Major Depressive Disorder/Suicide (21 Questions)

1.1 Mme. Josée Morin, 34 years old, recently experienced a stillbirth at 38 weeks gestation. In the weeks following, she has complained of various physical symptoms such as fatigue, body aches, and headaches, despite no medical findings. She has also isolated herself from friends and family, avoids communication, and has resigned from her job without giving a clear reason.

Question:
What is the most likely explanation for Mme. Morin’s current condition? *
1.2 Now, the patient is currently hospitalized for monitoring and emotional support. The care team wants to implement appropriate nursing interventions to support her adjustment and emotional recovery.

Question:
What is the most appropriate nursing intervention at this stage? *
2.1 Mr. Émile Robitaille, 81 years old, has been diagnosed with late-onset depression following the loss of his spouse. He has unintentionally lost 5 kg in the past month and reports decreased appetite and energy. He is currently prescribed the following medications:
*Citalopram 20 mg once daily (SSRI)
*Mirtazapine 15 mg at bedtime (antidepressant with appetite-stimulating and sedative effects)
*Lorazepam (Ativan) 0.5 mg at bedtime as needed for sleep
*Polyethylene glycol (Lax-A-Day) PRN for constipation

You are updating his therapeutic nursing plan.

Question:
Which priority problem and corresponding directive should be added to Mr. Robitaille’s therapeutic nursing plan? *
2.2 Two weeks after starting citalopram and mirtazapine, Mr. Émile Robitaille, 81 years old, appears visibly improved. He is now smiling, more talkative, eating better, and is described by staff as “almost unrecognizable” compared to admission. The nurse is reassessing his mental status.

Question:
What is the priority evaluation at this stage of his treatment? *
3. Mr. Léo B., 29 years old, is hospitalized and currently under suicide risk monitoring following a recent suicide attempt. His family visits and brings him a bag of personal effects, including clothing, toiletries, and small items from home.

Question:
As the nurse, what is the most appropriate action to take? *
4.1 Mr. Lesplante 47-year-old was admitted to the psychiatric unit following a suicide attempt by abdominal stabbing. He is currently under preventive confinement. Over the past three months, he experienced several major life stressors:
*He was laid off from his job in construction, which he held for 7 years.
*He is going through a separation from his partner of 10 years, with whom he shares custody of a young child.
*He has started drinking heavily in the evenings, stating “it’s the only thing that helps me sleep.”
*He also reports feeling like a burden and says, “nothing’s working out for me anymore.”

The team has initiated suicide prevention measures, and you are assessing his risk factors.

Question:
Which two factors in Mr. Lesplante’s situation are known to increase suicide risk? *
4.2 While reviewing his psychosocial history, you learn that Mr. Lesplante lives alone in a condominium downtown. He shares the space with his pet cat, Felix, whom he refers to as “my best buddy.” He also tells you that, no matter what’s going on in his life, he still makes it a point to attend church every Sunday, even if he doesn’t stay for the entire service.

Though he has limited contact with his family and recently separated from his partner, he mentions that the neighbors in his building occasionally check in on him, and that the doorman knows him by name.

Question:
Which two of the following are considered protective factors that may reduce Mr. Lespante’s risk for suicide? *
5. M. Larochelle, 45 years old, is admitted for severe depression. During your rounds, he hands you his wedding ring and says, "I won't be needing this anymore. My wife deserves a fresh start without a burden like me." He appears strangely calm compared to yesterday.

Question:
What is your priority intervention? *
6. Mme Gagnon, 32 years old, was admitted 10 days ago for severe major depression with suicidal ideation. She has been taking Sertraline (Zoloft) for 9 days. For the past week, she refused to get out of bed or groom herself. Today, she is up early, showered, smiling, and tells you, "I have so much energy today, everything is finally clear."

Question:
How should you interpret this change in behavior? *
7. M. Dubé, 19 years old, is admitted to the psychiatric unit for a suicide attempt. His mother arrives with a bag of personal items (clothes, toiletries) for him.

Medical Order: Suicide Precautions: Constant Observation.

Question:
What is the standard nursing protocol regarding these personal items? *
8. Mme Fortin, 68 years old, has severe vegetative depression. She has lost 5 kg in 2 weeks. She moves very slowly (psychomotor retardation) and states, "I'm too tired to chew. I'm not hungry."

Medical Order: Diet as tolerated. Weekly weights.

Question:
Which nursing intervention is most appropriate to improve her nutritional intake? *
9. M. Cloutier, 40 years old, has been on Fluoxetine (Prozac) for 3 months. He admits to taking "St. John's Wort" (an herbal supplement) recently to "boost" the effect because he felt low. He presents to the clinic with high fever, muscle rigidity, tremors, and confusion.

Question:
What medical emergency do you suspect? *
10. Mme Beaulieu, 55 years old, is sitting in the dayroom. She is slumped in her chair, staring at the floor, and has not spoken a word all day. You approach her to build a therapeutic relationship.

Question:
What is the most effective intervention? *
11. M. Lambert, 50 years old, is scheduled for his first Electroconvulsive Therapy (ECT) treatment for refractory depression. He asks, "Will I remember what happens during the shock?"

Question:
What is the correct information to give the patient regarding the procedure? *
12. Mme Caron, admitted for MDD, reports she has not had a bowel movement in 4 days. She is taking Amitriptyline (Elavil), a tricyclic antidepressant. She spends most of the day in bed.

Question:
What is the most likely cause, and what is the prevention strategy? *
13. M. Poirier is being discharged after a suicide attempt. He denies suicidal thoughts currently.

Question:
Which component of the discharge plan is most critical for safety? *
14. Police bring Mme Lapointe to the ER. She was standing on the edge of a bridge threatening to jump. She is screaming, "Let me go! I have the right to die! I refuse admission!" She is fully oriented but highly emotional.

Question: Can this patient be kept in the hospital against her will? *
15. M. Tremblay, 30 years old, was admitted last night for a serious suicide attempt by overdose. He is currently on "Constant Observation" (1:1 sitter). He approaches the nursing station, agitated, and demands: "I need a cigarette right now. I’m going outside to the designated smoking area. It is my legal right to smoke, you can't keep me prisoner here!"

Question:
What is your appropriate professional response? *
16. M. Boucher, 22 years old, is on high suicide risk precautions. He comes to the desk and asks calmly, "Can I please use the phone? I really need to call my brother to say goodbye and tell him where my bank papers are."

Question:
Will you allow this phone call? *
17. Mme Roy is being evaluated for a pass to go home for the weekend. The physician asks you if she has "contracted for safety." You ask Mme Roy, "If you feel like hurting yourself this weekend, what will you do?" She replies, "I guess I'll try to call the hospital."

Question:
How do you evaluate this response regarding her readiness for a pass? *
18. M. Fortin, admitted for a suicide attempt by cutting, has a visitor. You observe the visitor giving M. Fortin a backpack. Later, you see M. Fortin holding a glass soda bottle that was in the bag.

Question:
What is your immediate action? *