M28 Mood and Affect

The Concept of Mood and Affect
1) The nurse overhears a client apologize to the spouse about being ill and leaving tasks at home
uncompleted. In addition to this client's reason for hospitalization, the nurse realizes this client is at
risk for developing which of the following?
A) Musculoskeletal disorder
B) Heart disease
C) Diabetes
D) Depression
Answer: D
Explanation: People who are unusually sensitive to failure to achieve their goals are said to have self-
critical traits. These cognitive-personality features increase the likelihood that stressors will lead to
depression. There is not enough information to determine if the client will develop heart disease, a
musculoskeletal disorder, or diabetes. Page Ref: 1778
Cognitive Level: Analyzing Client Need: Psychosocial Integrity Nursing Process: Assessment
Learning Outcome: 1. Summarize the structure and physiological processes of the neurological
system related to mood and affect.
2) An older client tells the nurse about rarely going outdoors in the winter because of a lack of energy
or desire. What might this client be experiencing?
A) Seasonal affective disorder
B) Side effect of medication
C) Situational depression
D) Anxiety
Answer: A
Explanation: A decreased exposure to sunlight will reduce the production of serotonin in the brain,
and that can cause a type of depression termed seasonal affective disorder. Older individuals are
prone to isolation during the winter, so this is a likely explanation for the client's feelings. The nurse
does not have enough information to determine if the client is experiencing a side effect of medication
or anxiety. Situational depression is a depressive episode that occurs after an identifiable life event.
Page Ref: 1780
Learning Outcome: 2. Examine the relationship between mood and affect and other
concepts/systems.
3) A client with a 2-month-old child is experiencing insomnia, mood swings, and crying. From what
would this client most likely benefit?
Select all that apply.
A) Electroconvulsive therapy
B) Psychosocial interventions
C) Antidepressants
D) Time management and exercise therapy
E) Cognitive-behavioral therapy
Answer: B, C
Explanation: A) The client is demonstrating signs of postpartum depression as evidenced by the
mood swings, insomnia, and crying. Treatment for this disorder includes antidepressants and
psychosocial interventions. Electroconvulsive therapy would be indicated for some cases of
depression but not for postpartum depression. Cognitive-behavioral therapy would be indicated for
depression but not postpartum depression. Time management and exercise therapy would not be
beneficial for a client experiencing postpartum depression. Page Ref: 1780
Cognitive Level: Analyzing Client Need: Psychosocial Integrity Nursing Process: Planning
Learning Outcome: 3. Identify commonly occurring alterations in mood and affect and their related
therapies.
4) The nurse is planning to assess a client demonstrating signs of depression. What should the nurse
use to assess this client?
A) More time talking with the client
B) The client's family members, for answering the assessment questions
C) Beck Depression Inventory
D) Glasgow Coma Scale
Answer: C
Explanation: A) The Beck Depression Inventory is a series of 21 questions that the client answers in
order to self-rate the level of depression. It takes approximately 10 minutes for the client to complete.
The nurse can use it to help with the assessment of this client. The Glasgow Coma Scale is not used to
assess depression but rather level of responsiveness for neurological conditions. The nurse should not
ask family members to answer assessment questions for the client. Assessment of clients with
depression is often done in 15- to 20-minute increments because the client usually does not have the
energy to talk much longer. For that reason, the nurse should not plan more time with the client to
complete the assessment. Page Ref: 1785
Cognitive Level: Applying Client Need: Psychosocial Integrity Nursing Process: Assessment
Learning Outcome: 4. Differentiate common assessment procedures used to examine mood and
affect across the life span.
5) A client is experiencing symptoms of depression. Which laboratory or diagnostic test would be used
to determine if depression is being caused by another health problem?
A) Electrocardiogram
B) MRI of the brain
C) Thyroid function tests
D) Cerebral angiogram
Answer: C
Explanation: Heart disorders are not associated with the diagnosis of mood disorders. Cerebral MRI
is not used to differentiate mood disorders from physical disorders. Thyroid function tests would be
prescribed because thyroid disorders may mimic depression or hypomania. A cerebral angiogram is
not used to differentiate mood disorders from physical disorders. Page Ref: 1788
Learning Outcome: 5. Describe diagnostic and laboratory tests used to determine causes of
alterations in an individual's mood and affect.
6) A client with a history of depression says that since taking yoga classes, the depressive episodes
have decreased. What should the nurse explain about yoga?
A) Promotes alertness and enthusiasm
B) Raises levels of endorphins
C) Stimulates the production of serotonin
D) Increases blood flow to the brain
E) Improves physical energy
Answer: A, E
Explanation: A) Yoga has been found to improve wellness and prevent disorders such as depression.
The gentle nature of the exercises allows its use by people in almost any condition. Those who practice
yoga on a regular basis report improved life satisfaction, alertness, enthusiasm, and mental and
physical energy, all of which are the opposite of the symptoms of depression. Yoga does not
specifically increase blood flow to the brain. Yoga does not stimulate the production of serotonin.
Short periods of aerobic exercise or longer periods of anaerobic exercise over a period of weeks will
raise the level of endorphins, which enhance the feeling of well-being. Page Ref: 1796
Cognitive Level: Applying Client Need: Psychosocial Integrity Nursing Process: Implementation
Learning Outcome: 6. Explain prevention of and management strategies for alterations in mood and
affect.
7) An older client, unable to tolerate most antidepressant medications because of adverse effects, is
scheduled for electroconvulsive therapy. What should the nurse instruct this client?
A) Participation in psychotherapy with some medication therapy often needs to be continued after the
treatments.
B) These treatments will cure the depression.
C) Learn to write everything down, because repeated treatments can cause long-term memory loss.
D) The treatments are known to help some but not all people with depression.
Answer: A, D
Explanation: The nurse should instruct the client to expect to participate in psychotherapy with some
medication therapy after the treatments because electroconvulsive therapy does not cure depression.
The client may experience memory loss after treatment; however, it is transient. The nurse does not
need to instruct the client to write everything down because of permanent memory loss. Because of
other health conditions and intolerance to antidepressant medications, electroconvulsive therapy is
very helpful for the older client with depression. Page Ref: 1795
Learning Outcome: 7. Demonstrate the nursing process in providing culturally competent and caring
interventions across the life span for individuals with common alterations of mood and affect.
8) A client prescribed an antidepressant tells the nurse that the pill causes dizziness upon standing or
changing position too quickly. The nurse realizes the client is experiencing a side effect of which
medication?
A) Serotonin-norepinephrine reuptake inhibitor
B) Monoamine oxidase inhibitor
C) Selective serotonin reuptake inhibitor
D) Tricyclic antidepressant
Answer: D
Explanation: A) The most common side effect of tricyclic antidepressants is orthostatic hypotension,
due to alpha1 blockade on blood vessels. Orthostatic hypotension is not associated with the other
medications. Page Ref: 1790
Cognitive Level: Analyzing Client Need: Physiological Integrity Nursing Process: Assessment
Learning Outcome: 8. Compare and contrast common independent and collaborative interventions
for clients with alterations of mood and affect.
9) A nurse working on a psychiatric unit is caring for a client who has been diagnosed with major
depressive disorder (MDD). Upon assessment of the client, what clinical manifestations will the nurse
expect to find?
A) Depressed mood or loss of interest occasionally for at least 1 week
B) A depressed mood sporadically for at least 2 years
C) Restlessness, fatigue, suicidal ideation, feelings of guilt
D) Anxiety, change in appetite, grief, altered nutrition
Answer: C
Explanation: MDD is diagnosed when the client experiences either depressed mood or loss of interest
most of the day, almost every day, for at least 2 weeks. The depression must be accompanied by at
least four symptoms, including: sleep disturbance, fatigue, feelings of guilt or worthlessness,
restlessness or psychomotor agitation, and suicidal ideation or attempt. Page Ref: 1778
Learning Outcome: 3. Identify commonly occurring alterations in mood and affect and their related
therapies.
10) A nurse instructor is teaching a group of student nurses regarding depression, its
pathophysiology, and the theories related to the disorder. What statement(s) will the nurse instructor
include about the theories of depression?
A) Intrapersonal theory focuses on the theme of loss, either real or symbolic.
B) The sociocultural factor theory states that those who are depressed focus on negative messages in
the environment and ignore positive experiences.
C) The learning theory states that individuals learn to be depressed in response to a self-perception of
a lack of control over their life experiences.
D) The sociocultural factor theory suggests that gender socialization differences may be a factor in the
higher rate of depression in women.
E) The learning theory states that individuals with depression typically experience little success in
achieving gratification and little positive reinforcement in coping with negative incidents.
Answer: A, C, E
Explanation: A) Among the theories of depression, the intrapersonal theory focuses on the theme of
loss, either real or symbolic. Also, the learning theory states that individuals learn to be depressed in
response to a self-perception of a lack of control over their life experiences. The learning theory also
states that individuals with depression typically experience little success in achieving gratification and
little positive reinforcement in coping with negative incidents. The cognitive theory states that those
who are depressed focus on negative messages in the environment and ignore positive experiences.
The gender bias theory suggests that gender socialization differences may be a factor in the higher
rate of depression in women. Page Ref: 1781
Learning Outcome: 2. Examine the relationship between mood and affect and other
concepts/systems.
Exemplar 28.1 Depression
1) An older client with cardiac disease describes a decline in the amount of sleep and difficulty falling
asleep at night. What should the nurse consider is occurring with this client?
A) Normal signs of cardiac disease
B) Signs of anxiety and depression
C) Normal signs of aging
D) Normal signs of respiratory disease
Answer: B
Explanation: A) Drastic changes in sleep patterns may be early signs of underlying anxiety and
depression and should be investigated and not written off as normal changes of aging. Pain,
respiratory disease, and cardiac disease can also interfere with sleep, but sleep pattern disturbances
need to be assessed further to determine if there is an underlying psychiatric problem. Page Ref: 1799
Learning Outcome: 1. Describe the pathophysiology, psychopathology, and clinical manifestations of
depressive disorders.
2) A client was widowed 3 years ago and has nothing to do except visit with acquaintances at the
neighborhood bar. Of which health problem is this client demonstrating manifestations?
A) Bipolar disorder
B) Depression
C) Sadness
D) Extended grief
Answer: B
Explanation: A) Risk factors for the development of depression include a history of the loss of a close
family member and substance abuse. Bipolar disorder is characterized by periods of mania with
periods of depression. The client is not describing or demonstrating these periods. The client may or
may not be experiencing extended grief. There is not enough information to determine if the client is
demonstrating sadness. Page Ref: 1799
Learning Outcome: 2. Identify risk factors associated with depression.
3) An older client receiving pain medication for abdominal discomfort reports no relief of pain and
continues to describe multiple somatic complaints. What action should the nurse take at this time?
A) Further assessment and consider treatment for depression
B) Obtaining an order for different pain medication
C) Contacting the family to talk to the client
D) Review of the client's lab values
Answer: A
Explanation: A) Major clues to depression in the older adult include multiple somatic complaints and
reports of persistent chronic pain and some vague pain. Many older people have more physical than
emotional complaints. Therefore, further assessment for depression is warranted. The lab values are
not indicated in this case, and obtaining different pain medication would not treat potential
psychological problems. The family may also be ineffective in determining the client's psychological
need. Page Ref: 1800
Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the
life span for individuals with depression.
4) A client being treated for depression reports feeling better and has started to make plans. What is a
priority nursing concern?
A) Social Isolation
B) Hopelessness
C) Situational Low Self-Esteem
D) Risk for Self-Directed Violence
Answer: D
Explanation: A) The one risk that occurs with successful treatment of a client with depression is that
once the depression begins to resolve, the underlying thought of suicide could prevail. With
treatment, the client may begin to have more energy to make a plan regarding suicide. The nurse
should further assess this client's statement about making plans. The client is not demonstrating low
self-esteem, hopelessness, or social isolation. Page Ref: 1802
Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with
depression.
5) The spouse of a client being treated for depression believes the client is not responding to
prescribed medication. What should the nurse respond to the spouse?
A) "Stop the medication immediately."
B) "A trial-and-error period is the best way to determine which medication is the most effective."
C) "A trial of 4 to 6 weeks is usually done to see how people respond to the medication."
D) "Stay on the medication for 6 months to see if there is a response."
E) "Learn to live with the depression."
Answer: B, C
Explanation: A) A trial-and-error period may be needed to determine what medication is best for the
individual. About 30% of clients do not respond to their antidepressant in a trial of 4 to 6 weeks. Do
not stop medications without notification of the prescriber. Antidepressant medication is often
prescribed for clients with depression symptoms. Stating that the spouse will have to learn to live with
the depression is inappropriate. Page Ref: 1801
Learning Outcome: 6. Plan evidence-based care for an individual with depression and his or her
family in collaboration with other members of the healthcare team.
6) A client being treated for depression reports the desire to get out of bed, shower, eat, and contact
friends and family for socialization. What should the nurse realize this client is demonstrating?
A) Risk factors for self-harm
B) Improvement in depression
C) Denial of the diagnosis of depression
D) The need for assistance with activities of daily living
Answer: B
Explanation: A) The client reports the desire to get out of bed and is showering, eating, and
contacting friends and family members. These are all indications that the client's depression is
improving. This is not an indication of risk for harm, denial of the diagnosis, or the need for
assistance with activities of daily living. Page Ref: 1803
Cognitive Level: Analyzing Client Need: Psychosocial Integrity Nursing Process: Evaluation
Learning Outcome: 7. Evaluate expected outcomes for an individual with depression.
7) A client with depression is receiving electroconvulsive therapy. Which intervention(s) should the
nurse plan when caring for this client?
A) Maintain nothing-by-mouth status until fully awake.
B) Administer intravenous fluids for 8 hours post procedure.
C) Place in the lateral recumbent position.
D) Provide oral fluids immediately after the procedure.
E) Place in the supine position with the head flat.
Answer: A, C
Explanation: A) Care of the client recovering from electroconvulsive therapy includes placing in the
lateral recumbent position to facilitate drainage and to prevent aspiration and to maintain nothing by
mouth until fully awake. The supine with head flat position can lead to aspiration. The client does not
need intravenous fluids for 8 hours after the procedure. Providing oral fluids when not fully awake
can lead to aspiration. Page Ref: 1796
Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care
of an individual with depression.
8) The nurse observes a client being treated for depression sitting with the head down and avoiding
conversation with peers. What would be the nurse's priority intervention for this client?
A) Ask open-ended questions about the client's feelings.
B) Ask the client close-ended questions.
C) Encourage a peer to sit with the client and the nurse.
D) Tell the client that lack of involvement leads to more depression.
Answer: A
Explanation: A) An open-ended question encourages more than a one-word response. Depressed
clients should be comfortable with a one-to-one interaction prior to other-client involvement. A
closed-ended question is unlikely to encourage continued communication. Telling the client that if he
does not get involved, he will become more depressed is not encouraging communication.
Page Ref: 1801-1802
Learning Outcome: 6. Plan evidence-based care for an individual with depression and his or her
9) A nurse is caring for a client who displays symptoms associated with seasonal affective disorder
(SAD). What healthcare provider order would the nurse question as inappropriate for this client?
A) Cognitive-behavioral therapy
B) Light therapy
C) Bupropion extended-release
D) Selective serotonin reuptake inhibitor (SSRI)
Answer: D
Explanation: A) The nurse would question the order for a selective serotonin reuptake inhibitor
(SSRI). This medication is used in the treatment of major depressive disorder (MDD) and dysthymic
disorder, not seasonal affective disorder (SAD). All the other orders are appropriate for a client with
SAD. Page Ref: 1800
of an individual with depression.
10) A nurse working in a psychiatric hospital is performing a suicide assessment on a client diagnosed
with major depressive disorder (MDD). What is true regarding the suicide assessment?
A) Assess all clients for suicide risk by using indirect questioning.
B) Ask if the client has any thought of suicide.
C) Asking about suicide will "plant the idea" in the client's mind.
D) Assess the lethality of the suicide plan, if one exists.
E) If the client has suicidal thoughts, assess whether or not the client would act on them.
Answer: B, D, E
Explanation: A) When performing a suicide assessment, the nurse should always use direct, not
indirect, questioning. The nurse should ask if the client has any thought of suicide and assess the
lethality of the suicide plan, if one exists, and whether or not the client will act on these thoughts.
Asking about suicide will not "plant the idea" in the client's mind. Page Ref: 1802
life span for individuals with depression.
Exemplar 28.2 Adjustment Disorder With Depressed Mood
1) The home care nurse hears the spouse of an older client say "You have been so sick but you insist on
living in this huge home that you cannot maintain but expect me to." The client engages in an
argument with the spouse. What does the home care nurse identify as occurring with this couple?
A) Evidence of low blood glucose levels
B) Financial struggles within the family
C) Possible situational depression for both client and spouse
D) Spousal abuse
Answer: C
Explanation: A) Manifestations associated with situational depression in the older client include
irritability and poor work performance. One spouse is irritable because of overwork and the other
spouse is irritable because of the inability to perform household work. The nurse cannot determine if
the family is having financial struggles. There is no evidence of spousal abuse at this time. The nurse
cannot determine that the arguing is due to low blood glucose levels.
B) Manifestations associated with situational depression in the older client include irritability and
poor work performance. One spouse is irritable because of overwork and the other spouse is irritable
because of the inability to perform household work. The nurse cannot determine if the family is
having financial struggles. There is no evidence of spousal abuse at this time. The nurse cannot
determine that the arguing is due to low blood glucose levels.
C) Manifestations associated with situational depression in the older client include irritability and
D) Manifestations associated with situational depression in the older client include irritability and
Page Ref: 1805
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 1. Describe the features, clinical manifestations, and direct and indirect causes of
adjustment disorder with depressed mood.
2) The nurse sees a client crying after being dropped off for a physician's appointment in the clinic.
The client tells the nurse that not being able to drive anymore is making the client a burden to her
daughter. What should the nurse realize the client is at risk for developing?
A) Depression
B) Cardiac disease
C) Situational depression
D) Bipolar disorder
Answer: C
Explanation: A) The client is experiencing a loss of independence with the inability to drive. This loss
is causing tension between the client and daughter, and the client feels like a burden. This situation
places the client at risk for the development of situational depression. The client is not demonstrating
signs of bipolar disorder or depression. This type of situation is not linked to the development of
cardiac disease.
B) The client is experiencing a loss of independence with the inability to drive. This loss is causing
tension between the client and daughter, and the client feels like a burden. This situation places the
client at risk for the development of situational depression. The client is not demonstrating signs of
bipolar disorder or depression. This type of situation is not linked to the development of cardiac
disease.
C) The client is experiencing a loss of independence with the inability to drive. This loss is causing
disease.
D) The client is experiencing a loss of independence with the inability to drive. This loss is causing
disease.
Page Ref: 1805
Learning Outcome: 2. Identify risk factors associated with adjustment disorder with depressed mood.
3) A client experiencing situational depression after losing a good job tells the nurse, "I am tired of
always having to start over." What can the nurse do to assist this client?
A) Ask what the client has done in the past to make "starting over" so successful.
B) Suggest the client talk with the physician about medications to help his mood.
C) Remind the client that an alcoholic beverage with the evening meal could help with stress.
D) Encourage the client to take the time to rest and relax.
E) Encourage the client to maintain a consistent exercise plan.
Answer: A, D, E
Explanation: A) The nurse needs to assess the client's resiliency by finding out what he was able to do
in the past, in similar situations, to be successful. Exercise has been shown to improve cognitive
function, elevate mood, and relieve stress and anxiety. Suggesting that the client needs medication is
inappropriate without further assessment. The nurse should not encourage the client to rest and relax
because this could lead to a major depressive episode. The nurse should not encourage the client to
ingest alcohol because this can be a self-destructive behavior.
B) The nurse needs to assess the client's resiliency by finding out what he was able to do in the past, in
similar situations, to be successful. Exercise has been shown to improve cognitive function, elevate
mood, and relieve stress and anxiety. Suggesting that the client needs medication is inappropriate
without further assessment. The nurse should not encourage the client to rest and relax because this
could lead to a major depressive episode. The nurse should not encourage the client to ingest alcohol
because this can be a self-destructive behavior.
C) The nurse needs to assess the client's resiliency by finding out what he was able to do in the past, in
D) The nurse needs to assess the client's resiliency by finding out what he was able to do in the past, in
E) The nurse needs to assess the client's resiliency by finding out what he was able to do in the past, in
Page Ref: 1805
Cognitive Level: Applying
Nursing Process: Implementation
life span for individuals with adjustment disorder with depressed mood.
4) During a routine physical examination, a client tells the nurse, "I don't know what to do anymore
since my husband died and left me alone." Which nursing diagnosis would be appropriate for the
client at this time?
A) Helplessness
B) Anxiety
C) Imbalanced Nutrition
D) Overload Stress
Answer: A
Explanation: A) The client states that she does not know what to do since her spouse died. This
information would support the diagnosis of Helplessness. The client may or may not be anxious or
stressed. There is not enough information to determine whether the client is or is not experiencing
imbalanced nutrition.
B) The client states that she does not know what to do since her spouse died. This information would
support the diagnosis of Helplessness. The client may or may not be anxious or stressed. There is not
enough information to determine whether the client is or is not experiencing imbalanced nutrition.
C) The client states that she does not know what to do since her spouse died. This information would
D) The client states that she does not know what to do since her spouse died. This information would
Page Ref: 1806
Nursing Process: Planning
adjustment disorder with depressed mood.
5) A client informs the nurse, "My mother keeps telling me to get over the death of my spouse, but I'm
having a hard time doing that." What should the nurse do to assist the client and family?
A) The nurse should not get involved with a family conflict.
B) Tell the client that arguing with a parent never ends in a good way.
C) Remind the client and family that the grief process is different for everyone, and that no time limit
can be set.
D) Agree with the mother.
Answer: C
Explanation: A) The client's mother is urging the client to "get over" the death of a spouse. The nurse
should remind both the client and family that the grief process is individual and that there is no set
time limit for the process to end. Agreeing with the mother would be ignoring the client's feelings. The
nurse should not avoid getting involved with the family conflict if the client is experiencing an
alteration from a healthy state, because that would be ignoring the client's need. Telling the client that
arguing with a parent never ends in a good way is inappropriate.
B) The client's mother is urging the client to "get over" the death of a spouse. The nurse should
remind both the client and family that the grief process is individual and that there is no set time limit
for the process to end. Agreeing with the mother would be ignoring the client's feelings. The nurse
should not avoid getting involved with the family conflict if the client is experiencing an alteration
from a healthy state, because that would be ignoring the client's need. Telling the client that arguing
with a parent never ends in a good way is inappropriate.
C) The client's mother is urging the client to "get over" the death of a spouse. The nurse should
D) The client's mother is urging the client to "get over" the death of a spouse. The nurse should
Page Ref: 1805
Learning Outcome: 6. Plan evidence-based care for an individual with adjustment disorder with
depressed mood and his or her family in collaboration with other members of the healthcare team.
6) The nurse learns that a client experiencing situational depression after the death of the client's
mother has returned to work, is caring for her family, and spends quiet time reflecting on her life and
future. What is this client demonstrating?
A) The ability to work through the grief process
B) The denial of the mother's death
C) Ineffective coping
D) Anxiety
Answer: A
Explanation: A) The client has returned to work, cares for her family, and reflects on her life and
future. These are all indications that the client has the ability to work through the grief process, which
will reduce the negative consequences associated with situational depression. The client is not
denying the death of her mother. The client is not demonstrating anxiety or ineffective coping.
B) The client has returned to work, cares for her family, and reflects on her life and future. These are
all indications that the client has the ability to work through the grief process, which will reduce the
negative consequences associated with situational depression. The client is not denying the death of
her mother. The client is not demonstrating anxiety or ineffective coping.
C) The client has returned to work, cares for her family, and reflects on her life and future. These are
D) The client has returned to work, cares for her family, and reflects on her life and future. These are
Page Ref: 1805
Nursing Process: Evaluation
Learning Outcome: 7. Evaluate expected outcomes for an individual with adjustment disorder with
depressed mood.
7) A client experiencing situational depression after the traumatic death of the spouse tells the nurse,
"Since I started taking a walk every day, I've been feeling better." How has exercise impacted this
client?
A) Elevated the client's mood
B) Relieved stress
C) Provided a short-term diversion to the pain of losing the spouse
D) Given the client something to do
E) Improved the client's oxygenation to keep the brain stimulated
Answer: A, B
Explanation: A) Exercise has been known to improve the status of clients diagnosed with situational
depression by elevating mood, relieving stress, and helping with focus so that other tasks and
responsibilities can be completed. Exercise does more than give someone something to do. Exercise
does improve body oxygenation; however, that is not the reason why it has been effective for this
client. Exercise should not be seen as a short-term diversion for this client because it is a habit that
should be maintained in the future.
B) Exercise has been known to improve the status of clients diagnosed with situational depression by
elevating mood, relieving stress, and helping with focus so that other tasks and responsibilities can be
completed. Exercise does more than give someone something to do. Exercise does improve body
oxygenation; however, that is not the reason why it has been effective for this client. Exercise should
not be seen as a short-term diversion for this client because it is a habit that should be maintained in
the future.
C) Exercise has been known to improve the status of clients diagnosed with situational depression by
the future.
D) Exercise has been known to improve the status of clients diagnosed with situational depression by
the future.
E) Exercise has been known to improve the status of clients diagnosed with situational depression by
the future.
Page Ref: 1806
of an individual with adjustment order with depressed mood.
8) A client experiencing situational depression over the loss of a spouse is overwhelmed with having
to close the spouse's business, settle finances, and figure out a way to survive financially. What can the
nurse do to help this client?
A) Ask if the client can move in with parents.
B) Suggest that the client attend group therapy with a grief counselor.
C) Investigate whether the spouse had life insurance and what income the client can expect.
D) Help the client focus on strengths.
E) Help the client prioritize things that need to be accomplished.
Answer: D, E
Explanation: A) The client is demonstrating powerlessness. The nurse should help the client
problem-solve by strategizing what needs to be accomplished. The nurse should not suggest group
therapy with a grief counselor because the client is not demonstrating signs of dysfunctional grieving.
The nurse should not suggest the client move in with parents nor investigate whether the spouse had
life insurance to help with the client's income because the client has not yet determined the priority of
issues that need to be addressed. These suggestions might be beneficial after the client has prioritized
the things that need to be accomplished.
B) The client is demonstrating powerlessness. The nurse should help the client problem-solve by
strategizing what needs to be accomplished. The nurse should not suggest group therapy with a grief
counselor because the client is not demonstrating signs of dysfunctional grieving. The nurse should
not suggest the client move in with parents nor investigate whether the spouse had life insurance to
help with the client's income because the client has not yet determined the priority of issues that need
to be addressed. These suggestions might be beneficial after the client has prioritized the things that
need to be accomplished.
C) The client is demonstrating powerlessness. The nurse should help the client problem-solve by
D) The client is demonstrating powerlessness. The nurse should help the client problem-solve by
E) The client is demonstrating powerlessness. The nurse should help the client problem-solve by
Page Ref: 1807
9) A nurse is performing research on the etiology, pathophysiology, and treatment of adjustment
disorder with depressed mood. What research will the nurse most likely find regarding exercise and
this disorder?
A) Many studies specifically investigate the role of exercise in adjustment disorder with depressed
mood or situational depression.
B) Evidence indicates that exercise is effective in reducing symptoms of depression; however, exercise
must be aerobic and for 60 minutes or more per day.
C) Resistance exercise is less effective in reducing symptoms of depression than aerobic exercise
alone.
D) Evidence suggests that physical exercise is as effective as cognitive-behavioral therapy (CBT) or
medication in reducing depression.
Answer: D
Explanation: A) Although there are no studies that specifically investigate the role of exercise in
adjustment disorder with depressed mood or situational depression, evidence suggests that physical
exercise is as effective as CBT or medication in reducing depression. The exercise performed should
be aerobic combined with resistance to get the most antidepressant effect.
B) Although there are no studies that specifically investigate the role of exercise in adjustment
disorder with depressed mood or situational depression, evidence suggests that physical exercise is as
effective as CBT or medication in reducing depression. The exercise performed should be aerobic
combined with resistance to get the most antidepressant effect.
C) Although there are no studies that specifically investigate the role of exercise in adjustment
D) Although there are no studies that specifically investigate the role of exercise in adjustment
Page Ref: 1806
of an individual with adjustment order with depressed mood.
10) A nurse is caring for a client with an adjustment disorder with depressed mood. The nurse wants
to perform interventions that will promote hope for the client. What intervention best promotes hope
in this client?
A) Help caregivers acknowledge clients' dependency and assume appropriate responsibility.
B) Help clients to identify ways in which they have control of their lives.
C) Provide families with a list of community resources and encourage them to participate in support
groups.
D) Provide the families with information about clients'condition in accordance with client
preferences.
Answer: B
Explanation: A) A nurse who is promoting hope for a client with an adjustment disorder with
depressed mood will help clients identify ways in which they have control of their lives. The other
choices are correct interventions for supporting family function, not providing hope.
B) A nurse who is promoting hope for a client with an adjustment disorder with depressed mood will
help clients identify ways in which they have control of their lives. The other choices are correct
interventions for supporting family function, not providing hope.
C) A nurse who is promoting hope for a client with an adjustment disorder with depressed mood will
D) A nurse who is promoting hope for a client with an adjustment disorder with depressed mood will
Page Ref: 1807
Exemplar 28.3 Bipolar Disorders
1) The family member of a client diagnosed with bipolar disorder asks the nurse what that is. What
should the nurse respond to the family?
A) "Bipolar disorder is a type of depression that includes attention deficit disorder symptoms."
B) "Bipolar disorder means there are cycles of depression as well as hyperactivity, or mania."
C) "Bipolar disorder just means that the mood alternates with the seasons, and it becomes worse in
the winter."
D) "Bipolar disorder is just another type of depression, except depression occurs in cycles."
Answer: B
Explanation: A) Clients with bipolar disorder may shift from emotions of extreme depression to
extreme rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured
speech, racing thoughts, buying sprees, and sexual indiscretions. Bipolar disorder must include either
mania or hypomania, not just depression. Bipolar disorder must include depression with either mania
or hypomania, not attention deficit disorder. A mood change that becomes worse in the winter is
called seasonal affective disorder. Page Ref: 1809
bipolar disorders.
2) The nurse suspects a client is at risk for experiencing bipolar disorder. What did the nurse assess in
this client?
A) Blood pressure 120/80 mmHg
B) Recent major life-altering event
C) Works out at the gym every week
D) Currently employed
E) Mother diagnosed with bipolar disorder
Answer: B, E
Explanation: A) Bipolar disorders typically appear between the ages of 15 and 30. Risk factors include
a family history of bipolar disorders, drug abuse, periods of very high stress, and a major life-altering
event. Women and men are at equal risk of having bipolar disorders. A blood pressure of 120/80
mmHg does not put a client at risk for bipolar disorders. Being employed and working out regularly
are not risk factors for bipolar disorders. Page Ref: 1810
Learning Outcome: 2. Identify risk factors associated with bipolar disorders.
3) The nurse is planning care for an adolescent client experiencing the manic phase of bipolar
disorder. Which intervention would address hallucinations?
A) Encourage spending time with others.
B) Discuss a homework assignment.
C) Keep isolated in a quiet room.
D) Explain that hallucinations are not real.
Answer: D
Explanation: A) The adolescent client in the manic phase of bipolar disorder experiencing
hallucinations should not be left alone in a quiet room but rather should be talked with and explained
that the hallucinations are not real. The nurse should not discuss homework assignments or
encourage the client to spend time with others. The hallucinations need to be addressed.
Page Ref: 1813
life span for individuals with bipolar disorders.
4) The nurse is caring for an adolescent with bipolar disorder experiencing suicidal ideation. What
would be a priority nursing concern?
A) Powerlessness related to mood instability
B) Impaired Social Interaction
C) Risk for Suicide
D) Social Isolation related to disorder
Answer: C
Explanation: A) The priority for an adolescent with bipolar disorder and suicidal ideas is safety. Risk
for Suicide is the nursing diagnosis that would address safety for the client. The other diagnoses have
a lower priority and can be addressed once safety has been ensured. Page Ref: 1813
Cognitive Level: Analyzing Client Need: Psychosocial Integrity Nursing Process: Planning
bipolar disorder.
5) A client in the manic phase of bipolar disorder is unable to sleep during the night. What
intervention(s) could be helpful to this client?
A) Engage in conversation.
B) Extend daytime naps.
C) Encourage the client to watch television.
D) Assist the client with a warm bath and provide a light snack.
E) Encourage the client to listen to soothing music.
Answer: D, E
Explanation: A) To promote sleep during the night, the nurse should decrease lighting and noise,
encourage pre-sleep routines like a warm bath, and provide a snack. Listening to soothing music also
helps to promote sleep. Stimulation such as watching television and long conversations should be
avoided. To promote nighttime sleeping, daytime naps should be limited and not extended.
Page Ref: 1812
Learning Outcome: 6. Plan evidence-based care for an individual with bipolar disorder and his or her
6) Which client observation indicates that interventions provided to a client in the manic phase of
bipolar disorder has improved self-care activities?
A) Completed morning bath and changed clothes
B) Washes hands after using the toilet
C) Cleaned liquid spilled on floor but did not change clothes
D) Brushes own teeth every time when reminded
Answer: A
Explanation: A) The client completing a morning bath and changing clothes are evidence that the
interventions succeeded in improving the client's self-care activities. The client needing to be
reminded to brush teeth would not be a successful outcome. The client washing hands after using the
toilet may or may not be an improvement. The client cleaning spilled liquid on the floor but not
changing clothes is not evidence of improvement in self-care activities.
B) The client completing a morning bath and changing clothes are evidence that the interventions
succeeded in improving the client's self-care activities. The client needing to be reminded to brush
teeth would not be a successful outcome. The client washing hands after using the toilet may or may
not be an improvement. The client cleaning spilled liquid on the floor but not changing clothes is not
evidence of improvement in self-care activities.
C) The client completing a morning bath and changing clothes are evidence that the interventions
evidence of improvement in self-care activities.
D) The client completing a morning bath and changing clothes are evidence that the interventions
evidence of improvement in self-care activities. Page Ref: 1813
Cognitive Level: Analyzing Client Need: Psychosocial Integrity Nursing Process: Evaluation
Learning Outcome: 7. Evaluate expected outcomes for an individual with bipolar disorder.
7) A client in the manic phase of bipolar disorder is being provided with lithium and has a current
level of 0.4. What will the nurse assess in this client?
A) A decrease in manic behavior
B) Hyperactivity and pressured speech
C) A return to baseline behavior, calm and rational
D) Signs and symptoms of depression
Answer: B
Explanation: A) A therapeutic lithium level is 1.0-1.5 mEq/L. Because this client's level is low,
behaviors will indicate mania, that is, hyperactivity and pressured speech. There will be no decrease
in manic behavior because the lithium level is too low. The client will not exhibit signs and symptoms
of depression, but will continue in the manic phase until the lithium level is within a therapeutic
range. The client will not return to baseline behavior, but will continue in the manic phase until the
lithium level is within a therapeutic range. Page Ref: 1812-1813
of an individual with bipolar disorder.
8) A client in the manic phase of bipolar disorder will not sit down to eat. What can the nurse do to
ensure adequate nutrition and improved self-care of this client?
A) Provide a sedative before meals.
B) Discuss finger-food options with the dietitian.
C) Use a jacket restraint at meal times.
D) Ask the physician if intravenous feedings would be applicable.
E) Provide frequent nutritious snacks.
Answer: B, E
Explanation: A) The client who is unable to sit down and eat is most likely to consume frequent small
snacks that can be eaten "on the go." The nurse should discuss with a dietitian to ensure that high-
calorie finger foods and nutritious liquids are available on the nursing unit until the client is able to
attend regular meals. Sedating, restraining, and providing intravenous therapy are not appropriate
interventions and should not be done. Page Ref: 1815
Learning Outcome: 6. Plan evidence-based care for an individual with bipolar disorder and his or her
9) A student nurse is assisting in the care of a client with bipolar disorder. The student nurse
researches the disorder further, focusing on the pathophysiology and etiology of the disorder. What is
true regarding the pathophysiology and etiology of bipolar disorder?
A) No definitive cause or specific pathophysiology has been identified for bipolar spectrum disorders.
B) Bipolar disorders, anxiety disorders, and personality disorders share biological susceptibility and
inheritance patterns.
C) Immunological abnormalities may contribute to the pathophysiology of mania and bipolar
disorder.
D) Children of parents with bipolar disorder have an increased risk of developing the disorder.
E) Stressful life events and an emotionally overinvolved, hostile, and critical communication pattern
are factors associated with heritability of the disorder.
Answer: A, C, D, E
Explanation: A) Bipolar disorders, schizophrenia, and major depressive disorders share biological
susceptibility and inheritance patterns. All other choices are correct. Page Ref: 1809
bipolar disorders.
10) A new graduate nurse is working in a behavioral health hospital and desires to learn more about
bipolar disorders. The nurse understands that bipolar disorders affect clients differently across the
lifespan. What is true regarding bipolar disorders and lifespan considerations?
A) Children with bipolar disorders present with mood changes only.
B) Children with bipolar disorders are usually diagnosed quickly, preventing years of undiagnosed
mental illness.
C) Suicide risk does not increase in adolescents and teenagers who are diagnosed with bipolar
disorders.
D) Lifetime prevalence of bipolar disorders in adolescents is 0%-3%.
Answer: D
Explanation: A) Lifetime prevalence of bipolar disorders in adolescents is 0%-3%. Children with
bipolar disorders present with mood and behavioral changes. Children with bipolar disorders are
often misdiagnosed with ADD or ADHD, causing years of undiagnosed and untreated mental illness.
Suicide risk is increased among all age groups with bipolar disorders. Page Ref: 1811
life span for individuals with bipolar disorders.
Exemplar 28.4 Postpartum Depression
1) The postpartum client states that she cannot understand why she does not enjoy being with her
baby. What should cause the nurse concern?
A) Postpartum infection
B) Postpartum depression
C) Postpartum psychosis
D) Postpartum blues
Answer: B
Explanation: A) Postpartum depression is characterized by feelings of failure and self-accusation,
among others. Postpartum psychosis is more severe, and includes hallucinations and irrationality,
which are not represented in this situation. Postpartum infection has nothing to do with this
situation. Postpartum blues is characterized by mild depression interspersed with happier feelings,
and is self-limiting.
B) Postpartum depression is characterized by feelings of failure and self-accusation, among others.
Postpartum psychosis is more severe, and includes hallucinations and irrationality, which are not
represented in this situation. Postpartum infection has nothing to do with this situation. Postpartum
blues is characterized by mild depression interspersed with happier feelings, and is self-limiting.
C) Postpartum depression is characterized by feelings of failure and self-accusation, among others.
D) Postpartum depression is characterized by feelings of failure and self-accusation, among others.
Page Ref: 1817
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and
indirect causes of postpartum depression.
2) The nurse, who has been calling postpartum clients, learns that one client reports having no
appetite and wants to sleep all day. What does this information suggest to the nurse?
A) The client is feeling blue, which is normal.
B) The client's sleep-wake cycle is disrupted.
C) The client may be experiencing postpartum depression.
D) The client is developing postpartum psychosis.
Answer: C
Explanation: A) Lack of appetite and the desire to sleep are symptoms of developing postpartum
depression. The client could be developing postpartum depression and not just "the blues." The client
would need to have more acute symptoms such as hearing voices to consider postpartum psychosis.
The nurse has no way of knowing what the client's sleep-wake cycle is, so this choice is incorrect.
B) Lack of appetite and the desire to sleep are symptoms of developing postpartum depression. The
client could be developing postpartum depression and not just "the blues." The client would need to
have more acute symptoms such as hearing voices to consider postpartum psychosis. The nurse has
no way of knowing what the client's sleep-wake cycle is, so this choice is incorrect.
C) Lack of appetite and the desire to sleep are symptoms of developing postpartum depression. The
D) Lack of appetite and the desire to sleep are symptoms of developing postpartum depression. The
Page Ref: 1817
Learning Outcome: 2. Identify risk factors associated with postpartum depression.
3) A client of Eastern European descent who gave birth to her third child on the previous shift tells the
nurse that she wants to get cleaned up and have something to eat so that she can be ready to go home
in the morning. What should the nurse do to assist this client?
A) Suggest that the client take advantage of the rest since she has other children at home who will also
need her care.
B) Instruct the client to pace herself and that there is no hurry rush to go home.
C) Assist the client with self-care requests and check on when the meals will be delivered.
D) Suggest that her plans to go home depend upon her physician.
Answer: C
Explanation: A) To provide culturally sensitive care, the nurse should assist the client with self-care
requests and check on when the meals will be delivered because clients of European descent often
want to ambulate, shower, dress, and plan to go home quickly. The nurse should not suggest that the
discharge is dependent upon the physician. Telling the client to pace herself or to take advantage of
rest because she has other children at home who will also need her care does not allow for cultural
differences surrounding childbirth.
B) To provide culturally sensitive care, the nurse should assist the client with self-care requests and
check on when the meals will be delivered because clients of European descent often want to
ambulate, shower, dress, and plan to go home quickly. The nurse should not suggest that the
C) To provide culturally sensitive care, the nurse should assist the client with self-care requests and
D) To provide culturally sensitive care, the nurse should assist the client with self-care requests and
Page Ref: 1819
Client Need: Physiological Integrity
life span for women with postpartum depression.
4) The nurse caring for a postpartum client would consider the nursing diagnosis of ineffective
individual coping when the client demonstrates which behavior?
A) Reading material on care of a newborn
B) Lying in bed, lights dim, and refusing to spend time with the baby
C) Cuddling the new infant
D) Talking with friends and family on the phone
Answer: B
Explanation: A) The postpartum client who is lying in bed in a darkened room and not wanting to
spend time with the new baby is demonstrating signs of ineffective individual coping. The other
behaviors would not indicate ineffective copying but rather effective coping and are incorrect.
B) The postpartum client who is lying in bed in a darkened room and not wanting to spend time with
the new baby is demonstrating signs of ineffective individual coping. The other behaviors would not
indicate ineffective copying but rather effective coping and are incorrect.
C) The postpartum client who is lying in bed in a darkened room and not wanting to spend time with
D) The postpartum client who is lying in bed in a darkened room and not wanting to spend time with
Page Ref: 1825
Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for a woman with
postpartum depression.
5) The home care nurse is planning care for a client with a history of postpartum depression with
previous children. What should be included in this plan of care?
A) Take advantage of those who want to help and maintain outside interests.
B) Contact the physician to ensure the client is prescribed medication for postpartum depression.
C) Encourage as much sleep as possible.
D) Focus on the care the other children need.
E) Instruct to eat a healthful diet with limited alcohol intake.
Answer: A, E
Explanation: A) Because the client has a history of postpartum depression with other children, the
nurse needs to plan prevention strategies for the client. By taking advantage of those who want to help
and maintaining outside interests, the client may prevent the onset of postpartum depression.
Instructing to eat a healthful diet with limited alcohol intake is another strategy to prevent
postpartum depression. The other interventions would not help prevent postpartum depression.
B) Because the client has a history of postpartum depression with other children, the nurse needs to
plan prevention strategies for the client. By taking advantage of those who want to help and
maintaining outside interests, the client may prevent the onset of postpartum depression. Instructing
to eat a healthful diet with limited alcohol intake is another strategy to prevent postpartum
depression. The other interventions would not help prevent postpartum depression.
C) Because the client has a history of postpartum depression with other children, the nurse needs to
D) Because the client has a history of postpartum depression with other children, the nurse needs to
E) Because the client has a history of postpartum depression with other children, the nurse needs to
Page Ref: 1826
Learning Outcome: 6. Plan evidence-based care for an individual with postpartum depression and
her family in collaboration with other members of the healthcare team.
6) The home care nurse determines that a client being treated for postpartum depression is
improving. What did the nurse assess in this client?
A) Client in casual wear, holding baby while rocking in a chair
B) Spouse making dinner, client in bed asleep, baby in rocker in the kitchen
C) Dirty dishes in the sink, beds unmade, and client wearing clothing for sleep
D) Client watching television in the living room while the baby is in the crib crying
Answer: A
Explanation: A) The nurse who observes the client in casual wear, holding the baby while rocking in a
chair, should determine that treatment for postpartum depression has been effective because these
are signs the client is improving. The other choices would indicate disinterest in child care and care of
the home. The client who is sleeping while the spouse is making dinner and watching the baby would
indicate treatment has not been effective at all.
B) The nurse who observes the client in casual wear, holding the baby while rocking in a chair, should
determine that treatment for postpartum depression has been effective because these are signs the
client is improving. The other choices would indicate disinterest in child care and care of the home.
The client who is sleeping while the spouse is making dinner and watching the baby would indicate
treatment has not been effective at all.
C) The nurse who observes the client in casual wear, holding the baby while rocking in a chair, should
D) The nurse who observes the client in casual wear, holding the baby while rocking in a chair, should
Page Ref: 1827
Learning Outcome: 7. Evaluate expected outcomes for an individual with postpartum depression.
7) A client who is breastfeeding has been diagnosed with postpartum depression after delivering a
first child. Which medications might be prescribed for this client?
A) Diazepam
B) Phenytoin
C) Paroxetine
D) Fluoxetine
E) Sertraline
Answer: C, E
Explanation: A) Sertraline is recommended to be the first-line treatment for postpartum depression.
Paroxetine is the alternative first-line treatment for postpartum depression. Fluoxetine is not
recommended for lactating women because of the long half-life and the risk of the medication
crossing into the breast milk. Diazepam and phenytoin are not used to treat postpartum depression.
B) Sertraline is recommended to be the first-line treatment for postpartum depression. Paroxetine is
the alternative first-line treatment for postpartum depression. Fluoxetine is not recommended for
lactating women because of the long half-life and the risk of the medication crossing into the breast
milk. Diazepam and phenytoin are not used to treat postpartum depression.
C) Sertraline is recommended to be the first-line treatment for postpartum depression. Paroxetine is
D) Sertraline is recommended to be the first-line treatment for postpartum depression. Paroxetine is
E) Sertraline is recommended to be the first-line treatment for postpartum depression. Paroxetine is
Page Ref: 1822
of a woman with postpartum depression.
8) The nurse is instructing a new mother on the strategies to prevent the development of postpartum
depression. What should the nurse include in these instructions?
A) Restricting fluids and eating a low-fat diet help to avoid the onset of postpartum depression.
B) Realize that feeling depressed after delivering a baby is normal and can last for months.
C) The only way to avoid postpartum depression is to not have children.
D) Encourage the client to plan how to manage the baby's care needs at home to help adjust to
motherhood.
E) Instruct the client to recognize the signs and symptoms of postpartum depression and phone the
health care provider if these occur.
Answer: D, E
Explanation: A) The nurse should instruct the client on the signs and symptoms of postpartum
depression with the direction to phone her health care provider if this occurs. The nurse should also
encourage the client to plan how to manage the baby's care needs at home to help adjust to
motherhood. It is not normal to feel depressed for months after delivering a baby. Not having children
is not the only way to avoid postpartum depression. Restricting fluids and eating a low-fat diet will
not prevent postpartum depression and could harm the new mother's physiological status.
B) The nurse should instruct the client on the signs and symptoms of postpartum depression with the
direction to phone her health care provider if this occurs. The nurse should also encourage the client
to plan how to manage the baby's care needs at home to help adjust to motherhood. It is not normal to
feel depressed for months after delivering a baby. Not having children is not the only way to avoid
postpartum depression. Restricting fluids and eating a low-fat diet will not prevent postpartum
depression and could harm the new mother's physiological status.
C) The nurse should instruct the client on the signs and symptoms of postpartum depression with the
D) The nurse should instruct the client on the signs and symptoms of postpartum depression with the
E) The nurse should instruct the client on the signs and symptoms of postpartum depression with the
Page Ref: 1826
Learning Outcome: 6. Plan evidence-based care for an individual with postpartum depression and
her family in collaboration with other members of the healthcare team.
9) A nurse manager working in labor and delivery is providing educational material to staff nurses
regarding postpartum depression and the maternal role attainment (MRA) process. What information
is true regarding the MRA process?
A) Maternal role attainment occurs in five stages.
B) During the formal stage of the MRA process, the woman is still influenced by the guidance of
others and tries to act as she believes others expect her to act.
C) During the formal stage of the MRA process, the woman looks to role models, especially her own
mother, for examples of how to mother.
D) The personal stage of the MRA process begins when the mother starts making her own choices
about mothering.
Answer: B
Explanation: A) Maternal role attainment occurs in four stages. During the formal stage of the MRA
process, the woman is still influenced by the guidance of others and tries to act as she believes others
expect her to act. During the anticipatory stage of the MRA process, the woman looks to role models,
especially her own mother, for examples of how to mother. The informal stage of the MRA process
begins when the mother starts making her own choices about mothering.
B) Maternal role attainment occurs in four stages. During the formal stage of the MRA process, the
woman is still influenced by the guidance of others and tries to act as she believes others expect her to
act. During the anticipatory stage of the MRA process, the woman looks to role models, especially her
own mother, for examples of how to mother. The informal stage of the MRA process begins when the
mother starts making her own choices about mothering.
C) Maternal role attainment occurs in four stages. During the formal stage of the MRA process, the
D) Maternal role attainment occurs in four stages. During the formal stage of the MRA process, the
Page Ref: 1817
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and
indirect causes of postpartum depression.
10) A nurse working in labor and delivery is aware of the risk for postpartum clients to develop
postpartum depression. What is a risk factor for the development of postpartum depression?
A) Multiparity (multiple pregnancies)
B) Overwhelming family support
C) History of bipolar disorder
D) History of anxiety disorder
Answer: C
Explanation: A) A history of bipolar disorder is a risk factor for the development of postpartum
depression. Primiparity (first pregnancy) is a risk factor, not multiparity. A lack of family support, not
overwhelming family support, is a risk factor for the development of postpartum depression.
B) A history of bipolar disorder is a risk factor for the development of postpartum depression.
Primiparity (first pregnancy) is a risk factor, not multiparity. A lack of family support, not
C) A history of bipolar disorder is a risk factor for the development of postpartum depression.
D) A history of bipolar disorder is a risk factor for the development of postpartum depression.
Page Ref: 1820-1821
Learning Outcome: 2. Identify risk factors associated with postpartum depression.

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