Lippincott mood disorders (Question Bank, With Verified Answers)

Lippincott mood disorders 1. The nurse is planning care with a Mexican client who is diagnosed with depression. The client believes in "mal ojo" (the evil eye) and uses treatment by a root healer. The nurse should do which of the following? 1. Avoid talking to the client about the root healer. 2. Explain to the client that Western medicine has a scientific, not mystical, basis. 3. Explain that such beliefs are superstitious and should be forgotten. 4. Involve the root healer in a consultation with the client, primary health care provider, and nurse. 1. 4. Including the root healer gives credibility and respect to the client's cultural beliefs. Avoiding talking about the healer demonstrates either ignorance or disregard for the client's cultural values. Negative comparison of root healing with Western medicine not only denigrates the client's beliefs but is likely to alienate and cause the client to end treatment. 2. After a period of unsuccessful treatment with Elavil (amitriptyline), a woman diagnosed with depression is switched to Parnate (tranylcypromine). Which statement by the client indicates the client understands the side effects of Parnate? 1. "I need to increase my intake of sodium." 2. "I must refrain from strenuous exercise. ""I must refrain from eating aged cheese or yeast products." 4. "I should decrease my intake of foods containing sugar." ...2. 3. Cheese and yeast products contain tyramine which the client should avoid to prevent a negative interaction with Parnate, a monoamine oxidase (MAO) inhibitor . Sodium will not interact with Parnate and neither exercise nor sugar needs to be 3. A client is scheduled for the first electroconvulsive therapy (ECT) treatment in the morning. The client has been unable to sleep but at 10 pm refused to take Restoril as the nurse suggested. The client is still unable to sleep at 11: 15 pm. In what order should the nurse do the following? 1. Sit quietly with the client. 2. Encourage the use of Restoril. 3. Offer use of MP3 player with relaxing music. 4. Discuss specific concerns. ...3. 1. Sit quietly with the client. 4. Discuss specific concerns. 3. Offer use of MP3 player with relaxing music. 2. Encourage the use of Restoril. The client is likely anxious about the procedure. The nurse should first spend time with the client and then discuss the client's concerns about the procedure. Next, the nurse could suggest the client listen to relaxing music. The use of the sleeping medication would only be considered as a last resort since it might interfere with the effectiveness of the seizure required for the treatment. 4. The client is receiving 6 mg of selegiline transdermal system every 24 hours for major depression. The nurse should judge teaching about Emsam to be effective when the client makes which statement? "I need to avoid using the sauna at the gym." 2. "I can cut the patch and use a smaller piece." 3. "I need to wait until the next day to put on a new patch if it falls off." 4. "I might gain at least 10 lb (4.5 kg) from the medication." ...4. 1. Selegiline transdermal system is the first transdermal monoamine oxidase inhibitor. The client needs to avoid exposing the application site to external sources of direct heat , such as saunas, heating lamps , electric blankets , heating pads, heated water beds, and prolonged direct sunlight because heat increases the amount of selegiline that is absorbed, resulting in elevated serum levels of selegiline. Cutting the patch and using a smaller piece will result in a decreasedamount of medication absorption, most likely leading to a worsening of the symptoms of depression. The client should apply a new patch as soon as possible if one falls off to ensure an adequate amount of medication absorption. Selegiline is not associated with significant weight gain, although a weight gain of 1 to 2 lb (2.2 to 4.4 kg) is possible. 5. A client has been taking 30 mg of duloxetine hydrochloride (Cymbalta) twicedaily for 2 months because of depression and vague aches and pains. While interacting with the nurse, the client discloses a pattern of drinking a six-pack of beer daily for the past 10 years to help with sleep. What should the nurse do first? 1. Refer the client to the dual diagnosis program at the clinic. 2. Share the information at the next interdisciplinary treatment conference. 3. Report the client's beer consumption to the primary health care provider. 4. Teach the client relaxation exercises to perform before bedtime. ...5. 3. The nurse should report the client's beer consumption to the primary health care provider. Duloxetine should not be administered to a client with renal or hepatic insufficiency because the medication can elevate liver enzymes and, together with substantial alcohol use, can cause liver injury . Referring the client to the dual diagnosis program, sharing information at the next interdisciplinary treatment conference, and teaching the client relaxation exercises are helpful interventions for the nurse to implement. However, reporting the findings to the primary health care provider is most important. 6. A client was admitted to the inpatient unit 3 days ago with a flat affect , psychomotor retardation, anorexia, hopelessness, and suicidal ideation. The primary health care provider prescribed 75 mg of venlafaxine extended release (Effexor XR) to be given every morning. The client interacted minimally with the staff and spent most of the day in his room. As the nurse enters the unit at the beginning of the evening shift, the client is smiling and cheerful and appears to be relaxed. What should the nurse interpret as the most likely cause of the client's behavior? 1. The Effexor is helping the client's symptoms of depression significantly. 2. The client's sudden improvement calls for close observation by the staff. 3. The staff can decrease their observation of the client. 4. The client is nearing discharge due tothe improvement of his symptoms. ...6. 2. The client's sudden improvement and decrease in anxiety most likely indicate that the client is relieved because he has made the decision to kill himself and may now have the energy to complete the suicide . Symptoms of severe depression do not suddenly abate because most antidepressants work slowly and take 2 to 4 weeks to providea maximum benefit. The client will improve slowly due to the medication. The sudden improvement in symptoms does not mean the client is nearing discharge and decreasing observation of the client compromises the client's safety. 7. The client is taking 50 mg of lamotrigine (Lamictal) daily for bipolar depression. The client shows the nurse a rash on his arm. What should the nurse do? 1. Report the rash to the primary health care provider. 2. Explain that the rash is a temporary adverse effect. 3. Give the client an ice pack for his arm. 4. Question the client about recent sun exposure. ...7. 1. The nurse should immediately report the rash to the primary health care provider because lamotrigine can cause Stevens-Johnson syndrome, a toxic epidermal necrolysis. The rash is not a temporary adverse effect . Giving the client an ice pack and questioning the client about recent sun exposure are irresponsible nursing actions because of the possible seriousness of the rash. 8. The nurse is reviewing the laboratory report with the client's lithium level taken that morning prior to administering the 5 pm dose of lithium. The lithium level is 1.8 mEq/ L (1.8 mmol/ L). The nurse should: 1. Administer the 5 pm dose of lithium. 2. Hold the 5 pm dose of lithium. 3. Give the client 8 oz (236 mL) of water with the lithium. 4. Give the lithium after the client's supper. ...8. 2. The nurse should hold the 5 pm dose of lithium because a level of 1.8 mEq/ L (1.8 mmol/ L) can cause adverse reactions, including diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination , which are early signs of lithium toxicity. The nurse should report the lithium level to the primary health care provider, including any symptoms of toxicity. Administering the 5 pm dose of lithium, giving the client the lithium with 8 oz (236 mL) of water, or giving it after supper would result in an increase of the lithium level, thus increasing the risk of lithium toxicity. 9. A nurse is conducting a psychoeducational group for family members of clients hospitalized with depression. Which family member's statement indicates a need for additional teaching? 1. "My husband will slowly feel better as his medicine takes effect over the next 2 to 4 weeks." 2. "My wife will need to take her antidepressant medicine and go to group to stay well." "My son will only need to attend outpatientappointments when he starts to feel depressed again." 4. "My mother might need help with grocery shopping, cooking, and cleaning for a while." ...9. 3. Additional teaching is needed for the family member who states her son will only need to attend outpatient appointments when he starts to feel depressed again. Compliance with medication and outpatient follow-up are key in preventing relapse and rehospitalization. The statements expressing expectations of feeling better as medication takes effect , needing medicine and group therapy to stay well, and needing help with grocery shopping, cooking, and cleaning for a while indicate the families' understanding of depression, medication, and follow-up care. 10. A 16-year-old client is prescribed 10 mg of paroxetine (Paxil ) at bedtime for major depression. The nurse should instruct the client and parents to monitor the client closely for which adverse effect? 1. Headache. 2. Nausea. 3. Fatigue. 4. Agitation. ...10. 4. The nurse closely monitors the client taking paroxetine for the development of agitation, which could lead to self-harm in the form of a suicide attempt. Headache, nausea, and fatigue are transient adverse effects of paroxetine. 11. A client diagnosed with major depression spends most of the day lying in bed with the sheet pulled over his head . Which of the following approaches by the nurse is most therapeutic? 1. Wait for the client to begin the conversation. 2. Initiate contact with the client frequently. 3. Sit outside the client's room. 4. Question the client until the client responds. ...11. 2. The nurse should initiate brief, frequent contacts throughout the day to let the client know that he is important to the nurse. This will positively affect the client's self-esteem. The nurse's action conveys acceptance of the client as a worthwhile person and provides some structure to the seemingly monotonous day. Waiting for the client to begin the conversation with the nurse is not helpful because the depressedclient resists interaction and involvement with others. Sitting outside of the client's room is not productive and not necessary in this situation. If the client were actively suicidal, then a one-on-one client-to-staff assignment would be necessary. Questioning the client until he responds would overwhelm him because he could not meet the nurse's expectations to interact. 12. The client exhibits a flat affect, psychomotor retardation, and depressed mood. The nurse attempts to engage the client in an interaction , but the client does not respond to the nurse . Which response by the nurse is most appropriate? "I'll sit here with you for 15 minutes." 2. "I'll come back a little bit later to talk. " 3. "I'll find someone else for you to talkwith." 4. "I'll get you something to read." ...12. 1. The most appropriate action is for the nurse to remain with the client even if the client does not engage in conversation with the nurse. A client with severe depression may be unable to engage in an interaction with the nurse because the client feels worthless and lacks the necessary energy to do so. However , the nurse's presence conveys acceptance and caring, thus helping to increase the client's self-worth. Telling the client that the nurse will come back later , stating that the nurse will find someone else for the client to talk with, or telling the client that the nurse will get her something to read conveys to the client that she is not important, reinforcing the client's negative view of herself. Additionally , such statements interfere with the client's development of a sense of security and trust in the nurse. 13. After a few minutes of conversation, a female client who is depressed wearily asks the nurse, "Why pick me to talk to? Go talk to someone else." Which of the following replies by the nurse is best? 1. "I'm assigned to care for you today, if you'll let me." 2. "You have a lot of potential, and I'd like to help you." 3. "I'll talk to someone else later." "I'm interested in you and want to help you." ...13. 4. The nurse tells the client that the nurse is interested in her to increase the client's sense of importance, worth, and self -esteem. Also, stating that the nurse wants to help conveys to the client that she is worthwhile and important. Telling the client that the nurse is assigned to care for her is impersonal and implies that the client is being uncooperative. Telling the client that the nurse is there because the client has potential for improvement will not help the client with low self-esteem because most people develop a sense of self-worth through accomplishment. Simply saying that the client has a lot of potential will not convince her that she is worthwhile. Telling the client that the nurse will talk to someone else later is not client focused and does not address the client's question or concern. 14. A client is receiving paroxetine (Paxil) 20 mg every morning. After taking the first three doses, the client tells the nurse that the medication upsets the stomach. Which of the following instructions should the nurse give to the client? 1. "Take the medication an hour before breakfast." "Take the medication with some food." 3. "Take the medication at bedtime. " 4. "Take the medication with 4 oz (120 mL) of orange juice." ...14. 2. Nausea and gastrointestinal upset is a common, but usually temporary, side effect of paroxetine (Paxil). Therefore, the nurse would instruct the client to take the medication with food to minimize nausea and stomach upset. Other more common side effects are dry mouth, constipation, headache, dizziness, sweating, loss of appetite, ejaculatory problems in men, and decreased orgasms in women. Taking the medication an hour before breakfast would most likely lead to further gastrointestinal upset. Taking the medication at bedtime is not recommended because Paxil can cause nervousness and interfere with sleep. Because orange juice is acidic, taking the medication with it, especially on an emptystomach, may lead to nausea or increase the client's gastrointestinal upset. 15. The primary health care provider prescribes fluoxetine (Prozac) orally every morning for a 72-year-old client with depression. Which transient adverse effect of this drug requires immediate action by the nurse? 1. Nausea. 2. Dizziness. 3. Sedation. 4. Dry mouth. ...15. 2. The presence of dizziness could indicate orthostatic hypotension, which may cause injury to the client from falling. Nausea, sedation, and dry mouth do not require immediate intervention by the nurse. 16. Which of the following statements by a client taking trazodone (Desyrel) as prescribed by the primary health care provider indicates to the nurse that further teaching about the medication is needed? 1. "I will continue to take my medication after a light snack." 2. "Taking Desyrel at night will help me to sleep." "My depression will be gone in about 5 to 7 days." 4. "I won't drink alcohol while taking Desyrel." ...16. 3. Symptom relief can occur during the first week of therapy, with optimal effects possible within 2 weeks. For some clients, 2 to 4 weeks is needed for optimal effects. The client's statement that the depression will be gone in 5 to 7 days indicates to the nurse that clarification and further teaching is needed . Trazodone should be taken after a meal or light snack to enhance its absorption. Trazodone can cause drowsiness, and therefore the major portion of the drug should be taken at bedtime . The depressant effects of central nervous system depressants and alcohol may be potentiated by this drug. 17. A 62-year-old female client with severe depression and psychotic symptoms is scheduled for electroconvulsive therapy (ECT) tomorrow morning. The client's daughter asks the nurse, "How painful will the treatment be for Mom?" The nurse should respond by saying which of the following? 1. "Your mother will be given something for pain before the treatment." 2. "The primary health care provider will make sure your mother doesn't suffer needlessly." "Your mother will be asleep during the treatment and will not be in pain." 4. "Your mother will be able talk to us and tell us if she's in pain." ...17. 3. The nurse should explain that ECT is a safe treatment and that the client is given an ultrashort-acting anesthetic to induce sleep before ECT and a muscle relaxant to prevent musculoskeletal complications during the convulsion, which typically lasts 30 to 60 seconds to be therapeutic. Atropineis given before ECT to inhibit salivation and respiratory tract secretions and thereby minimize the risk of aspiration. Medication for pain is not necessary and is not given before or during the treatment. Some clients experience a headache after the treatment and may request and be given an analgesic such as acetaminophen (Tylenol). Telling the daughter that the primary health care provider will ensure that the client does not suffer needlessly would not provide accurate information about ECT. This statement also implies that the client will have pain during the treatment, which is untrue. 18. During a group session, a client who is depressed tells the group that he lost his job. Which of the following responses by the nurse is best? "It must have been very upsetting for you." 2. "Would you tell us about your job?" 3. "You'll find another job when you're better." 4. "You were probably too depressed to work." ...18. 1. By stating, "It must have been very upsetting for you," the nurse conveys empathy to the client by recognizing the underlying meaning of a painful occurrence . The nurse's statement invites the client to verbalize feelings and thoughts and lets the client know that the nurse is listening to and respects the client. Telling the client to talk about the job disregards the client's feelings and is nontherapeutic for the depressed client because of underlying feelings of worthlessness and guilt that are commonly present. Telling the client that he will find another job when he is better or that he was probably too depressed to work is inappropriate because it disregards the client's feelings and may promote additional feelings of failure and inadequacy in the client. 19. A male client who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse observes the client to be in need of grooming and hygiene. Which of the following nursing actions is most appropriate? 1. Explaining the importance of hygiene to the client. 2. Asking the client if he is ready to shower. 3. Waiting until the client's family can participate in the client's care. 4. Stating to the client that it's time for him to take a shower. ...19. 4. The client with depression is preoccupied, has decreased energy, and cannot make decisions, even simple ones . Therefore, the nurse presents the situation , "It's time for a shower," and assists the client with personal hygiene to preserve his dignity and self-esteem. Explaining the importance of good hygiene to the client is inappropriate because the client may know the benefits of hygiene but is too fatigued and preoccupied to pay attention to self -care. Asking the client if he is ready for a shower is not helpful because the client with depression commonly cannot make even simple decisions. This action also reinforces the client's feeling about not caring about showering. Waiting for the family to visit to help with the client's hygiene is inappropriate and irresponsible on the part of the nurse. The nurse is responsible for making basic decisions for the client until the client can make decisions for himself. 20. When developing the teaching plan for the family of a client with severe depression who is to receive electroconvulsive therapy (ECT), which of the following information should the nurse include?