Chapter 17 Mood Disorders and Suicide

Chapter 17: Mood Disorders and Suicide After assessing a client, the nurse identifies that the client is at risk for suicide. Which would be the nurse's priority intervention? A. B. C. D. Communicate a desire to help the client. Remove means of suicide from the client's access. Determine the course of the client's suicidal thoughts. Provide mood-stabilizing medications per physician order. Which mental health disorder has the most significant risk factor for suicide? A. B. C. D. Depression Anxiety Schizophrenia Mania 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? A. B. C. D. Inappropriate Blunted Flat Constricted During a night shift, a hospitalized client with depression tells a nurse that the client is going to kill himself or herself. The client is placed on constant observation. When the client asks to use the toilet, the nurse follows the client into the bathroom. The client says, “You don’t need to follow me into the bathroom. Give me some space.” Which response by the nurse is most appropriate? A. “You’re right. I don’t need to come into the bathroom with you. I will wait outside the door.” B. “I must stay with you until we are sure you will not hurt yourself.” C. “If you think you are going to be OK, I will check on you in 5 minutes.” D. “I can’t imagine anything dangerous is in the bathroom. Go ahead. I will wait for you in the hallway.” After being diagnosed with a chronic disease, a client has been feeling depressed. Which diagnosis has the strongest association with an increased suicide risk? A. B. C. D. Chronic obstructive pulmonary disease Congestive heart failure Coronary heart disease Acquired immunodeficiency syndrome The nurse is assessing a client for warning signs of suicide. Which would be a concern? A. B. C. D. The client has decreased substance use. The client is reaching out to family and friends. The client has forgiven those who have caused emotional pain. The client has engaged in risky behaviors and tends to be impulsive. When completing a baseline assessment of a client with depression, which diagnostic tests would the nurse anticipate? A. B. C. D. Renal function tests Coagulation profile Thyroid function tests Abdominal ultrasound A nurse is caring for a white, 30-year-old man whose wife has recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important? A. B. C. D. Refer the client for long-term psychotherapy. Determine the client's risk of psychosis. Determine whether anyone in the client's family has had depression. Ask the client whether he is thinking about killing himself. The nurse is performing an assessment of a client with depression. It took more than four sessions to complete. What is the likely reason for needing multiple sessions? A. The client was unwilling to answer the nurse’s questions. B. The client was too tired to answer all of the nurse’s questions in one session. C. The client had an insufficient attention span to understand and answer the nurse’s questions. D. The client had impaired cognition leading to the inability to answer the nurse’s questions. Which would be the priority diagnosis for the client in the manic phase of bipolar disorder who is exhibiting aggressive behavior? A. B. C. D. Ineffective health maintenance Risk for other-directed violence Disturbed thought processes Impaired social interaction Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder? A. B. C. D. Bizarre, colorful, inappropriate dress Grandiose thinking and poor concentration Insulting, provocative behavior directed at staff Hyperactivity, dismissing meals, and sleep disturbance A client who is depressed tells the nurse, "If I'm honest, I really see suicide as the only way out." In order to challenge the client's belief, the nurse should ... A. B. C. D. help the client to identify and explore other options. encourage the client to identify and attend outpatient support groups. provide distraction by organizing therapeutic recreation. organize a family meeting. A client has just been admitted to the inpatient psychiatry unit following a suicide attempt. During the client's first 24 hours of care, what outcome should be identified? A. B. C. D. Client will express that the client feels safe on the unit Client will implement strategies for managing stress Client will participate actively in cognitive behavioral therapy Client will state that the client feels optimistic about the client's future The nurse is planning a presentation about suicide to a group of health professionals. Which should be included in the nurse’s teaching plan? A. B. C. D. Men are more likely to commit suicide than women are. Suicide rates for women are highest among women with children. Suicide tends to be most prevalent in the those in the age group of 30 to 40. The most common method of committing suicide is the use of sleeping pills. A 50-year-old client who has recently been diagnosed with a chronic degenerative illness has announced to the nurse the intention to commit suicide in order to prevent future suffering. Which fact should underlie the nurse's response to this client? A. The nurse is required to document the client's wishes and begin to facilitate an assisted suicide B. The nurse is obliged to protect the client from self-harm. C. The nurse must refer the client to a physician who is authorized to assist the client with a suicide. D. The nurse is ethically obliged to inform law enforcement. Research has shown that risk of suicide increases within which time frame for initiation of antidepressant therapy? A. 14 days B. 28 days C. 35 days D. 42 days A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what? A. B. C. D. Initial insomnia Terminal insomnia Hypersomnia Middle insomnia The nurse is conducting an admission assessment for a client with major depressive disorder. Which is the priority assessment for the nurse? A. B. C. D. Suicide risk assessment risk assessment Medication compliance assessment Mental status assessment 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? A. B. C. D. "I'm obliged to share what we talk about with the other people on your care team." "Why is it important to you that this be kept between you and I?" "In my experience, nothing good ever comes of keeping secrets." "What can I do to get your permission to share with the other members of the care team?" A 46-year-old client comes to the community mental health center because the client thinks they might be suffering from depression. When assessing this client, which symptom would the nurse identify as being necessary for the diagnosis of major depressive disorder to be made? A. B. C. D. Euphoria along with poor decision making ability Disregard for personal hygiene including cleanliness and appearance A loss of interest or inability to derive pleasure for previously enjoyed activities A stooped posture and nonverbal signs of a depressed mood The police bring a client to the hospital. They found the client in a hospital gown, swimming in a local creek. The client states that the client was “being baptized by Mother Nature, who loves and worships me.” How would the nurse describe the client's current alterations in mental status? A. Visual hallucinations B. Grandiose delusions C. Neologisms D. Dysphoria 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? A. B. C. D. Ensuring a plan is in place for the client's community-based care Ensuring that the client has created a commitment to treatment statement Documenting the client's psychiatric advance directive Communicating with the pharmacy where the client will obtain prescribed medications 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? A. B. C. D. Encourage the client to engage in calming group activities. Remove all dangerous items from the client's room. Provide antianxiety medication to prevent an incident. Encourage the client to act on thoughts that are leading to aggression. 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? A. B. C. D. The higher the potassium level, the lower the lithium level will be. The higher the sodium level, the lower the lithium level will be. Changes in diet will not affect lithium levels. Lithium has few interactions with other drugs. 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? A. B. C. D. substance abuse media influences lack of conflict resolution skills parenting practices 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? A. “You should notice an immediate improvement in your mood.” B. “You may not notice an improvement in your symptoms for 2 to 6 weeks.” C. “If you do not notice an improvement in your symptoms in 1 to 2 weeks, a different antidepressant will be prescribed.” D. The antidepressant's ability to affect the neurons in your brain will take between 2 to 6 weeks.” 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? A. B. C. D. Assess the client's blood pressure Perform a Mini Mental Status Examination (MMSE) Assess the client's jugular venous pressure Call an emergency code A 40-year-old client was admitted to the psychiatric unit after a suicide attempt in which the client was found standing on the edge of a bridge. Which statement made by the client would lead the nurse to suspect a potential imminent suicide attempt? A. B. C. D. “When will I be discharged?” “I don't want to be alone just now.” “How often does the night personnel make rounds?” “I'm bored. What's there to do around here?” 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? A. B. C. D. Establishing a support system for the woman and teaching her some coping measures Beginning treatment with a selective serotonin reuptake inhibitor Placing the woman on suicide precautions and establishing a no-suicide contract Beginning a course of therapy with a nurse–therapist or psychologist When conducting a suicide risk assessment, the nurse understands that which method has the least lethality? A. B. C. D. Hanging Wrist slashing Overdose of benzodiazepines Jumping of a building A 20-year-old client was admitted to the inpatient unit following a suicide attempt. The client is disheveled, disorganized, and dehydrated. The priority for the client's care during the first 24 hours of admission will be what? A. Assisting the client with activities of daily living, including a shower and clean clothing. B. Assessing the client's current suicidal ideation and putting the client on suicide precautions. C. Rehydrating the client by forcing fluid D. Assessing the client's recent suicide attempt and identifying factors that may have contributed to it. 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? A. B. C. D. Increased focus Decreased complains of pain Psychomotor retardation Increased energy level The policies and procedures at a community psychiatric-mental health center include an emphasis on case finding. How can a nurse at the center best perform case finding? A. B. C. D. Assessing all clients carefully to identify those at risk for suicide Modifying the center's environment to maximize client safety Organizing the layout of the center to allow observation of clients Encouraging clients not to be ashamed of previous suicide attempts or suicidal thoughts When caring for a client with mania, which would the nurse most likely assess? A. B. C. D. Slow, repetitive speech Logical thinking Narrowed focus Unusual self-confidence 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? A. B. C. D. Antidepressant therapy Psychotherapy Light therapy Electroconvulsive therapy 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? A. "How would you describe your relationship with your parents?" B. "Do you ever feel like your situation is hopeless?" C. "Do you feel like your antidepressant is helping your mood?" D. "What are your plans for the next few days?" Which biogenic amines have been implicated in depression? A. Norepinephrine and serotonin B. Epinephrine and dopamine C. Dopamine and histamine D. Epinephrine and serotonin Which client is most likely to benefit from electroconvulsive therapy (ECT)? A. A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy B. A client with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode C. A client whose major depression has not responded appreciably to antidepressants D. A client whose recent strange behavior has been attributed to cyclothymic disorder The nurse has been asked to assess a client to determine if the client has a suicide plan. Which question would assist the nurse in assessing this area? A. "Are you a religious person?" B. “Do you have people in your life who are supportive of you?” C. “Are you thinking about killing yourself right now?” D. “How do you generally cope with problems in your life?” 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? A. B. C. D. Include family members to provide a better understanding of symptoms of the illness Avoid inclusion of significant others to ensure confidentiality of client Discuss how the client's risk factors have decreased following the hospitalization Remind the client to make an outpatient appointment for follow-up care 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? A. B. C. D. Suicide Dehydration Sleep disturbance Sleep disturbance The priority concern for people with mood disorders is what? A. Safety B. Social functioning C. Occupational functioning D. Basic care A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis? A. B. C. D. The client will discuss the cause of the fatigue. The client will reframe negative thoughts in a more positive way. The client will identify factors that contribute to depression. The client will differentiate between reality and fantasy. 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? A. Fifty percent of all suicides occur as a result of major psychoses. B. Analysis of suicide notes reveals that most people who commit suicide are extremely unhappy. C. Suicidal tendencies are inherited. D. Suicide attempts are very common in teenage girls. The nurse is assessing a client who has presented to the emergency department in emotional distress. What client data represents the greatest risk for suicide? A. B. C. D. The client overdosed on pills 2 years earlier The client states, "Everything just seems really dark right now." The client has been treated with a variety of antidepressants over the years. The client sits silently after being asked several of the assessment questions 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? A. The client recently purchased a large bottle of over-the-counter analgesics B. The client stopped attending a depression support group, despite initially benefiting from it C. The client told the nurse, "I just want to stop being a burden to my wife and kids." D. The client has told the nurse, "I'm pretty sure my meds aren't working." 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. A. B. C. D. E. "I've been drinking about three or four more beers every night." “I've been going out with my friends about once or twice a week.” “I'm so tired that all I ever want to do is sleep all the time.” “Most times, I feel like I'm trapped with no way out.” “I'm looking for a new job because my job is so stressful.” The nurse is preparing to discharge a client from the inpatient facility where the client was treated following an unsuccessful suicide attempt. The priority assessment for the nurse to make is to assess whether or not the client can do what? A. Identify a person to whom he or she can turn to for help after discharge. B. Understand the need for daily medications. C. Feel stigmatized by the hospitalization experience. D. Complete activities of daily living independently. A client is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also reports having felt unhappy most of the time for "as long as I can remember." Which diagnosis should the nurse anticipate for this client? A. Bipolar disorder B. Rapid cycling disorder C. Mild depressive disorder D. Persistent depressive disorder 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? A. Point out that each time the client stops taking medication, the client becomes manic again. B. During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. C. Ensure that a family member takes responsibility for administering medications. D. Remind the client that the client owes it to the client's spouse and children to stay well. 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? A. “Try to limit your fluid intake to no more than four to six glasses per day.” B. “If you don't feel substantially different in a few days, increase your dose by 50%.” C. Avoid exercise at the hottest times of the day.” D. Try to adapt to a low-salt diet as soon as possible.” Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what? A. B. C. D. Anaclitic depression Moderate depression A mood disorder due to a general medical condition Postpartum psychosis 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? A. "You'll need to continue the medication for about 6 to 12 months to see how things go." B. "It's probably best to continue the medication for another month, gradually decreasing the dosage over that time." C. "Since you have no more symptoms, you can stop taking the medications tomorrow." D. "The medication has eliminated your symptoms so you'll need to keep taking it for the rest of your life." A client on the psychiatric mental health unit completed suicide. A nurse who cared for the client has been experiencing insomnia and anxiety attacks since the event. What is the nurse's first action? A. Confide in one of the psychiatrists who gives care on the unit B. Dialogue with a trusted colleague about these feelings C. Take a leave of absence until the symptoms have stopped D. Interact with other clients in order to witness improvements in their condition 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? A. B. C. D. Cognitive awareness and intellectual abilities Interest in learning about the disorder Ability to concentrate and process the information Likelihood to assume responsibility for self-care