# A 28-year-old woman is at her 6-week postpartum visit. The Edinburgh Postnatal Depression Scale (EPDS) score is 14 and she reports persistent low mood, anhedonia, and intrusive thoughts of self-harm. Which nursing interventions are appropriate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374202&lang=en  
> language: en  
> subject: Psychosocial Integrity  
> category: PSI

## Question

A 28-year-old woman is at her 6-week postpartum visit. The Edinburgh Postnatal Depression Scale (EPDS) score is 14 and she reports persistent low mood, anhedonia, and intrusive thoughts of self-harm. Which nursing interventions are appropriate? Select all that apply.

1

Reassure the patient that her feelings are normal after childbirth and that supportive counseling and rest will resolve the mood disturbance within 14 days.

2

Perform a direct, specific suicide-risk assessment now (ideation, plan, means, intent) and do not leave her unattended if active risk is identified.

3

Notify the provider STAT and arrange same-day mental-health evaluation; PPD with self-harm ideation is not a wait-and-see condition.

4

Discuss the safety of evidence-based treatment, including SSRIs (sertraline is generally compatible with breastfeeding) and psychotherapy, framing treatment as protecting both her and the baby.

5

Engage the partner or trusted family member with the patient's consent to reinforce a safety plan and arrange in-home support during the acute period.

## Explanation

PPD with self-harm ideation requires immediate action: direct suicide-risk assessment, urgent provider notification, same-day mental-health evaluation, evidence-based treatment discussion (SSRI such as sertraline is compatible with breastfeeding), and safety planning with family. Choice 1 is wrong and dangerous — "baby blues" resolves in 10-14 days and does NOT include self-harm ideation; PPD is a clinical depression requiring treatment, not reassurance.

## In-depth explanation

The single most dangerous NCLEX trap on PPD is "this is just baby blues, reassure and discharge". Any postpartum patient with self-harm ideation, suicidal thoughts of harming the infant, or psychotic symptoms is a psychiatric emergency. Sertraline is generally first-line in breastfeeding women due to favorable transfer profile.

## Clinical scenario

**28-year-old, 6 weeks postpartum**. EPDS score **14** (≥ 10 suggests possible depression, ≥ 13 stronger concern). She reports **persistent low mood, anhedonia, and intrusive thoughts of self-harm**. Infant is healthy.

## Key concepts

- **Postpartum depression (PPD)** — Major depressive episode beginning during pregnancy or within 12 months postpartum; affects ~10-15% of mothers.
- **Edinburgh Postnatal Depression Scale (EPDS)** — 10-item screening tool; ≥ 10 suggests possible depression, ≥ 13 stronger concern; item 10 specifically screens self-harm.
- **Sertraline in breastfeeding** — SSRI generally first-line in lactating women due to low milk transfer; benefits typically outweigh risks.

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