Question 1 of 5.

Extract:The following scenario applies to the next 6 items The nurse in the behavioral health clinic is caring for a 26-year-old female client. Item 1 of 6 Nurses' Note 1025: Client presents for initial evaluation, reporting that she “feels all over the place and it is time that she receives some treatment.” “At times I feel empty inside, sometimes feel hyped up, and at times, like now, I feel sad”. On assessment, the client has a constricted affect, and her eyes were cast downward. Client reports that her depression has been present for as long as she can remember, including throughout grade school. Her first clearly recalled depressive episode occurred in the sixth grade, when she felt she was "not living up to my own expectations." These episodes varied in duration—some lasting several months, others only a few hours—but typically persisted for 2 to 4 weeks. Onset could range from a day to a week, while the offset was often abrupt, resolving within a day or less. She reported intermittent difficulty falling asleep. Lately, she has had to use 2-3 tablets of diphenhydramine to help her fall asleep. She denied experiencing racing thoughts but acknowledged being told on numerous occasions that she spoke in ways that felt ‘pressured.' She also endorsed distractibility and noted frequent difficulty completing tasks. During times of good mood or when she felt "aligned with others,” she found herself more productive, particularly in creative endeavors. However, at other times, even simple tasks felt overwhelming. She described experiencing "a flurry of thoughts," particularly while writing or during creative projects. At age 23, she experienced what she referred to as "an explosive outburst of rage," which culminated in her punching a hole in her roommate's car's windshield. She reports this occurred during a two-day ‘episode' of her being irritable. Medical history of tension headaches, mild eczema in winter months, and seasonal allergic rhinitis. The client consumes 1-2 glasses of alcohol a year. She does smoke cigarettes daily and started smoking when she was 20.

Which assessment findings are most concerning? Select all that apply.

Question 2 of 5.

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?

Question 3 of 5.

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?

Question 4 of 5.

A client who experienced sleep disturbances, feelings of worthlessness, and an inability to concentrate for the past 3 months was fired from her job a month ago. The client tells the nurse, 'My boss was wonderful! He was understanding and a really nice man.' The nurse interprets the client's statement as representing the defense mechanism of reaction formation. Which of the following would be the best response by the nurse?

Question 5 of 5.

A client with major depression is to be discharged home tomorrow. When preparing the client's discharge plan, which of the following areas is most important for the nurse to review with the client?