Depression and anxiety

The client on the mental health unit is diagnosed with major depressive disorder and was started on an antidepressant two days ago. The nurse observes that two days ago the client appeared  sad and remained in bed. Now the client is awake at 4 am. and planning a unit party. Which conclusion should the nurse make regarding the client’s change in behavior?

A. The client is responding positively to the antidepressant medication.

B. Treatment was effective, and the client plans on being discharged soon.

C. The client is more familiar with the unit and is able to be self-expressive.

D. The client may have been misdiagnosed and may have a bipolar disorder.

ANSWER: D

A. Antidepressant medication takes weeks to reach therapeutic effectiveness, not 2 days.

B. Treatment in a mental health setting would be longer than a few days.

C. There is no information about how familiar the client is with the unit.

D. The clinical presentation of unipolar and bipolar depression can be similar. The client can have a manic episode precipitated if a bipolar disorder exists and the client receives only an antidepressant without a concurrent mood stabilizer.

A client with severe major depressive disorder is lying in bed and has not moved for 3 hours.  The client will respond slowly to "yes" and "no" questions; otherwise, the client does not respond when spoken to.  The clinical manifestations exhibited by the client are known as:

1.  Psychogenic dystonia

2.  Psychogenic gait

3.  Psychomotor retardation

4.  Somatization

correct 3

Psychomotor retardation is a clinical symptom of major depressive disorder.  Manifestations of psychomotor retardation include slowed speech, decreased movement, and impaired cognitive function.  The individual may not have the energy or ability to perform activities of daily living or to interact with others.  Psychomotor retardation may range from severe (total immobility and speechlessness -catatonia) or mild (slowing of speech and behavior).

The nurse is caring for a client scheduled for electroconvulsive therapy (ECT). Which medication should the nurse question?

A. Venlafaxine

B. Esomeprazole

C. Topiramate

D. Lurasidone

Choice C is correct. ECT is a safe therapy that induces seizures theorized to release monoamines, which may assist in treating psychiatric illnesses such as major depressive disorder. If a client is taking the anticonvulsant topiramate, this will increase the seizure threshold and may attenuate the efficacy of ECT.

A client with a diagnosis of depression is prescribed phenelzine sulfate (Nardil). When he returns to the clinic a week later, he reports that he doesn't feel any better. The nurse explains that when starting a monoamine oxidase inhibitor (MAOI), the client won't experience relief of symptoms for how long?

A. 3–4 weeks

B. 2 weeks

C. 2 months

D. 3–4 months

A client should be taught that MAOI inhibitors, such as Nardil, require about a month to achieve therapeutic blood levels and demonstrate relief of symptoms. Clients should also be instructed never to discontinue an MAOI drug abruptly without first consulting with their provider. A

A patient diagnosed with depression is prescribed a monoamine oxidase inhibitor (MAOI). When teaching the patient about the medication, which statement made by the patient would indicate a need for additional teaching?

1 "I'm glad I can still eat hamburgers and french fries."

2 "I can still eat out at restaurants as long as I'm careful."

3 "I will miss putting soy sauce on my noodles."

4 "I don't have to limit the pepperoni on my pizza

4 ✅✅✅

The patient will need to avoid consuming foods that are high in tyramine. Processed meats such as pepperoni are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor (MAOI) can result in a hypertensive crisis. Other foods to avoid are cheese, yogurt, alcohol, fermented foods (sauerkraut, kimchi, soy sauce), and some fruits and vegetables.

Which nursing intervention is most appropriate if a client develops orthostatic hypotension while taking amitriptyline (Elavil)?

1.    Consulting the physician about substituting a different type of antidepressant

2.    Advising the client to sit up for 1 minute before getting out of bed

3.    Instructing the client to halve the dosage until the problem resolves

4.    Informing the client that this adverse reaction should disappear within 1 week

2

To minimize the effects of amitriptyline-induced orthostatic hypotension, the nurse should advise the client to sit up for 1 minute before getting out of bed. Orthostatic hypotension commonly occurs with tricyclic antidepressant therapy. In these cases, the physician may decrease the dosage or order nortriptyline, another tricyclic antidepressant. It isn't appropriate for the nurse to change the dosage without discussing it with the physician. Orthostatic hypotension disappears only when the drug is discontinued.

The nurse assesses that the client with acute mania has coarse hand tremors, and the serum lithium level is 1.8 m Eq/L. What should the nurse do?

A. Advise the client to limit the intake of fluids.

B. Continue to administer lithium as prescribed.

C. withhold the lithium dose and notify the HCP.

D. Request a medication to treat the hand tremors.

ANSWER: C

A. Limiting fluids would worsen lithium toxicity.

B. The nurse should not continue to administer lithium because the lithium level is toxic.

C. The nurse should withhold the lithium (Lithobid) and notify the HCP. Lithium is at a toxic level. A therapeutic lithium level is 0.8 to 1.2 mEq/L.

D. Coarse hand tremor is a symptom of lithium toxicity, and once the level is normalized the tremors should subside.

client under your care as a nurse was newly prescribed with lithium carbonate. To prevent lithium toxicity, the nurse should advise the client to do which of the following?

A. Avoid the use of acetaminophen for headaches

B. Decrease fluid intake to less than 1,500 mL daily

C. Restrict intake of foods rich in sodium

D. Limit aerobic activity in hot weather

Answer: D

Activities that could cause sodium/water depletion should be avoided in order to prevent lithium carbonate toxicity. Acetaminophen, rather than NSAIDs such as ibuprofen, should be used for headaches because NSAIDs interact with lithium and could cause increased blood levels of lithium. The client should make sure to take in enough sodium and increase, rather than decrease fluid intake to prevent toxicity

A client receiving lithium carbonate has a lithium level of 2.3 mEq/L. The nurse will immediately assess the client for which of the following symptoms?

A. Weakness

B. Diarrhea

C. Blurred Vision

D. Fecal incontinence

Answer: C

At lithium levels of 2 -2.5 mEq/L the client will experience blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting. With levels between 1.5 and 2 mEq/L the client experiencing vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion. At lithium levels of 2.5 to 3 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular collapse, and death.