Passage / Scenario

The following scenario applies to the next 6 items
The nurse in the behavioral health clinic is caring for a 26-year-old female client.
Item 1 of 6
Nurses' Note
1025: Client presents for initial evaluation, reporting that she ÔÇ£feels all over the place and it is time that she receives some treatment.ÔÇØ ÔÇ£At times I feel empty inside, sometimes feel hyped up, and at times, like now, I feel sadÔÇØ. On assessment, the client has a constricted affect, and her eyes were cast downward. Client reports that her depression has been present for as long as she can remember, including throughout grade school. Her first clearly recalled depressive episode occurred in the sixth grade, when she felt she was "not living up to my own expectations." These episodes varied in durationÔÇösome lasting several months, others only a few hoursÔÇöbut typically persisted for 2 to 4 weeks. Onset could range from a day to a week, while the offset was often abrupt, resolving within a day or less. She reported intermittent difficulty falling asleep. Lately, she has had to use 2-3 tablets of diphenhydramine to help her fall asleep. She denied experiencing racing thoughts but acknowledged being told on numerous occasions that she spoke in ways that felt ÔÇÿpressured.ÔÇÖ She also endorsed distractibility and noted frequent difficulty completing tasks. During times of good mood or when she felt "aligned with others,ÔÇØ she found herself more productive, particularly in creative endeavors. However, at other times, even simple tasks felt overwhelming. She described experiencing "a flurry of thoughts," particularly while writing or during creative projects. At age 23, she experienced what she referred to as "an explosive outburst of rage," which culminated in her punching a hole in her roommateÔÇÖs car's windshield. She reports this occurred during a two-day ÔÇÿepisodeÔÇÖ of her being irritable. Medical history of tension headaches, mild eczema in winter months, and seasonal allergic rhinitis. The client consumes 1-2 glasses of alcohol a year. She does smoke cigarettes daily and started smoking when she was 20.