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The nurse is reviewing the laboratory results of a client receiving lithium carbonate. The nurse determines the client’s medication level is therapeutic based on which result?
A. 0.2 mEq/L (0.2 mmol/L)
B. 0.4 mEq/L (0.4 mmol/L)
C. 1.0 mEq/L (1.0 mmol/L)
D. 1.4 mEq/L (1.4 mmol/L)
Answer: C
Rationale: Therapeutic serum levels for lithium are 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L). The other options are not within that determined range.
A client diagnosed with bipolar disorder is verbalizing, “The mare, doesn't care, over there, if you dare, anywhere.” The nurse documents the client’s statement as which thought pattern?
A. Grandiosity
B. Auditory hallucination
C. Clang association
D. Flight of ideas
Answer: C
Rationale: Clang associations are words that are strung together in rhyming phrases that have no connected meaning. Grandiosity thought pattern involves an unrealistic or exaggerated sense of self-worth, importance, wealth, or ability. Auditory hallucinations are communications heard only by the client. The person usually talks incessantly with flight of ideas or jumping from one subject to another and may describe thoughts as racing or pressured.
A client diagnosed with mania is pacing back and forth. To ensure adequate nutrition for this client, which action would be most appropriate to implement?
A. Ensuring the client's chooses food from the menu
B. Providing small pieces of fruit and grilled chicken
C. Encouraging at least one large meal to assure calorie intake
D. Making liquid meals available to the client at any time
Answer: B
Rationale: The client diagnosed with mania should be provided with foods that the client can eat while moving, when the client is unable to sit long enough to eat. When a client is in the manic stage, they may be unable to make decisions, including those regarding food selection. The manic client cannot stop to eat a large meal. Liquid meals do not contain enough calories for this client.
A nurse is preparing a plan of care for a client after the client receives electroconvulsive therapy (ECT). Which action would be most appropriate to include?
A. Reinforcing the client to time, place, and person
B. Evaluating the client for indications of severe confusion
C. Implementing seizure precautions
D. Monitoring the client for electrolyte imbalances
Answer: A
Rationale: Depending on whether unilateral or bilateral ECT is used, the person may have either short-term or long-term memory deficits. Mild, not severe, confusion may occur. Seizures and electrolyte imbalances typically do not occur post procedurally.
A client prescribed phenelzine has spent the afternoon away from the unit with family. Which intervention should the nurse initiate immediately upon learning that the client had pepperoni pizza for lunch?
A. Assess the client's blood pressure.
B. Check blood glucose level for 24 hours.
C. Perform a bedside electrocardiogram.
D. Assess urinary output.
Answer: A
Rationale: Phenelzine, a monoamine oxidase inhibitor (MAOI), can interact with numerous foods and drugs to produce a hypertensive crisis making the assessment and documentation of the client's blood pressure the priority intervention. Clients taking an MAOI should avoid foods that contain tyramine, a precursor of norepinephrine. This list includes several foods that are traditionally associated with pizza such as parmesan, provolone, and Romano cheeses as well as meats like pepperoni and sausage. Cardiac arrhythmias, hypotension, and alterations in blood glucose levels and urinary retention are identified as side effects associated with tricyclic antidepressants.
After educating a client who is prescribed lithium about the drug, the nurse determines that additional teaching is needed based on which client statement?
A. “I need to make sure I drink milk daily.”
B. “I must eat a 4 to 6 oz (112 to 168 g) of almonds each day.”
C. “It's alright to add raisins to my morning cereal.”
D. “I can eat a little of salt one day and a lot the next.”
Answer: D
Rationale: The reabsorption of sodium and lithium is closely related, with any increase or decrease in dietary sodium intake affecting the levels of lithium in the blood plasma. Lithium is not affected by calcium (dairy), magnesium (almonds), or potassium (raisins).
After reviewing the instructions given to a client prescribed a monoamine oxidase inhibitor (MAOI), the nurse determines that the teaching was successful when the client states the need to avoid which food?
A. Orange juice
B. Sauerkraut
C. Whole milk
D. Pickles
Answer: B
Rationale: MAOIs can interact with numerous foods and drugs to produce a hypertensive crisis. Foods such as sauerkraut contain tyramine and should be avoided. Vitamin C (orange juice), fats (whole milk), and sodium (pickles) do not need to be avoided when taking this medication.
A client's plan of care indicates the need for close monitoring of the client's cardiac status for arrhythmias. When reviewing the client’s medical record, the nurse notes that the client is receiving antidepressant therapy. Which antidepressant would the nurse identify as a potential factor contributing to the client's risk for arrhythmias?
A. Monoamine oxidase inhibitors (MAOIs)
B. Tricyclic antidepressants (TCAs)
C. Serotonin-specific reuptake inhibitors (SSRIs)
D. Heterocyclics
Answer: B
Rationale: TCAs also affect other body chemicals and characteristically produce a number of adverse and potentially dangerous side effects, including cardiac arrhythmias. This factor requires that all clients taking these agents be monitored closely. The other drugs are not associated with cardiac arrhythmias.
Which statement made by the nurse is appropriate to support the teaching plan for a client being prepared for electroconvulsive therapy (ECT)?
A. “This type of therapy induces a seizure that will be managed by the staff.”
B. “ECT has a high cure rate for your type of depression.”
C. “A registered nurse will perform the procedure for you.”
D. “There is little chance that you have any memory loss after the procedure.”
Answer: A
Rationale: ECT does trigger a seizure that is controlled and closely monitored by medical and psychiatric staff. While many clients experience good results from the treatment, ECT does not cure the depression. The person may have short-term or long-term memory loss. The procedure is performed by a health care provider, not a nurse.
A client is admitted to the psychiatric unit following a suicide attempt. Which client behavior demonstrates the best indicator of future client safety?
A. Suicide precautions have been implemented for this client.
B. The client is monitored for “cheeking” after each medication administration.
C. Client signs a no-harm contract for three consecutive shifts.
D. A one-on-one monitor is assigned to the client during shift changes.
Answer: C
Rationale: A “no-harm” contract may be established with the client every shift and renewed at a specific time. The contract should include a statement that the client will not kill or injure themself and will notify the staff when suicidal thoughts first occur. Agreeing to such a contract demonstrates client compliance with the treatment plan. Suicide precautions and specialized monitoring are appropriate but do not indicate that the client is agreeing to comply with treatment.
. A client who is willing to take a prescribed antidepressant medication is very resistant to attending cognitive-behavioral therapy sessions. Which response by the nurse is most appropriate to reinforce the importance of compliance with all aspects of treatment for depression?
A. “Most clients initially resist attending formal therapy sessions, but they soon realize the benefits of the sessions.”
B. “The focus of the therapy sessions will be to help you understand how negative thoughts and feelings are causing you to be depressed.”
C. “The medication will help improve your mood while the therapy helps you learn how to cope with the feelings that are triggering the depression.”
D. “It's been shown that taking the medication without working with a therapist produces only short-term improvement.”
Answer: C
Rationale: Psychotherapeutic drug agents are used very successfully in managing depression. As the medication becomes effective in restoring levels of neurotransmitters, the client's mood and energy level usually will improve as well. It is generally felt that medications help make the client more accepting of other interventions, but used alone, prove ineffective for long-term treatment. Psychotherapy for the depressed client involves assisting the client in exploring how negative thoughts and feelings are affecting their behavior. Once the underlying thoughts and feelings are understood, the client can identify more effective ways of coping. While all the remaining options are true statements, none explains the benefit of combining both medication and cognitive-behavioral therapies as effectively as the correct option.
A client who is demonstrating behaviors associated with severe depression is being admitted to the psychiatric unit. Which question would be most important to ask initially?
A. “Is it okay for us to watch you closely so you won't hurt yourself?”
B. “Do you have any thoughts about hurting yourself?”
C. “Describe to me how you plan to hurt yourself?”
D. “Are you familiar with suicidal prevention procedures?”
Answer: B
Rationale: Initially on admission, the nurse will attempt to determine the content of any suicidal thoughts or ideations. If the client has a plan, this usually indicates that the client is more serious about committing suicide and it is then that the nurse would determine the lethality of the method. A more lethal method usually indicates increased likelihood of an attempt. After the client confirms intention for self-harm and how they plan to achieve that goal, the nurse would create and implement a plan of care.
A client is being treated for acute depression. Which client statement supports the nurse's evaluation that the risk for relapse is minimal?
A. “I'm feeling more hopeful than I have in months.”
B. “The death of my parents was the trigger for my depression.”
C. “Treatment has taught me I can learn the skills to manage my stress.”
D. “I've scheduled evening counseling sessions, so I'll have no problem attending all of them.”
Answer: D
Rationale: The maintenance of a continued state of mood stability will depend on compliance with the medication and follow-up treatment plan. Arranging counseling sessions at a time that is favorable for the long term demonstrates a commitment to treatment compliance, which is the key to the prevention of relapse. Feeling hopeful and being confident about learning coping skills are positive but short-term outcomes. Understanding the triggers for one's depression is important in order to avoid or manage similar situations in the future, but such knowledge has a limited impact of relapse.
A nurse is interviewing a client with a suspected mood disorder. The client tells the nurse, “ I feel so inadequate over the years. Anything I’ve tried doesn’t work and I feel so helpless. I’ve given up looking for solutions.” Further interviewing reveals that the client has never experienced a major depressive episode but does report feeling this way most of the time. The client reports that symptoms disappear “for a month or so, but they always come back.” Based on this data, which condition would the nurse suspect?
A. Mania
B. Bipolar disorder
C. Persistent depressive disorder
D. Cyclothymic disorder
Answer: C
Rationale: The client with persistent depressive disorder has never had a major depressive episode and does not exhibit any symptoms of manic behavior. The symptoms of persistent depressive disorder are less severe than those of major depression, but the disorder tends to be more chronic. When the individual feels it is impossible to be rid of the feelings of depression, they may eventually give up trying to find a solution, even when presented with options. The feeling of having no hope for relief and a loss of control over the situation causes some individuals to behave in a helpless manner and overlook possible solutions (learned helplessness). They may seek options thought to be helpful but when the option is ineffective, it reinforces the initial feelings of helplessness. Cyclothymic disorder is a milder form of bipolar disorder characterized by mood disturbances, which involve periods of hypomanic symptoms and periods of depression. In bipolar disorder, there are alternate changes between extreme moods, ranging from high manic episodes to low depressive periods that are often related to increased stress in a person's life.
The medical record of a client with bipolar disorder reveals that the client has had five mood shifts within 1 year, alternating between mania and depression. The nurse would expect to find which condition as being documented?
A. Persistent depressive disorder
B. Rapid cycling
C. Cyclothymia
D. Hypomania
Answer: B
Rationale If the individual has four or more episodes of mania or depression within a year, they are said to be rapid cycling. Hypomania is a lesser mild to moderate form of mania. The client with persistent depressive disorder has never had a major depressive episode and does not exhibit any symptoms of manic behavior. The symptoms of persistent depressive disorder are less severe than those of major depression, but the disorder tends to be more chronic and there are no symptoms of mania. Cyclothymic disorder is a milder form of bipolar disorder characterized by mood disturbances, which involve periods of hypomanic symptoms and periods of depression.
The nurse documents an alteration in the client's affect based on which finding?
A. Being observed in the dayroom crying
B. Reporting being angry that dinner was late
C. Smiling when told they have mail
D. Reporting “I've been depressed for years”
Answer: C
Rationale: Affect describes the facial expression an individual displays (shows) in association with the mood (e.g., smiling when happy, grimacing when angry). Mood is an emotion that a person feels such as happiness, anger, sadness that can trigger certain behaviors such as crying.
A nurse practitioner is conducting a class for a group of staff nurses about neurotransmitters and their role in depression. The nurse practitioner determines that the teaching was successful when the group identifies depression as being associated with a deficit in which neurotransmitter(s)? Select all that apply.
A. Norepinephrine
B. GABA
C. Serotonin
D. Dopamine
E. Tyramine
Answer: A, C, D
Rationale: Depression results from a decrease in monoamine neurotransmitter (norepinephrine, serotonin, and dopamine) concentration to a level insufficient to stimulate the receptors. Foods to avoid contain tyramine, a precursor of norepinephrine. The substance gamma-aminobutyric acid (GABA) is a neurotransmitter that acts in an inhibitory manner, tending to cause nerves to “calm down.”
When reviewing the chart of a client diagnosed with acute depression, the nurse notes that the client has demonstrated behaviors associated with anhedonia. Which assessment data would the nurse document to support this observation? Select all that apply.
A. Client repeatedly reports “being worth 2 million dollars.”
B. Family says that client “loved to knit but now doesn't seem interested in doing so.”
C. Client demonstrates low-energy levels often reporting “I'm too tired.”
D. Most client interactions with other clients is to tell them what they are “doing wrong.”
E. Client says, “I just don't have any desire to play golf anymore like I did.”
Answer: B, E
Rationale: Anhedonia is the lack of pleasure in things an individual previously enjoyed. This often accompanies the depressive state. Delusions of grandiosity are noted by an exaggerated self-worth. Anergia is a marked decrease in energy level. Mania is a frenzied unstable mood that can be critical in nature.
A client is being discharged on a tricyclic antidepressant (TCA). The nurse should reinforce which statement(s) from the discharge teaching? Select all that apply.
A. “Limit the amount of foods containing tyramine in your diet.”
B. “Do not take this medication if you might be pregnant.”
C. “Begin tapering off the medication when you’re feeling less depressed.”
D. “Continue to follow your sodium-restricted diet.”
E. “Check with your provider before taking any over-the-counter drugs”
Answer: B, E
Rationale: Antidepressants are contraindicated in clients who are hypersensitive to the drug class and those who are pregnant or lactating. There are many drug–drug interactions that may occur with antidepressant medications. A health care provider or pharmacist should be consulted before combining these drugs with any other prescription or nonprescription (OTC) drugs. Tyramine and sodium do not need to be restricted. It is important that the client continues taking the medication, even if it does not seem to be helping.
A nurse is reviewing the medical records of several clients. The nurse anticipates that mood-stabilizing treatment would be contraindicated for which client(s)? Select all that apply.
A. 45-year-old with a history of chronic renal failure
B. 20-year-old client who is hypernatremia
C. 35-year-old client who is pregnant
D. 40-year-old client diagnosed with asthma
E. 70-year-old client with a history of diabetes
Answer: A, B, C
Rationale: Mood stabilizers are contraindicated in clients with hypersensitivity to the drug, cardiac or renal disease, and sodium imbalance and in clients who are pregnant or lactating. These agents should be used cautiously in older people and those with metabolic disorders (such as diabetes), urinary retention, or seizure disorders.