Mood Disorders — NCLEX Nursing Lesson Mental Health Nursing · RN Track · Psychiatric–Mental Health · Conditions · Mood Disorders Condition Lesson · NCLEX-PN / NCLEX-RN

When mood moves outside the normal range—down into depression or up into mania—and disrupts life. The neurobiology, the safety-first nursing, the medications (and their monitoring), and the suicide risk you can never miss.

Builds on prior lessons This lesson assumes you've completed the psychiatric foundations and mental status/health assessment lessons. Recall the Mental Status Exam (MSE) components (appearance, behavior, mood/affect, speech, thought process/content, cognition, insight/judgment) and the neurotransmitters involved in mood—serotonin, norepinephrine, and dopamine. Here we focus on the disorders themselves and on safety. In this lesson

Lesson Objectives
Why This Matters
Disease Overview
Pathophysiology
Risk Factors
Signs & Symptoms
Nursing Assessment
Diagnostic Tests
Laboratory Tests
Medications
Nursing Interventions
Complications
Patient Education
Clinical Judgment
Clinical Connections
NCLEX High-Yield Review
Memory Aids
Case Study
Practice Questions
Key Takeaways
References

Lesson Objectives

Differentiate major depressive disorder from bipolar I/II disorder and explain the neurobiology behind each.
Perform a suicide risk assessment and implement safety (the top priority) for depressed and manic patients.
Explain why antidepressants, mood stabilizers, antipsychotics, and ECT are used—and their key monitoring and safety points.
Recognize psychiatric emergencies: acute suicidality, serotonin syndrome, and lithium toxicity.
Apply therapeutic communication and clinical judgment to plan safe, recovery-oriented care.

Why This Matters

Prevalence: mood disorders are among the most common psychiatric conditions. Major depression affects a large share of adults over a lifetime; bipolar disorder typically emerges in late adolescence/early adulthood. Nurses encounter these on psychiatric units and throughout medical-surgical, OB, and community settings.

Patient safety: mood disorders carry a serious risk of suicide—the single most important safety concern. Mania brings its own dangers: impulsivity, exhaustion, dehydration, and poor judgment. The nurse's first job is to keep the patient safe.

NCLEX importance: heavy testing on suicide risk and precautions, lithium therapeutic range and toxicity, SSRI black box warning and serotonin syndrome, therapeutic communication, and manic-patient management (structure, low stimulation, finger foods).

Why nurses encounter this: depression and bipolar disorder are frequently comorbid with medical illness and life stress, so every nurse must recognize warning signs and respond safely.

A note on this topic This lesson discusses suicide and self-harm in a clinical, educational context to prepare nurses to assess and protect patients. If you or someone you know is struggling, help is available—in the U.S. and Canada you can call or text 988 (Suicide & Crisis Lifeline).

Disease Overview

Mood disorders involve a persistent disturbance in mood that impairs functioning—beyond ordinary sadness or excitement. The two poles:

Disorder	Core disturbance
Major depressive disorder (MDD)	≥2 weeks of depressed mood and/or loss of interest (anhedonia) plus neurovegetative symptoms (sleep, appetite, energy, concentration), often with hopelessness and suicidal thoughts.
Bipolar I	At least one manic episode (may alternate with depression). Mania = abnormally elevated/irritable mood + increased energy for ≥1 week (or any duration if hospitalization is needed).
Bipolar II	Hypomania (a milder, shorter high without psychosis or marked impairment) + major depressive episodes.
Related	Persistent depressive disorder (dysthymia, chronic low mood); cyclothymia (chronic mood swings below full episodes).

How it affects normal physiology: mood is regulated by monoamine neurotransmitters (serotonin, norepinephrine, dopamine), the HPA (stress) axis, and circadian/sleep systems. Mood disorders reflect dysregulation across these systems—which is why they affect sleep, appetite, energy, and thinking, not just "feelings."

Pathophysiology

Normal: balanced serotonin/norepinephrine/dopamine signaling and a well-regulated stress (HPA) axis maintain stable mood, sleep, appetite, energy, and motivation. ↓ What goes wrong: genetic vulnerability + stress → dysregulated monoamine signaling and an overactive HPA axis (elevated cortisol). In depression, reduced monoamine function; in mania, excessive/dysregulated catecholamine–dopamine activity. ↓ How symptoms arise: low serotonin/norepinephrine → depressed mood, anhedonia, poor sleep/appetite, low energy, guilt, and suicidal thinking. Excess dopamine/norepinephrine → elevated mood, decreased need for sleep, racing thoughts, pressured speech, grandiosity, and impulsivity. ↓ Progression: untreated episodes can worsen, recur, and shorten the interval between episodes ("kindling"). Depression can deepen toward hopelessness and suicide; mania can escalate to psychosis and physical exhaustion. Analogy — a thermostat that's lost calibration Think of mood like a thermostat. Normally it holds a comfortable range. In a mood disorder the thermostat is miscalibrated: in depression it's stuck too low (the "furnace" of motivation and energy won't turn on); in mania it's stuck too high (everything runs hot—no off switch for sleep, speech, or spending). Treatment recalibrates the system rather than just "changing the mood" for a moment.

Risk Factors

Category	Examples
Non-modifiable	Family history/genetics (strong for bipolar), female sex (higher MDD rates), age of onset (bipolar in late teens/20s), personal history of prior episodes, chronic medical illness
Modifiable	Substance use (alcohol/stimulants), sleep disruption, chronic stress, medication nonadherence, social isolation, untreated pain
Preventable/protective	Early treatment, adherence, therapy, strong support systems, sleep hygiene, avoiding substances; screening (e.g., PHQ-9) to catch illness early
High-risk populations (suicide)	Prior attempt (strongest predictor), access to lethal means, recent loss, substance use, older adults, adolescents, and—importantly—patients whose energy returns early in depression treatment while mood is still low

Signs & Symptoms

Depression

Category	Findings (and WHY)
Early / expected	Depressed mood, anhedonia, fatigue, poor concentration, sleep/appetite changes — reduced monoamine signaling affects mood, energy, and vegetative functions
Late	Hopelessness, worthlessness/guilt, psychomotor slowing, social withdrawal, weight change — deepening dysregulation
Unexpected	Psychotic features (mood-congruent delusions), severe agitation — indicates severe illness
Emergency	Suicidal ideation with a plan/means, or a sudden calm/energy return in a still-depressed patient (may signal a decision to act) — highest priority

Mania / hypomania

Category	Findings (and WHY)
Early	Elevated/irritable mood, decreased need for sleep, increased energy/talkativeness — catecholamine/dopamine excess
Expected	Pressured speech, flight of ideas, grandiosity, distractibility, impulsivity (spending, sex, risky behavior) — dysregulated drive/reward and disinhibition
Late/unexpected	Psychosis (grandiose delusions), poor hygiene from being "too busy," not eating/drinking — escalating illness
Emergency	Physical exhaustion, dehydration, cardiovascular collapse, or dangerous impulsivity/harm — mania is a medical as well as psychiatric emergency

Nursing Assessment

Subjective

Mood, sleep, appetite/energy, interest/anhedonia, concentration, guilt/hopelessness, thoughts of death or suicide (ask directly), substance use, medication adherence, history of episodes, and manic symptoms (need for sleep, spending, risky behavior). Asking about suicide does not plant the idea—it opens the door to help.

Objective (Mental Status Exam)

Appearance/behavior (grooming, psychomotor activity), speech (slow/monotone in depression; loud/pressured in mania), mood/affect, thought process (flight of ideas vs. slowed), thought content (hopelessness, grandiosity, suicidal/homicidal ideation), cognition, insight, and judgment.

Priority findings & red flags — act & notify immediately

Suicidal ideation with plan/intent/means, a prior attempt, or giving away possessions/putting affairs in order.
A sudden lift in mood or energy in a depressed patient—may mean they've decided to act.
Serotonin syndrome (agitation, hyperthermia, tremor, clonus, autonomic instability) or lithium toxicity (see labs/meds).
Manic physical exhaustion/dehydration, or harm to self/others.

Suicide risk is the #1 priority — safety first For any patient with mood disorder, assess suicide risk directly and repeatedly. If risk is present: ensure a safe environment (remove means, one-to-one or close observation per policy), stay with the patient, and notify the provider. Safety always comes before insight-oriented therapy.

Diagnostic Tests

Mood disorders are clinical diagnoses (DSM-5-TR criteria)—there is no single confirmatory test. Tools and tests screen, rule out medical causes, and monitor treatment.

Test/tool	Purpose / why ordered	Findings & nursing considerations
PHQ-9 / Beck Depression Inventory	Screen & grade depression severity	Higher scores = greater severity; item 9 screens for suicidal thoughts—follow up any positive.
Mood Disorder Questionnaire / clinical interview	Screen for bipolarity	Screen for past mania before treating "depression" with an antidepressant alone—it can trigger mania.
Columbia Suicide Severity Rating Scale (C-SSRS)	Structured suicide risk assessment	Guides level of observation and safety planning.
Structured MSE	Objective mental status data	Documents thought process/content, risk, insight/judgment.
Labs/ECG (below)	Rule out medical mimics; baseline for meds	Thyroid disease, anemia, and substances can mimic mood disorders.

Laboratory Tests

Lab	Purpose / normal	Significance & nursing implications
Lithium level	Monitor therapy; maintenance 0.6–1.2 mEq/L (acute mania up to ~1.5)	Narrow therapeutic range. >1.5 = toxicity (GI upset, coarse tremor, confusion, ataxia); >2.0 = severe (seizures, arrhythmia). Draw trough (~12 hr after dose). Hold and notify for toxicity signs.
TSH / thyroid panel	Rule out thyroid disease; lithium can cause hypothyroidism	Hypothyroidism mimics depression; monitor on lithium.
BMP (Na⁺, renal function)	Lithium safety	Low sodium/dehydration raises lithium levels → toxicity. Maintain steady salt & fluid intake; monitor renal function.
Valproate level / LFTs / CBC	Monitor valproic acid (mood stabilizer)	Therapeutic ~50–100 mcg/mL; monitor for hepatotoxicity and thrombocytopenia.
CBC (carbamazepine)	Monitor for blood dyscrasias	Risk of agranulocytosis/aplastic anemia—watch for fever/infection.
Pregnancy test	Before starting mood stabilizers	Lithium, valproate, and carbamazepine are teratogenic—counsel and screen.

NCLEX pearl — lithium is all about sodium & fluid Lithium is handled like sodium by the kidney. Dehydration, low salt, NSAIDs, and diuretics raise lithium levels → toxicity. Teach patients to keep consistent sodium and fluid intake, stay hydrated, and get regular level checks. Know the range: 0.6–1.2 mEq/L.

Medications

SSRIs (first-line for depression)

MOA/why: block serotonin reuptake → more serotonin in the synapse → improved mood (over weeks). Examples: sertraline, fluoxetine, escitalopram, citalopram, paroxetine. Side effects: GI upset, headache, sexual dysfunction, initial anxiety. Serious: serotonin syndrome (with other serotonergic drugs), hyponatremia (older adults). Black Box Warning: increased suicidal ideation in children/adolescents/young adults—monitor closely, especially early. Teaching: full effect takes 4–6 weeks; don't stop abruptly (discontinuation syndrome); avoid combining with MAOIs.

SNRIs & others

SNRIs (venlafaxine, duloxetine) raise serotonin and norepinephrine—useful for depression with low energy/pain; monitor blood pressure. Bupropion (dopamine/norepinephrine) has no sexual side effects but lowers the seizure threshold (avoid in eating disorders/seizures). Mirtazapine aids sleep/appetite.

TCAs & MAOIs (older agents)

TCAs (amitriptyline) are effective but dangerous in overdose (cardiotoxic)—a concern in suicidal patients. MAOIs (phenelzine) require a tyramine-free diet (aged cheese, cured meats, wine) to avoid hypertensive crisis; many drug interactions.

Mood stabilizers (bipolar)

Lithium — first-line for bipolar; reduces mania and suicide risk. Narrow therapeutic range (0.6–1.2 mEq/L); monitor levels, renal, and thyroid function; teach sodium/fluid consistency. Anticonvulsants: valproate (monitor LFTs, platelets; teratogenic), carbamazepine (blood dyscrasias, many interactions), lamotrigine (bipolar depression—titrate slowly to avoid Stevens-Johnson syndrome; teach to report any rash).

Antipsychotics

Why: second-generation antipsychotics (quetiapine, olanzapine, risperidone, aripiprazole) treat acute mania and psychotic features and stabilize mood. Monitor: metabolic effects (weight, glucose, lipids), extrapyramidal symptoms, and—rarely—neuroleptic malignant syndrome (NMS): high fever, rigidity, autonomic instability—an emergency.

Electroconvulsive therapy (ECT)

Why: for severe, treatment-resistant depression, acute suicidality, or catatonia—works faster than medication. Nursing: informed consent, NPO pre-procedure, brief general anesthesia; expect transient confusion and short-term memory loss afterward. Reassure and reorient.

Emergency reflexes — serotonin syndrome, lithium toxicity, NMS Serotonin syndrome: agitation, hyperthermia, tremor/clonus, diaphoresis, tachycardia → stop the serotonergic drug, supportive care. Lithium toxicity: tremor, GI upset, ataxia, confusion → hold, check level, hydrate/notify. NMS: high fever, "lead-pipe" rigidity, altered LOC → stop the antipsychotic, cool, support—medical emergency.

Nursing Interventions (Priorities)

Safety FIRST (the "airway" of psychiatry): assess suicide/violence risk, provide a safe environment (remove means, appropriate observation), stay with an at-risk patient, and create a safety plan. Why: a dead patient can't recover—preventing self-harm is the priority. ↓ Physiologic stability (Breathing/Circulation): in mania, monitor hydration, nutrition, sleep, and cardiac status—provide finger foods and rest; in ECT/medication emergencies, support ABCs. Why: mania and psychiatric emergencies have real physical risks. ↓ Therapeutic communication: for depression, use simple, direct language, silence, and presence; for mania, use calm, firm, consistent limits and a low-stimulation environment. Why: matching approach to state reduces distress and agitation. ↓ Structure & comfort: establish routine, encourage small achievable activities in depression, and redirect (don't argue with) grandiosity in mania. Why: structure builds safety and success. ↓ Medication management & teaching: give and monitor meds, teach the 4–6 week onset of antidepressants, adherence, and warning signs. Why: adherence prevents relapse. ↓ Interdisciplinary care: psychiatry, therapy (CBT), social work, pharmacy, and support groups. Why: recovery is multimodal. Why the manic patient gets "finger foods" and low stimulation A manic patient is often too active to sit and eat and is easily overstimulated. High-calorie finger foods they can eat on the move prevent exhaustion and weight loss, and a calm, low-stimulation setting with consistent limits reduces escalation. You redirect rather than confront grandiosity.

Potential Complications

Complication	Early signs	Nursing/emergency response
Suicide/self-harm	Ideation, plan, giving away items, sudden calm	Constant/close observation, remove means, stay with patient, notify provider—top priority.
Serotonin syndrome	Agitation, hyperthermia, tremor/clonus, diaphoresis	Stop serotonergic drug, supportive care, notify provider—emergency.
Lithium toxicity	Coarse tremor, GI upset, ataxia, confusion	Hold lithium, check level, hydrate, notify—emergency if severe.
Manic exhaustion/dehydration	Not eating/drinking/sleeping, tachycardia	Provide finger foods/fluids, promote rest, monitor cardiac status.
Antidepressant-induced mania	Elevated mood, decreased sleep, agitation	Hold/notify—screen for bipolar before starting antidepressants.
NMS (antipsychotics)	High fever, rigidity, altered LOC	Stop drug, cool, support ABCs—medical emergency.

Patient Education

Disease process: mood disorders are medical illnesses, not weakness or a character flaw—and they're treatable. Recovery takes time.

Medication adherence: antidepressants take 4–6 weeks for full effect—don't stop early or abruptly; continue even when feeling better to prevent relapse. For lithium, keep steady salt/fluid intake, stay hydrated, avoid NSAIDs without guidance, and get regular level and thyroid/renal checks. Report any rash on lamotrigine immediately.

Lifestyle: regular sleep (protective—especially in bipolar), exercise, avoid alcohol/stimulants, maintain routine, and use therapy and support systems.

Warning signs / when to seek emergency care: thoughts of suicide or self-harm, a plan or access to means, worsening hopelessness, or (in bipolar) decreasing sleep and rising energy signaling a manic switch. Provide the 988 Suicide & Crisis Lifeline and a personalized safety plan.

Clinical Judgment (NCSBN Model)

A patient hospitalized for severe depression has appeared withdrawn and tearful for a week. This morning the nurse notices the patient is suddenly bright, energetic, and calm, and has given a favorite watch to a roommate.

Recognize cues

A sudden improvement in mood/energy in a still-depressed patient, plus giving away a possession—classic warning signs.

Analyze cues

The abrupt calm may mean the patient has decided to act on suicidal thoughts and now has the energy to do so—this is increased, not decreased, risk.

Prioritize hypotheses

Priority: acute suicide risk—the most immediate threat to life.

Generate solutions

Directly assess suicidal ideation/plan, ensure a safe environment, initiate close/constant observation, and notify the provider.

Take action

Stay with the patient, ask directly about suicide, remove access to means, implement one-to-one observation per policy, and document/communicate the risk.

Evaluate outcomes

Success = the patient is safe, risk is reassessed, and a safety plan is in place. Continue monitoring—risk can persist even as mood improves.

Clinical Connections — Commonly Confused

	Major depression (unipolar)	Bipolar disorder
Cause/course	Depressive episodes only	Depressive + manic/hypomanic episodes (strong genetic link)
Assessment	Low mood, anhedonia, neurovegetative symptoms	Also periods of elevated mood, ↓ need for sleep, grandiosity, impulsivity
Diagnostics	PHQ-9; screen for past mania	Must identify mania/hypomania history
Treatment	Antidepressant + therapy	Mood stabilizer ± antipsychotic; antidepressant alone can trigger mania
Priority nursing	Suicide safety, activity, med teaching	Suicide safety + manic safety (rest, nutrition, low stimulation)

	Mania (Bipolar I)	Hypomania (Bipolar II)
Severity/duration	≥1 week; marked impairment; may need hospitalization	≥4 days; less severe; no marked impairment
Psychosis	May be present	Absent by definition
Priority nursing	Safety, rest, nutrition, limit-setting	Monitor for progression; medication adherence

	Serotonin syndrome	Neuroleptic malignant syndrome (NMS)
Trigger	Serotonergic drugs (SSRIs, esp. with others)	Antipsychotics (dopamine blockade)
Key features	Hyperthermia, clonus/hyperreflexia, agitation, rapid onset	Hyperthermia, "lead-pipe" rigidity, ↑CK, slower onset
Priority nursing	Stop drug, cool, support	Stop drug, cool, support

NCLEX High-Yield Review

What the NCLEX Wants You to Know

Suicide risk = the #1 priority; ask directly, ensure safety, remove means
Sudden calm/energy in a depressed patient = increased risk
Lithium range 0.6–1.2 mEq/L; toxicity with dehydration/low sodium/NSAIDs/diuretics
SSRIs: 4–6 weeks to work; Black Box = suicidality in youth; watch serotonin syndrome
Screen for bipolar before antidepressants — they can trigger mania
Mania: safety, rest, finger foods, low stimulation, set limits/redirect
Lamotrigine → report rash (Stevens-Johnson); valproate → LFTs; carbamazepine → CBC
ECT for severe/treatment-resistant depression → expect transient memory loss

Common distractors: "don't ask about suicide, it plants the idea" (false—ask directly); expecting antidepressants to work immediately; treating bipolar depression with an antidepressant alone; arguing with a manic patient's grandiosity; ignoring dehydration in mania. Delegation: the RN performs risk assessment, med administration, and therapeutic interventions; UAP can provide constant observation as directed, obtain vitals, and assist with ADLs/meals—not assess risk or lead therapeutic communication. Critical values: lithium >1.5 mEq/L (toxic), valproate & renal/thyroid on lithium. Most common mistakes: under-assessing suicide risk, missing lithium toxicity, and misreading returning energy as recovery.

Memory Aids

Depression "SIG E CAPS": Sleep, Interest (anhedonia), Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide — the core symptom checklist.
Mania "DIG FAST": Distractibility, Impulsivity/Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep decrease, Talkativeness.
Lithium "LITH": Levels 0.6–1.2, Increase fluids/salt consistency, Toxicity with dehydration/NSAIDs/diuretics, Hypothyroidism/renal monitoring.
Antidepressants "4–6 weeks": tell every patient the effect isn't immediate—don't stop early.
Serotonin syndrome "hot, twitchy, agitated": hyperthermia + clonus/hyperreflexia + agitation.
Mania care "SAFE-R": Safety, Activity/rest balance, Finger foods/fluids, Environment low-stimulation, Redirect (don't argue).
Warning sign trick: a suddenly "better" depressed patient who gives things away is a red flag, not a discharge.

Case Study

A 24-year-old is admitted with a manic episode of bipolar I: sleeping ~2 hours/night for a week, pressured speech, grandiose plans, spending sprees, wearing bright flashy clothes, and eating almost nothing "because there's no time." Lithium is started. Vitals show mild tachycardia; the patient is irritable and intrusive with other patients.

Recognize & analyze cues

Decreased sleep, pressured speech, grandiosity, impulsive spending, and poor intake = acute mania. The patient is at risk for exhaustion, dehydration, and impulsive harm; lithium requires monitoring.

Prioritize & plan

Priorities: safety and physiologic stability. Provide a low-stimulation environment, set consistent limits, offer finger foods and fluids, promote rest, and monitor lithium level, sodium, and hydration.

Take action

Reduce stimulation, redirect grandiosity without arguing, provide high-calorie finger foods/fluids, structure rest periods, administer lithium and antipsychotic as ordered, draw a trough lithium level, and teach sodium/fluid consistency and toxicity signs.

Evaluate & discharge

Success = improved sleep/nutrition, decreasing manic symptoms, therapeutic lithium level, and no harm. Before discharge: reinforce adherence, regular level checks, sleep hygiene, avoiding substances, and recognizing early warning signs of relapse.

NCLEX Practice Questions

Answer choices are numbered; the correct answer is given as a number.

1. A hospitalized patient with severe depression suddenly appears cheerful and energetic and gives away a personal item. The nurse's priority interpretation is that the patient:

Is recovering and ready for discharge
May have decided to act on suicidal thoughts and needs increased safety measures
Is experiencing a normal mood fluctuation
Should be encouraged to attend group therapy

Rationale

Answer: 2. A sudden lift in mood/energy plus giving away possessions can signal a decision to act—increased suicide risk. It's not recovery/discharge (1), a normal fluctuation (3), or a cue for routine activity (4).

2. A patient taking lithium reports nausea, vomiting, diarrhea, coarse hand tremor, and unsteady gait. The nurse should first:

Encourage the patient to restrict fluids
Administer the next scheduled dose as ordered
Reassure the patient these are expected effects
Hold the lithium and obtain a serum lithium level

Rationale

Answer: 4. These are signs of lithium toxicity—hold the dose and check the level, then notify the provider. Restricting fluids (1) worsens toxicity, giving more (2) is dangerous, and this is not expected/benign (3).

3. A patient newly prescribed an SSRI for depression asks when they will feel better. The best response is:

"It may take about 4 to 6 weeks to feel the full effect, so keep taking it as prescribed."
"You should feel completely better within 2 to 3 days."
"If it doesn't work in a week, stop taking it."
"You can double the dose if you don't feel better soon."

Rationale

Answer: 1. SSRIs take 4–6 weeks for full effect; patients must continue and not stop or self-adjust. Options 2, 3, and 4 give unsafe or inaccurate information.

4. A patient in an acute manic episode is unable to sit for meals and has eaten little in two days. Which intervention is most appropriate?

Insist the patient remain seated in the dining room until finished
Withhold food until the patient calms down
Provide high-calorie finger foods and fluids the patient can eat while moving
Serve large, elaborate meals to encourage intake

Rationale

Answer: 3. A manic patient is too active to sit and eat—high-calorie finger foods and fluids prevent exhaustion and dehydration. Forcing seating (1), withholding food (2), or large meals (4) are ineffective or harmful.

5. A patient taking an SSRI is started on another serotonergic medication and develops agitation, hyperthermia, diaphoresis, tremor, and hyperreflexia. The nurse suspects:

Neuroleptic malignant syndrome
Serotonin syndrome
Lithium toxicity
Anticholinergic crisis

Rationale

Answer: 2. Agitation, hyperthermia, diaphoresis, tremor, and hyperreflexia/clonus after adding a serotonergic drug indicate serotonin syndrome. NMS (1) comes from antipsychotics with rigidity; lithium toxicity (3) and anticholinergic crisis (4) present differently.

6. SATA. Which patients are at increased risk for suicide? Select all that apply.

A patient with a previous suicide attempt
A patient with access to lethal means and a specific plan
A depressed patient whose energy is returning while mood remains low
A patient who denies any sadness and has strong social support
A patient with recent significant loss and active substance use

Rationale

Answers: 1, 2, 3, 5. Prior attempt, a plan with access to means, returning energy in a still-depressed patient, and recent loss with substance use all raise risk. A patient without sadness and with strong support (4) is at lower risk.

7. SATA. Which teaching points are appropriate for a patient starting lithium? Select all that apply.

Maintain consistent salt and fluid intake
Report vomiting, diarrhea, tremor, or confusion promptly
Stop the medication as soon as you feel better
Attend regular blood level and thyroid/renal monitoring
Avoid becoming dehydrated and check before using NSAIDs

Rationale

Answers: 1, 2, 4, 5. Consistent salt/fluids, reporting toxicity signs, regular monitoring, and avoiding dehydration/NSAIDs are correct. Stopping abruptly when feeling better (3) risks relapse—continue as prescribed.

8. Priority. The nurse is assigned four patients on a psychiatric unit. Which should be assessed first?

A patient with depression asking about medication side effects
A manic patient who wants to reorganize the day room furniture
A patient in group therapy discussing coping skills
A patient who states they have a plan to end their life and access to a means

Rationale

Answer: 4. A patient with a suicide plan and access to means is at imminent risk—assess and ensure safety first. The others are stable/routine.

9. Delegation. Which task can the RN appropriately delegate to unlicensed assistive personnel (UAP)?

Providing one-to-one constant observation of a suicidal patient as directed
Conducting the suicide risk assessment
Teaching the patient about SSRI therapy
Evaluating the patient's response to a mood stabilizer

Rationale

Answer: 1. UAP can provide constant observation under RN direction. Risk assessment (2), teaching (3), and evaluation (4) require the RN.

10. NGN Case Study. A 30-year-old with bipolar I is admitted in a manic episode. He has slept ~3 hours in 3 days, has pressured speech and grandiose plans, is spending impulsively, and has eaten little. Lithium and an antipsychotic are ordered.

10a. Which findings require nursing intervention? Select all that apply.

Sleeping only 3 hours over 3 days
Minimal food and fluid intake
Impulsive spending and risky plans
Wearing colorful clothing
Pressured speech with flight of ideas

Rationale

Answers: 1, 2, 3, 5. Severe sleep loss, poor intake, impulsivity/risk, and pressured speech/flight of ideas need intervention (exhaustion, dehydration, safety). Colorful clothing (4) alone is not harmful.

10b. Which interventions are appropriate? Select all that apply.

Provide a low-stimulation environment with consistent limits
Offer high-calorie finger foods and fluids
Engage the patient in a competitive group game to burn energy
Monitor lithium level, sodium, and hydration
Promote rest periods and a consistent routine

Rationale

Answers: 1, 2, 4, 5. Low stimulation with limits, finger foods/fluids, lithium/hydration monitoring, and rest support the manic patient. A competitive, stimulating game (3) increases arousal and agitation—avoid it.

Key Takeaways

Safety is always first: assess suicide risk directly and repeatedly, remove means, and use appropriate observation. A sudden calm/energy return in a depressed patient signals increased risk, not recovery.
Depression vs. bipolar: screen for a history of mania/hypomania before starting an antidepressant—used alone it can trigger mania. Bipolar is treated with mood stabilizers ± antipsychotics.
Lithium: narrow range 0.6–1.2 mEq/L; toxicity with dehydration, low sodium, NSAIDs, and diuretics. Teach consistent salt/fluids and regular monitoring (level, thyroid, renal).
Antidepressants: take 4–6 weeks; SSRIs carry a Black Box Warning for suicidality in youth and can cause serotonin syndrome. Lamotrigine → report rash; ECT → transient memory loss.
Mania care: safety, rest, finger foods/fluids, low stimulation, and consistent limits—redirect, don't argue. Watch for exhaustion and dehydration.
Mood disorders are treatable medical illnesses; adherence, therapy, routine, and support drive recovery.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). APA.
Halter, M. J. (2022). Varcarolis' foundations of psychiatric-mental health nursing: A clinical approach (9th ed.). Elsevier.
Townsend, M. C., & Morgan, K. I. (2020). Psychiatric mental health nursing: Concepts of care in evidence-based practice (10th ed.). F. A. Davis.
Silvestri, L. A., & Silvestri, A. E. (2023). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier.
Assessment Technologies Institute. (2023). ATI RN mental health nursing review module (11th ed.). ATI Nursing Education.
National Institute of Mental Health. (2024). Depression and bipolar disorder. U.S. Department of Health and Human Services. https://www.nimh.nih.gov
Substance Abuse and Mental Health Services Administration. (2024). 988 Suicide & Crisis Lifeline and safety planning resources. SAMHSA. https://www.samhsa.gov
American Psychiatric Association. (2023). Practice guideline resources for the treatment of major depressive disorder and bipolar disorder. APA. https://www.psychiatry.org

Mood Disorders

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