reports that the client has been "extremely depressed lately." When assessing this client, which would be a priority assessment?
Thoughts of self-harm

Although appetite and weight changes, sleep disturbances, decreased energy, and fatigue are important indicators for the severity of depression, identifying the possibility of self-harm (suicide) is always a priority in clients who are depressed.
Which best defines the term suicide?
Thinking about and planning one's own death

The term "suicide ideation" is the thinking about and planning one's own death. Parasuicide is an unsuccessful attempt at suicide.
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?
Dehydration

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 weight loss.
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
Psychomotor retardation

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.
Which statement regarding suicide is correct?
Suicide has profound effects on those connected to the individual.
A client who has a recent diagnosis of bipolar I disorder is scheduled to begin therapy with lithium. Which instruction should the nurse provide to this client?
"Avoid exercise at the hottest times of the day."

Heavy perspiration increases the possibility of adverse effects during lithium therapy. A high-fluid diet with normal levels of salt is indicated, and doses should not be independently adjusted
A client's physician has prescribed paroxetine for the treatment of the client's depression. Which teaching points should the nurse include in the client education related to this treatment?
"Make sure that you don't change the quantity or timing of your medication without first consulting your doctor."

During client education, it is necessary to stress the importance of consulting the prescriber before discontinuing or changing the dosing of any medication. Paroxetine, like all drugs, carries the potential of adverse side effects.
A nurse is providing a presentation about suicide for a group of health professionals. Which would the nurse address as a major contributing factor to the rising suicide rate among men?
Substance abuse

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.
Trying to kill oneself and surviving the ordeal is identified as what?
Suicide attempt
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?
Selective serotonin reuptake inhibitors

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.
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

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.
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.

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.
A nurse is providing psycho-education to a client who has been admitted to the inpatient mental health unit for a manic episode. In order to ensure the teaching is effective, the nurse must first determine which regarding the client?
Ability to concentrate and process the information

To best assure successful outcomes related to client education of an individual experiencing a manic episode, the nurse's initial assessment is focused on the client's ability to concentrate and process the information.
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
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

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

The first 2 years after a suicide attempt represent the highest risk period, especially the first 3 months.
Which biogenic amines have been implicated in depression?
Norepinephrine and serotonin

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 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 people experience mild confusion after ECT. Generally it clears in a few days, though it may take longer

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 nurse is preparing a client for discharge. As part of the discharge process, the nurse provides education to the client regarding safety from self-harm. Which intervention should the nurse employ?
Include family members to provide a better understanding of symptoms of the illness

In addition to trying to reduce the stigma that the client and family may associate with suicide, the nurse must educate them about depression, suicidal behavior, and treatments. When possible, the nurse should schedule educational sessions to include significant others so that they will better understand the client's illness and also learn what is necessary in providing outpatient care.
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?
"How often are you having thoughts about suicide this morning?"

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 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 recently purchased a large bottle of over-the-counter analgesics

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.
The nurse is planning the inpatient care of a client who has been admitted with major depression. The client's plan of care includes regular exercise, but the client is reluctant to participate due to a lack of energy and motivation. What is the nurse's best action?
Collaborate with the client to choose a manageable amount of exercise and acknowledge the client's subsequent effort

In general, a good approach is to collaborate with the client to find an agreeable solution. Energy levels do not change in the short term following antidepressant administration. Threatening the loss of privileges is an inappropriate and unnecessary approach. The nurse should not accommodate the client's remaining in bed unless it is a necessity.
The mental health nurse appropriately provides education on light therapy to which client?
20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

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 46-year-old client has been diagnosed with major depressive disorder. The client is seeing a nurse practitioner who is deciding on an appropriate treatment regimen. The nurse practitioner knows that which will be the most effective treatment for this client's depressive disorder?
A combination of psychotherapy and medication

A combination of psychotherapy and medications is more effective than either approach alone in treating depressive disorders. Individual psychotherapeutic modalities are numerous. Family therapy also may help clients and their loved ones struggling with ongoing challenges related to chronic depression. In addition to psychopharmacologic strategies, somatic therapies such as electroconvulsive therapy may be alternatives for clients with refractory depression.
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?
Anger toward the loved one who committed suicide

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 29-year-old first-time mother has been diagnosed with postpartum psychosis after her partner reported the client was hearing voices and told the partner she "saw someone trying to steal the baby." In the planning of this client's care, which outcome should the nurse prioritize?
The client will demonstrate the ability to differentiate between perceptual disturbances and reality.

An inability to differentiate perceptual disturbances from reality is a hallmark of psychosis, and the ability to do so should be a priority goal in the care of a client with postpartum psychosis. Fatigue, nutrition, and self-expression are less likely to be central issues.
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?
Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy.

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 with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation?
The client is experiencing catatonia.

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).
The nurse is conducting an admission assessment with a 45-year-old client who has been demonstrating signs of bipolar disorder. While conducting the assessment, the client starts speaking in illogical rhymes and using word associations. What is the name for this thought pattern?
Flight of ideas

Rapid "flights of ideas" lead to excessive and illogical rhyming, punning, and word associations, along with pressured speech.
Pharmacotherapy is essential to the management of the client with bipolar disorder. The nurse understands that the goals for such therapy are what? Select all that apply.
Rapid control of symptoms
Decreased frequency of manic episodes
Prevention of future episodes
Decreased severity of manic episodes
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?"

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.
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?
Ensuring a plan is in place for the client's community-based care

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.
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