A patient has been admitted due to severe depression. What symptoms should the nurse anticipate during the assessment?

Changes in sleep pattern, fatigue, and an elevated mood.

Depressed mood, feelings of guilt, and rapid speech.

Difficulty concentrating, feelings of helplessness, and rapid shifts in thoughts.

Feelings of hopelessness, worthlessness, and difficulty focusing.

Answer and Explanation

The Correct Answer is D

Choice D rationale
Feelings of hopelessness, worthlessness, and difficulty focusing are common symptoms of severe depression. Depression is a serious mood disorder that affects how a person feels, thinks, and handles daily activities. To be diagnosed with depression, the symptoms must be present for at least 2 weeks.
Choice A rationale
Changes in sleep pattern and fatigue are symptoms of depression, but an elevated mood is not. An elevated mood is more commonly associated with bipolar disorder.
Choice B rationale
While a depressed mood and feelings of guilt are symptoms of depression, rapid speech is not. Rapid speech is more commonly associated with mania or hypomania, conditions seen in bipolar disorder.
Choice C rationale
Difficulty concentrating and feelings of helplessness are symptoms of depression, but rapid shifts in thoughts are not. Rapid shifts in thoughts are more commonly associated with conditions such as bipolar disorder.

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Free Nursing Study Resources

Correct Answer is ["A","B"]

Explanation

The correct answer is Choice A and B.

A score of 1 to 10 on the Global Assessment Functioning (GAF) scale indicates that a client is in persistent danger of severely hurting self or others or has a persistent inability to maintain minimal personal hygiene.

A. Monitor mental status. B. Encourage the individual to recall recent events. C. Assess vital signs. D. Contact family members.

Correct Answer is C

Explanation

Choice A rationale
Monitoring mental status is important, but it is not the priority nursing action in this situation. The individual has been found after being missing for 48 hours and the immediate concern should be their physical well-being.
Choice B rationale
Encouraging the individual to recall recent events may be part of the assessment process, but it is not the priority nursing action. The individual’s physical health could be at risk after being outside for an extended period, and this should be addressed first.
Choice C rationale
Assessing vital signs is the priority nursing action. The individual has been found after being missing for 48 hours, potentially exposed to harsh weather conditions and without access to food or water. It is crucial to assess their physical state as they may be dehydrated, hypothermic, or have other immediate health concerns.
Choice D rationale
Contacting family members is important for providing information and support, but it is not the priority nursing action. The first concern should be to assess and stabilize the individual’s physical condition.

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A patient has been admitted due to severe depression. What symptoms should the nurse anticipate during the assessment?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A score of 1 to 10 on the Global Assessment Functioning (GAF) scale would indicate that a client was at risk for:

Correct Answer is ["A","B"]

Explanation

Correct Answer is C

Explanation

A nurse is providing a community health education class about suicide prevention. Which of the following should the nurse identify as risk factors for suicide? (Select all that apply).

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A patient has been admitted due to severe depression. What symptoms should the nurse anticipate during the assessment?