Test Yourself Questions - Suicide, Depression, Bipolar Disorder, and ECT

Suicide is an inherited trait. True or False?

False

Gunshot wounds are the leading cause of death among suicide victims. True or False?

False

Most people give clues and warnings about their suicidal intentions. True or False?

True

If a person has attempted suicide, he or she will not do it again. True or False?

False

Suicide is the act of a psychotic person. True or False?

False

Once a person is suicidal, he or she is suicidal forever. True or False?

False

Most suicides occur when the severe depression has started to improve. True or False?

True

Most suicidal people have ambivalent feelings about living and dying. True or False?

True

If a suicidal person is intent upon dying, he or she cannot be stopped. True or False?

False

People who talk about suicide don’t commit suicide. True or False?

False

A patient, aged 40, was admitted to the psychiatric unit after a suicide attempt in which he was found holding a loaded gun to his head. Which statement made by this patient would lead the nurse to suspect a potential imminent suicide attempt include:

a. “How often do the night personnel make rounds?”

b. “When will I be discharged?”

c. “I don’t want to be alone just now.”

d. “I’m bored. What’s there to do around here?”

a. “How often do the night personnel make rounds?”

Which of the following times is a depressed client at **HIGHEST** risk for attempting suicide?

a. Immediately after admission, during one-to-one observation.

b. 7 to 14 days after initiation of antidepressant medication and psychotherapy when energy increases.

c. Following an angry outburst with roommate.

d. During group therapy while experiencing sadness about loss of mother.

b. 7 to 14 days after initiation of antidepressant medication and psychotherapy when energy increases.

Nursing interventions for the depressed person include which of the following attitudes?

a. Acceptance, honesty, empathy, patience

b. Cheerfulness, gregariousness, happiness

c. Decisiveness, businesslike efficiency

d. Confrontational questioning, authoritative

a. Acceptance, honesty, empathy, patience

Electroconvulsive shock therapy is likely to produce which of the following side effects?

a. tardive dyskinesia

b. memory loss

c. oculogyric crisis

d. waxy flexibility

b. memory loss

When planning care for a client with a depressive disorder PRIORITY should be given to:

a. planning appropriate activities.

b. structuring a pleasant milieu.

c. preventing suicidal behavior.

d. assisting the client to express repressed anger.

c. preventing suicidal behavior.

A depressed client tells the nurse, “I’m no good. I deserve to die”. Which of these responses would be **MOST** emotionally supportive?

a. Assurance that everyone has value and reminders that the client held a job until admission.

b. Telling the client that everyone dies sooner or later and one’s worth has nothing to do with it.

c. Acknowledging feelings and then engaging the client in helping the nurse with a simple task.

d. Admitting that the client probably has things to be ashamed of and helping to identify them.

c. Acknowledging feelings and then engaging the client in helping the nurse with a simple task.

Which of the following is **MOST** important in intervention with a suicidal client?

a. Actively show concern for the person

b. Agree with the person’s analysis of the situation

c. Point out the person’s ambivalence about dying

d. Direct the person’s attention to the successes in his life

c. Point out the person’s ambivalence about dying

Of the following nursing care plans for a suicidal client the **LEAST** essential is:

a. Close observation and removal of environmental hazards

b. Giving consistent feedback to positive changes in behavior

c. A contract not to harm self while in the unit

d. Shift assessment

b. Giving consistent feedback to positive changes in behavior

A client states, “You won’t have to worry about me anymore, it will soon be over”. Your **INITIAL** response would be:

a. “What do you mean?”

b. “You are feeling hopeless?”

c. “Why are you so angry?”

d. “Are you thinking about harming yourself?”

d. “Are you thinking about harming yourself?”

Which of the following approaches should be used to assess a suicidal client?

a. Use a non-directive approach

b. Allow the client to bring up suicide as a topic

c. Obtain specifics about a suicidal plan or ideation

d. Explore past suicidal gestures, thoughts, and ideas

c. Obtain specifics about a suicidal plan or ideation

In the initial assessment of persons who may be suicidal, the nurse asks:

a. “Have you ever been in the hospital?”

b. “Have you thought of harming yourself?”

c. “What was your childhood like?”

d. “What was your day like today?”

b. “Have you thought of harming yourself?”

A person with severe depression is MORE likely to commit suicide than a person with mild-moderate depression. True or False?

False

The charge nurse in an acute care setting assigns to a male client, who’s on one-to-one suicide precautions, to a psychiatric aide. This assignment is considered:

a. poor nursing practice because a registered nurse should work with this client.

b. reasonable nursing practice because one-to-one supervision requires the total attention of a staff member.

c. outside the responsibility of an aide.

d. illegal to delegate to an aide.

b. reasonable nursing practice because one-to-one supervision requires the total attention of a staff member.

Which of the following interventions should be prioritized in the care of the suicidal client?

a. remove all potentially harmful items from the client’s room

b. allow the client to express feelings of hopelessness

c. note the client’s capabilities to increase self-esteem

d. set a “no suicide” contract with the client

a. remove all potentially harmful items from the client’s room

A client tells a nurse, “Everyone would be better off if I wasn’t alive”. Which nursing diagnosis would be made based on this sentiment?

a. disturbed thought processes

b. ineffective coping

c. risk of self-directed violence

d. impaired social interaction

c. risk of self-directed violence

The client says to the nurse, “Pray for me”, and entrusts her wedding ring to the nurse. The nurse knows that this may signal which of the following?

a. anxiety

b. suicidal ideation

c. major depression

d. hopelessness

b. suicidal ideation

A young woman brought to the emergency room appearing depressed. The nurse learned that her child died a year ago due to an accident. The initial nursing diagnosis is %%dysfunctional grieving%%. The statement of the woman that supports this diagnosis is:

a. “I feel envious of mothers who have toddlers.”

b. “I haven’t been able to open the door and go into my baby’s room.”

c. “I watch other toddlers and think about their play activities and I cry.”

d. “I often find myself thinking of how I could have prevented the death.”

b. “I haven’t been able to open the door and go into my baby’s room.”

After an upsetting divorce, a male client threatens to commit suicide with a handgun and is involuntarily admitted to the psychiatric unit with major depression. Which nursing diagnosis takes highest priority for this client?

a. hopelessness related to recent divorce

b. ineffective coping related to inadequate stress management

c. spiritual distress related to conflicting thoughts about suicide and sin

d. risk of self-directed violence related to planning to commit suicide with a handgun

d. risk of self-directed violence related to planning to commit suicide with a handgun

Which is the highest priority in the post ECT care?

a. observe for confusion

b. monitor respiratory status

c. reorient to time, place, and person

d. document the client’s response to the treatment

b. monitor respiratory status

The nurse is aware that the primary indication for the use of electroconvulsive therapy (ECT) is:

a. severe agitation

b. antisocial behavior

c. noncompliance with treatment

d. major depression with psychotic features

d. major depression with psychotic features

Nursing preparations for a client undergoing electroconvulsive therapy (ECT) resembles those used for:

a. physical therapy

b. neurologic examination

c. general anesthesia

d. cardiac stress testing

c. general anesthesia

Of the following nursing diagnosis, which one is likely to appear in the nursing care plan of a depressed client who is psychotic?

a. alteration sleep and rest patterns

b. potential for self-injury

c. alteration in thought process and sensorium

d. alteration in nutritional requirements

c. alteration in thought process and sensorium

A 24-year-old man has been depressed for three weeks. His girlfriend has brought him to the emergency room because he has not eaten or slept in four days. His physical examinations and diagnostic tests are normal. One question the nurse should ask is:

a. “Have you had treatment for depression in the past?”

b. “Have you thought about killing yourself?”

c. “How is your relationship with your girlfriend?”

d. “Has anyone in your family committed suicide?”

b. “Have you thought about killing yourself?”

A 24-year-old man has been depressed for three weeks. His girlfriend has brought him to the emergency room because he has not eaten or slept in four days. His physical examinations and diagnostic tests are normal. Based on presenting symptoms, the nurse should take the following action:

a. assess his lethality level

b. administer an antidepressant

c. establish rapport

d. maintain his nutritional status

a. assess his lethality level

According to %%psychoanalytic theory%%, depression is:

a. projected anger

b. anger turned inward

c. learned helplessness

d. poor self-esteem

b. anger turned inward

The %%cognitive theory%% of depression postulates that depression stems from:

a. anger turned inward

b. projected anger

c. faulty thinking

d. learned helplessness

c. faulty thinking

A client with a bipolar disorder exhibits manic behavior. The nursing diagnosis is disturbed thought processes related to difficulty concentrating, secondary to flight of ideas. Which of the following outcome criteria would indicate improvement in the client?

a. The client verbalizes feelings directly during treatment.

b. The client verbalizes positive “self” statement.

c. The client speaks in coherent sentences.

d. The client reports feeling calmer.

c. The client speaks in coherent sentences.

Which of the groups of symptoms **BEST** characterizes depression?

a. Anorexia, insomnia, poor grooming, psychomotor retardation

b. Overeating, hypersomnia, poor grooming, pressured speech

c. Lack of interest, loss of libido, flights of ideas, weight loss

d. Insomnia, poor hygiene, restlessness, grandiose ideas

a. Anorexia, insomnia, poor grooming, psychomotor retardation

A woman, age 60, was admitted yesterday for treatment of major depression. She is observed pacing, wringing her hands, and saying over and over again, “My whole life has been a failure”. When she verbalizes feelings of worthlessness and failure, it is appropriate for the nurse to respond by:

a. changing the subject to something more cheerful.

b. reminding her of her accomplishments.

c. accepting what she says without agreeing.

d. asking why she feels this way.

c. accepting what she says without agreeing.

A client in a manic state often has intrusive behavior, which of the following would be essential to include in the care plan?

a. encouragement to express emotions

b. calling attention to self-deprecating remarks

c. protecting her from attack

d. preventing her from talking about her problems

c. protecting her from attack

An overactive client says, “My name is B.J. but you can call me Cool Dude. I’m a flyer with unrestricted license. My CIA status is 007 - licensed to kill. $2,000 that’s what this suit cost. I got this blind eye when my rodeo chute wouldn’t open”. This speech pattern is:

a. flight of ideas.

b. preservation.

c. clang association.

d. associative looseness.

a. flight of ideas.

A behavior that suggests the greatest improvement in a client experiencing manic behavior would be:

a. sitting through a group meeting.

b. commenting about the environment.

c. initiating interactions with others.

d. expressing dissatisfaction directly to the nurse.

a. sitting through a group meeting.

A woman was admitted to the psychiatric unit after being picked up by police officers who found her frantically running back and forth across the free-way. Her husband related that she stayed up all night, ate very little, and talked incessantly. Additional assessments that indicate a manic episode include:

a. Psychomotor retardation, fatigue, apathy

b. Pressured speech, combative behavior, impaired judgment

c. Catatonic excitement, loose associations, recurrent illusions

d. Self-destructive behavior, over-idealization, devaluation

b. Pressured speech, combative behavior, impaired judgment

Additional assessments associated with the manic phase of bipolar disorder include:

a. Outlandish clothing, excessive phone calls and spending

b. One-task behavior, obsessive attention to detail

c. Sad affect, apathy, suicidal thoughts

d. Belief that one is being persecuted, withdrawal from people

a. Outlandish clothing, excessive phone calls and spending

When completing discharge medication teaching for a patient, she asks how long it will take before the effects of lithium take place. The nurse states that it will take:

a. 1 to 2 days

b. 5 to 7 days

c. 10 to 14 days

d. 3 to 4 weeks

c. 10 to 14 days

A client has been diagnosed as having %%unipolar depression%% has received Doxepin (Sinequan) 100 mg B.I.D. for 1 week. In this interval the client has maintained the admissions weight, but complains of anorexia. Sleep assessment shows early morning awakening occurring at 4:30 AM. Admission assessment states the client had awakened at 4 AM for the past several weeks. The client’s mood is described as sad, with pessimistic thoughts being verbalized often. The most accurate assessment of the client’s response to medication is:

a. Assessment of effectiveness will not be valid until the client has received medication for a minimum of 2 - 3 weeks.

b. The dose is inadequate and should be increased.

a. Assessment of effectiveness will not be valid until the client has received medication for a minimum of 2 - 3 weeks.

A manic client whose symptoms have been well controlled on lithium carbonate 300 mg B.I.D. begins to exhibit grandiosity and accelerated behavior. Which **INITIAL** action on the part of the clinic nurse would be preferable?

a. Assess serum lithium level

b. Notify physician that haloperidol therapy should be instituted

c. Schedule an appointment with the client in 3 days to reassess

d. Arrange for thyroid function tests

e. Arrange for renal function tests

a. Assess serum lithium level

A client on lithium has diarrhea and vomiting. What should the nurse do first?

a. Recognize this a drug interaction

b. Give the client Cogentin

c. Reassure the client that these are common side effects of lithium therapy

d. Hold the next dose and obtain an order for a stat serum lithium level

d. Hold the next dose and obtain an order for a stat serum lithium level

The desirable serum level for a client on maintenance doses of lithium would be:

a. 0.1 to 0.5 mEq/L

b. 0.6 to 1.2 mEq/L

c. 1.5 to 2.5 mEq/L

d. 3.0 to 3.5 mEq/L

b. 0.6 to 1.2 mEq/L

Side effects of lithium therapy often experienced by clients whose serum lithium level is within the therapeutic range include all of the following **EXCEPT**:

a. dry mouth

b. increased thirst

c. fine tremor of hands

d. severe sunburn with brief exposure to sun

e. mild nausea

d. severe sunburn with brief exposure to sun