Combo with "Ch 14 Depressive Disorders" and 1 other – Flashcards
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The nurse caring for a patient who exhibits disorganized thinking and delusions. The patient repeatedly states, "I hear voices of aliens trying to contact me." The nurse should recognize this presentation as which types of major depressive disorder (major depression)?
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Psychotic
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A nurse is educating a patient about the causes of depression. Which statement lets the nurse know the patient understands the neurobiological theory of depression?
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"If I take these medications as prescribed, I should start to think clearly and feel energized"
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The nurse is planning care for a patient with depression who will be discharged to home soon. What aspect of teaching should be priority on the nurse's discharge plan of care?
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Awareness of symptoms that increase depression.
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The nurse is reviewing orders given for a patient with depression. Which order should the nurse question?
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An SSRI given initially with an MAOI
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A female patient tells the nurse that she would like to begin taking St. John's wort for depression. What teaching should the nurse provide?
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"St. John's wort has generally been shown to be effective in treating depression"
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Which nursing diagnosis supports the psychoanalytic theory of development of major depressive disorder
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Social isolation r/t self directed anger
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Which client statement is evidence of the etiology of major depressive disorder from a genetic perspective?
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My maternal grandmother was diagnosed with bipolar affective disorder
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During an intake assessment, which client statement is evidence of the etiology of major depressive disorder from an object-loss theory perspective?
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I don't know about my biological family I was in foster care as an infant
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Which statement about the development of bipolar disorder is from a biochemicl perspective?
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In bipolar disorder, there may be possible alterations in normal electrolyte transfers
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What statement describes a major difference between a client dignosed with major depressive disorder and a client diagnosed with dysthymic disorder
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A client diagnosed with dysthymic disorder has symptoms for at least 2 years
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A client expresses frustration and hostility toward the nursing staff regarding the lack of care his or her recently deceased parent received. Which stage of grief is this?
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Anger
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A client plans and follows thru with the wake and buriall of a child lost in an auto accident.
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Restitution
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What charting entry most accurately documents a clients mood?
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Client rates mood 2 out of 10
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Which client is at highest risk for the diagnosis of major depressive disorders?
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24 year old woman
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A client is admitted to an inpatient pscyh unit with a dx of major depressive disorder. Which of the following would the nurse expect to assess? Select all:
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Loss of interest Change in body weight Psychomotor retardation Insomnia/hypersomnia
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A client is exhibiting behavioral symptoms of depression. Which charting entry would appropriately document these symptoms?
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Became irritable and agitated on walking.
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Which symptom is an example of physiological alterations exhibited by clients diag- nosed with moderate depression?
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decreased libido
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Which symptom is an example of an affective alteration exhibited by clients diagnosed with severe depression?
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Apathy
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Major depressive disorder would be most difficult to detect in which of the following clients?
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A 13 year old boy.
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Which is the key to understanding if a child or adolescent is experiencing an underlying depressive disorder?
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A change in behavior over a 2 week period
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Which nursing charting entry is documentation of a behavioral symptom of mania?
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Pacing halls throughout the day. Exhibits poor impulse control.
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A nurse on an in-patient psychiatric unit receives report at 1500 hours. Which client would need to be assessed first?
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A client pacing the hall and experiencing irritability and flight of ideas.
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A nurse is planning to teach about appropriate coping skills. The nurse would expect which client to be at the highest level of readiness to participate in this instruction?
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A client admitted 6 days ago for suicidal ideations following a depressive episode.
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A newly admitted client has been diagnosed with major depressive disorder. Which nursing diagnosis takes priority?
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Risk for self directed violence r/t depressed mood
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A client's outcome states, "The client will make a plan to take control of one life situation by discharge." Which nursing diagnosis documents the client's problem that this outcome addresses?
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Powerlessness
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Which nursing diagnosis takes priority for a client immediately after electroconvulsive therapy (ECT)?
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Risk for injury r/t altered mental status
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A client diagnosed with major depressive disorder has been newly admitted to an in-patient psychiatric unit. The client has a history of two suicide attempts by hanging. Which nursing diagnosis takes priority?
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Risk for suicide R / T history of attempts
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A client diagnosed with cyclothymia is newly admitted to an in-patient psychiatric unit. The client has a history of irritability and grandiosity and is currently sleeping 2 hours a night. Which nursing diagnoses takes priority?
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Disturbed sleep patterns R / T agitation.
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A client diagnosed with bipolar I disorder and experiencing a manic episode is newly admitted to the in-patient psychiatric unit. Which nursing diagnosis is a priority at this time?
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Risk for violence: other-directed R / T poor impulse control.
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A client admitted with major depressive disorder has a nursing diagnosis of ineffective sleep pattern R / T aches and pains. Which is an appropriate short-term outcome for this client
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The client will sleep 6 to 8 hours at night by day 5
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Which client would the charge nurse assign to an agency nurse working on the inpatient psychiatric unit for the first time?
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A client rating mood as 3/10 and attending but not participating in group therapy.
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A client has a nursing diagnosis of risk for suicide R / T a past suicide attempt. Which outcome, based on this diagnosis, would the nurse prioritize?
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The client will remain free from injury throughout hospitalization.
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A client diagnosed with bipolar I disorder has a nursing diagnosis of disturbed thought process R / T biochemical alterations. Based on this diagnosis, which outcome would be appropriate?
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The client will distinguish reality from delusions by day 6
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A client diagnosed with bipolar II disorder has a nursing diagnosis of impaired social interactions R / T egocentrism. Which short-term outcome is an appropriate expectation for this client problem?
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The client will have an appropriate 1:1 interaction with a peer by day 4
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A suicidal Jewish-American client is admitted to an in-patient psychiatric unit 2 days after the death of a parent. Which intervention must the nurse include in the care of this client?
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Allow the client time to mourn the loss during this time of shiva.
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A client denying suicidal ideations comes into the emergency department complaining about insomnia, irritability, anorexia, and depressed mood. Which intervention would the nurse implement first?
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Complete a thorough physical assessment including lab tests
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A client diagnosed with major depressive disorder has a nursing diagnosis of low self-esteem R / T negative view of self. Which cognitive intervention by the nurse would be appropriate to deal with this client's problem?
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Focus on strengths and accomplishments to minimize failures.
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A newly admitted client diagnosed with major depressive disorder isolates self in room and stares out the window. Which nursing intervention would be the most appropriate to implement initially, when establishing a nurse-client relationship?
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Sit with the client and offer self frequently.
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A client diagnosed with major depressive disorder is being considered for electroconvulsive therapy (ECT). Which client teaching should the nurse prioritize?
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Discuss with the client and family expected short-term memory loss.
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Which intervention takes priority when working with newly admitted clients experiencing suicidal ideations
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Monitor the client at close, but irregular, intervals
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A client notifies a staff member of current suicidal ideations. Which intervention by the nurse would take priority
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Determine if the client has a specific plan to commit suicide.
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A client seen in the emergency department is experiencing irritability, pressured speech, and increased levels of anxiety. Which would be the nurse's priority intervention?
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Assess vital signs, and complete physical assessment.
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A client experiencing mania states, "Everything I do is great." Using a cognitive approach, which nursing response would be most appropriate
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"Is there a time in your life when things didn't go as planned?"
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A client newly admitted to an in-patient psychiatric unit who is experiencing a manic episode. The client's a nursing diagnosis is imbalanced nutrition, less than body requirements. Which meal is most appropriate for this client?
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Chicken fingers and French fries.
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A provocatively dressed client diagnosed with bipolar I disorder is observed laughing loudly with peers in the milieu. Which nursing action is a priority in this situation?
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Privately discuss with the client the inappropriateness of provocative dress during hospitalization.
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A client diagnosed with bipolar I disorder in the manic phase is yelling at another peer in the milieu. Which nursing intervention takes priority?
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Calmly redirect and remove the client from the milieu.
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A client newly admitted with bipolar I disorder has a nursing diagnosis of risk for injury R / T extreme hyperactivity. Which nursing intervention is appropriate?
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Use PRN antipsychotic medications as ordered by the physician.
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A client diagnosed with bipolar I disorder experienced an acute manic episode and was admitted to the in-patient psychiatric unit. The client is now ready for discharge. Which of the following resource services should be included in discharge teaching? Select all that apply.
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Financial and legal assistance Crisis hotline Individual psychotherapy Support groups Family education groups
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A nursing student is studying major depressive disorder. Which student statement indicates that learning has occurred?
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"Major depression is a leading cause of disability in the United States."
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A client has a nursing diagnosis of dysfunctional grieving R / T loss of a job AEB inability to seek employment because of sad mood. Which would support a resolution of this client's problem?
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The client recognizes and accepts the role he or she played in the loss of the job.
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A nursing instructor is teaching about the cause of mood disorders. Which statement by a nursing student best indicates an understanding of the etiology of mood disorders
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"Evidence continues to support multiple causations related to an individual's susceptibility to mood symptoms.
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A nursing instructor is presenting statistics regarding suicide. Which student statement indicates that learning has occurred?
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"Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder."
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A client diagnosed with major depressive disorder has an outcome that states, "The client will verbalize a measure of hope about future by day 3." Which client statement indicates this outcome was successful?
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"I think I am going to talk to my boss about conflicts at work."
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A nursing instructor is teaching about the psychosocial theory related to the development of bipolar disorder. Which student statement would indicate that learning has occurred?
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"The etiology of bipolar disorder is unclear, but it is possible that biological and psy- chosocial factors are influential."
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A nurse working with a client diagnosed with bipolar I disorder attempts to recognize the motivation behind the client's use of grandiosity. Which is the rationale for this nurse's action?
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Understanding the reason behind a behavior would assist the nurse to accept and relate to the client, not the behavior.
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A nursing instructor is teaching about the criteria for the diagnosis of bipolar II disorder. Which student statement indicates that learning has occurred?
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Clients diagnosed with bipolar II disorder experience recurrent bouts of depression with episodic occurrences of hypomania.
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Which of the following medications may be administered before electroconvulsive therapy? Select all that apply.
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(Robinul). (Pentothal). (Anectine).
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A client diagnosed with major depressive disorder is prescribed phenelzine (Nardil). Which teaching should the nurse prioritize?
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Instruct the client and family about the many food-drug and drug-drug interactions.
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A client diagnosed with bipolar I disorder is experiencing auditory hallucinations and flight of ideas. Which medication combination would the nurse expect to be prescribed to treat these symptoms?
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(Risperdal) and (Lamictal).
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A client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of dilute urine, tremors, and muscular irritability. These symptoms would lead the nurse to expect that the client's lithium serum level would be which of the following?
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2.6 mEq/L.
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A client diagnosed with major depressive disorder is newly prescribed sertraline (Zoloft). Which of the following teaching points would the nurse review with the client? Select all that apply.
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-Discuss the need to take medications, even when symptoms improve. -Instruct the client about the risks of abruptly stopping the medication. -Alert the client to the risks of dry mouth, sedation, nausea, and sexual side effects. -Remind the client that the medication's full effect does not occur for 4 to 6 weeks.
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Which symptoms would the nurse expect to assess in a client suspected to have serotonin syndrome?
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Alterations in mental status, restlessness, tachycardia, labile blood pressure, and diaphoresis.
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Which medication would be classified as a tricyclic antidepressant?
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Nortriptyline (Pamelor).
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Which of the following are examples of anticholinergic side effects from tricyclic antidepressants? select all that apply
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Urinary Hesitation. Constipation. Blurred vision.
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A client diagnosed with MDD and experiencing suicidal ideation is showing signs of anxiety. Alprazolam (Xanax) is prescribed. Which assessment should be prioritized?
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Ask the client to rate his/her mood on the mood scale, and monitor for suicidal ideations.
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A client is admitted to the hospital with suicidal ideations and is prescribed paroxetine (Paxil). The client has a nursing diagnosis of knowledge deficit R?T newly prescribed medication. Which nursing intervention addresses this problem?
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Teaching the client regarding the risk for discontinuation syndrome.
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Which situation would place a client at high risk for a life threatening hypertensive crisis?
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Client who is prescribed isocarboxazid (Marplan) and drinks hot chocolate.
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A client has been taking bupropion (Wellbutrin) for more than 1 year. The client has been in a car accident with loss of consciousness and is brought to the ED. For which reason would the nurse question the continued use of this medication?
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The client is at risk for seizures.
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A client experiencing suicidal ideations with a plan to overdose on medications is admitted to an in-patient psychiatric unit. Mirtazipine (Remeron) is prescribed. Which nursing intervention takes priority?
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Monitor for signs of "cheeking"
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A client on an in-patient psychiatric unit has been prescribed tranycypromine (Parnate) 30mg QD. Which client statement indicates that discharge teaching has been successful?
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"I have been craving a hamburger with lettuce and onion, potato chips and milk"
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A client recently prescribed venlafaxine (effexor) 37.5 mg bid complains of dry mouth, orthostatic hypotension, and blurred vision. Which nursing intervention is appropriate?
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Reassure client that side effects are transient and teach ways to deal with it.
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A client comes to the hospital complaining of depression with suicidal ideations. The physician prescribes citalopram (Celexa). Approximately 4 days later, the client has pressured speech and is noted wearing heavy makeup. What might be the potential reason for this behavior?
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The client is in a manic episode caused by the citalopram /Celexa.
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Lithium is to mania as clozapine/Clozaril is to
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Psychosis
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A client prescribed Lithium 300mg QAM and 600mg QHS enters the ED experiencing impaired consciousness, nystagmus, and arrhythmia. Earlier today the client had 2 seizures. Which serum lithium level would the nurse expect to assess?
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3.7. Levels over 3.5 show signs of impaired consiousness, nystagmus, seizures, arrhythmias, MI,cardiovascular collapse.
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A client is prescribed Lithium. Which is the teaching priority?
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Make sure your salt intake is consistent.
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Which list contains medications that the nurse may see prescribed to treat clients diagnosed with bipolar affective disorder?
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Divalproex sodium/Depekote. verapamil/Calan. olanzapine/Zyprexa.
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The nurse is evaluating lab results for a client prescribed lithium carbonate. The client's lithium level is 1.9. Which nursing intervention takes priority?
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Immediately notify the physician, and hold the dose until instructed further.
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A client prescribed lithium 300mg bid 3 months ago is brought to the Ed with mental confusion, excessive diluted urine output, and consistent tremors. Which lithium level would the nurse expect?
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2.2. When the lithium level is between 2.0-3.5 the client may show signs of excessive urine output, increased tremors, muscular irritability, psycho motor retardation and mental confusion.
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A client diagnosed with bipolar affective disorder is prescribed divalproex/Depekote. Which of the following lab tests would the nurse need to monitor throughout drug therapy? Select all that apply.
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1. Platelet and bleeding time. 2. AST 3. ALT 4. Valproic acid level
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A client on an in-patient psychiatric unit is prescribed lamotrigine/Lamictal 50 mg QD. After client teaching, which client statement reflects understanding of the important information related to lamotrigine/Lamictal .
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"I know the importance of reporting any alteration in my medication schedule"
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A client diagnosed with bipolar affective disorder is prescribed carbamazepine/Tegretol. The client exhibits nausea, vomiting and anorexia. Which is an appropriate nursing intervention at this time?
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Administer next dose with food
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A client is discussing plans to have a serum lithium carbonate/Lithium level taken on discharge. To obtain an accurate serum level, which discharge teaching information should be included?
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Remind the client to have a serum level drawn 12 hours after taking dose of lithium.
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A client diagnosed with bipolar II disorder is experiencing hypomania. The client is not hostile, but is taken talking nonstop and disrupting an educational session. The client is forcibly taken to the clients room and placed in 4-point restraints. Which principles have been violated?
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The principle of 1. nonmalefence 2. least restrictive treatment. 3. beneficence 4. negligence
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A client has been taking Lithium for 3 months. Which assessment would make the nurse request a lithium level?
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Blurred vision and vomiting
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An extremely suicidal client needs to be admitted to the locked psychiatric unit. There are no beds available. Which client would the nurse anticipate that the treatment team would discharge?
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A client voluntarily committed 4 days ago with delerium owing to a urinary tract infection.
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A client is diagnosed w/ Major Depression. What is the most important part of the mental status exam to assess? A. judgment B. mood > "how are you feeling?" C. insight D. behavior
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B. mood > "how are you feeling?"
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Randall is a 36 yo male admitted to the hospital for sx's of depression and passive suicidal thoughts
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Set limits on interactions with this pt and discuss his case with fellow nurses
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After his wife's death, 84-year old is paying less attention to his hygiene, due to no wife. His wife died two months ago Lacks energy:
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Arrange for appointment for suspected depression.
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The parent of an adolescent diagnosed w/ depression asks the nurse, "Why do you want to do a family assessment? My teenager is the patient, not the rest of us." Select the nurse's best response. A. family dysfunction might have caused the mental illness B. family members provide more accurate information than the patient C. family assessment is part of the protocol for care of all patients with mental illness D. every family member's perception of events is different and helps in planning how to improve functioning of the family
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D. every family member's perception of events is different and helps in planning how to improve functioning of the family
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A nurse working in an acute mental health facility is caring for a 35-year-old female client who has clinical findings of depression. The client lives at home with her husband and two young children. She currently smokes and has a history of chronic asthma. The nurse should identify which of the following as risk factors for depression for this client? (Select all that apply.) A. Age of 35 years old B. Female gender C. History of chronic asthma D. Currently smokes E. Being married
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A. Age of 35 years old B. Female gender C. History of chronic asthma D. Currently smokes
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A nurse working in an outpatient clinic is providing teaching to a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I'm menstruating." B. "I will use light therapy 30 min a day to prevent further recurrences of PMDD." C. "I am aware that my PMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active."
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C. "I am aware that my PMDD causes me to have rapid mood swings."
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A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The goal of treatment during the maintenance phase is prevention of future episodes of MDD." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are used to prevent a relapse of MDD."
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A. "Care during the continuation phase focuses on treating continued manifestations of MDD."
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A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following is the highest priority action by the nurse? A. Placing the client on one-to-one observation B. Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects
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A. Placing the client on one-to-one observation
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A nurse is interviewing a 25-year-old client who has a new diagnosis of dysthymia. Which of the following findings should the nurse expect? A. There are wide fluctuations in mood. B. The report of a minimum of five clinical findings of depression. C. The presence of manifestations for at least 2 years. D. There is an inflated sense of self-esteem.
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C. The presence of manifestations for at least 2 years.
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A nurse is caring for a client who has acute stress disorder and is experiencing severe anxiety. Which of the following statements by the nurse is appropriate? A. "Tell me about how you are feeling right now." B. "You should focus on the positive things in your life to decrease your anxiety." C. "Why do you believe you are experiencing this anxiety?" D. "Let's discuss the medications your provider is prescribing to decrease your anxiety."
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A. "Tell me about how you are feeling right now."
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A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following? A. Narcissistic behavior B. Fear of rejection from staff C. Attempt to reduce anxiety D. Adverse effect of antidepressant medication
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C. Attempt to reduce anxiety
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A nurse is caring for a client who is experiencing a panic attack. Which of the following is an appropriate nursing intervention? A. Discuss new relaxation techniques. B. Show the client how to change his behavior. C. Distract the client with a television show. D. Stay with the client, and remain quiet.
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D. Stay with the client, and remain quiet.
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A nurse observes a client who is pacing and wringing his hands. The client states, "I don't know why, but I've worried every day for over a year that my son will die a horrible death." The nurse identifies that this finding is consistent with which of the following disorders? A. Generalized anxiety disorder B. Panic disorder C. Posttraumatic stress disorder D. Acute stress disorder
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A. Generalized anxiety disorder
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A nurse working on an acute mental health unit is caring for a client who has posttraumatic stress disorder (PTSD). Which of the following is an expected finding? (Select all that apply.) A. Hallucinations B. Obsessive need to talk about the traumatic event C. Exaggerated displays of emotion D. Recurring nightmares E. Diminished reflexes
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A D
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A client currently hospitalized for the third alcohol detoxification in 1 year believes relapses are partially due to an inability to control cravings. Which prescribed medication would meet this client's need? 1. Buspirone (BuSpar). 2. Disulfiram (Antabuse). 3. Naltrexone (ReVia). 4. Lorazepam (Ativan).
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3. Naltrexone (ReVia).
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A client with a long history of alcohol abuse is showing signs of cognitive deficits. What drug would the nurse recognize as appropriate in assisting with this client's alcohol recovery? 1. Disulfiram (Antabuse). 2. Naltrexone (ReVia). 3. Lorazepam (Ativan). 4. Methadone (Dolophine).
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2. Naltrexone (ReVia).
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2. What activity is most appropriate for a bipolar clinet? a. A game of twister b. B. a football game with other clients c. Riding the stationary bike d. Coloring activity with the nurse
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d. Coloring activity with the nurse
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A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following is appropriate for the nurse to include in the plan of care? (Select all that apply.) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client complaints E. Use a firm approach with communication
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BCE
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A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder." B. "ECT is contraindicated for clients who have suicidal ideation." C. "ECT is effective for clients who are experiencing severe mania." D. "ECT is prescribed to prevent relapse of bipolar disorder."
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C. "ECT is effective for clients who are experiencing severe mania."
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A nurse in an acute mental health facility is caring for a client who is experiencing a mixed episode of bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior. B. Administer prescribed medications as scheduled. C. Provide the client with step-by-step instructions during hygiene activities. D. Monitor the client for escalating behavior.
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D. Monitor the client for escalating behavior.
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A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following is an appropriate response by the nurse? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate."
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B. "I am here to provide care and cannot accept this from you."
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A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Use caffeine in moderation to prevent relapse. B. Difficulty sleeping can indicate a relapse. C. Begin taking your medications as soon as a relapse begins. D. Participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.
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B D E
