Depression

A client with depression was prescribed fluoxetine. After two days, the client arrives at the hospital and reports restlessness, confusion, and poor concentration. Upon assessment, the nurse finds an elevated body temperature. Which intervention by the healthcare provider would be beneficial to the client? 1 Withdrawing the drug 2 Administering isocarboxazid 3 Reducing the dose of the drug 4 Informing the client that these are expected side effects

1 Restlessness, confusion, poor concentration, and fever are symptoms of serotonin syndrome. The only treatment for serotonin syndrome is discontinuation of the drug. Isocarboxazid is a monoamine oxidase inhibitor that should not be used in a client with serotonin syndrome because it may lead to life-threatening conditions. Reducing the drug dosage may not reverse the symptoms completely. Informing the client that these are expected adverse effects is important, but the drug should be discontinued immediately.

A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client? 1 Sertraline 2 Fluoxetine 3 Amphetamine 4 Carbamazepine

1 Sertraline is considered safe in lactating females. Dosing immediately after breast-feeding can reduce the risk of the drug excreted in the breast milk by the next feeding time. Fluoxetine and amphetamine are not recommended for breast-feeding clients. Carbamazepine is not used to treat depression.

A client with a diagnosis of major depression tells a nurse, "No matter what I do, everything turns out bad." The nurse recognizes this as an example of what? 1 Using a cognitive distortion 2 Seeking sympathy from the nurse 3 Regressing to an earlier developmental level 4 Avoiding responsibility for previous behavior

1 The client is using the cognitive distortions of overgeneralization and pessimism. Negative events are magnified and become the focus, whereas contrary positive experiences are minimized and ignored. With the focus on the negative events, the depressive mood is reinforced. There are no data to support the conclusion that the client is seeking sympathy, regressing, or avoiding responsibility.

The nurse noticed increased blood pressure in a client on treatment for depression. Which antidepressant drug does the nurse ask the primary healthcare provider to reconsider? 1 Fluoxetine 2 Bupropion 3 Trazodone 4 Mirtazapine

2 Bupropion is the antidepressant drug used in the treatment of depression. The adverse effect of this drug is increased blood pressure. Fluoxetine is used in the treatment of depression. Anxiety and insomnia are the adverse effects of this drug. Trazodone is used in the treatment of depression. Sedative effects are the adverse effects of this drug. Mirtazapine is used in the treatment of depression. Drowsiness and abnormal dreams are the adverse effects of this drug.

A client is admitted with the diagnosis of borderline personality disorder and possible depression. The client has a history of abusive acting-out behavior. What is most important to assess when caring for this client? 1 Degree of anger 2 Potential for suicide 3 Level of intelligence 4 Ability to test reality

2 Depressed clients may use suicide as the ultimate escape from feelings; ensuring safety by protecting the client from self-harm is the priority. Although degree of anger is important, it is not the priority. Assessment of the level of intelligence is unnecessary; clients with a diagnosis of borderline personality disorder are usually of average intelligence. Clients with a diagnosis of borderline personality disorder are more concerned with satisfying their needs than testing reality; they are more concerned about themselves than others or the environment.

Two weeks after a client has been admitted to the mental health hospital, the client's depression begins to lift. What is the primary reason the nurse encourages involvement with unit activities? 1 They support self-confidence. 2 They provide for group interaction. 3 They limit opportunities for suicide. 4 They allow verbalization of repressed feelings of hostility.

2 Group interaction provides a sense of belonging and fosters the assumption of responsibility. Support of self-confidence and limitation of opportunities for suicide are not ensured by group interaction. The group is not the best arena for the expression of repressed hostility.

A 65-year-old man is admitted to the hospital with a history of depression. The client, who speaks little English and has had few outside interests since retiring, says, "I feel useless and unneeded." The nurse concludes that the client is in which Erikson's developmental stage? 1 Initiative versus guilt 2 Integrity versus despair 3 Intimacy versus isolation 4 Identity versus role confusion

2 Integrity versus despair is the task of the older adult; the client has difficulty accepting what life is and was, resulting in feelings of despair and disgust. Initiative versus guilt is the task of the preschool-aged child. Intimacy versus isolation is the task of the young adult. Identity versus role confusion is the task of the adolescent.

A depressed client has been prescribed a tricyclic antidepressant. How long does the nurse inform the client that it usually takes before clients notices a significant change in the depression? 1 4 to 6 days 2 2 to 4 weeks 3 5 to 6 weeks 4 12 to 16 hours

2 It takes 2 to 4 weeks for the tricyclic antidepressant to reach a therapeutic blood level. Time spans of 4 to 6 days and 12 to 16 hours are both too short for a therapeutic blood level of the drug to be achieved. Improvement in depression should be demonstrated sooner than 5 to 6 weeks.

A client in a psychiatric hospital with the diagnosis of major depression is tearful and refuses to eat dinner after a visit with a friend. What is the most therapeutic nursing action? 1 Allowing the client to skip the meal 2 Offering an opportunity to discuss the visit 3 Reinforcing the importance of adequate nutrition 4 Providing the client with adequate quiet thinking time

2 Offering to discuss the visit shows support and provides the client with an opportunity to discuss feelings. Allowing the client to skip dinner does not address the client's depression. Teaching is inappropriate when a client is emotionally distressed. Providing quiet thinking time will limit further communication and may imply rejection.

An older client who is hospitalized for depression is receiving citalopram. During discharge teaching, the client asks the nurse whether there is anything that should be known about taking this medication. What is the nurse's reply? 1 "You're concerned about taking this medication." 2 "You should take each dose of medication as prescribed." 3 "You must discontinue the medication if side effects occur." 4 "You may find it necessary to adjust the dosage if side effects occur."

2 The client should be encouraged to follow the medical regimen to maximize the response to drug therapy. The client asked a direct question; stating "You're concerned about taking this medication" does not answer the question. The healthcare provider should be notified of side effects. Legally it is the healthcare provider who is responsible for discontinuing a medication or adjusting a medication dosage.

A client with a history of depression tells the nurse about planning to retire from work next year. What common dynamic about retirement should the nurse consider when interacting with this client? 1 It is damaging to self-esteem. 2 It is a developmental task of significance. 3 It is a negative event associated with the concept of aging. 4 It is a milestone that is eagerly anticipated by most older people.

2 The response to retirement varies, but it is a task representing a developmental milestone for all people who work. Retirement may or may not be damaging to self-esteem; it depends on the individual and the circumstances. Whether retirement is dreaded or eagerly anticipated depends on the individual and the circumstances.

A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? Select all that apply. 1 Dementia 2 Multiple losses 3 Declines in health 4 A milestone birthday 5 An injury requiring hospitalization

2 & 3 Depression in the older adult is most often associated with the loss of family members and friends (e.g., death, relocation) and declines in mobility, health, and income.

Which drug is used to treat both generalized anxiety disorder and depression? 1 Fluoxetine 2 Bupropion 3 Duloxetine 4 Mirtazapine

3 Duloxetine is an antidepressant drug used to treat both generalized anxiety disorder and depression. Fluoxetine is used to treat depression. Bupropion is used to treat depression and also aid in smoking cessation. Mirtazapine is used in the treatment of depression and also helpful in reducing the adverse sexual side effects in the male client receiving selective serotonin reuptake inhibitors therapy.

The nurse is caring for a client who had a brain attack (cerebrovascular accident) and who has varying moods. The moods range from anger to depression to concern about the aphasia, hemiparesis, and the gavage feedings. Which behavior best indicates the client's acceptance of physical limitations? 1 Performs tube feedings without assistance 2 Allows family members to assist with care 3 Smiles and becomes more extroverted 4 Walks in the hall and sits in the lounge

1 The best indicator of acceptance is when the client begins to participate in self-care (tube feedings). Allowing others to provide care does not indicate acceptance. The nurse cannot assume that physical limitations have been accepted just because a client smiles. Walking in the hall and sitting in the lounge do not indicate acceptance; they may be an attempt to relieve boredom.

One morning a client with the diagnosis of acute depression says, "God is punishing me for my past sins." What is the best response by the nurse? 1 "Why do you think that?" 2 "You sound very upset about this." 3 "Do you believe that God is punishing you for your sins?" 4 "If you feel this way, you should talk to your spiritual advisor."

2 The response focuses on the client's feelings rather than the statement, and it serves to open channels of communication. "Why do you think that?" asks the client to decide what is causing the feelings; most people are unable to explain why they feel as they do. "Do you believe that God is punishing you for your sins?" simply echoes the client's statement and does not reflect feelings or stimulate further communication. "If you feel this way, you should talk to your spiritual advisor" does nothing to stimulate further communication; in fact, it tells the client to talk about the feelings with someone else.

Which symptoms of depression, often overlooked in the older adult client, should the nurse include in the assessment process? Select all that apply. 1 Anxiety 2 Insomnia 3 Weight loss 4 Weight gain 5 General fatigue

2, 5 Insomnia and general fatigue are symptoms of depression that are often overlooked for the older adult client. Anxiety, weight loss and weight gain are all symptoms of depression; however, these symptoms are not often overlooked for the older adult client.

An adolescent having premenstrual syndrome displays pelvic fullness, irritability, depression, fatigue, and backaches. What instructions should the nurse provide to the adolescent to help obtain relief? Select all that apply. 1 Do aerobics 3 to 4 times a week. 2 Follow stress reduction techniques. 3 Take NSAIDs or progesterone. 4 Consume sugar, salt, red meat, alcohol, and coffee regularly. 5 Eat food rich in complex carbohydrates and fiber in three small portions.

1, 2, 3, 5 30 to 80% of women will experience premenstrual syndrome. Regular exercise, especially in the luteal phase, is extremely helpful in overcoming the symptoms and reducing anxiety. Stress reduction techniques may also aid in relieving symptoms. Eating three small to moderate sized meals with a high content of carbohydrates and fiber may also grant relief from symptoms. Medications that can be used to provide symptomatic relief include NSAIDs, progesterone, and diuretics. Clients should avoid smoking, alcohol, sweets, salt, meat, and alcohol.

While conducting an assessment, the nurse finds that the client shivers uncontrollably and experiences memory loss, depression, and poor judgment. What might the client's body temperature be? 1 29° C 2 33° C 3 36° C 4 38° C

2 A body temperature in the range of 36° to 38° C is normal. When skin temperature drops below 35° C, the client may exhibit uncontrolled shivering, loss of memory, depression, and poor judgment as a result of hypothermia. A body temperature lower than 30° C represents severe hyperthermia. In this condition, the client will demonstrate a lack of response to stimuli and extremely slow respiration and pulse. Based on the signs given, the client's temperature is most likely 33° C.

Certain foods and drugs are known to cause serious adverse effects when used in combination with monoamine oxidase inhibitors (MAOIs). Which adverse effect could occur in clients treated with MAOIs for depression? 1 A serious drop in blood pressure 2 A serious increase in blood pressure 3 A significant increase in liver enzymes 4 A significant increase in cholesterol levels

2 MAOIs, when taken with foods high in tyramine (e.g., pickled foods, beer, wine, aged cheeses), drugs such as antidepressants, certain pain medications, and decongestants can cause a life-threatening increase (not decrease) in blood pressure or hypertensive crisis. For this reason they are seldom used to treat symptoms of depression. MAOIs do not increase liver enzymes or cholesterol levels.

A client is admitted to the hospital with a diagnosis of depression. What clinical manifestations of depression does the nurse expect when assessing this client? 1 Flight of ideas 2 Suspicion of others 3 Psychomotor retardation 4 Intrusive social behaviors

3 Both thought and motor activity, which require physical and psychic energy, are commonly slowed when someone is depressed. Flight of ideas is associated with manic behavior because it requires psychic energy. Suspicion is associated with paranoid ideation and is less common with depression. Intrusive social behaviors are associated with manic behavior.

A registered nurse provides dietary instructions to a client who is prescribed isocarboxazid for depression. Which statements made by the client indicates a need for further education? 1 "I will limit my intake of fish." 2 "I will limit my intake of yogurt." 3 "I will limit my intake of bananas." 4 "I will limit my intake of beer." 5 "I will limit my intake of chocolate."

3 & 4 If a client is unresponsive to other antipsychotic drugs, isocarboxazid (a monoamine oxidase inhibitor) is used to treat depression. Clients taking isocarboxazid should avoid foods high in tyramine and should limit the intake of foods (banana or chocolate) that contain a moderate amount of tyramine content because these foods may cause a hypertensive crisis

A male client with the dual diagnosis of major depression and polysubstance abuse has been attending group therapy. One day the client tells the nurse, "The things they talk about in group don't really pertain to me." What is the most therapeutic response by the nurse? A) Confronting the client with realistic feedback B) Identifying the client's stress-coping tolerance C) Informing the client that he needs to get more involved D)Asking the client what therapy he thinks would be more helpful

A

Which assessment finding is associated with depression? 1 The client has islands of intact memory. 2 The client has impaired recent and remote memory. 3 The client has impaired recent and immediate memory. 4 The client needs step-by-step instructions for simple tasks.

1 Depression may occur with major changes in life. A client with depression has selective or patchy memory loss with islands of intact memory. A client with dementia has impaired recent and remote memory. The onset of delirium may be abrupt, causing impaired recent and immediate memory. A client with delirium is forgetful and requires step-by-step instructions to complete simple tasks.

A client is found to have an adjustment disorder with mixed anxiety and depression. What should the nurse anticipate as the client's primary problem? 1 Low self-esteem 2 Deficient memory 3 Intolerance of activity 4 Disturbed personal identity

1 When a client has an adjustment disorder, anxiety may be related to a disturbance in self-esteem and depression may be related to impaired social interaction. Problems with memory are not specifically related to an adjustment disorder. Activity intolerance, which is related to oxygenation problems, is not associated with adjustment disorders. A client with an adjustment disorder does not experience a disturbance in personal identity.

Four clients are admitted to a hospital with different symptoms associated with depression. Which client would benefit from mirtazapine? 1 Client 1 2 Client 2 3 Client 3 4 Client 4

2 Mirtazapine causes substantial sedation. Therefore, client 2 would benefit from mirtazapine. Client 1 requires a central nervous system stimulant such as fluoxetine. Client 3 will benefit from duloxetine, which is a drug relieves chronic pain. Client 4 would benefit from bupropion, which enhances a person's libido.

During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. 1 Lethargy 2 Ambivalence 3 Emotional lability 4 Increased appetite 5 Long periods of sleep

1, 2, 3 Lethargy reflects the lack of physical and emotional energy that is associated with depression. Ambivalence, the coexistence of contradictory feelings about an object, person, or idea, is associated with postpartum depression. Emotional lability is associated with postpartum depression. Anorexia, rather than increased appetite, is associated with postpartum depression; the client lacks the physical and emotional energy to eat. Insomnia, rather than long periods of sleep, is also associated with postpartum depression.

The nurse is providing instructions to a client who is on isocarboxazid for depression. Which statements made by the client indicate effective learning? Select all that apply. 1 "I will include yogurt in my diet." 2 "I will avoid soy sauce in my diet." 3 "I will avoid pepperoni in my diet." 4 "I will include cream cheese in my diet." 5 "I will avoid fermented bean curds in my diet."

1, 3, 4, 5 Isocarboxazid is a monoamine oxidase (MAO) inhibitor used to treat depression. Clients on MAOIs should avoid foods containing high amounts of tyramine. Yogurt and cream cheese are foods containing low to no tyramine content. Fermented bean curds are high tyramine-containing foods that should be avoided. Pepperoni are high tyramine foods that should be avoided. Soy sauce containing low tyramine content and this is permissible.

The practitioner prescribes a tricyclic antidepressant medication to ease a suicidal client's depression. What factor should the nurse consider when initiating treatment with this type of medication? 1 Eating aged cheese may cause a hypertensive crisis. 2 There may not be a noticeable improvement for 2 to 3 weeks. 3 They must be given with milk to avoid gastrointestinal irritation. 4 Blood specimens are required weekly for 3 months to check for a therapeutic drug level.

2 These drugs do not produce an immediate effect; nursing measures must continue to decrease the risk of suicide. Avoiding aged cheese is a precaution taken with monoamine oxidase (MAO) inhibitors. Giving the medicine with milk is unnecessary. Blood specimens are not necessary; toxicity is not as prevalent a problem with tricyclic antidepressants as it is with medications such as lithium.

Which statements regarding the use of selegiline to treat depression are true? Select all that apply. 1 Carbamazepine lowers selegiline levels. 2 Oxcarbazepine significantly raises the level of selegiline. 3 Oral forms of selegiline are approved for bipolar disease. 4 The most common adverse reaction of selegiline is a localized rash. 5 Transdermal selegiline is the only transdermal treatment for major depression.

2, 3, 5 Oxcarbazepine significantly raises the level of selegiline and is contraindicated. The most common adverse reaction of selegiline is a localized rash. Transdermal selegiline is the first and only transdermal treatment for major depression. Carbamazepine raises the level of selegiline. Oral forms of selegiline are approved to treat symptoms of Parkinson disease.

A client with a history of smoking is suspected of having depression. The primary healthcare provider prescribes a drug that would be beneficial in treating depression and would aid in smoking cessation. Which adverse effects would the nurse suspect in this client? Select all that apply. 1 Asthenia 2 Confusion 3 Tachycardia 4 Constipation 5 Increased appetite

2, 3 Bupropion is used to treat depression and aid in smoking cessation. Therefore, the nurse would suspect confusion and tachycardia in a client who is prescribed bupropion. Mirtazapine is indicated for the treatment of depression. Asthenia, constipation, and increased appetite are adverse effects associated with mirtazapine.

A client with depression has not responded to a tricyclic antidepressant and outpatient electroconvulsive therapy (ECT). The healthcare provider prescribes selegiline, and the nurse teaches the client about food to be avoided while taking this medication. Which foods identified by the client allow the nurse to conclude that the instructions have been understood? Select all that apply. 1 Fresh fish 2 Beer 3 Fried chicken 4 Licorice 5 Leafy vegetables

2, 4 Foods containing tyramine can cause hypertensive crisis and should be eliminated from the diet. These foods include pickled herring, beer, wine, chicken livers, aged or natural cheese, caffeine, cola, licorice, avocados, bananas, and bologna. Chocolate in moderation is safe for some patients, but it does contain caffeine. Overripe fruits and caffeine have high levels of tyramine, which can cause dangerous hypertension in clients taking monoamine oxidase inhibitors (MAOIs). Also, large amounts of caffeine can increase blood pressure and should be avoided. There is no need to limit the intake of fish, chicken, or leafy vegetables while taking an MAOI.

A client has been hospitalized for 3 weeks while receiving a tricyclic medication for severe depression. One day the client says to the nurse, "I'm really feeling better; my energy level is up." After the encounter an aide tells the nurse that the client has given away a favorite jacket. What should the nurse conclude that the client's statement indicates? 1 Improved mood 2 Improved socialization 3 Increased risk for suicide 4 Heightened need for independence

3 When the energy level improves in the depressed client, the risk for suicide increases; also, the client has given away a personal belonging, which may indicate a plan to commit suicide. Elevated mood may be true, but the gift of a cherished personal belonging decreases the possibility that the client's statement simply reflects an improvement in mood. The client's socialization may be improved, but the gift of a valuable personal belonging decreases the possibility that the act simply reflects an improved level of socialization. Giving something away is unrelated to independence.

A nurse is assigned to care for a group of clients who have been found to have depression. Which clinical manifestations does the nurse anticipate? Select all that apply. 1 Lability of affect 2 Specific food cravings 3 Neglect of personal hygiene 4 "I don't know" answers to questions 5 Apathetic response to the environment

3, 4, 5 Clients with depression are uninterested in their appearance because of low self-esteem. "I don't know" answers to questions require little thought or decision making, typical of depression. These clients' sense of futility leads to a lack of response to the environment. With depression there is little or no emotional involvement and therefore little alteration in affect. Clients with depression are uninterested in food of any kind.

The nurse suspects serotonin syndrome in a client prescribed second-generation antidepressants for depression. Which assessment findings observed by the nurse would be beneficial in diagnosing the severity of the syndrome? Select all that apply. 1 Delirium 2 Hyperreflexia 3 Hyperthermia 4 Muscle spasms 5 Rhabdomyolysis

3, 5 Serotonin syndrome is a potentially hazardous adverse effect of second-generation antidepressants that are used to treat depression. Hyperthermia and rhabdomyolysis are symptoms observed in severe cases of serotonin syndrome. Delirium, hyperreflexia, and muscle spasms are common symptoms of this syndrome.

An older client is admitted to the hospital with the diagnosis of dementia of the Alzheimer type and depression. Which signs of depression does the nurse identify? Select all that apply. 1 Loss of memory 2 Increased appetite 3 Neglect of personal hygiene 4 "I don't know" answers to questions 5 "I can't remember" answers to questions

2, 3, 4, 5 Neglect of personal hygiene is associated with depression because of low self-esteem. People who are depressed do not have physical or emotional energy; "I don't know" and "I can't remember" answers require little thought or decision-making. Patients with depression can either have decreased or increased appetite. Depression does not cause memory deficits.

A client is hospitalized because of severe depression. The client refuses to eat, stays in bed most of the time, does not talk with family members, and will not leave the room. The nurse attempts to initiate a conversation by asking questions but receives no answers. Finally the nurse tells the client that if there is no response, the nurse will leave and the client will remain alone. How should the nurse's behavior be interpreted? 1 A system of rewards and punishment is being used to motivate the client. 2 Leaving the client alone allows time for the nurse to think of other strategies. 3 This behavior indicates the client's desire for solitude that the nurse is respecting. 4 This threat is considered assault, and the nurse should not have reacted in this manner.

4 This response is a threat (assault), because the nurse is attempting to put pressure on the client to speak or be left alone. This is not a reward and punishment technique that is used in behavior modification therapy. Clients in emotional crisis should not be left alone.

A client diagnosed with depression is prescribed phenelzine. Which foods consumed along with this drug would cause a hypertensive crisis? 1 Yogurt 2 Soy sauce 3 Cream cheese 4 Soybean paste 5 Over-ripened bananas

2, 4, 5 Monoamine oxidase inhibitors (MAOIs) may cause hypertensive crisis if the client consumes foods rich in tyramine. Soy sauce, soybean, and over-ripened bananas contain high amounts of tyramine

A client who was forced into early retirement is found to have severe depression. The client says, "I feel useless, and I've got nothing to do." What is the best initial response by the nurse? 1 "Tell me more about feeling useless." 2 "Volunteering can help you fill your time." 3 "Your illness is adding to your current feelings." 4 "Let's talk about what you'd like to be doing right now."

1 An open-ended response encourages further discussion and allows exploration of feelings. Telling the client that volunteering will help pass the time ignores the client's feelings. The depression is not adding to the feelings; the feelings are causing the depression. Asking the client to talk about what the client would rather be doing ignores the client's feelings. 62%

A client is known to be on lithium therapy for the treatment of depression. What is the expected adverse effect of this drug? 1 Ataxia 2 Confusion 3 Blurred vision 4 Paradoxical anxiety

1 Ataxia is the expected adverse effect in clients who are undergoing lithium therapy for the treatment of depression. Confusion is one of the adverse effects of diazepam. Blurred vision and paradoxical anxiety are the adverse effects of buspirone.

A client is admitted to the psychiatric unit for severe depression with the potential for suicide. What is the most therapeutic nursing intervention when the client becomes more energized and communicative? 1 Continuing to assess the client at regular intervals 2 Encouraging the client to participate in group activities 3 Giving the client more autonomy to decide about privileges 4 Starting to teach the client about medications in preparation for discharge

1 Although the client appears to be improving, the possibility of suicide is still present, because the client's physical and psychic energy has increased. Although the client may now be able to participate more fully in groups, the safety issue of monitoring the client's mood and actions is the priority. It is too soon to increase privileges; the client's increase in physical and psychic energy may permit the client to act on suicidal thoughts. Teaching the client about medications in preparation for discharge should have been included in the initial plan of care.

The primary healthcare provider notices that a client exhibits a period of mania followed by hypomania and depression and prescribes lithium carbonate. What is the mode of administration of the prescribed drug? 1 Oral route 2 Sublingual route 3 Intravenous route 4 Transdermal route

1 Episodes of mania followed by hypomania and depression are indicative of bipolar disease. Lithium carbonate is the drug of choice to treat this condition and should be administered only by the oral route

A client with a history of schizophrenia has recently begun reporting symptoms of depression and is now prescribed a selective serotonin reuptake inhibitor (SSRI). In light of the information in the client's chart, what is the nurse's priority? 1 Educating both the client and family on how to identify the early signs of extrapyramidal symptoms 2 Requesting a gastrointestinal consult to identify the cause of the client's need for frequent antacids 3 Stressing the importance of managing the client's diet while taking the prescribed antidepressant 4 Discussing the stressors that have developed since the client moved in with the sister and brother-in-law

1 Extrapyramidal symptoms can result from antipsychotic medication therapy, and the risk is increased when the treatment plan includes an SSRI antidepressant. The cause of the frequent use of antacids should be explored, but does not take priority in this situation. A well-balanced diet is always important, but the importance of diet management would still exist if the antidepressant were a monoamine oxidase inhibitor (MAOI) and not an SSRI. Identifying and addressing stressors is important, but it does not take priority in this situation.

What should the nurse teach parents about childhood depression? 1 May appear as acting-out behavior 2 Looks almost identical to adult depression 3 Does not respond to conventional treatment 4 Is short in duration and has an early resolution

1 Children have difficulty verbally expressing their feelings; acting-out behaviors, such as temper tantrums, may indicate an underlying depression. Many conventional therapies for adults with depression, including medication, are effective for children with depression. Adult and childhood depression may be manifested in different ways. Childhood depression is not necessarily short and requires treatment.

A client with major depression is admitted to the hospital. What is the most therapeutic initial nursing intervention? 1 Introducing the client to one other client 2 Requiring participation in therapy sessions 3 Encouraging interaction with others in small groups 4 Conveying an attitude of concern that is not intrusive

4 Conveying concern without being intrusive will allow the client to control the pace of development of the nurse-client relationship. Depressed clients are unable to move into relationships with other clients or group situations. It is too early for therapy sessions; the first thing that must be established is a trusting nurse-client relationship.

A nurse in the mental health clinic is counseling a client with the diagnosis of depression. During the counseling session the client says, "Things always seem the same. They never change." The nurse suspects that the client is feeling hopeless. For what indication of hopelessness should the nurse assess the client? 1 Outbursts of anger 2 Focused concentration 3 Preoccupation with delusions 4 Intense interpersonal relationships

1 Clients who are depressed and feeling hopeless also tend to have inappropriate expressions of anger. Depressed clients frequently have a diminished ability to think or concentrate. Preoccupation with delusions is usually associated with clients who have schizophrenia rather than with clients experiencing depression and hopelessness. Clients who are depressed and feeling hopeless tend to be socially withdrawn and do not have the physical or emotional energy for intense interpersonal relationships.

What treatment should a nurse anticipate will be prescribed for a client with severe, persistent, intractable depression and suicidal ideation? 1 Electroconvulsive therapy 2 Short-term psychoanalysis 3 Nondirective psychotherapy 4 High doses of anxiolytic drugs

1 Electroconvulsive therapy, which interrupts established patterns of behavior, helps relieve symptoms and limits suicide attempts in clients with severe, intractable depression that does not respond to antidepressant medication. The client's depressed mood limits participation in psychotherapy; feelings precipitated by therapy may lead to suicidal acting out. Psychotherapy is directed toward helping the person learn new coping mechanisms and better ways of coping with problems; the depressed client needs direction to accomplish this. Antianxiety medications are usually not prescribed for clients with depression.

A client with a history of alcohol abuse says to the nurse, "Drinking is a way out of my depression." Which strategy will probably be most effective for the client at this time? 1 A self-help group 2 Psychoanalytical therapy 3 A visit with a religious advisor 4 Talking with an alcoholic friend

1 Members of self-help groups, particularly Alcoholics Anonymous, are living with the problem themselves; therefore problem identification and self-responsibility are emphasized, and manipulation is limited. Long-term therapy tends to increase anxiety until resolution occurs; level of commitment and duration of therapy render it a less desirable choice for substance abusers. Depending on the client's feelings about religion, talking with a religious advisor may or may not be helpful. Whether talking with an alcoholic friend will be useful depends on the friend's drinking status; it may be helpful or harmful. These variables negate the effectiveness of this choice.

A nurse is caring for a primigravida during labor. At 7 cm of dilation a prescribed pain medication is administered. Which medication requires monitoring of the newborn for the side effect of respiratory depression? 1 Butorphanol 2 Hydroxyzine 3 Promethazine 4 Diphenhydramine

1 Respiratory depression may occur in the newborn because the duration of action of butorphanol is 3 to 4 hours and the circulating blood level will be high if birth occurs during that time. Hydroxyzine, promethazine, and diphenhydramine are all antihistamines that have a sedative effect and are administered early in labor to promote sleep and decrease anxiety.

Which drug would the nurse administer transdermally to treat a client with major depression? 1 Selegiline 2 Phenelzine 3 Isocarboxazid 4 Tranylcypromine

1 Selegiline is a selective monoamine oxidase inhibitor-B (MAOI-B) that comes in a transdermal dosage form; this drug is used in the management of major depression. Phenelzine, Isocarboxazid, and tranylcypromine are nonselective inhibitors of both MAOI type A and MAOI type B. These drugs are administered orally.

A client with major depression that includes psychotic features tells the nurse, "All of my relatives have been killed because I've been sinful and need to be punished." What is the primary focus of nursing interventions? 1 Protecting the client against any suicidal impulses 2 Supporting the client's interest in the outside world 3 Helping the client manage the concern for family members 4 Reassuring the client that past behaviors are not being punished

1 Suicidal impulses take priority, and the client must be stopped from acting on them while treatment is in progress; the client's safety is the focus of nursing interventions. Supporting the client's interest in the outside world is of very low priority. The client is focusing on the current personal situation, not the outside world. Helping the client manage the concern for family members is a secondary concern. Reassurance will not change the client's belief.

A client with a history of schizophrenia who responds poorly to medication is now being treated for acute depression. In light of the information elicited from the medication list and laboratory results, what does the nurse advise? 1 Come in for weekly blood tests to monitor for drug-induced agranulocytosis. 2 Report incidents of unusual bleeding or easy bruising while taking fluoxetine. 3 Expect to be prescribed only 1 week's supply of fluoxetine at a time. 4 Consume a high-protein diet to offset the risk of anemia while taking clozapine.

1 The antipsychotic medication clozapine poses a risk for the development of agranulocytosis, especially when combined with a selective serotonin reuptake inhibitor such as fluoxetine. The client's neutrophil and white blood cell (WBC) counts are borderline and therefore suggestive of the disorder. Weekly blood testing to monitor these blood values in required. The client's platelet count is in the low-normal range, but fluoxetine is not generally considered a factor in bleeding disorders. Clozapine, not fluoxetine, would likely be prescribed on a week-by-week basis to both help manage side effects and encourage weekly visits for lab work. Clozapine is not generally considered a factor in the development of anemia.

Fourteen months after the traumatic death of a spouse, a client comes to the mental health clinic complaining of continuing depression and states, "I haven't been seeing any of my friends or attending any of the activities I previously enjoyed. My children are married and live in another state, and I almost never see them." What does the nurse determine that the client is experiencing? 1 Difficulty grieving 2 Ineffective family interactions 3 Problems in communicating with others 4 Low motivation to resume daily activities

1 The client's grieving process is severe and extended, indicating dysfunction. There are not enough data to support the conclusion that the family's interactions are ineffective. The data do not indicate problems with communication; the client is communicating effectively with the nurse. Low motivation is not the reason for the client's inability to cope.

Laboratory results of a client's blood after chemotherapy indicate bone marrow depression. What should the nurse encourage the client to do? Select all that apply. 1 Use a soft toothbrush. 2 Sleep with the head of the bed elevated. 3 Increase activity levels and take frequent walks. 4 Drink more citrus juices and eat more citrus fruits. Correct 5 Read the ingredients in over-the-counter drugs before taking them.

1 The gums are vascular tissue and prone to bleed easily if the platelet count is low. Drugs such as ibuprofen and salicylates in any analgesic or cold medicine should be avoided because they increase the risk of bleeding by inhibiting platelet function. With bone marrow depression, red blood cells are decreased and the oxygen-carrying capacity of the blood is decreased; raising the head of the bed will not increase the number of red blood cells. Rest should be encouraged. Citrus fruits and juices will not change the bone marrow depression; they should be avoided because they are acidic and aggravate stomatitis.

The nurse finds that a client prefers Reiki to antidepressants for treating depression. Which intervention of the nurse indicates open-mindedness? 1 Respecting the client's preference 2 Suggesting other options in addition to Reiki 3 Dissuading the client against continuing Reiki 4 Emphasizing that not taking antidepressants may be harmful

1 The nurse demonstrates open-mindedness by respecting the client's preference of treatments [1] [2] and client's beliefs. Other options of treating depression may not be helpful, and the nurse should not advise alternate treatments. Asking the client not to practice Reiki indicates that the nurse is closed-minded. Forcing the client to take antidepressants by emphasizing harmful effects may be unprofessional and it does not indicate open-mindedness.

After reviewing the data of a client with depression, the primary healthcare provider decided not to prescribe bupropion. Which statements made by the client would support the decision? Select all that apply. 1 "I have a history of epilepsy." 2 "I have not used phenelzine for two months." 3 "I have recently been diagnosed with glaucoma." 4 "I have a history of congestive heart failure." 5 "I have recently been diagnosed with anorexia nervosa."

1, 2, 5 Bupropion is contraindicated in clients with a history of seizures because this drug lowers the seizure threshold. Cardiac diseases such as congestive heart failure, and eating disorders, such as anorexia nervosa, are contraindications for bupropion. Bupropion is contraindicated with concurrent use or 14 days previous use of phenelzine. Duloxetine is contraindicated for clients with uncontrolled angle-closure glaucoma.

Which priority assessments should be included by the nurse when caring for a client who is experiencing depression? Select all that apply. 1 Appetite 2 Irritability 3 Restlessness 4 Activity status 5 Emotional status

1, 4, 5 The priority assessment for a client experiencing depression is to inquire about appetite, activity status, and emotional status. These helps determine the level of depression. Irritability and restlessness are secondary assessments for determining the depression level of a client.

A client with phobias about elevators and large crowds comes to the clinic for help because of feelings of depression related to these fears. What is an appropriate short-term goal for this client? 1 Riding an elevator without anxiety when accompanied by the nurse 2 Describing the thoughts and feelings experienced in terrifying situations 3 Experiencing an elevation of mood and relief from feelings of depression 4 Identifying the early childhood conflicts that resulted in the development of these fears

2 Describing the thoughts and feelings experienced in terrifying situations is a realistic essential first step. The problem and related feelings must be thoroughly explored before solutions can be developed. Riding an elevator without anxiety when accompanied by the nurse is a long-term goal. Experiencing an elevation of mood and relief from feelings of depression is a long-term goal. Identifying the early childhood conflicts leading to the development of the fears is an inappropriate goal; a direct connection to life events is often difficult to find.

An adolescent has pinpoint pupils, respiratory depression, and cyanosis. Upon assessment, the school nurse observes needle marks on arms and legs. Which drug is the adolescent probably abusing? 1 Cocaine 2 Narcotics 3 Hallucinogens 4 Central nervous system (CNS) stimulants

2 Opioids such as morphine, heroin, codeine, and fentanyl are grouped under narcotic drugs. Physical signs of narcotic abuse include constricted pupils, respiratory depression and cyanosis. Cocaine creates a state of indefinable high or euphoria; withdrawal signs include depression, irritability, seizures, and cardiovascular manifestations. Hallucinogens produce vivid hallucinations and euphoria; they do not produce physical dependence. Clients with acute intoxication of central nervous system (CNS) stimulants may display aggressive behavior along with psychotic episodes of agitation and restlessness.

A breastfeeding mother requires treatment for depression. Which drug would be safe to use if the mother wishes to continue breastfeeding the newborn? 1 Fluoxetine 2 Paroxetine 3 Valproic acid 4 Methotrexate

2 Paroxetine can be safely given during breastfeeding. Fluoxetine can easily enter breast milk; therefore this drug would only be used when other selective serotonin reuptake inhibitors are ineffective. Valproic acid is an antiepileptic drug that can be given safely to breastfeeding women. Methotrexate is an anticancer drug that cannot be given during breastfeeding because it enters the breast milk and can cause adverse effects in the baby.

A client is admitted to a mental health facility for depression. What action should a nurse take to help the client develop a positive self-regard? 1 Set limits on the client's negative behaviors. 2 Involve the client in activities that promote success. 3 Demonstrate approval of the client's efforts at every opportunity. 4 Encourage the client to participate in activities with other clients.

2 Self-esteem and feelings of competence are increased when a person experiences success. Although setting limits on the client's negative behaviors is a necessary intervention when a depressed client tries to engage in self-harm, it will not promote feelings of self-esteem. Clients recognize unwarranted praise and often interpret such responses as a form of belittlement or pity. Encouraging the client to participate in activities with other clients may or may not increase self-esteem; also, the client may not have the physical or emotional energy to interact with other clients.

What should the nurse ask while assessing a Latina woman with depression for the risk of self-harm? 1 "When did you last spend time with friends?" 2 "How do you express yourself when you're angry?" 3 "When did you first notice that you were depressed?" 4 "Do you have interests outside your work and home?"

2 The Hispanic culture tends to limit the ways in which a woman can acceptably express anger and frustration, and this results in a higher risk for suicidal behavior. Asking when the client last spent time with friends, when she noticed that she was depressed, or whether she has interests outside her home and work, though appropriate, are not culturally focused.

A nurse is caring for a client who is experiencing major depression. What feeling should the nurse anticipate that the client will likely have difficulty expressing? 1 Need for comforting 2 Anger toward others 3 Remorse for past behaviors 4 Feelings of low self-esteem

2 The client is dependent, and such individuals can never get enough attention to meet their dependent needs. This unfulfilled need causes anger, which the client has problems expressing for fear of losing the people on whom the client is dependent. The client is expressing the need for comfort. The client is able to express remorse and guilt. The client is able to express feelings of low self-esteem.

A 37-year-old woman is admitted to the unit with severe menorrhagia. During assessment the nurse learns that she has a history of fibroids, menorrhagia, pelvic pain, and depression. The client has been undergoing hormone therapy in hopes of easing the symptoms and reducing the size of the fibroids, without success. The lab reports hemoglobin and hematocrit readings of 6.8 g/dL (68 mmol/l) and 20.2 (20%), respectively. The client begins to sob and cries, "I don't know what to do—my primary healthcare provider is recommending a hysterectomy, but I haven't had children yet!" What is the best response by the nurse? 1 "There are so many children up for adoption, looking for a mother." 2 "This must be so difficult for you. Children are really important to you?" 3 "You really have no choice but to follow the recommendation; the primary healthcare provider is right." 4 "Believe me when I tell you that kids are so difficult to raise—you're better off without them."

2 Validating the client's feelings and including an open-ended question will encourage further expression. Previous problems and health conditions could later be included in the conversation to help the client make the best decision. Adoption is certainly an option for this person, but this is not what she needs to hear at this time. This statement also closes down communication. The client does have a choice, and telling her that she does not could preclude further communication and cause anger and defensiveness. Telling the client that she's better off without children is not what the client needs to hear, especially when she is facing an operation that could end her chance of giving birth to children.

What characteristics are commonly associated with adolescent depression? Select all that apply. 1 Exercising daily 2 Having suicidal ideation 3 Exhibiting tearfulness 4 Having poor muscle tone 5 Avoiding previously enjoyed activities and relationships

2, 3, 5 Having suicidal ideation, exhibiting tearfulness, and avoiding previously enjoyed activities and relationships are characteristic features of depression. Having poor muscle tone and performing physical exercise routine are uncommon in depressed adolescents.

The primary healthcare provider prescribed imipramine to a client with depression. Which adverse effects would the nurse anticipate in the client? Select all that apply. 1 Asthenia 2 Skin rash 3 Hepatotoxicity 4 Photosensitivity 5 Blood dyscrasias

2, 4, 5 Imipramine is a tricyclic antidepressant used to treat depression. Skin rash, photosensitivity, and blood dyscrasias are adverse effects associated with tricyclic antidepressants. Asthenia is an adverse effect of tetracyclines. Hepatotoxicity is associated with the use of selective norepinephrine reuptake inhibitors (SSNRIs).

A client is admitted to the mental health hospital with the diagnosis of major depression. What is a common problem that clients experience with this diagnosis? 1 Loss of faith in God 2 Visual hallucinations 3 Decreased social interaction 4 Feelings about the future are absent

3 Depressed clients demonstrate decreased social interaction because of a lack of psychic or physical energy. They tend to withdraw, speak in monosyllables, and avoid contact with others. Loss of faith and visual hallucinations are not commonly associated with the diagnosis of major depression. Hallucinations are associated with schizophrenic disorders. Depressed clients are commonly negative and pessimistic, especially regarding their future.

A client is experiencing feelings of sadness and is having difficulty concentrating and sleeping. What are additional common signs and symptoms of depression that the nurse should expect when performing an assessment of this client? 1 Rigidity and a narrowing of perception 2 Alternating episodes of fatigue and high energy 3 Diminished pleasure in activities and alteration in appetite 4 Excessive socialization and interest in activities of daily living

3 Depression is characterized by feelings of hopelessness, helplessness, and despair, leaving little room for any pleasure; alteration in appetite (either decreased or increased) is common in depressed clients. Although there is a narrowing of perception, rigidity is uncommon with depression. Fatigue is continually present and does not alternate with a high energy level. There is a loss of interest in socialization and little participation in activities of daily living.

A pregnant client is treated with sertraline for depression. What can be inferred about the drug's action? 1 It will only affect the client. 2 It will only affect the fetus. 3 It will affect both the client and the fetus. 4 It will not have any effect on both client and the fetus.

3 Drugs taken during pregnancy may act on both the client and the fetus as the drug passes through the placenta from the mother to the fetus. The drug action would be meant for treatment in the client and it may affect the fetus in anyway. The drug does not show effects only on the fetus.

A client with depression is to be given fluoxetine. What precaution will the nurse consider when initiating treatment with this drug? 1 It must be given with milk and crackers to prevent hyperacidity and discomfort. 2 Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis. 3 The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. 4 The blood level should be checked weekly for 3 months to monitor for an appropriate level.

3 Fluoxetine does not produce an immediate effect; nursing measures must be continued to reduce the risk for suicide. Consuming milk and crackers to help prevent hyperacidity and discomfort is not necessary. Avoiding cheese, pickled herring, and wine is a precaution taken with the monoamine oxidase inhibitors. Weekly blood level checks are not necessary with fluoxetine.

A client scheduled to begin electroconvulsive therapy (ECT) to treat severe depression that has not responded to any of the antidepressant medications tells the nurse, "I'm scared that I'll lose my memory forever after the treatment." What is the most therapeutic response by the nurse? 1 "Your memory loss may be permanent, but usually it's just temporary." 2 "You won't experience a permanent memory loss, so there's no need to be frightened." 3 "You'll experience a temporary loss of memory, and feeling frightened about it is expected." 4 "Your memory loss will be temporary, and it will help block out many of your painful past experiences."

3 Giving the client simple facts and assuring the client that being frightened is expected may help ease the client's fears. Memory loss affects recently learned information such as the ECT experience; the response that it may be permanent may unnecessarily worry the client. Although it is a true statement that memory loss is not permanent and there is no need to worry, this response negates the client's feelings. ECT does not selectively block out painful experiences.

A client is not responding to antidepressant medications for treatment of major depression with suicidal ideation. After learning about electroconvulsive therapy (ECT), the client discusses the advantages and disadvantages with the primary nurse. The nurse concludes that the client understands the disadvantages of ECT when the client states that what is one major disadvantage of ECT? 1 The seizures may cause bone fractures. 2 Relief of symptoms requires many weeks of treatment. 3 Memory is impaired after the treatment. 4 Loss of mental function occurs and continues for a long time.

3 Impaired memory is an expected side effect of the therapy. Succinylcholine prevents the external manifestations of a tonic-clonic seizure, thereby minimizing fractures and dislocations. The therapy begins to elicit results in two or three treatments. There is no substantial loss of mental function after the treatment is completed.

A nurse is discharging a client from the mental health unit who has been treated for major depression. Which statement is most therapeutic at this time? 1 "I'm going to miss you; we've become good friends." 2 "I know that you're going to be all right when you go home." 3 "Call the contact number we gave you if you have an emergency." 4 "This is my phone number; call and let me know how you're doing."

3 Instructing the client to call the contact number that was provided in case of emergency demonstrates an understanding that the newly discharged client needs to have a support system. Clients need to feel that in a crisis there will be someone there for them. The role of the nurse is not to become a good friend but instead to help the client become a functioning being again. The statement "I know you're going to be all right when you go home" provides false reassurance; the nurse does not know this. Saying "This is my phone number; call and let me know how you're doing" is unprofessional and blurs the roles of nurse and client.

A client with mild Alzheimer disease has been taking galantamine, and the primary healthcare provider prescribes paroxetine for depression. For what effect will a nurse assess the client when these medications are taken concurrently? 1 Allergic 2 Dystonic 3 Additive 4 Extrapyramidal

3 Paroxetine and galantamine potentiate each other's action. Giving these medications concurrently will not precipitate an allergic reaction. Dystonic effects are associated with antipsychotic medications. Extrapyramidal effects occur with antipsychotic medications.

A client is admitted to the psychiatric service with a diagnosis of severe depression. When approached by the nurse, the client says, "You know I'm a sorry, lazy person. I don't deserve a job. I'm just stupid and no good." What does the nurse conclude that the client is experiencing? 1 Nihilistic delusions 2 Delusions of persecution 3 Feelings of self-deprecation 4 Experiences of depersonalization

3 The client's statements are self-derogatory and reveal low self-esteem. There is no evidence of feelings about nonexistence. There is no evidence that the client feels controlled or manipulated by others. There is no evidence that the client has a feeling of unreality or of alienation from the self.

The nurse notices that one of her clients, who has depression, is sitting by the window crying. What is the most appropriate response by the nurse? 1 "It's okay. No need to cry or worry while you're here. We all feel down now and then." 2 "Please don't consider suicide. It really isn't an appropriate way out of your troubles." 3 "You seem to be experiencing a sad moment. I'll sit here with you for a while and talk if you would like." 4 "Why don't you go into the dayroom and join the card game going on? That'll take your mind off of your problems for a while."

3 The nurse is acknowledging that the client is feeling especially down and offering to be available for discussion or just to provide a presence. Telling the client not to cry and suggesting a card game do not acknowledge the client's feelings and appear to trivialize the situation. The response regarding suicide is judgmental and may discourage any effort by the client to initiate a discussion.

A nursing student is listing the steps that need to be followed for applying developmental theory when caring for chronically ill older adults with depression. Which step listed by the nursing student needs correction? 1 "The nurse should understand adult development and its implications for practice." 2 "The nurse should be aware of signs of depression such as general fatigue or insomnia." 3 "The nurse should recognize the need to identify depression so that heart failure can be prevented." 4 "The nurse should understand the older adult's concept of depression and views on treatment for mental illness."

3 The nurse should recognize the need to identify depression so that appropriate treatment can be provided to the older adults. Congestive heart failure is not caused by depression. The nurse should understand adult development and its implications for practice when applying developmental theory. The nurse should be aware of signs of depression such as general fatigue or insomnia. The nurse should understand the older adult's concept of depression and views on treatment for mental illness as it helps him or her to get complementary and alternative treatment measures.

A client is responding within 5 minutes of receiving naloxone to combat respiratory depression from an overdose of heroin. Why will a nurse continue to closely monitor this client's status? 1 The drug may cause peripheral neuropathy. 2 Naloxone and heroin can cause cardiac depression when combined. 3 Symptoms of the heroin overdose may return after the naloxone is metabolized. 4 Hyperexcitability and amnesia may cause the client to thrash about and become abusive.

3 When naloxone is metabolized and its effects are diminished, the respiratory distress caused by the original drug overdose returns. A combination of these drugs does not cause cardiac depression. There are no reports of peripheral neuropathy or hyperexcitability and amnesia with naloxone.

The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. 1 Monitor for signs of alopecia. 2 Encourage an increase in fluids. 3 Wash hands before entering the client's room. 4 Advise use of a soft toothbrush for oral hygiene. 5 Report an elevation in temperature immediately. 6 Encourage the client to eat raw, fresh fruits and vegetables.

3, 4, 5 It is essential to prevent infection in a client with severe bone marrow depression; thorough handwashing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the primary healthcare provider immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables and undercooked meat, eggs, and fish to prevent possible exposure to microbes.

A client is admitted to the mental health unit because of a progressively increasing depression over the past month. What clinical finding does a nurse expect during the initial assessment of the client? 1 Elated affect related to reaction formation 2 Loose associations related to thought disorder 3 Physical exhaustion resulting from decreased physical activity 4 Diminished verbal expression caused by a slowed thought process

4 As depression increases, thought processes become slower and verbal expression decreases due to lack of emotional energy. Elation is associated with bipolar disorder, manic episode; the affect of a depressed person is usually one of sadness, or it may be blank. Loose associations are related to schizophrenia, not depression. Physical exhaustion is associated with bipolar disorder, manic episode; decreased physical activity does not produce physical exhaustion.

A client is admitted with bipolar disorder, depressed episode. The nursing history indicates a progressive increase in depression over the past month. What should the nurse expect the client to display? 1 Elated affect related to reaction formation 2 Loose associations related to a thought disorder 3 Physical exhaustion related to decreased physical activity 4 Paucity of verbal expression related to slowed thought processes

4 As depression increases, thought processes become slower and verbal expression decreases because of lack of emotional energy. Elation is associated with bipolar disorder, manic episode; the affect of a depressed person is usually one of sadness, or it may be blank. Loose associations are related to schizophrenia, not depression. Physical exhaustion is associated with bipolar disorder, manic episode; decreased physical activity does not produce physical exhaustion.

A client is admitted with a bipolar disorder, depressed episode. The nursing history indicates a progressive increase in depression over the past month. What should the nurse expect the client to display? 1 Elated affect related to reaction formation 2 Loose associations related to a thought disorder 3 Physical exhaustion related to decreased physical activity 4 Decrease of verbal expression related to slowed thought processes

4 As depression increases, thought processes become slower and verbal expression decreases due to lack of emotional energy. Elation is associated with bipolar disorder, manic episode; the affect of a depressed person is usually one of sadness, or it may be blank. Loose associations are related to schizophrenia, not depression. Physical exhaustion is associated with bipolar disorder, manic episode; decreased physical activity does not produce physical exhaustion.

A client whose depression is beginning to lift remains aloof from the other clients on the mental health unit. How can a nurse help the client participate in an activity? 1 Find solitary pursuits that the client can enjoy. 2 Speak to the client about the importance of entering into activities. 3 Ask the primary healthcare provider to speak to the client about participating. 4 Invite another client to take part in a joint activity with the nurse and the client.

4 Bringing another client into a set situation is the most therapeutic, least threatening approach. At this point in time it is not therapeutic to allow the client to follow solitary pursuits; it will promote isolation. Explanations will not necessarily change behavior. Asking the primary healthcare provider to speak to the client about participating transfers the nurse's responsibility to the primary healthcare provider.

An older adult who is undergoing follow-up treatment for mild depression at a local walk-in mental health clinic reports the onset of nausea, headache, and episodes of double vision during the past few weeks. In light of the assessment information, what is the nurse's priority? 1 Performing an in-depth cardiac assessment 2 Arranging for an ophthalmic consultation immediately 3 Initiating a conversation about the son's cancer diagnosis 4 Inquiring when the client began therapy for hypertension

4 Calcium channel blockers such as diltiazem can cause neurotoxin symptoms like the ones the individual is describing when taken in combination with a selective serotonin reuptake inhibitor (SSRI) such as citalopram. Although the client is taking a calcium channel blocker for hypertension, there is no indication that there is a cardiac cause of the symptoms. Diplopia (double vision) is an abnormal condition and will require further attention but is not the priority at this point in time. The son's cancer diagnosis is a potential source of anxiety and depression, but the physical symptoms are not classically seen in either of those emotional states.

When caring for a client with major depression, what do nurses usually have the most difficulty dealing with? 1 The client's lack of energy 2 Negative nonverbal responses 3 The client's psychomotor retardation 4 The pervasive quality of the depression

4 Depression is "contagious"; it affects the nurse as well as the client. The client's lack of energy should not make nursing care difficult. These clients usually do not offer negative responses; they offer no response.

A client with a diagnosis of major depression refuses to participate in unit activities, claiming to be "just too tired." What is the best nursing approach? 1 Planning one rest period during each activity 2 Explaining why the staff believes that the activities are therapeutic 3 Encouraging the client to express negative feelings about the activities 4 Accepting the client's feelings about activities calmly while setting firm limits

4 Fatigue and apathy are symptoms of depression and should be accepted; however, limits should be set to facilitate participation in unit activities. Planning one rest period during each activity allows the client to manipulate the environment. Explaining why the staff believes that the activities are therapeutic will not change the client's mind about them, and this response does not show an understanding of the client's needs. Encouraging the client to express negative feelings about the activities will reinforce negative feelings about participating in them.

The nurse is caring for an Asian-American client with a diagnosis of depression. While interviewing this client the nurse notes that the client maintains traditional cultural beliefs and values. What is the most important information for the nurse to obtain about the client? 1 Dietary practices 2 Concept of space 3 Immigration status 4 Role within the family

4 If an Asian-American client adheres to traditional Asian practices, the nurse must recognize that the family is the central and most important social force acting on the individual. Dietary practices, concept of space, and immigration status are not as significant as family dynamics.

A client who has been attending a day treatment facility for 1 month with the diagnosis of major depression is to be discharged in a week. Because the nurse and the client are aware of this, what is the most appropriate comment by the nurse? 1 "We have just a few sessions left. I'm really pleased at your progress." 2 "Your discharge date has been set for next week. That's wonderful news." 3 "We have five sessions remaining. We need to start making plans to end our sessions." 4 "I understand that your discharge is set for next week. I'm wondering how you feel about that."

4 Plans for termination that take emotional needs into account are best made after exploration of the client's thoughts and feelings about discharge. Noting that there are just a few sessions left and expressing pleasure at the client's progress acknowledges the future termination but focuses on the nurse's, not the client's, feelings. Noting that the client's discharge date has been set for next week and calling this wonderful news acknowledges the future termination but suggests that the client should feel wonderful about the discharge, which may or may not be true. Although noting that the client and nurse have five sessions remaining and that the two need to start making plans to end the sessions acknowledges the future termination, plans for termination should be made after a discussion of the client's emotional response to the pending discharge.

A male client is brought to the psychiatric emergency department with severe depression with bouts of crying on and off throughout the day. He is unable to sleep at night. He feels hopeless and discouraged. The client's wife states that he lost his job several months ago and has been unable to find another one. The priority nursing intervention at this time is assessing the client for what? 1 Feelings of failure 2 Marital difficulties 3 Past episodes of depression 4 Plans of committing suicide

4 The existence of a suicide plan is a major criterion in the assessment of a client's determination to make an attempt. Although assessing the client for feelings of failure, marital difficulties, or past episodes of depression may be important in planning future therapeutic approaches, it does not explore the potential for suicide, the priority at this time.

The registered nurse instructed the nursing student to care for a client who suffers from depression. During a follow up visit, the registered nurse finds that the client's symptoms have not improved. Which activity of the nursing student would the registered nurse relate this to? 1 Modifying the environment 2 Limiting the client's choices of diet and clothing 3 Encouraging fluid intake 4 Discouraging social interaction to avoid the client's distraction from outside environment

4 The nursing student's act of discouraging interactions due to fear of the client's distraction may result in a lack of improvement. Social interactions should be encouraged instead. Modifying the environment may help to provide better healthcare. The nurse should limit the client's choices of food and clothing to relieve any decision-making stress. The nurse should also encourage fluid intake.

The nurse is assisting the primary healthcare provider, who is examining the client's skull radiograph. An abnormality in the endocrine gland situated in a depression of the sphenoid bone is suspected. Which hormone release is most probably affected? 1 Glucagon 2 Cortisol 3 Aldosterone 4 Corticotropin

4 The pituitary gland is the endocrine gland that is situated in a bony depression of the sphenoid bone. Corticotropin or adrenocorticotropic hormones are secreted by the anterior pituitary and could be affected by an abnormality in the pituitary. Glucagon is a hormone that is secreted by the pancreas. Cortisol and aldosterone are hormones secreted by the adrenal cortex. There is less likelihood that the release of glucagon, cortisol, or aldosterone might be affected by a suspected abnormality in the pituitary gland.

As depression begins to lift, a client is asked to join a small discussion group that meets every evening on the unit. The client is reluctant to join and says, "I have nothing to talk about." What is the best response by the nurse? 1 "Maybe tomorrow you'll feel more like talking." 2 "Could you start off by talking about your family?" 3 "A person like you has a great deal to offer the group." 4 "You feel you won't be accepted unless you have something to say?"

4 The statement about the client's feelings of acceptance is a reflective statement that allows the client to either validate the statement or correct the nurse. Postponing the conversation delays addressing the problem and avoids exploring feelings. Asking the client to start talking about her or his family is a response that gives advice and does not allow the client to explore feelings. Stating that the client has a lot to offer the group denies the client's statement and does not allow the exploration of feelings.

The primary healthcare provider prescribes the tricyclic antidepressant imipramine for a client with depression. The client asks the nurse what the medication will do. How does the nurse respond? 1 "It will help you forget why you are depressed." 2 "It will help keep you alert and cure your insomnia." 3 "It will help you feel better after taking it for several days." 4 "It will help you feel better, but make sure to report feelings of self-harm."

4 This drug creates a general sense of well-being and helps lift depression. It blocks the reuptake of norepinephrine and serotonin into nerve endings, increasing their action in nerve cells. The client might not know the reason for depression, and the drug does not cause amnesia. Side effects of imipramine include drowsiness and insomnia. The information provided does not indicate that the client is experiencing insomnia. Symptomatic relief usually begins after 2 to 3 weeks of therapy.

An older client with depression is prescribed a tricyclic antidepressant. What is the priority nursing intervention in this situation? 1 Providing psychotherapy to the client 2 Teaching strategies to overcome depression 3 Encouraging the client to walk for 30 minutes 4 Requesting that the physician change the drug

4 Tricyclic antidepressants have anticholinergic properties that can cause acute confusion, severe constipation, and urinary incontinence in older adults. Therefore the priority nursing care for an older client who is prescribed a tricyclic antidepressant is to request that the physician change the drug. Providing psychotherapy is an alternate treatment, which is of medium priority. Teaching strategies to overcome depression is of low priority. Encouraging the client to walk for 30 minutes overcomes the feelings of depression, but it is not the priority.

A client is receiving imipramine, a tricyclic antidepressant, for depression. The nurse assesses the client for side effects and adverse effects. Which adverse effect requires further assessment and possible medical intervention? 1 Dry mouth 2 Weight gain 3 Blurred vision 4 Urinary hesitancy

4 Urinary hesitancy and retention are adverse effects of imipramine that may require immediate medical intervention. Dry mouth, weight gain related to increased appetite, and blurred vision may occur as side effects of imipramine; they usually decrease over time or can be managed through nursing interventions.

A client with chronic depression has a history of suicidal ideations. Place the following nursing assessment questions in the appropriate order to best ensure client safety. Correct 1. "Are you thinking about hurting yourself?" 2. "Have you decided upon a plan to harm yourself?" 3. "What is your plan for killing yourself?" 4. "How would you get what you need to end your life?

The initial action is to determine whether the client intends to commit suicide. The second step is to determine whether the client has made the intention specific by planning a method of suicide. The third step is to determine to what extend the client has decided on the details of the act of suicide. Finally it is necessary to determine whether the client has the means to actually complete the plan.