Depression, Bipolar & Suicide

When assessing a patient with severe depression, which of the following would the healthcare provider identify as a cognitive alteration?

• Low self-esteem

• Anxiety

• Powerlessness

• Somatic Delusions

Answer explanation

Patients diagnosed with depression may experience cognitive, affective, behavioral, or physiological alterations.

Cognition relates to processes such as judgment, evaluation, and reasoning.

A somatic delusion, the false belief that the patient has some physical defect or disease (e.g. the patient might think he/she has an internal parasite), is a cognitive alteration associated with depression.

The other choices are affective alterations.

The healthcare provider is caring for a patient who has undergone electroconvulsive therapy (ECT). The patient should be carefully assessed for which of the following common adverse effects of this treatment?

• Headache and memory loss

• Aggression and violent behavior

• Palpitations and cardiac arrest

• Dizziness and blurred vision

Answer explanation

ECT induces a seizure, which can cause transient increases in blood pressure, pulse, and intracranial pressure.

ECT causes numerous alterations in the central nervous system.

The most common adverse effects a patient may experience after ECT include headache, confusion, and memory loss.

A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis?

• The client is disheveled and malodorous.

• The client refuses to interact with others.

• The client is unable to feel any pleasure.

• The client has maxed-out charge cards and exhibits promiscuous behaviors.

Answer explanation

The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior would be exhibiting manic symptoms.

According to the DSM-IV-TR, these symptoms would rule out the diagnosis of major depressive disorder.

What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include exaggerated physical activity, agitation, insomnia, and anorexia?

• Risk for injury

• Chronic low self-esteem

• Noncompliance

• Insomnia

Answer explanation

Risk for injury is the priority diagnosis.

Possible injuries include dehydration, which may result from not drinking and trauma, which may result from bumping into objects or from physical altercations.

The other options are valid diagnoses, but not of highest priority.

An inappropriately dressed patient has not slept for 3 days while making excessive, expensive long-distance phone calls. When the patient can be heard singing loudly in the examining room, the nurse makes initial plans to focus on:

• Assessing needs for food, liquids, and rest

• Setting strict limits on dress and behavior

• Conducting an in-depth suicide assessment

• Obtaining a complete psychosocial assessment

Answer explanation

Patients with mania frequently ignore their basic physiologic needs, as evidenced by not sleeping for 3 days, thus making these assessments the priority.

Limits, although appropriate to consider, are not the priority.

The manic state precludes a thorough assessment initially.

Suicide assessment is not a priority at this time but reckless behavior could result in personal injury.

Which principle should the nurse apply when planning nursing care for a patient who was voluntarily admitted after a suicide attempt?

• Patients who attempt suicide and fail will not try again.

• The more specific the plan, the greater the risk for suicide.

• Patients who talk about suicide are less likely to attempt it.

• Patients who attempt suicide and fail do not really want to die.

Answer explanation

Patients whose suicidal ideation includes a vague, diffuse plan or no plan at all are not at as high a risk for attempting suicide as an individual who has a well-developed plan and the means to carry it out.

The nurse will need to continually reassess the patient.

None of the remaining options are true statements concerning suicide attempts.

An appropriate nursing strategy to assist a patient who was involuntarily admitted after a suicide attempt is::

• Avoiding any focus on the topic of suicide

• Encouraging patient to verbalize personal feelings

• Supporting patient focus on others rather than self

• Discussing the impact of suicidal thoughts on the family

Answer explanation

Verbalization helps relieve pent-up feelings and emotional pain.

Avoidance of the topic is nontherapeutic for a suicidal patient.

The remaining options may serve to increase the patient’s feelings of guilt.

A client is admitted to the mental health unit with a diagnosis of depression. The nurse would develop a plan of care for the client that includes which intervention?

• Encouraging quiet reading and writing for the first few days

• Identification of physical activities that will provide exercise

• No socializing activities until the client asks to participate in milieu

• A structured program of activities in which the client can participate

Answer explanation

A client with depression often is withdrawn while experiencing difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness and poor self-esteem.

The plan of care needs to provide successful experiences in a stimulating yet structured environment.

The remaining options are either too “restrictive” or offer little or no structure and stimulation.

A manic client begins to make sexual advances toward visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which intervention would the nurse implement?

• Place the client in seclusion for 30 minutes.

• Tell the client that the behavior is inappropriate.

• Escort the client to their room, with the assistance of other staff.

• Tell the client that their telephone privileges are revoked for 24 hours.

Answer explanation

The client is at risk for injury to self and others and should be escorted out of the dayroom.

Seclusion is premature in this situation.

Telling the client that the behavior is inappropriate has already been attempted by the nurse.

Denying privileges may increase the agitation that already exists in this client.

The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client’s speech pattern is rapid, and affect is belligerent. Based on these observations, which is the nurse’s immediate priority of care?

• Provide safety for the client and other clients on the unit.

• Provide the clients on the unit with a sense of comfort and safety.

• Assist the staff in caring for the client in a controlled environment.

• Offer the client a less stimulating area in which to calm down and gain control.

Answer explanation

Safety of the client and other clients is the immediate priority.

The correct option is the only one that addresses the safety needs of the client as well as those of the other clients.