Ch. 25 Depression and Suicide – Flashcards
Unlock all answers in this set
Unlock answersquestion
1. Which nursing diagnosis supports the psychoanalytic theory of development of major depressive disorder? 1. Social isolation R/T self-directed anger. 2. Low self-esteem R/T learned helplessness. 3. Risk for suicide R/T neurochemical imbalances. 4. Imbalanced nutrition less than body requirements R/T weakness.
answer
1. Social isolation R/T self-directed anger supports the psychoanalytic theory in the development of major depressive disorder (MDD).
question
2. Which client statement is evidence of the etiology of major depressive disorder from a genetic perspective? 1. "My maternal grandmother was diagnosed with bipolar affective disorder." 2. "My mood is a 7 out of 10, and I won't harm myself or others." 3."I am so angry that my father left our family when I was 6." 4. "I just can't do anything right. I am worthless."
answer
1. A family history of mood disorder indicates a genetic predisposition to the development of major depressive disorder. Twin, family, and adoptive studies further support a genetic link as an etiological influence in the development of mood disorders.
question
3. During an intake assessment, which client statement is evidence of the etiology of major depressive disorder from an object-loss theory perspective? 1. "I am so angry all the time and seem to take it out on myself." 2. "My grandmother and great-grandfather also had depression." 3. "I just don't think my life is ever going to get better. I keep messing up." 4. "I don't know about my biological family; I was in foster care as an infant."
answer
4. Object-loss theorists suggest that depressive illness occurs as a result of being abandoned by or otherwise separated from a significant other during the first 6 months of life. The client in the question experienced parental abandonment, and according to objectloss theory, this loss has led to the diagnosis of MDD.
question
4. Which statement describes a major difference between a client diagnosed with major depressive disorder and a client diagnosed with dysthymic disorder? 1. A client diagnosed with dysthymic disorder is at higher risk for suicide. 2. A client diagnosed with dysthymic disorder may experience psychotic features. 3. A client diagnosed with dysthymic disorder experiences excessive guilt. 4. A client diagnosed with dysthymic disorder has symptoms for at least 2 years.
answer
4. An individual suspected to have dysthymic disorder needs to experience symptoms for at least 2 years before a diagnosis can be made. The essential feature is a chronically depressed mood (or possibly an irritable mood in children and adolescents) for most of the day, more days than not, for at least 2 years (1 year for children and adolescents). Clients with a diagnosis of MDD show impaired social and occupational functioning that has existed for at least 2 weeks.
question
5. A client plans and follows through with the wake and burial of a child lost in an automobile accident. Using Engel's model of normal grief response, in which stage would this client fall? 1. Resolution of the loss. 2. Recovery. 3. Restitution. 4. Developing awareness.
answer
3. The client in the question is exhibiting signs associated with Engel's stage of restitution.
question
6. Which charting entry most accurately documents a client's mood? 1. "The client expresses an elevation in mood." 2. "The client appears euthymic and is interacting with others." 3. "The client isolates self and is tearful most of the day." 4."The client rates mood at a 2 out of 10."
answer
4. The use of a mood scale objectifies the subjective symptom of mood as a pain scale objectifies the subjective symptom of pain. The use of scales is the most accurate way to assess subjective data.
question
7. Which client is at highest risk for the diagnosis of major depressive disorder? 1. A 24 year-old married woman. 2. A 64 year-old single woman. 3. A 30 year-old single man. 4. A 70 year-old married man.
answer
1. Research indicates that depressive symptoms are highest among young, married women of low socioeconomic backgrounds. Compared with the other clients presented, this client is at highest risk for the diagnosis of major depressive disorder (MDD).
question
8. A client is admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder. Which of the following data would the nurse expect to assess? Select all that apply. 1. Loss of interest in almost all activities and anhedonia. 2. A change of more than 5% of body weight in 1 month. 3. Fluctuation between increased energy and loss of energy. 4. Psychomotor retardation or agitation. 5. Insomnia or hypersomnia.
answer
1. Loss of interest in almost all activities and anhedonia, the inability to experience or even imagine any pleasant emotion, are symptoms of major depressive disorder (MDD). 2. Significant weight loss or gain of more than 5% of body weight in 1 month is one of the many diagnostic criteria for MDD. 4. Psychomotor retardation or agitation, occurring nearly every day, is a diagnostic criterion for MDD. 5. Sleep alterations, such as insomnia or hypersomnia, that occur nearly every day are diagnostic criteria for MDD.
question
9. A client is exhibiting behavioral symptoms of depression. Which charting entry would appropriately document these symptoms? 1. "Rates mood as 4/10." 2. "Expresses thoughts of poor self-esteem during group." 3. "Became irritable and agitated on waking." 4. "Rates anxiety as 2/10 after receiving lorazepam (Ativan)."
answer
3. When the client becomes irritable and agitated on awakening, the client is exhibiting behavioral symptoms of depression. Other behavioral symptoms include, but are not limited to, tearfulness, restlessness, slumped posture, and withdrawal.
question
10. Which symptom is an example of physiological alterations exhibited by clients diagnosed with moderate depression? 1. Decreased libido. 2. Difficulty concentrating. 3. Slumped posture. 4. Helplessness.
answer
1. Decreased libido is a physiological alteration exhibited by clients diagnosed with moderate depression.
question
11. Major depressive disorder would be most difficult to detect in which of the following clients? 1. A 5 year-old girl. 2. A 13 year-old boy. 3. A 25 year-old woman. 4. A 75 year-old man.
answer
2. Assessment of depressive disorders in 13 year-old children would include feelings of sadness, loneliness, anxiety, and hopelessness. These symptoms may be perceived as normal emotional stresses of growing up.
question
12. Which is the key to understanding whether a child or adolescent is experiencing an underlying depressive disorder? 1. Irritability with authority. 2. Being uninterested in school. 3. A change in behaviors over a 2-week period. 4. Feeling insecure at a social gathering.
answer
3. Change in behavior is an indicator that differentiates mood disorders from the typical stormy behaviors of adolescence.
question
13. The nurse in the emergency department is assessing a client suspected of being suicidal. Number the following assessment questions, beginning with the most critical and ending with the least critical. 1. _____ "Are you currently thinking about suicide?" 2. _____ "Do you have a gun in your possession?" 3. _____ "Do you have a plan to commit suicide?" 4. _____ "Do you live alone? Do you have local friends or family?"
answer
The assessment questions should be numbered as follows: 1, 3, 2, 4.
question
14. 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? 1. A newly admitted client with an anxiety level of 8/10 and racing thoughts. 2. A client admitted 6 days ago for a manic episode refusing to take medications. 3. A newly admitted client experiencing suicidal ideations with a plan to overdose. 4. A client admitted 6 days ago for suicidal ideations following a depressive episode.
answer
4. A client admitted 6 days ago for suicidal ideations has begun to stabilize because of the treatment received during this time frame.
question
16. Which nursing diagnosis takes priority for a client immediately after electroconvulsive therapy (ECT)? 1. Risk for injury R/T altered mental status. 2. Impaired social interaction R/T confusion. 3. Activity intolerance R/T weakness. 4. Chronic confusion R/T side effect of ECT.
answer
1. Immediately after electroconvulsive therapy (ECT), risk for injury R/T altered mental status is the priority nursing diagnosis. The most common side effect of ECT is memory loss and confusion, and these place the client at risk for injury.
question
17. A newly admitted client diagnosed with major depressive disorder has a history of two suicide attempts by hanging. Which nursing diagnosis takes priority? 1. Risk for violence directed at others R/T anger turned outward. 2. Social isolation R/T depressed mood. 3. Risk for suicide R/T history of attempts. 4. Hopelessness R/T multiple suicide attempts.
answer
3. Risk for suicide R/T history of attempts is a priority nursing diagnosis.
question
18. 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? 1. Impaired social interaction. 2. Powerlessness. 3. Knowledge deficit. 4. Dysfunctional grieving.
answer
2. Powerlessness is defined as the perception that one's own action would not significantly affect an outcome—a perceived lack of control over a current situation or immediate happening.
question
19. 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? 1. The client will express feeling rested upon awakening. 2. The client will rate pain level at or below a 4/10. 3. The client will sleep 6 to 8 hours at night by day 5. 4. The client will maintain a steady sleep pattern while hospitalized.
answer
3. The appropriate short-term outcome for the nursing diagnosis of ineffective sleep pattern R/T aches and pains is to expect the client to sleep 6 to 8 hours a night by day 5. This outcome is client specific, realistic, and measurable and includes a time frame.
question
20. Which client would the charge nurse assign to an agency nurse working on the in-patient psychiatric unit for the first time? 1. A client experiencing passive suicidal ideations with a past history of an attempt. 2. A client rating mood as 3/10 and attending but not participating in group therapy. 3. A client lying in bed all day long in a fetal position and refusing all meals. 4. A client admitted for the first time with a diagnosis of major depression.
answer
2. Although this client rates mood low, there is no indication of suicidal ideations, and the client is attending groups in the milieu. Because this client is observable in the milieu by all staff members, assignment to an agency nurse would be appropriate.
question
21. 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? 1. The client will remain free from injury throughout hospitalization. 2. The client will set one realistic goal related to relationships by day 3. 3. The client will verbalize one positive attribute about self by day 4. 4. The client will be easily redirected when discussion about suicide occurs by day 5.
answer
1. Remaining free from injury throughout hospitalization is a priority outcome for the nursing diagnosis of risk for suicide R/T a past suicide attempt. Because this outcome addresses client safety, it is prioritized.
question
22. 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? 1. Allow the client time to mourn the loss during this time of shiva. 2. Distract the client from the loss and encourage participation in unit groups. 3. Teach the client alternative coping skills to deal with grief. 4. Discuss positive aspects the client has in his or her life to build on strengths.
answer
1. In the Jewish faith, the 7-day period beginning with the burial is called shiva. During this time, mourners do not work, and no activity is permitted that diverts attention from thinking about the deceased. Because this client's parent died 2 days ago, the client needs time to participate in this religious ritual.
question
23. 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? 1. Request a psychiatric consultation. 2. Complete a thorough physical assessment including lab tests. 3. Remove all hazardous materials from the environment. 4. Place the client on a one-to-one observation.
answer
2. Numerous physical conditions can contribute to symptoms of insomnia, including irritability, anorexia, and depressed mood. It is important for the nurse to rule out these physical problems before assuming that the symptoms are psychological in nature.
question
24. A client diagnosed with major depressive disorder has a nursing diagnosis of low self-esteem R/T negative view of self. Which cognitive nursing intervention would be appropriate to deal with this client's problem? 1. Promote attendance in group therapy to assist the client in socializing. 2. Teach assertiveness skills by role-playing situations. 3. Encourage the client to journal to uncover underlying feelings. 4. Focus on strengths and accomplishments to minimize failures.
answer
4. Focusing on strengths and accomplishments to minimize failures is a cognitive nursing intervention. Cognitive interventions focus on altering distortions of thoughts and negative thinking.
question
25. 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 when first establishing a nurse-client relationship? 1. Sit with the client and offer self frequently. 2. Notify the client of group therapy schedule. 3. Introduce the client to others on the unit. 4. Help the client to identify stressors of life that precipitate life crises.
answer
1. Offering self is one technique to generate the establishment of trust with a newly admitted client diagnosed with major depressive disorder (MDD). Trust is the basis for the establishment of any nurse client relationship.
question
26. A client diagnosed with major depressive disorder is being considered for electroconvulsive therapy (ECT). Which client teaching should the nurse prioritize? 1. Empathize with the client about fears regarding ECT. 2. Monitor for any cardiac alterations to prevent possible negative outcomes. 3. Discuss with the client and family expected short-term memory loss. 4. Inform the client that injury related to induced seizure commonly occurs.
answer
3. An expected and acceptable side effect of ECT is short-term memory loss. It is important for the nurse to teach the client and family members this information to prevent unnecessary anxiety about this symptom.
question
27. Which nursing intervention takes priority when working with a newly admitted client experiencing suicidal ideations? 1. Monitor the client at close, but irregular, intervals. 2. Encourage the client to participate in group therapy. 3. Enlist friends and family to assist the client in remaining safe after discharge. 4. Remind the client that it takes 6 to 8 weeks for antidepressants to be fully effective.
answer
1. Clients who experience suicidal ideations must be monitored closely to prevent suicide attempts. By monitoring at irregular intervals, the nurse would prevent the client from recognizing patterns of observation. If a client recognizes a pattern of observation, the client can use the time in which he or she is not observed to plan and implement a suicide attempt.
question
28. A nursing student is studying major depressive disorder. Which student statement indicates that learning has occurred? 1. "1% of the population is affected by depression yearly." 2. "2% to 5% of women experience depression during their lifetimes." 3. "1% to 3% of men become clinically depressed." 4."Major depression is a leading cause of disability in the United States."
answer
4. Major depression is one of the leading causes of disability in the United States.
question
29. 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? 1. The client reports an anxiety level of 2 out of 10 and denies suicidal ideations. 2. The client exhibits trusting behaviors toward the treatment team. 3. The client is noted to be in the denial stage of the grief process. 4. The client recognizes and accepts the role he or she played in the loss of the job.
answer
4. Accepting responsibility for the role played in a loss indicates that the client has moved forward in the grieving process and resolved the problem of dysfunctional grieving.
question
30. A nursing instructor is presenting statistics regarding suicide. Which student statement indicates that learning has occurred? 1. "Approximately 10,000 individuals in the United States will commit suicide each year." 2. "Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder." 3."Suicide is the eighth leading cause of death among young Americans 15 to 24 years old." 4. "Depressive disorders account for 70% of all individuals who commit or attempt suicide."
answer
2. Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder. Most suicides are associated with mood disorders.
question
31. A client diagnosed with major depressive disorder has an outcome that states, "The client will verbalize a measure of hope about the future by day 3." Which client statement indicates this outcome was successful? 1. "I don't want to die because it would hurt my family." 2. "I need to go to group and get out of this room." 3."I think I am going to talk to my boss about conflicts at work." 4. "I thank you for your compassionate care."
answer
3. When the client begins to plan how to deal with conflicts at work, the client is focusing on a hopeful future. This indicates that the outcome of verbalizing a measure of hope about the future by day 3 has been successful.
question
32. Which of the following medications may be administered before electroconvulsive therapy? Select all that apply. 1. Glycopyrrolate (Robinul). 2. Thiopental sodium (Pentothal). 3. Succinylcholine chloride (Anectine). 4. Lorazepam (Ativan). 5. Divalproex sodium (Depakote).
answer
1. Glycopyrrolate (Robinul) is given to decrease secretions and counteract the effects of vagal stimulation induced by electroconvulsive therapy (ECT). 2. Thiopental sodium (Pentothal) is a short-acting anesthetic medication administered to produce loss of consciousness during ECT. 3. Succinylcholine chloride (Anectine) is a muscle relaxant administered to prevent severe muscle contractions during the seizure, reducing the risk for fractured or dislocated bones
question
33. A client diagnosed with major depressive disorder is prescribed phenelzine (Nardil). Which teaching should the nurse prioritize? 1. Remind the client that the medication takes 6 to 8 weeks to take full effect. 2. Instruct the client and family about the many food-drug and drug-drug interactions. 3. Teach the client about the possible sexual side effects and insomnia that can occur. 4. Educate the client about taking the medication prescribed even after symptoms improve.
answer
2. Because there are numerous drug-food and drug drug interactions that may precipitate a hypertensive crisis during treatment with MAOIs, it is critical that the nurse prioritize this teaching.
question
34. 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. 1. Ask the client about suicidal ideations related to depressed mood. 2. Discuss the need to take medications, even when symptoms improve. 3. Instruct the client about the risks of abruptly stopping the medication. 4. Alert the client to the risks of dry mouth, sedation, nausea, and sexual side effects. 5. Remind the client that the medication's full effect may not occur for 6 to 8 weeks.
answer
2. Discussing the need for medication compliance, even when symptoms improve, is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline. 3. Instructing the client about the risk for discontinuation syndrome is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline. 4. Alerting the client to the risks of dry mouth, sedation, nausea, and sexual side effects is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline. 5. Reminding the client that sertraline's full effect may not occur for 6 to 8 weeks is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline.
question
35. Which symptoms would the nurse expect to assess in a client experiencing serotonin syndrome? 1. Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis. 2. Hypomania, akathisia, cardiac arrhythmias, and panic attacks. 3. Dizziness, lethargy, headache, and nausea. 4. Orthostatic hypotension, urinary retention, constipation, and blurred vision.
answer
1. Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis all are symptoms of serotonin syndrome. Other symptoms include dilated pupils, loss of muscle coordination or twitching, diarrhea, headache, shivering and goose bumps. If this syndrome were suspected, the offending agent would be discontinued immediately.
question
36. Which medication would be classified as a tricyclic antidepressant? 1. Bupropion (Wellbutrin). 2. Mirtazapine (Remeron). 3. Citalopram (Celexa). 4. Nortriptyline (Pamelor).
answer
4. Nortriptyline (Pamelor) is classified as a tricyclic antidepressant. Other tricyclic antidepressants include amitriptyline (Elavil), doxepin (Sinequan), and imipramine (Tofranil).
question
37. Which of the following are examples of anticholinergic side effects from tricyclic antidepressants? Select all that apply. 1. Urinary hesitancy. 2. Constipation. 3. Blurred vision. 4. Sedation. 5. Weight gain.
answer
1. Urinary hesitancy is an anticholinergic side effect. 2. Constipation is an anticholinergic side effect. 3. Blurred vision is an anticholinergic side effect.
question
38. A client diagnosed with major depressive disorder and experiencing suicidal ideation is showing signs of anxiety. Alprazolam (Xanax) is prescribed. Which assessment should be prioritized? 1. Monitor for signs and symptoms of physical and psychological withdrawal. 2. Teach the client about side effects of the medication, and how to handle these side effects. 3. Assess for nausea, and give the medication with food if nausea occurs. 4. Ask the client to rate his or her mood on a mood scale, and monitor for suicidal ideations.
answer
4. Alprazolam is a central nervous system depressant, and it is important for the nurse in this situation to monitor for worsening depressive symptoms and possible worsening of suicidal ideations.
question
39. Which situation would place a client at high risk for a life-threatening hypertensive crisis? 1. A client is prescribed tranylcypromine (Parnate) and eats chicken salad. 2. A client is prescribed isocarboxazid (Marplan) and drinks hot chocolate. 3. A client is prescribed venlafaxine (Effexor) and drinks wine. 4. A client is prescribed phenelzine (Nardil) and eats fresh roasted chicken.
answer
2. Isocarboxazid is an MAOI, and the intake of chocolate would cause a life-threatening hypertensive crisis.
question
40. 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? 1. The client may have a possible injury to the gastrointestinal system. 2. The client is at risk for seizures from a potential closed head injury. 3. The client is at increased risk of bleeding while taking bupropion. 4. The client may experience sedation from bupropion, making assessment difficult.
answer
2. Bupropion lowers the seizure threshold. Bupropion is contraindicated for clients who have increased potential for seizures, such as a client with a closed head trauma injury.
question
41. A client experiencing suicidal ideations with a plan to overdose on medications is admitted to an in-patient psychiatric unit. Mirtazapine (Remeron) is prescribed. Which nursing intervention takes priority? 1. Remind the client that medication effectiveness may take 2 to 3 weeks. 2. Teach the client to take the medication with food to avoid nausea. 3. Check the client's blood pressure every shift to monitor for hypertension. 4. Monitor closely for signs that the client might be "cheeking" medications.
answer
4. If a client comes into the in-patient psychiatric unit with a plan to overdose, it is critical that the nurse monitor for cheeking and hoarding of medications. Clients may cheek and hoard medications to take, as an overdose, at another time.
question
42. A client recently prescribed venlafaxine (Effexor) 37.5 mg bid complains of dry mouth, orthostatic hypotension, and blurred vision. Which nursing intervention is appropriate? 1. Hold the next dose, and document symptoms immediately. 2. Reassure the client that side effects are transient, and teach ways to deal with them. 3. Call the physician to receive an order for benztropine (Cogentin). 4. Notify the dietary department about restrictions related to monoamine oxidase inhibitors.
answer
2. The nurse needs to teach the client about acceptable side effects, and what the client can do to deal with them. The nurse can suggest that the client use ice chips, sip small amounts of water, or chew sugar-free gum or candy to moisten the dry mouth. For orthostatic hypotension, the nurse may encourage the client to change positions slowly. For blurred vision, the nurse may encourage the use of moisturizing eyedrops.
question
43. A client, admitted after experiencing suicidal ideations, is prescribed citalopram (Celexa). Four days later, the client has pressured speech and is noted wearing heavy makeup. What may be a potential reason for this client's behavior? 1. The client is in a manic episode caused by the citalopram (Celexa). 2. The client is showing improvement and is close to discharge. 3. The client is masking depression in an attempt to get out of the hospital. 4. The client has "cheeked" medications and taken them all at once in an attempt to overdose.
answer
1. When an SSRI is prescribed for clients with bipolar affective disorder, it can cause alterations in neurotransmitters and trigger a hypomanic or manic episode.
question
44. A client is prescribed venlafaxine (Effexor) 75 mg qam and 150 mg qhs. Venlafaxine is supplied in a 37.5-mg tablet. How many tablets would the nurse administer a day? _____ tablets.
answer
The nurse will administer 6 tablets in 1 day.
question
45. The physician orders fluoxetine (Prozac) for a client diagnosed with depression. Which information is true about this medication? 1) Prozac is a tricyclic antidepressant. 2) The therapeutic effect of Prozac occurs 2 to 4 weeks after treatment is begun. 3) Aged cheese, yogurt, soy sauce, and bananas should not be eaten while the client is taking this drug. 4) Prozac may be administered in combination with monoamine oxidase inhibitors (MAOIs).
answer
2) The therapeutic effect of Prozac occurs 2 to 4 weeks after treatment is begun.
question
46. Tara experienced the death of a parent 2 years ago. She has not been able to work since the death, cannot look at any of the parent's belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes Tara's problem? 1) Post-trauma syndrome R/T parent's death. 2) Anxiety R/T parent's death. 3) Coping, ineffective, R/T parent's death. 4) Grieving, complicated, R/T parent's death.
answer
4) Grieving, complicated, R/T parent's death. The excessive reactions that the individual continues to exhibit, such as daily crying, inability to return to work, and inability to look at the parent's belongings after a 2-year period, are indicative of dysfunctional or complicated grieving. This individual's grieving response has arrested in the anger stage of grief and is manifested by exaggerated grieving behaviors.
question
47. Hannah is being evaluated for postpartum depression after she reported to her family physician that she just doesn't think she can take care of her baby. She expresses fear that God will take her children from her for being a bad mother. Which of the following is the highest priority for the nurse to assess during the initial interview? 1) The number of children Hannah is currently trying to care for. 2) Availability of support systems in Hannah's family. 3) Risks for suicide and/or infanticide. 4) What time of day the symptoms occur.
answer
3) Risks for suicide and/or infanticide. The risks for suicide and/or infanticide should not be overlooked. Hannah's concern that she can't care for the baby and that God might take her children raises additional concern that further assessment for these risks is a priority.
question
48. Susan is being seen in the emergency department. Her sister brought her in with concern that Susan is depressed and might be suicidal. Which of the following questions are priorities for the nurse to ask when assessing for suicide risk? Select all that apply. 1) "Why are you feeling depressed and suicidal?" 2) "Are you having thoughts of hurting or killing yourself?" 3) "When you have these thoughts, do you have a plan in mind?" 4) "Do you ever feel like you want to hurt someone else?" 5) "Are you currently using any drugs or alcohol?"
answer
Feedback 1: This question is not relevant and, in general, is nontherapeutic. It challenges the client and does not identify level of suicide risk. Correct 2: Asking this question elicits information about whether the client is having suicide ideation and promotes further assessment of how often, how intrusive, and how intentional the person perceives these ideas to be. Correct 3: Asking this question allows the nurse to assess whether the client's thoughts have become more specific and intentional. It also allows the nurse to assess the lethality of means, which is important information in assessing suicide risk. Additional assessment should include an assessment of whether or not the client has access to the identified means for attempting suicide. Feedback 4: This question is directed toward assessing other directed violence and/or homicidal ideation rather than suicidal ideation. Correct 5: This is a priority question, since evidence supports that substance abuse by people with depression and suicidal ideation increases the risk for suicide.
question
49. A client has a history of major depressive disorder (MDD). Police escort the client to the ED after finding the client nude at an ATM, screaming for money to pay off credit card debt. What would make the ED psychiatrist question the client's prior diagnosis? 1) The client is experiencing symptoms of mania. 2) The client is experiencing symptoms of a severe anxiety disorder. 3) The client is experiencing symptoms of an amnestic disorder. 4) The client is experiencing symptoms of a histrionic personality disorder.
answer
1) The client is experiencing symptoms of mania. The symptoms described in the question indicate that this client is experiencing a manic episode. Therefore, it would be appropriate for the ED psychiatrist to question the diagnosis of MDD.
question
50. Shelly is a patient on the inpatient psychiatric unit and was diagnosed with major depressive disorder. She is staying in her room and sleeping most of the day. Which of the following approaches by the nurse would best facilitate getting Shelly involved in the occupational therapy group on the unit? 1) "Would you like to go to occupational therapy? It is starting right now." 2) "Let me know what activities you want to be involved in and I'll give you a schedule." 3) "If you don't go to occupational therapy today, you will have to stay in your room for the entire evening." 4) "Occupational therapy is starting in 30 minutes; I'll help you get ready."
answer
4) "Occupational therapy is starting in 30 minutes; I'll help you get ready." This response by the nurse uses an active approach (stating the expected behavior rather than encouraging the patient to decide), provides time to prepare, and offers assistance in the process. This approach would most likely facilitate Shelly's participation in the occupational therapy activities.
question
51. A client diagnosed with major depression is being discharged from the hospital with a prescription for fluoxetine (Prozac). The nurse's discharge teaching should include which of the following? Select all that apply. 1) "It may take a few weeks before you begin to feel better; however, continue taking Prozac as prescribed." 2) "Make sure that you follow up with scheduled outpatient psychotherapy." 3) "If significant mood elevation is noted, your psychiatrist may discontinue this medication within 6 months to a year." 4) "You should avoid foods with tyramine, including beer, beans, processed meats, and red wine." 5) "You can discontinue the Prozac when you are feeling better."
answer
Correct 1: The nurse should inform the client that it is important to take Prozac as prescribed and that the therapeutic effect can take up to 4 weeks to be realized. Correct 2: Along with medication compliance, the nurse should also stress the importance of follow-up psychotherapy. Correct 3: The nurse should advise the client to discontinue the medication only under a doctor's supervision. Although the medication may be tapered and stopped after 6 months, there is a risk for further depressive episodes. Feedback 4: Avoidance of foods with tyramine would hold true if the client were taking an MAOI, not a selective serotonin reuptake inhibitor, such as Prozac. Feedback 5: The client should be advised to not stop taking Prozac abruptly. To do so might produce withdrawal symptoms such as nausea, vertigo, insomnia, headache, malaise, and nightmares.
question
52. A client has been diagnosed with major depression. The psychiatrist prescribes imipramine (Tofranil). Which of the following medication information should the nurse include in discharge teaching? Select all that apply. 1) "The medication may cause dry mouth." 2) "The medication may cause urinary incontinence." 3) "The medication should not be discontinued abruptly." 4) "The medication may cause photosensitivity." 5) "The medication may cause nausea."
answer
Correct 1: Dry mouth can occur with all antidepressants, including imipramine. Feedback 2: Urinary retention, not incontinence, may occur when taking imipramine. Correct 3: Antidepressants such as imipramine must be tapered and not stopped abruptly. Correct 4: Tricyclic antidepressants such as imipramine can cause photosensitivity, whereas other types of antidepressants do not. Therefore, the client must be educated specifically about this potential side effect. Correct 5: Nausea can occur with all antidepressants, including imipramine.
question
53. Emily has been receiving treatment for major depressive disorder over several weeks. She is taking an antidepressant and attending cognitive behavioral therapy group once a week. When the nurse evaluates her progress in treatment, which of the following are indications that the depression is improving? Select all that apply. 1) Emily is taking the antidepressant medication as ordered. 2) Emily is expressing hope that she can return to her university classes soon and continue her education. 3) Emily demonstrates ability to make decisions concerning her own self-care. 4) Emily reports that suicide ideas have subsided. 5) Emily is engaging in activities that she enjoys.
answer
Feedback 1: Adherence to the medication regime does not presume effectiveness. More relevant indications would be the patient's report of improved mood, improved sleep and rest, and increase in energy. Correct 2: Hopelessness is a characteristic symptom in major depressive disorder, and a return to expressing hopefulness is an indicator of improvement. Correct 3: Indecisiveness is a symptom in depression, and a return to the ability to make decisions is an indication of improvement. Correct 4: Suicide ideas can be pervasive and troubling symptoms in depression. When they begin to abate, it may be an indication that the depression is lifting. Correct 5: One of the symptoms in major depressive disorder is lack of interest in activities that one used to enjoy. The return of interest in activities and in social interaction are indications that the depression is abating.
question
54. Chloe is suffering from depression and not responding to antidepressant treatment. She asks the nurse to tell her more about transcranial magnetic stimulation (TMS). Which of the following responses is accurate with regard to this treatment modality? 1) TMS uses magnetic energy to induce a seizure. 2) One study concluded that electroconvulsive therapy was more effective than TMS for short-term treatment of depression. 3) TMS is a safe and inexpensive treatment for depression. 4) TMS has been demonstrated to be more effective than any other treatment modality for depression.
answer
2) One study concluded that electroconvulsive therapy was more effective than TMS for short-term treatment of depression. Patients often rely on nurses to provide current accurate information about new or experimental treatment modalities, so it is important for nurses to continue to evaluate current evidence in order to provide patients with the most up-to-date, accurate information.
question
55. When teaching about the tricyclic group of antidepressant medications, which information should the nurse include? 1) Strong or aged cheese should not be eaten while the client is taking this group of medications. 2) The full therapeutic potential of tricyclics may not be reached for 4 weeks. 3) Tricyclics may cause hypomania or recent memory impairment. 4) Tricyclics should not be given with antianxiety agents.
answer
2) The full therapeutic potential of tricyclics may not be reached for 4 weeks.
question
56. A client being treated for depression asks the nurse what causes this illness. Which response by the nurse is the most accurate, evidence-based statement? 1) "The etiology of depression is unclear. Evidence supports there may be several different causative factors." 2) "Depression has been proven to be the result of an imbalance in certain neurotransmitters." 3) "Depression is transmitted by a specific gene for the illness." 4) "Depression has been proven to develop as a result of negative thinking patterns."
answer
1) "The etiology of depression is unclear. Evidence supports there may be several different causative factors." Although several theories have been advanced, no single cause for depression has been identified conclusively.
question
57. Ursula has sought counseling for persistent depressive disorder. She identifies that she has "always had low self-esteem" and says "I just let people walk all over me." The nurse is providing psycho-educational groups on improving self-esteem. Ursula would likely benefit from education on which of the following topics? 1) Antipsychotic medications 2) Anger management 3) Assertive communication 4) Alcoholics Anonymous groups
answer
3) Assertive communication Education in assertive communication is recognized as an intervention to build positive self-esteem. Ursula's statement that she lets people walk all over her is an indication that this would be beneficial education for her.
question
58. Janice is diagnosed with major depressive disorder and is beginning to participate in a cognitive therapy group. As the nurse is orienting Janice to the group, which of the following statements about cognitive therapy are accurate? Select all that apply. 1) Cognitive therapy is designed to focus on emotional dysregulation. 2) Cognitive distortions, such as negative expectations about oneself, serve as the basis for depression. 3) Cognitive therapy focuses on altering mood by changing the way one thinks. 4) Cognitive distortions arise out of a defect in cognitive development. 5) Cognitive therapy explores pent-up rage that has been turned against oneself because of identification with the loss of a loved object.
answer
Feedback 1: In cognitive therapy the focus is on cognitive distortions. Emotional dysregulation is the central focus of dialectical behavior therapy. Correct 2: Beck et al. (1979) postulated that negative and irrational thinking contribute to depression. These are referred to as cognitive distortions. Correct 3: A primary assumption in cognitive therapy is that changing the way one thinks will change one's mood. Specifically, developing patterns of more rational and positive thinking will improve one's mood. Correct 4: In cognitive theory, it is assumed that cognitive distortions arise from a defect in cognitive development, which culminates in an individual thinking that he or she is worthless, inadequate, and rejected by others. These patterns of thinking need to be corrected to promote a positive change in mood. Feedback 5: The concept of rage turned inward is based in psychoanalytical theory, not cognitive theory.
question
59. Lamont has been scheduled for electroconvulsive therapy (ECT) and asks the nurse, "Is it true what I heard, that ECT causes brain damage?" Which of these would be the most appropriate, evidence-based response by the nurse? 1) "ECT has no effect on brain function at all." 2) "ECT has only been shown to cause brain damage in the elderly population." 3) "There is no evidence that ECT causes permanent changes in brain structure or function." 4) "Current evidence suggests that brain damage after ECT treatments is related to the anesthetic agents, not the treatment itself."
answer
3) "There is no evidence that ECT causes permanent changes in brain structure or function."
question
60. A client is being treated with sertraline (Zoloft) for major depression. The client tells the nurse, "I've been taking this drug for only a week, but I'm sleeping better and my appetite has improved." Which is the most appropriate response by the nurse? 1) "It will take a minimum of 3 to 4 weeks for therapeutic effects to occur." 2) "Sleep disturbances and appetite problems are not affected by Zoloft." 3) "A change in your environment and activity is the reason for this improvement." 4) "The initiation of Zoloft therapy can improve insomnia and appetite within 1 week."
answer
4) "The initiation of Zoloft therapy can improve insomnia and appetite within 1 week." Zoloft is known to improve middle and terminal insomnia, appetite disturbances, and anxiety as early as 1 week after initiation of treatment.
question
61. Bill is a 70-year-old man who is diagnosed with major depressive disorder. He is married and has two adult children who are alcoholics. He currently lives in a rural neighborhood and works part-time at a convenience mart. Which of these demographics is a risk factor for suicide? 1) 70-year-old male 2) Parent of alcoholic children 3) Lives in a rural neighborhood 4) Works part-time
answer
1) 70-year-old male Suicide is highest among persons over 50, and men are at higher risk than females.
question
62. Cliff has been attending group counseling for depression and has been expressing more hopelessness in the last few days. When the nurse provides the group with a homework assignment to be completed and returned to the group the next day, Cliff responds "I don't need to bother." Which of these responses by the nurse is most appropriate? 1) "Are you having suicidal thoughts?" 2) "Trust me, it will be beneficial." 3) "Why don't you want to cooperate?" 4) "This assignment will help you combat the hopelessness."
answer
1) "Are you having suicidal thoughts?" Hopelessness is a risk factor for suicide, and the client's statement may be a veiled suicide threat, so it is most important to assess for suicide risk in response.
question
63. The nurse is conducting an assessment for Leroy, a 65-year-old man who presented at the health clinic with complaints of depression. He lists several medications he has been taking. Of the following medications on his list, which are known to produce a depressive syndrome? Select all that apply. 1) Prednisone 2) Cimetidine (Tagamet) 3) Ampicillin 4) Ibuprofen (Advil) 5) Aspirin
answer
Correct 1: Prednisone is a steroid medication that can produce depression. Correct 2: Cimetidine is an anti-ulcer medication that can produce depression. Correct 3: Ampicillin is an antibacterial medication that can produce depression. Correct 4: Ibuprofen is an analgesic/anti-inflammatory medication that can produce depression. Feedback 5: Aspirin has not been associated with producing depression.
