Depression

A client is being discharged after a suicide attempt. Which action should the nurse include when designing a home safety plan with the​ client? (Select all that​ apply.) A. A list of triggers B. Memorandum from previous depressive episodes C. Contact information for family members D. Medications that should be taken E. A list of useful coping strategies

A. A list of triggers C. Contact information for family members E. A list of useful coping strategies ​Rationale: Information for a home safety plan includes a list of​ triggers, a list of coping​ strategies, and contact information for family. Medications are not a part of a home safety plan. Information about previous depressive episodes is not essential for this plan.

The nurse is preparing an educational seminar on depression for a community health fair. Which strategy should the nurse include to reduce depressive​ episodes? (Select all that​ apply.) A. Be aware of family risk factors. B. Ingest alcohol on a daily basis. C. Obtain adequate rest. D. Have regular visits with the healthcare provider. E. Build a strong support system.

A. Be aware of family risk factors. C. Obtain adequate rest. D. Have regular visits with the healthcare provider. E. Build a strong support system. ​Rationale: Strategies to reduce the onset of depressive episodes include obtaining adequate​ rest, building a strong support​ system, being aware of family risk​ factors, and having regular appointments with the healthcare provider to detect symptoms of depression early. Alcohol intake should be limited to prevent the onset of substance abuse disorders.

Which should the nurse identify as a risk factor for the development of​ depression? (Select all that​ apply.) A. Family member with depression B. Male sex C. Childhood sexual abuse D. Dysfunctional family relationship E. Caucasian

A. Family member with depression C. Childhood sexual abuse D. Dysfunctional family relationship Rationale: A dysfunctional family​ relationship, having a family member with​ depression, and having been sexually abused as a child are all risk factors for the development of depression. Male sex or Caucasian is not considered a risk factor for the development of depression.

A client is being treated for a major depressive disorder. Which symptom should the nurse expect to assess in this​ client? A. Insomnia B. Euphoria C. Increased libido D. Enhanced energy

A. Insomnia Rationale: Insomnia is a symptom of a major depressive disorder.​ Euphoria, increased​ libido, and enhanced energy are not symptoms of a major depressive disorder.

A recently widowed client is experiencing memory​ loss, insomnia, loss of​ appetite, and irritability over the last few months. Which data should the nurse obtain when assessing this​ client? A. Suicidal ideations B. Anhedonia C. Medication history D. Alcohol use

A. Suicidal ideations ​Rationale: The client is likely experiencing a major depressive disorder and is at risk for suicidal ideations or recurring thoughts of death. To ensure the​ client's safety, the nurse needs to identify if he is having any suicidal ideations. Once it has been identified that the client is​ safe, the nurse can determine whether he is experiencing anhedonia or has been drinking alcohol and can obtain his medication history.

Which expected outcome should the nurse document for a client with a depressive​ disorder? (Select all that​ apply.) A. The client describes hopefulness for the future. B. The client reports no side effects from medication. C. The client returns to work or school. D. The client does not express suicidal ideation. E. The client sleeps 8 hours a night.

A. The client describes hopefulness for the future. C. The client returns to work or school. D. The client does not express suicidal ideation. E. The client sleeps 8 hours a night. ​Rationale: Expected outcomes for clients with any of the depressive disorders include having adequate​ rest, returning to routine​ activities, not expressing suicide​ ideation, and feeling hopeful about the future. It is expected that the client who adheres to the medication regimen will report a few side​ effects; it is not expected that the client will experience no side effects at all from medication.

The nurse reviews the importance of accepting a​ client's negative feelings with a group of colleagues. Which statement should indicate to the nurse that teaching was​ effective? A. ​"I should limit the amount of time spent on the​ negative." B. ​"I can turn all the negatives into positives for the​ client." C. ​"I will write down the positives and negatives for the​ client." D. ​"I should share my past failures with the​ client."

A. ​"I should limit the amount of time spent on the​ negative." ​Rationale: The nurse should be accepting of​ clients' negative feelings but set limits on the amount of time spent discussing accounts of past failures. The nurse should also be alert for opportunities to interrupt negative conversational patterns with more neutral ones.

The nurse notes a behavior change in a client. Which manifestation should the nurse identify that is a less obvious symptom of​ depression? (Select all that​ apply.) A. Sadness B. Anger C. Aches and pains D. Excessive sleep E. Insomnia

B. Anger C. Aches and pains ​Rationale: Anger and physical complaints are less obvious symptoms of depression.​ Sadness, insomnia, and excessive sleep are considered major symptoms of depression.

A client reports feeling depressed most days for the last 2 years. Which health problem should the nurse associate with these​ symptoms? A. Situational disorder B. Dysthymia C. Major depressive disorder​ (MDD) D. Seasonal affective disorder​ (SAD)

B. Dysthymia Rationale: The term persistent depressive disorder​, also known as dysthymia or dysthymic​ disorder, describes chronic depression for most days for at least 2 years​ (1 year for children and​ adolescents). Throughout those 2​ years, no more than 2 months can be described as symptom free. The symptoms of dysthymic disorder tend to be less severe than those in​ MDD, with fewer physiologic symptoms. But the degree of impact on individual functioning can be as great or greater than that of MDD. The​ client's symptoms are not associated with situational disorder or SAD.

The nurse is completing a health history on a client with seasonal affective disorder​ (SAD). Which data should the nurse obtain during this​ interview? (Select all that​ apply.) A. Sexual history B. Feelings of guilt C. Medical history D. Anhedonia E. Sleep disturbances

B. Feelings of guilt C. Medical history D. Anhedonia E. Sleep disturbances Rationale: When completing a health history on a client with seasonal affective​ disorder, the nurse needs to obtain information regarding sleep​ disturbances, medical​ history, feelings of​ guilt, and anhedonia​ (decreased ability to experience​ pleasure). The​ client's sexual history is not pertinent when completing the health history on this client.

The nurse is teaching a group at a community event on depression. Which primary prevention strategy should the nurse​ emphasize? (Select all that​ apply.) A. ​Age-related issues B. Socialization C. Dietary management D. Stress management E. Family dynamics

B. Socialization C. Dietary management D. Stress management E. Family dynamics ​Rationale: A number of approaches can be useful in preventing depression. Individuals should be encouraged to eat a healthy​ diet, engage in regular​ exercise, avoid​ smoking, and obtain adequate sleep. Other primary prevention strategies include providing teaching about stress management and healthy emotional​ functioning; encouraging clients to participate in meaningful social​ relationships; providing targeted teaching and support to individuals who have experienced traumatic or otherwise​ life-altering events; and using​ family-based cognitive-behavioral interventions to reduce the likelihood of depression among children with depressed parents.​ Age-related issues are not a strategy to prevent depression.

A client with major depressive disorder​ (MDD) no longer wants to participate in activities that once were a source of pleasure. In which way should the nurse document this​ finding? A. Anorexia B. Hypersomnia C. Anhedonia D. Psychomotor retardation

C. Anhedonia ​Rationale: No longer enjoying activities that previously brought pleasure is termed anhedonia. Hypersomnia is sleeping for prolonged periods during the day and night. Anorexia is a loss of the desire for food. Psychomotor retardation is slowed body movements.

An older client with severe depression and suicide ideation is prescribed an antidepressant medication. Which home safety issue should the nurse discuss with the client and​ spouse? A. Disposing of all medications at home B. Taking antidepressant medication as needed C. Discussing any herbal medications with the healthcare provider D. Allowing client to drive the car

C. Discussing any herbal medications with the healthcare provider ​Rationale: Herbal medications such as St.​ John's wort may be used to treat symptoms of​ depression, but can cause serotonin syndrome when used with a selective serotonin reuptake inhibitor​ (SSRI). The nurse should emphasize first discussing the use of any herbal preparation with the healthcare provider. Driving would depend upon the effects of the medication. There is no reason to dispose of all medications in the home unless the client used medications for a previous suicide attempt. Antidepressant medication should be taken as prescribed.

A client who has been depressed most of the time for the past 2 years is unable to cope with family​ responsibilities, and has frequent thoughts of suicide and death. For which disorder should the nurse plan care for this​ client? A. Bipolar B. Seasonal affective C. Dysthymic D. Cyclothymic

C. Dysthymic ​Rationale: Manifestations of a dysthymic disorder include a depressed mood most of the time for 2 years​ (for adults), inability to cope with​ responsibilities, and having thoughts of suicide and death. Bipolar disorders are a group of mood disorders that include manic​ episodes, hypomanic​ episodes, and mixed episodes. Cyclothymic disorder symptoms include fluctuating mood disturbances involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms. Seasonal affective disorder occurs when the individual experiences depression during the fall and winter seasons.

A client with severe depression reports waking up almost every night and being unable to fall back asleep. Which symptom should the nurse realize this client is​ describing? A. Hypersomnia B. REM sleep C. Middle insomnia D. Narcolepsy

C. Middle insomnia ​Rationale: Middle insomnia refers to waking up during the night and having difficulty falling asleep again. The client is not described​ REM, narcolepsy, or hypersomnia.

A client with depression is admitted to the mental health unit because of attempted suicide. Which​ short-term goal should be given the highest priority for this​ client? A. The client will establish healthy and mutually caring relationships. B. The client will identify and discuss actual and perceived losses. C. The client will seek out the nurse when feeling​ self-destructive. D. The client will learn strategies to promote relaxation and​ self-care.

C. The client will seek out the nurse when feeling​ self-destructive. ​Rationale: By seeking out a nurse when feeling​ self-destructive, the client can feel safe and begin to discover coping skills to assist in dealing with her​ self-destructive tendencies. Identifying actual and perceived​ losses, learning strategies to promote relaxation and​ self-care, and developing healthy caring relationships are all important for the client with depression to​ achieve, but safety is the priority goal for this client at this time.

A client with major depressive disorder​ (MDD) has not gotten out of bed for weeks and has not gone outside of the home for a month. Which should the nurse recall about this​ disorder? A. The risk of suicide decreases as the client begins to get back into society. B. Depression will eventually resolve in this particular client. C. The course of MDD can be extremely variable in this client. D. The client seems to be on the upswing of this depressive episode.

C. The course of MDD can be extremely variable in this client. ​Rationale: Onset of MDD generally occurs​ gradually, with symptoms progressing from anxiety and mild depression to a major depressive episode over a period of​ days, weeks, or months. The course of MDD is extremely​ variable, with some individuals experiencing remission for a period of months and others experiencing many years between episodes. Individuals who experience MDD in the context of another​ disorder, such as substance abuse or borderline personality​ disorder, often experience symptoms that are more difficult to treat.

A client is experiencing sadness and anhedonia. Which clinical manifestation indicates that the client may be grieving and not experiencing​ depression? A. Displays low​ self-esteem and confidence B. May dwell on past failures C. Lacks interest in previously enjoyed activities D. Actively feels their emotional pain and emptiness

D. Actively feels their emotional pain and emptiness ​Rationale: Clients who are experiencing grief tend to actively feel their emotional pain and​ emptiness, in which a client with depression will have a generalized feeling of helplessness and hopelessness. Clients experiencing grief can be persuaded to participate in​ activities, have intact​ self-esteem and​ confidence, unless a sense of failure relates directly to the loss.

During the physical assessment of a mental health​ client, it is important for the nurse to thoroughly assess for any medical​ conditions, because clients who are depressed are at greater risk for comorbidities. Which rationale explains the above​ statement? A. Impaired sensory function B. Impaired oxygen exchange C. Impaired​ self-care D. Impaired circulation

D. Impaired circulation ​Rationale: Assess for the presence of medical illnesses. This is important not only to rule out the possibility of an underlying medical condition causing the​ client's symptoms of​ depression, but also to identify illnesses that may trigger depression. These include​ autoimmune, oncologic,​ metabolic, and endocrine disorders. Chronic​ illnesses, such as asthma and​ diabetes, are associated with increased risk of depression. A diagnosis of a chronic or​ life-threatening illness may also trigger a depressive episode.

The nurse reviews the symptoms of a major depressive disorder​ (MDD) with a new colleague. Which statement should the nurse identify that indicates teaching was​ effective? A. ​"A person with MDD will not have problems​ concentrating." B. ​"A person with MDD will be​ aggressive." C. ​"A person with MDD will more than likely be using​ substances." D. ​"A person with MDD may sleep​ excessively."

D. ​"A person with MDD may sleep​ excessively." ​Rationale: Major depressive disorder​ (MDD) may consist of a single episode or may exhibit as recurrent major depression at various points in life. Signs and symptoms of MDD include sleep​ disturbances, ranging from excessive sleeping to no​ sleep, feelings of​ despair, sadness,​ crying, and recurrent thoughts of suicide.​ Aggression, problems with​ concentrating, and use of substances are not typically associated with MDD.