Nclex Review: Depression, Depression NCLEX, Bipolar

Nclex Review: Depression, Depression NCLEX, Bipolar

Disorder NCLEX, Schizophrenia NCLEX Questions, Schizophrenia NCLEX questions, Schizophrenia NCLEX part 2, NCLEX Schizophrenia 5.0 (1 review) Students also studied Terms in this set (212) Science MedicineNursing Save

Mood Diorders: Depression NCLEX

30 terms hawkinsr10Preview Eating Disorders NCLEX 21 terms sjbredehoftPreview Schizophrenia and Other Psychotic ...30 terms saly47Preview Diabete Teacher ssa The nurse is planning care with a Mexican-American 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.

• Explain to the client that Western medicine has a

scientific, not mystical, basis.

• Explain that such beliefs are superstitious and should

be forgotten.

• Involve the root healer in a consultation with the client,

physician and nurse.

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 denigrate the client's beliefs, but are likely to alienate him or her and cause them to end treatment.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?

• "I need to increase my intake of sodium."
• "I must refrain from strenuous exercise."
• "I must refrain from eating aged cheese or yeast

products."

• "I should decrease my intake of foods containing

sugar." 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 limited.

The client is receiving 6 mg of selegiline transdermal system (Emsam) 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."
• "I can cut the patch and use a smaller piece."
• "I need to wait until the next day to put on a new patch

if it falls off."

• "I might gain at least 10 lb from Emsam."

1.Selegiline transdermal system is the first transdermal monoamine oxidase inhibitor. The client on Emsam 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 decreased amount 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.Emsam is not associated with significant weight gain, although a weight gain of 1 to 2 lb (2.2 to 4.4 kg) is possible.A client has been taking 30 mg of duloxetine hydrochloride (Cymbalta) twice daily for 2 months because of depression and vague aches and pains. While interacting with the nurse, the client discloses a pattern of drinking a 6-pack of beer daily for the past 10 years to help with sleep. What should the nurse do first?

• Refer the client to the dual diagnosis program at the

clinic.

• Share the information at the next interdisciplinary

treatment conference.

• Report the client's beer consumption to the physician.
• Teach the client relaxation exercises to perform before

bedtime.

3.The nurse should report the client's beer consumption to the physician.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 physician is most important.A client was admitted to the inpatient unit 3 days ago with a flat affect, psychomotor retardation, anorexia, hopelessness, and suicidal ideation. The physician 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 cheerfully greets the nurse. He appears to be relaxed and joins the group for community meeting before supper. What should the nurse interpret as the most likely cause of the client's behavior?

• The Effexor is helping the client's symptoms of

depression significantly.

• The client's sudden improvement calls for close

observation by the staff.

• The staff can decrease their observation of the client. 4.

The client is nearing discharge due to the improvement of his symptoms.

2.The client's sudden improvement and decrease in anxiety most likely indicates 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 provide a 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.

The nurse is conducting an intake interview with an Asian American female who reports sadness, physical and mental fatigue, anxiety, and sleep disturbance. Prior to the client's time with the physician, it is important for the nurse to obtain information about the client's use of which of the following? Select all that apply.

• Tea.
• Herbal medicine.
• Breathing exercise.
• Massage.
• Folk healer.

1, 2, 5.

It is important for the nurse to obtain information about the client's use of tea, herbal medicine, and a folk healer because the information is critical to the safe prescription of psychotropic medication. Breathing exercises, massage, and acupuncture are also traditional therapies used by the Asian American population, but do not interfere with the use of medications.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?

• Report the rash to the physician.
• Explain that the rash is a temporary adverse effect.
• Give the client an ice pack for his arm.
• Question the client about recent sun exposure.

1.The nurse should immediately report the rash to the physician 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.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?

• "My husband will slowly feel better as his medicine

takes effect over the next 2 to 4 weeks."

• "My wife will need to take her antidepressant medicine

and go to group to stay well."

• "My son will only need to attend outpatient

appointments when he starts to feel depressed again."

• "My mother might need help with grocery shopping,

cooking, and cleaning for a while." 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.The nurse is distinguishing between delusions experienced by a client diagnosed with major depression with psychotic features and the delusions of a client

diagnosed with schizophrenia. The essential difference is:

• Major depression delusions are more likely to be

negative than schizophrenic delusions.

• Major depression delusions clear up less quickly than

schizophrenic delusions.

• Major depression delusions are more likely than

schizophrenic delusions to require long-acting depot antipsychotic medication given intramuscularly.

• Major depression delusions are more mood congruent

than schizophrenic delusions.

4.Delusions occurring in schizophrenia tend to be more mood incongruent and more bizarre than delusions experienced with depression. Schizophrenic delusions clear up less quickly and are more likely to require depot antipsychotic medication, which are administered intramuscularly. Delusions in major depression match the client's mood, are somewhat more reality based, and tend to resolve once the client is properly medicated.

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?

• Headache.
• Nausea.
• Fatigue.
• Agitation.

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.A client who has had three episodes of recurrent endogenous depression within the past 2 years states to the nurse, "I want to know why I'm so depressed." Which of the following statements by the nurse is most helpful?

• "I know you'll get better with the right medication."
• "Let's discuss possible reasons underlying your

depression."

• "Your depression is most likely caused by a brain

chemical imbalance."

• "Members of your family seem very supportive of you."

3.Endogenous depression (depression coming from within the person) is biochemical in nature. The biologic theory of depression indicates a neurotransmitter imbalance involving serotonin, norepinephrine, and possibly dopamine. Reactive depression is caused by the occurrence of something happening outside the body, such as the death of a loved one or another significant loss. Stating that the client will improve with the right medication or that family members seem supportive does not address the client's immediate concerns of not knowing the cause of the depression. Discussing possible reasons for the client's depression is nontherapeutic because the depression is endogenous and biochemically based.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?

• Wait for the client to begin the conversation.
• Initiate contact with the client frequently.
• Sit outside the client's room.
• Question the client until he responds.

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 depressed client 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.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."
• "I'll come back a little bit later to talk."
• "I'll find someone else for you to talk with."
• "I'll get you something to read."

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.