Chapter 14: Depressive Disorders

Which documentation for a patient diagnosed with major depression indicates the treatment plan was effective?

a. Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild.

A disheveled patient with severe depression and psychomotor retardation has not showered for several days. The nurse will:

d. firmly and neutrally assist the patient with showering.

A patient was diagnosed with seasonal affective disorder (SAD). During which month would this patient's symptoms be most acute?

a. January

Transcranial Magnetic Stimulation (TCM) is scheduled for a patient diagnosed with major depression. Which comment by the patient indicates teaching about the procedure was effective?

b. "I might be a little dizzy or have a mild headache after each procedure."

When counseling patients diagnosed with major depression, an advanced practice nurse will address the negative thought patterns by using:

c.cognitive behavioral therapy.

A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate from this patient?

d. Eyes pointed downward

A nurse provided medication education for a patient diagnosed with major depression who began a new prescription for phenelzine (Nardil). Which behavior indicates effective learning? The patient:

d. confers with a pharmacist when selecting over-the-counter medications.

A patient diagnosed with major depression refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient?

milk

A patient diagnosed with depression repeatedly tells staff, "I have cancer. It's my punishment for being a bad person." Diagnostic tests reveal no cancer. Select the priority nursing diagnosis.

risk for suicide

A student nurse caring for a patient diagnosed with depression reads in the patient's medical record, "This patient shows vegetative signs of depression." Which nursing diagnoses most clearly relate to the vegetative signs? Select all that apply.

a. Imbalanced nutrition: less than body requirements c. Sexual dysfunction d. Self-care deficit f. Insomnia

A patient diagnosed with major depression does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective?

a. Make observations.

A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, "I took a few extra tablets earlier today and now I feel bad." Which assessments are most critical? Select all that apply.

a. Vital signs d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness

A patient diagnosed with major depression shows vegetative signs of depression. Which nursing actions should be implemented? Select all that apply.

a.Offer laxatives if needed. b.Monitor food and fluid intake. c.Provide a quiet sleep environment.

An adult diagnosed with major depression was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?

a.Social skills training

A patient became depressed after the last of the family's six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment. The patient will:

a.verbalize realistic positive characteristics about self by (date).

A patient diagnosed with major depression tells the nurse, "Bad things that happen are always my fault." Which response by the nurse will best assist the patient to reframe this overgeneralization?

b. "Let's look at one bad thing that happened to see if another explanation exists."

During a psychiatric assessment, the nurse observes a patient's facial expression is without emotion. The patient says, "Life feels so hopeless to me. I've been feeling sad for several months." How will the nurse document the patient's affect and mood?

b. Affect flat; mood depressed

A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve?

b. Mashed potatoes, ground beef patty, corn, green beans, apple pie

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment?

b. Supporting physiological stability

The admission note indicates a patient diagnosed with major depression has anergia and anhedonia. For which measures should the nurse plan? Select all that apply.

c. Instilling a sense of hopefulness d. Assisting with self-care activities e. Accommodating psychomotor retardation

A patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of:

b. anhedonia.

A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of:

b. hypertensive crisis.

A patient diagnosed with major depression says, "No one cares about me anymore. I'm not worth anything." Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient?

b."You're wearing a new shirt."

Priority interventions for a patient diagnosed with major depression and feelings of worthlessness should include:

b.careful unobtrusive observation around the clock.

Major depression resulted after a patient's employment was terminated. The patient now says to the nurse, "I'm not worth the time you spend with me. I am the most useless person in the world." Which nursing diagnosis applies?

c. Situational low self-esteem

A patient diagnosed with major depression received six electroconvulsive therapy sessions and aggressive doses of antidepressant medication. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling.

c. Temporary memory impairments and confusion may occur with electroconvulsive therapy.

A patient diagnosed with major depression began taking escitalopram (Lexapro) 5 days ago. The patient now says, "This medicine isn't working." The nurse's best intervention would be to:

c. explain the time lag before antidepressants relieve symptoms.

A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about:

c. reporting increased suicidal thoughts.

A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today the patient says, "I don't think I can keep taking these pills. They make me so dizzy, especially when I stand up." The nurse will:

c. teach the patient strategies to manage postural hypotension.

A patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, "I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares." The nurse will advise the patient to:

c."Take a dose of your antidepressant now and come to the clinic to see the health care provider."

A nurse worked with a patient diagnosed with major depression, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of:

d. ineffectiveness and frustration.

A patient became severely depressed when the last of the family's six children moved out of the home 4 months ago. The patient repeatedly says, "No one cares about me. I'm not worth anything." Which response by the nurse would be the most helpful?

d."I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you."

A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?

d.Urinary retention