Deck 17: Mood Disorders and Suicide

Question 1

Which best explains the neurochemical processes responsible for depression?

A) Increased activity of dopamine
B) Decreased glucocorticoid activity
C) Decreased serotonin and norepinephrine activity
D) Potentiating of the kindling process

Answer 1

Decreased serotonin and norepinephrine activity

Question 2

Which is a freudian explanation of the etiology of depression?

A) Depression is a reaction to a distressing life experience.
B) Depression results from being raised by rejecting or unloving parents.
C) Depression results from cognitive distortions.
D) Depression is anger turned inward.

Answer 2

Depression is anger turned inward.

Question 3

Which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply.

A) Norepinephrine levels may be increased in mania.
B) Manic episodes are a defense against underlying depression.
C) Acetylcholine seems to be implicated in mania.
D) The id takes over the ego and acts as an undisciplined hedonistic being (child).

Answer 3

Manic episodes are a defense against underlying depression.
The id takes over the ego and acts as an undisciplined hedonistic being (child).

Question 4

Which variables represent the highest risk for developing major depressive disorder? Select all that apply.

A) Male gender
B) Mood disorder in first-degree relatives
C) Substance abuse
D) Divorced
E) Older adult

Question 5

A concerned family member tells the nurse, I am concerned about my brother. He has been acting very different lately. Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the brother has bipolar disorder?

A) Taking unnecessary risks
B) Sleeping more
C) Intense focus
D) Showing low self-esteem

Question 6

A client is admitted for major depression. What should the nurse expect to find during assessment?

A) Anhedonia, feelings of worthlessness, and difficulty focusing
B) Depressed mood, guilt, and pressured speech
C) Changes in sleep pattern, tired, and grandiose mood
D) Difficulty focusing, feelings of helplessness, and flight of ideas

Question 7

A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm?

A) Immediately after a family visit
B) On the anniversary of significant life events in the client's life
C) During the first few days after admission
D) Approximately 2 weeks after starting antidepressant medication

Question 8

The nurse is planning care for a client with major depression. Which is an appropriate expected outcome?

A) The client will avoid causing harm to others.
B) The client will be free from stress.
C) The client will independently carry out activities of daily living.
D) The client will not experience agitation.

Question 9

A client who is depressed begins to cry and states, I'm just really sick of feeling this way. Nothing ever seems to go right in my life. Which would be the most appropriate response by the nurse?

A) Don't cry. Try to look at the positive side of things.
B) You are feeling really sad right now. It's a hard time.
C) Hang in there. Your medication will start helping in a few days.
D) Nothing ever goes right?

Question 10

A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior?

A) Administering a sedative that has been prescribed to be used PRN.
B) Insisting the client take a time-out in his room
C) Clearing the area of all other clients
D) Setting limits on aggressive and intimidating behavior

Question 11

Which meal would the nurse provide to best meet the nutritional needs of a client who is manic?

A) Peanut butter sandwich, chips, cola
B) Fried chicken, mashed potatoes, milk
C) Ham sandwich, cheese slices, milk
D) Spaghetti, garlic bread, salad, tea

Question 12

A client who is manic states, What time is it? I have to see the doctor. Is breakfast here yet? I've got to see the doctor first. Can I get my cereal out of the kitchen? Which would be the most appropriate response by the nurse?

A) Please slow down. I'm not sure what you need first.
B) You will have to be quiet and have breakfast after the doctor comes.
C) Are you hungry?
D) Your thoughts seem to be racing this morning.

Question 13

A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time?

A) Accompany the client to his or her room to get dressed.
B) Put the client in seclusion for his or her own protection.
C) Tell other clients to ignore the behavior because it is harmless.
D) Tell the client that the behaviors have to stop right now.

Question 14

The client with mania attempts to hit the nurse. Which is the best response by the nurse?

A) Do not swing at me again. If you cannot control yourself, we will help you.
B) If you do that one more time, you will be put in seclusion immediately.
C) Stop that. I didn't do anything to provoke an attack.
D) Why do you continue that kind of behavior? You know I won't let you do it.

Question 15

During report, the nurse learns that a client with mania has not slept since admission 2 days ago. On entering the day room, the nurse finds this client dancing to loud music. Which would be the most appropriate statement by the nurse?

A) Do you think you could sit still for a few minutes so we can talk?
B) How are you ever going to get any rest if you keep that music on?
C) Let's go to the conference room and talk for a while.
D) Turn the radio down so we can hear ourselves talk.

Question 16

At 1 _AM, the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. What would be the nurse's most therapeutic response?

A) Go to the day room and wait while I call your psychiatrist.
B) Don't be unreasonable. I can't call the psychiatrist at this time of night.
C) I can't call the psychiatrist now, but you and I can talk about your request for a pass.
D) You must really be upset to want a pass immediately; I'll give you some medication.

Question 17

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale?

A) As soon as lunch is over, the client will calm down.
B) Other clients need to be protected from the intrusive behavior.
C) The client's behavior is not an imminent threat to anyone's physical safety.
D) The client needs food and fluids in any way possible.

Question 18

A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first?

A) Decrease the client's environmental stimuli.
B) Give the client feedback about his behavior.
C) Introduce the client to other staff on the unit.
D) Tell the client about hospital rules and policies.

Question 19

The nurse observes a client sitting alone at a table, looking sad and preoccupied. The nurse sits down and says, I saw you sitting alone and thought I might keep you company. The client turns away from the nurse. Which would be the most therapeutic nursing intervention?

A) Move to another chair closer to the client and say, The staff is here to help you.
B) Move to a chair a little further away and say, We can just sit together quietly.
C) Remain in place and say, How are you feeling today?
D) Say, I'll visit with you a little later, and leave the client alone for a while.

Question 20

A client with depression appears lethargic and apathetic but agrees to participate in a leisure activity group. Which nursing intervention is most likely to help the client successfully participate?

A) Allowing the client to direct her participation at her own pace
B) Giving the client several choices of projects, so she can choose her favorite
C) Staying away from the client during the session to encourage free expression
D) Structuring the activity to facilitate completion of one specific task

Question 21

A client asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. Which would be the most therapeutic nursing intervention?

A) Stating, The effects of medications will not last forever. You will need to eventually learn to function without them.
B) Stating, Medications help your brain function better, but the therapy helps you achieve lasting behavior change.
C) Stating, Both are recommended. Since your insurance covers both, that is the best plan for you.
D) Asking, Do you have reservations about going to therapy?

Question 22

A client who has been discharged home on Celexa (citalopram) calls the nurse complaining that the medication causes her to feel too drowsy. The nurse should make which of the following suggestions?

A) Make an appointment to change to a different medication.
B) Take the medication at night.
C) Be patient while this early side effect subsides.
D) Skip a dose if drowsiness is excessive.

Question 23

The wife of a client with bipolar disorder calls the nurse expressing distress about recent spending patterns of her husband. The nurse suggests the wife implement the limit- setting skills she has learned in family therapy. In this instance, the nurse's action would be considered

A) inappropriate; the nurse should not give advice to the wife.
B) inappropriate; the husband has the legal right to spend personal money.
C) appropriate; the wife is responsible for the husband's actions since he has a mental illness.
D) appropriate; the wife needs support in setting boundaries.

Question 24

A client is being discharged on lithium. The nurse encourages the client to follow which health maintenance recommendations? Select all that apply.

A) Weigh self weekly at the same time of day.
B) Drink a 2-L bottle of decaffeinated fluid daily.
C) Do not alter dietary salt intake.
D) See the doctor if you get the flu.
E) Restrict involvement in intense exercise.

Question 25

The nurse is teaching a 70-year-old man about his depression. Which statement by the client would indicate that teaching has been effective?

A) All old people get depressed at times.
B) I'm glad I'll feel better in 2 or 3 days.
C) I never knew depression could just happen for no specific reason.
D) When I reduce the stress in my life, the depression will go away.

Question 26

Which individual is at highest risk for committing suicide?

A) A 71-year-old male, alcohol user, independent minded
B) A 16-year-old female, diabetic, two best friends
C) A 47-year-old male, schizophrenic, unemployed
D) A 57-year-old female, depression, active in church

Question 27

Which is a possible explanation for the increased risk of suicide in persons who have had a relative who committed suicide?

A) The relative's suicide offers a sense of permission or acceptance of suicide as a method of escaping a difficult situation.
B) Many people with depression who have suicidal ideation lack the energy to implement suicide plans, but antidepressant treatment can actually give clients with depression the energy to act on suicidal ideation.
C) Suicide is more likely to occur in April when natural energy from increased sunlight may give the client the energy to act on suicidal ideation.
D) The relative's suicide caused the family members to realize that suicide is emotionally harmful to the ones left behind and vow not to consider suicide.

Question 28

Which time periods during antidepressant therapy are persons most likely to commit suicide? Select all that apply.

A) After starting antidepressant therapy but not having reached the therapeutic level
B) After having reached the therapeutic level of antidepressants and maintained it for several years
C) If the client has made a choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed
D) If the client does not adhere to the medication regimen and takes antidepressant medications irregularly
E) Prior to initiating antidepressant therapy but before the depression results in lack of energy

Question 29

Which client is at highest risk for carrying out a suicide plan?

A) A client who plans to take a bottle of sleeping pills.
B) A client who says, My life is over.
C) A client who has a private gun collection.
D) A client who says, I'm going to jump off the next bridge I see.

Question 30

A client who is depressed states, I think my family would be better off without me. They don't need to worry. Which would be the most appropriate response by the nurse?

A) Are you planning to commit suicide?
B) What do you think they are worried about?
C) Where are you going?
D) You don't mean that. Your family loves you.

Question 31

A visitor comes to see a client who is suicidal. Upon entering the unit, the nurse notices that the visitor has brought the client a can of his favorite soda. Which action should the nurse take at his time?

A) Confiscate the soda can as a restricted item.
B) Pour the soda into a plastic cup.
C) Ask the visitor to place the soda can at the nurse's desk until he or she leaves.
D) Ask the visitor not to bring outside items on the unit in the future.

Question 32

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has the highest priority?

A) Hopelessness related to recent divorce
B) Ineffective coping related to inadequate stress management
C) Spiritual distress related to conflicting thoughts about suicide and sin
D) Risk for suicide related to a highly lethal plan

Question 33

The nursing instructor is conducting a preconference with a group of nursing students on a psychiatric unit. Which statement made by a student reflects the greatest barrier to being able to provide professional care to the client who is suicidal?

A) I just don't understand why anyone would want to kill themselves.
B) I think suicide is wrong and selfish.
C) I get frustrated when my client negates all the positives I try to point out.
D) I can see how much my client is hurting inside.

Question 34

Which may contribute to a staff person being less effective in dealing with a person who is at increased risk for suicide? Select all that apply.

A) Negative societal view of suicide
B) Feeling inadequate and anxious about suicide and/or his or her own mortality
C) Having personally considered suicide but decided against it and not having dealt with the associated anxiety
D) Being unaware of his or her own feelings and beliefs about suicide
E) Implementing nursing interventions to decrease the risk of suicide