A nurse is contributing to the care plan for a newly admitted client suffering from severe depressive disorder.
Which of the following interventions should the nurse incorporate into the plan?

Encourage the client to make decisions.

Spend time with the client.

Provide the client with a selection of activities.

Play a game of chess with the client.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

While encouraging decision-making can be empowering for some individuals with depression, it may not be appropriate for those with severe depressive disorder.

Individuals with severe depression often experience significant anhedonia (loss of interest in activities), fatigue, and difficulty concentrating, which can make decision-making overwhelming and even worsen their symptoms.

It's important to assess the client's individual level of functioning and decision-making capacity before implementing this intervention.

Choice C rationale:

Providing a selection of activities can be helpful, but it's crucial to tailor the activities to the client's interests and energy level.

Offering too many choices or activities that are too demanding can be counterproductive.

It's essential to collaborate with the client to identify activities that are meaningful and achievable, and to gradually increase the level of activity as tolerated.

Choice D rationale:

Playing a game of chess can be a stimulating and enjoyable activity, but it may not be appropriate for all clients with severe depression.

Chess requires cognitive focus and strategic thinking, which can be challenging for individuals experiencing cognitive impairment or fatigue associated with depression.

It's important to assess the client's cognitive abilities and interests before suggesting this activity.

Rationale for the correct answer, B:

Spending time with the client offers several benefits:

Conveys caring and support: It demonstrates to the client that they are not alone and that someone cares about their wellbeing.

Provides opportunities for therapeutic communication: Spending time together allows for meaningful conversations, which can help the client express their feelings, concerns, and experiences.

Facilitates observation and assessment: The nurse can observe the client's mood, behavior, and interactions, which can inform treatment planning and evaluation.

Promotes engagement and participation: Spending time with the client can encourage them to engage in other therapeutic activities and interventions.

Builds rapport and trust: Developing a strong therapeutic relationship is essential for effective treatment of depression.

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Correct Answer is A

Explanation

Choice A rationale:

Pseudoparkinsonism is an extrapyramidal side effect (EPSE) of antipsychotic medications, particularly first-generation antipsychotics (FGAs) like haloperidol, that closely resembles the symptoms of Parkinson's disease. It's characterized by:

Stooped posture: A forward-leaning posture, often with rounded shoulders and a head that is bent forward.

Shuffling gait: Small, slow steps with reduced arm swing, often described as a "shuffling" or "dragging" walk.

Rigidity: Increased muscle stiffness throughout the body, leading to resistance to movement and a feeling of tightness.

Bradykinesia: Slowness of movement, both in initiating and completing actions.

Tremor: Involuntary shaking, often most noticeable in the hands, but can also affect the arms, legs, head, or jaw.

Masked facies: A decreased facial expression, often described as a "flat" or "expressionless" face.

Mechanism of pseudoparkinsonism:

Haloperidol primarily blocks dopamine D2 receptors in the nigrostriatal pathway of the brain.

Dopamine plays a crucial role in motor control, and its blockade in this pathway leads to a disruption in the balance of dopamine and acetylcholine, another neurotransmitter involved in movement.

This imbalance results in the characteristic symptoms of pseudoparkinsonism.

Risk factors for pseudoparkinsonism:

Older age

Female sex

Higher doses of antipsychotic medication

Prolonged use of antipsychotic medication

History of Parkinson's disease or other movement disorders

Presence of other EPSEs

Management of pseudoparkinsonism:

Dose reduction: If possible, the dose of the antipsychotic medication may be reduced.

Switching to a different antipsychotic: Some antipsychotics, such as second-generation antipsychotics (SGAs), have a lower risk of causing EPSEs.

Anticholinergic medications: These medications can help to counteract the effects of dopamine blockade on the acetylcholine system, but they can have their own side effects, such as dry mouth, constipation, and urinary retention.

Amantadine: This medication can also be used to treat pseudoparkinsonism, but it has the potential to cause side effects such as insomnia, anxiety, and livedo reticularis (a mottled skin rash).

A. Stating that he wants to be with his peers more than with his parents. B. Telling his parents that he doesn’t want to talk about the attempt. C. Preferring to eat his meals while watching TV. D. Planning to give his CD collection to his girlfriend.

Correct Answer is D

Explanation

Planning to give away prized possessions is a significant warning sign of potential suicide. This behavior often signals that the individual is preparing for death and believes they will no longer need those items. It's a concerning indication that they may have made a decision to end their life and are putting their affairs in order.

Here's a detailed breakdown of why this behavior is so concerning:

Final Arrangements: Giving away cherished belongings suggests a sense of finality and a belief that there's no future to look forward to. It's a way of detaching from material possessions and preparing for a perceived ending.

Loss of Interest: When someone loses interest in activities or items they previously valued, it can reflect a profound loss of hope and a withdrawal from life. This detachment is often a feature of suicidal ideation.

Saying Goodbye: Distributing belongings can serve as a symbolic way of saying goodbye to loved ones without explicitly stating suicidal intentions. It's a nonverbal communication of their plans, often done to avoid intervention or to ease the burden on others after their death.

Lack of Self-Preservation: The act of giving away possessions demonstrates a disregard for one's own future needs and a lack of investment in their continued existence. It suggests a mindset that they won't be around to enjoy those items any longer.

No Hope for Change: This behavior can also signal a belief that their circumstances are hopeless and that suicide is the only viable solution. It reflects a sense of despair and a conviction that things won't improve.

It's crucial to note that not all individuals who contemplate suicide will exhibit this specific behavior. However, it's a serious red flag that should never be ignored. If you witness someone giving away their possessions, it's imperative to take immediate action to assess their safety and seek professional help.

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A nurse is contributing to the care plan for a newly admitted client suffering from severe depressive disorder. Which of the following interventions should the nurse incorporate into the plan?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has schizophrenia and is taking haloperidol. The nurse observes that the client has developed a stooped posture and shuffling gait. The nurse should document these findings as which of the following extrapyramidal side effects of haloperidol?

Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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A nurse is contributing to the care plan for a newly admitted client suffering from severe depressive disorder.
Which of the following interventions should the nurse incorporate into the plan?