MH Exam #3 - Ch 25
A client on antidepressant therapy visits the hospital after a week and reports, "Ever since I started taking the medication, I am so dizzy that it is difficult to get dressed, and moreover, I can see no improvement in my condition." Which information provided by the nurse is beneficial to the client?
"Stop taking the drug until the dizziness subsides and resume the course later." The nurse would never ask the client to stop the drug. The client should not stop the medication during the therapy unless suggested by the primary health-care provider. "Avoid consuming red wine and aged cheese because they increase depression." Red wine and aged cheese do not cause depression. Instead, they interact with monoamine oxidase inhibitors to cause hypertensive crisis. "Keep taking the medication, but we will report the side effect to the health-care provider." It is important the client not stop taking the medication, but because the side effect is interfering with activities of daily life, the health-care provider would be notified. "Never stop the therapy. Take over-the-counter medications if a headache accompanies your dizziness." No other medications are recommended for a client on antidepressant therapy due to potential drug interactions.
The nurse is caring for a client who is a musician who has gone into a state of depression after the death of his or her spouse. The nurse tells the client, "You need to refocus on your music." Which statement made by the client after a few days indicates effective nursing intervention?
"Music was my passion until caring for my spouse started taking up all my time." The nurse is trying to raise the spirits of the client who seems hopeless. When the client verbalizes previous life events, it does not indicate that the nursing intervention is effective. "I need more time to refocus on music." When the client verbalizes that he or she requires more time to refocus on music, it does not indicate that the nursing intervention is effective. "I will now be able to record good music for my upcoming album." When the client verbalizes that he or she is able to refocus on music and feels hopeful about a future album, it indicates that the nursing intervention to raise the client's hopes about the future is effective. "God has not helped me understand the meaning of life." When the client verbalizes distress regarding God, it does not indicate that nursing intervention to raise the client's hopes about the future is effective.
Which endocrine conditions would result in symptoms of depression that might lead to a misdiagnosis of the actual underlying condition? Select all that apply.
Addison's disease Clients with Addison's disease, or dysfunction of the adrenal cortex, may exhibit symptoms of depression. Diabetes Clients with diabetes do not typically exhibit symptoms of depression. Hypothyroidism Hypothyroidism is an endocrine condition in which the client may typically exhibit symptoms of depression, so the endocrine disorder may be misdiagnosed. Osteoporosis Individuals with osteoporosis do not typically exhibit symptoms of depression. Cushing's syndrome Individuals with Cushing's syndrome may exhibit symptoms of depression.
A client with multiple sclerosis has depression. Which symptoms can indicate underlying depression in this client?
Agitation and restlessness Agitation and restlessness usually represent underlying depression in a client with multiple sclerosis. Hopelessness and worthlessness Hopelessness and worthlessness may be symptoms of low self-esteem. Weight loss and poor muscle tone Weight loss and poor muscle tone may be due to imbalanced nutrition and may not be symptoms of underlying depression. Gastrointestinal complaints and jaundice Gastrointestinal complaints and jaundice may be symptoms of hepatic failure.
An adolescent in a psychiatric unit has a temperamental outburst, saying, "I tried my best but could not reach my parents' expectations. I disappointed them. My life is of no use." Which condition would the nurse suspect in the client?
Complicated grieving Complicated grieving is a condition in which the client is depressed as a result of the loss of a significant person and has inappropriate expressions of anger. Major depressive disorder Loss of interest and pleasure is a symptom of major depressive disorder. Persistent depressive disorder In persistent depressive disorder, there is an irritable mood for a long time, also known as down in the dumps. Disruptive mood dysregulation disorder Disruptive mood dysregulation disorder is a childhood disorder in which the child is depressed as a result of separation from the parent or academic failure. When the child fails in academics, he or she feels depressed and may have suicidal thoughts.
While caring for a postpartum client, the nurse suspects the client to have postpartum depression with psychotic features. Which symptom in the client made the nurse suspect this condition?
Disheartened nature Disheartened nature, or despondency, is a symptom of "maternity blues." Rejection of the baby Symptoms of postpartum depression with psychotic features can include lack of interest in or rejection of the baby. Depressed mood with more bad days than good A depressed mood with more bad days than good is a symptom of moderate postpartum depression. Concerns about ability to care for the baby In moderate postpartum depression, the client has great concerns about the inability to care for the baby.
A nurse, on reviewing the prescription of a client with depression, instructs the client to chew sugarless candies occasionally. Which complication can be relieved in the client by implementing the nurse's suggestion?
Dizziness Dizziness is caused by antidepressant therapy but it is not controlled by candies. Instead, the client is asked to rest until the symptom subsides. Dry mouth Antidepressant drugs can cause dry mouth as a complication. The client is advised to chew sugarless candies to prevent dry mouth. Hypoglycemia Hypoglycemia is observed more in clients who are on antidiabetic agents. Moreover, hypoglycemic levels are adjusted by consuming a substance containing sugar. Hypertensive crisis Hypertensive crisis is a drug interaction that occurs with tyramine and monoamine oxidase inhibitor interaction.
A client with transient depression tells the nurse, "Things will never get better for me," to which the nurse responds by asking, "Why are you so depressed?" Which statement describes the significance of this question asked by the nurse?
It helps the nurse instill a positive attitude in the client. A positive attitude can be instilled in the client by providing expressions of hope to the client in a positive, low-key manner. It helps the nurse plan appropriate assistance for the client. Identifying the causative or contributing factors for grief will help the nurse plan appropriate assistance for the client. It helps the client recognize personal strengths that have been helpful in the past. The client recognizes his or her personal strengths when the nurse determines the coping behavior previously practiced by the client. It helps the client identify the feelings underlying behavior and take control of his or her own life. The nurse would encourage the client to explore and verbalize feelings and perceptions in order to help the client take control of his or her own life, but the nurse's question does not address this goal.
A client has been in multiple abusive relationships yet stays with the significant other because the client feels he or she cannot leave. Which theory best explains the client's depression?
Learning theory Learning theory suggests that the client learns helplessness and feels a lack of control over his or her life. Cognitive theory Cognitive theory suggests that during depression, the primary disturbance is cognitive rather than affective. Object loss theory Object loss theory suggests that depression occurs as a result of separation from a significant other during the first 6 months of life. Psychoanalytical theory Psychoanalytical theory suggests that the client's depression is directed internally.
Which client's condition can be best explained using the psychoanalytical theory of depression?
A client who is experiencing depression after the sudden death of a loved one Psychoanalytic theory postulates that depression is a result of melancholia that may occur as the result of the loss of a loved one. A client who is depressed after failing an examination even after multiple attempts Learning theory postulates that depression is a result of numerous failures in daily life. A client becoming depressed after thinking about negative expectations about the future Cognitive theory states that depression is a result of negative expectations about the future or environment. A child becoming depressed after separation from the mother for an extended period of time The object loss theory of depression states that depression occurs when a child is separated from the mother for an extended period of time in the first year of life.
A nurse is assessing a client who is on monoamine oxidase inhibitor (MAOI) therapy. Which suggestion provided by the nurse prevents a hypertensive crisis in the client?
Avoid consuming red wine Clients on MAOIs are contraindicated for tyramine-containing food products due to risk of a hypertensive crisis. Red wine has high tyramine content, and the client on MAOIs is advised to avoid it. Avoid cottage cheese on food Cottage cheese has low tyramine; limited consumption of this food is accepted while a client is on MAOI therapy. Use soy sauce topping on food Soy sauce has a high tyramine content, which is contraindicated for clients on MAOI therapy. Include raisins in the regular diet plan Raisins have a high tyramine content, which is contraindicated for clients on MAOI therapy.
The nurse is providing information about dietary restrictions to a client who was prescribed a monoamine oxidase inhibitor (MAOI) to treat depression. Which food product can the client consume safely while on MAOI therapy?
Beer Beer has high tyramine content and would be avoided while on MAOI therapy. Soy sauce Soy sauce is rich in tyramine and would be avoided while on MAOI therapy. Chocolate Chocolate is rich in tyramine and would be avoided while on MAOI therapy. Cottage cheese Cottage cheese has low tyramine content and is safe for the client to consume while on MAOI therapy.
Why is the dose of antidepressant drugs decreased in elderly clients?
Brain receptor sensitivity is high in elderly people. Elderly people will have low brain receptor sensitivity. Elderly people have decreased elimination of drugs. Elderly people have decreased elimination of drugs, resulting in high plasma levels of drugs, even with moderate doses. Therefore, the dose of antidepressant drugs is reduced to minimize side effects. Elderly people will experience only transient depression. Elderly people will experience all types of depression, not just transient depression. The primary treatment includes psychosocial and biological approaches. Although the treatment for depression in elderly people includes psychosocial and biological approaches, it is not the reason for administering lower doses of antidepressants than in younger adults.
A primary health-care provider infers from a test that a client's depression is somatically treatable. The elevated level of which parameter might be the reason for reaching such a conclusion?
Calcium Excessive levels of calcium can produce symptoms of depression. This parameter does not indicate that the depression can be treated somatically. Serum cortisol An elevated level of serum cortisol is determined in a dexamethasone suppression test. This test is sometimes used to determine if the client's depression is somatically treatable. Sodium bicarbonate Excessive levels of sodium bicarbonate can produce symptoms of depression. This parameter does not indicate that the depression can be treated somatically. Thyroid-stimulating hormone Thyroid-stimulating hormone stimulates the thyroid gland. This parameter does not indicate that the depression can be treated somatically.
A client with depression tells the nurse, "I am a loser and have not achieved anything big in life. My family and friends think that I am worthless." Which therapy does the nurse anticipate will be prescribed by the primary health-care provider to help in improving the mood of the client?
Cognitive therapy Cognitive therapy is helpful in changing the mood of the client by altering the way he or she thinks. It will help the client think positively about the environment and the future. Antidepressant therapy Antidepressant therapy is helpful if there is a clear neurological condition. In this case, the client has depression due to his or her emotional status of feeling worthlessness. Parent and family therapy Parent and family therapy is helpful in treating depression in young children. It is not helpful in changing the mood of a client who has negative thinking. Electroconvulsive therapy Electroconvulsive therapy is helpful in treating major depressive disorders in elderly clients who have suicidal risk and are unresponsive to antidepressant medications.
A client is diagnosed with anaclitic depression. Which could be the cause of such a condition?
Depression due to loss of interest in sexual activity Loss of libido is the loss of interest in sexual activity. It is a symptom of postpartum depression. Depression due to loss of interest in usual activities Losing interest in the usual activities is a manifestation of major depressive disorder. Depression due to loss of a significant person Being depressed after losing a significant person is a symptom of complicated grieving. Separation from the mother during the first year of life Anaclitic depression is a childhood disorder that occurs when the child is separated from the mother for a long period during the first year of life.
A client has been feeling "down in the dumps" because of the loss of a pet 2 years ago. Which condition would the nurse suspect in the client?
Depressive psychosis Depressive psychosis describes the range of symptoms in a person with depression. It may range from "maternity blues" to severe psychotic symptoms. Major depressive disorder Major depressive disorder is a depressed mood in which there is loss of interest or pleasure in usual activities. Persistent depressive disorder Persistent depressive disorder or dysthymia refers to a chronically depressed mood that lasts most of the day, more days than not, for at least 2 years. This mood may be described as "down in the dumps." Premenstrual dysphoric disorder Premenstrual dysphoric disorder is characterized by depressed mood, mood swings, excessive anxiety, and a decrease in activities during the weeks prior to menses.
A client is diagnosed with disruptive mood dysregulation disorder. Which nursing intervention is appropriate for this client?
Determining the stage of grief Determining the stage of grief is a nursing intervention in complicated grieving. Teaching effective communication skills A client with a self-esteem deficit is taught effective communication skills. Strengthening the client's coping and adaptive skills The focus of intervention for disruptive mood dysregulation disorder is to strengthen the client's coping and adaptive skills. Encouraging the client to take responsibility for self-care practices Encouraging the client to take as much responsibility as possible for self-care practices is a nursing intervention when a client is diagnosed with powerlessness.
The nurse is caring for a client with depression. Which primary nursing intervention is appropriate for this client?
Develop a trusting relationship with the client. Developing a trusting relationship with the client would be the primary intervention by the nurse. Help the client openly express his or her feelings. Helping the client express his or her feelings openly may be achieved after another nursing intervention. Help discharge pent-up anger in the client. The nurse could help the client discharge his or her pent-up anger after another nursing intervention. Tell the client that crying is acceptable and relieves depression. The nurse can tell the client that crying is acceptable to relieve depression only after another nursing intervention.
Which biochemical is estimated in the dexamethasone suppression test performed to determine if a client has somatically treatable depression?
Dopamine Dopamine is a neurotransmitter, which will not be estimated in the dexamethasone suppression test. Serum cortisol Serum cortisol is increased during depression. It is estimated in the dexamethasone suppression test to determine if the individual has somatically treatable depression. Norepinephrine Norepinephrine is a neurotransmitter, which will not be estimated in the dexamethasone suppression test. Thyroid-stimulating hormone Thyroid-stimulating hormone is an endogenous hormone that stimulates the thyroid gland. It is not estimated in the dexamethasone suppression test.
A client reports dry mouth, blurred vision, constipation, and urinary retention after taking the medication prescribed by the primary health-care provider to treat depression. Which medication does the nurse find in the client's prescription?
Duloxetine Duloxetine is a selective serotonin reuptake inhibitor that blocks the reuptake of serotonin and norepinephrine, resulting in tremors, cardiac arrhythmias, sexual dysfunction, hypertension, and gastrointestinal disturbances. Bupropion Bupropion does not cause dry mouth, blurred vision, constipation, or urinary retention because it does not block the reuptake of acetylcholine. Venlafaxine Venlafaxine does not block reuptake and/or receptors of acetylcholine. Therefore, the symptoms of blurred vision, constipation, and urinary retention are not observed with the administration of venlafaxine. Imipramine Imipramine is a tricyclic antidepressant that blocks reuptake and/or receptors of acetylcholine, resulting in dry mouth, blurred vision, constipation, and urinary retention.
How does electroconvulsive therapy (ECT) work to treat a depressed client?
ECT increases melatonin levels. Melatonin is a hormone that is increased in dim light and is not related to ECT. ECT decreases dopamine levels. ECT increases dopamine levels. ECT increases serotonin levels. The electrical stimulation of ECT causes significant increase in neurotransmitter levels. This increases serotonin levels. ECT decreases gamma-aminobutyric acid levels. ECT increases gamma-aminobutyric acid levels.
Which electrolyte imbalance would the nurse expect to be present in an elderly client receiving a serotonergic antidepressant?
Hypermagnesemia Hypermagnesemia is not a side effect of clients receiving serotonergic antidepressants. Hyperkalemia Hypokalemia is seen in depression. Hyponatremia Hyponatremia is a side effect of serotonergic antidepressants and is problematic in elderly clients. Hypocalcemia Hypocalcemia is not a side effect of serotonergic antidepressants.
Which electrolyte imbalance may be present in a client with depression?
Increased levels of sodium Increased levels of sodium do not result in depressive symptoms; rather, they help in cell functioning. Sodium deficit may be seen in a client with depression. Decreased levels of calcium Decreased levels of calcium in the body do not result in depressive symptoms, though increased levels of calcium may be seen in a client with depression. Increased levels of potassium Increased or decreased levels of potassium result in depressive symptoms. Increased levels of magnesium Decreased levels of magnesium result in depressive symptoms.
Which physiological symptom is observed in a client with transient depression?
Insomnia Insomnia is not a physiological symptom observed in a client with transient depression. It is observed in the advanced stages of depression. Listlessness Listlessness is a physiological symptom observed in a client with transient depression. Anorexia Anorexia is not a symptom observed in a client with transient depression because the depressive symptoms subside relatively quickly. Urinary retention Urinary retention is a physiological symptom observed in severe depression due to a general slowdown of body function.
Which therapy is beneficial to a client who frequently expresses the thought that he or she is a complete failure and feels depressed?
Light therapy Light therapy is most beneficial to clients who experience winter blues or seasonal patterns of depressive disorder. Family therapy Family therapy is beneficial to the client who is depressed due to family situations. This therapy works by involving the client's family in resolving the client's symptoms. Cognitive therapy Clients with automated thoughts of feeling low undergo cognitive therapy. This therapy helps relieve the thought distortions that cause depression in the client. Electroconvulsive therapy (ECT) ECT is used to treat major depressive disorder, in which the client shows suicidal tendencies.
A client with severe depressive disorder is found to be obsessively washing hands. Which therapy would be beneficial to control this condition in the client?
Light therapy Light therapy is used to treat winter "blues" by exposing the client to light. In this therapy, the client is instructed to sit in front of a light box with his or her eyes open. Group therapy Group therapy provides an atmosphere in which the clients discuss their issues and resolve them. Cognitive therapy Obsessive hand washing is a thought distortion. In cognitive therapy, the client is taught how to control thought distortions and is also assisted in identifying dysfunctional patterns of thinking and behavior. Electroconvulsive therapy Electroconvulsive therapy refers to the induction of generalized seizure through the application of electric current to the brain. It is effective in treating clients who are suicidal and also in treating severe depression.
Which treatment modality is beneficial to a client who experiences winter "blues"?
Light therapy Winter "blues" is a seasonal affective depressive disorder caused by changes in the levels of the hormone melatonin. Light therapy is effectively used to restore melatonin levels to normal and reduce the client's depressive symptoms. Cognitive therapy Cognitive therapy is used to control the client's thought distortions, which are uncommon in the case of seasonal affective depressive disorder, or winter "blues." Electroconvulsive therapy (ECT) ECT is beneficial to clients with severe depression and those who have psychotic thoughts. Transcranial magnetic stimulation (TMS) TMS is used to treat severe depression and may not be suggested for a seasonal affective depressive disorder, or winter "blues."
A female client is on hormonal replacement therapy because of hormonal imbalance. Which disorders are more likely to appear in the client? Select all that apply.
Major depressive disorder Major depressive disorder cannot be attributed to a substance or a medical condition. Persistent depressive disorder Persistent depressive disorder is a long-term depressed mood for at least 2 years. Premenstrual dysphoric disorder Premenstrual dysphoric disorder occurs as a result of an imbalance of the hormones estrogen and progesterone. As the client has hormonal imbalance, she is more likely to develop this disorder. Disruptive mood dysregulation disorder Disruptive mood dysregulation disorder is a childhood disorder. Medication-induced depressive disorder Medication-induced depressive disorder is a depressive disorder caused by a medication. High levels of estrogen have been found to be associated with depression. Thus, clients who are on estrogen therapy, which is a hormonal replacement therapy, may experience depression.
Which type of depression occurs with everyday disappointments?
Mild depression Everyday disappointments are not categorized as mild depression as they will not last for weeks and do not include any symptoms of hopelessness. Severe depression Severe depression does not include everyday disappointments as they will not cause a depressed mood. Transient depression Transient depression includes everyday disappointments that result in depressive symptoms that will subside soon. Moderate depression Everyday disappointments are not the cause of moderate depression. The symptoms of depression caused by everyday disappointments subside within days.
Which type of depression involves mood variation that is worse in the morning and gets better as the day progresses?
Mild depression Mild depression does not cause mood variations because it does not involve diurnal variations in the neurotransmitter levels. Severe depression Severe depression includes physiological changes resulting in mood variation that is worse in the morning and gets better as the day progresses. This mood variation is caused by diurnal variations in the neurotransmitter levels. Moderate depression Moderate depression includes mood variation. However, the client feels better in the morning, and the depression gets worse as the day progresses. Transient depression Transient depression does not include mood variations because the symptoms will subside quickly.
During a checkup, a client reports having a depressed mood and sometimes having trouble falling asleep. The nurse notices that the client fidgets and twirls a strand of hair throughout the interview. On further interaction, the nurse does not observe any additional symptoms of depression in the client. According to the Hamilton Depression Rating Scale (HDRS), which can be concluded about this client?
Mild depression The Hamilton score would be between 7 and 17 to confirm that the client has mild depression. The client would not score this high given the conditions listed. Severe depression The Hamilton score would be higher than 24 to confirm that the client has severe depression. The client would not score this high given the conditions listed. Moderate depression The Hamilton score would be between 18 and 24 to confirm that the client has moderate depression. The client would not score this high given the conditions listed. No evidence of depressive illness According to the HDRS, the score for verbal reporting on depressed mood is two, the score for having trouble falling asleep is one, and the agitation score for playing with hair is two. This adds up to a total score of five, which indicates that there is no evidence of depressive illness. While the client may be temporarily depressed or agitated, the condition is not lasting.
Which signs of depression are commonly observed in a 7-year-old child? Select all that apply.
Morbid thoughts Morbid thoughts are a sign of depression observed in children in the 9- to 12-year age group. Excessive worrying Excessive worrying is a sign of depression observed in children in the 9- to 12-year age group. Aggressive behavior Aggressive behavior is a sign of depression observed in children in the 6- to 8-year age group. Lack of social interactions Lack of social interaction is a sign of depression observed in children in the 6- to 8-year age group. Lack of emotional expressiveness Lack of emotional expressiveness is a sign of depression observed in children up to 3 years of age.
The primary health-care provider suggests that the nurse schedule light therapy for a client early in the day. Which complication can be prevented in the client as a result of this intervention?
Nausea Nausea is a side effect of light therapy. However, scheduling the light therapy during morning hours does not help prevent nausea. Insomnia In light therapy, the client is exposed to bright light to treat depression. The client may develop insomnia or sleeplessness when the therapy is performed late in the day. Therefore, the nurse schedules an appointment for the client early in the day. Irritability Rationale: Irritability cannot be prevented by scheduling light therapy during early hours of the day. Photophobia Photophobia, or sensitivity toward light, is common with light therapy, and it cannot be prevented by scheduling the therapy early in the day.
Which antidepressant drug acts as a serotonin-norepinephrine reuptake inhibitor?
Phenelzine Phenelzine is an antidepressant drug that acts as a monoamine oxidase inhibitor. Desvenlafaxine Desvenlafaxine is an antidepressant drug that acts as a serotonin-norepinephrine reuptake inhibitor. Bupropion Bupropion is a heterocyclic antidepressant drug. Isocarboxazid Isocarboxazid is an antidepressant drug that acts as a monoamine oxidase inhibitor.
Which side effects are commonly seen in clients taking monoamine oxidase inhibitors (MAOIs)? Select all that apply.
Photosensitivity Tricyclic and heterocyclic antidepressants may cause photosensitivity. Sexual dysfunction Sexual dysfunction is a side effect that may be observed with selective serotonin reuptake inhibitors. Hypertensive crisis Hypertensive crisis is the most common side effect experienced in clients taking MAOIs. Symptoms of hypertensive crisis include severe occipital headache, palpitations, nuchal rigidity, chest pain, and coma. Orthostatic hypotension Orthostatic hypotension is a common side effect with tricyclic and heterocyclic antidepressants. Application site reactions Application site reactions occur with selegiline transdermal systems. They include rash, itching, erythema, irritation, swelling, and urticarial lesions.
Which condition would the nurse suspect if a client who just gave birth complains of "feeling blue"?
Postpartum depression Postpartum depression is found in a client who just gave birth and feels "maternity blues," which include anxiety, tearfulness, despondency, and impaired concentration. Major depressive disorder Major depressive disorder is a depressed mood in which is the client experiences loss of interest or pleasure in his or her usual activities. Persistent depressive disorder Mood disturbance persisting for a long time is known as persistent depressive disorder. Disruptive mood dysregulation disorder Disruptive mood dysregulation disorder is a childhood disorder characterized by severe temper outbursts directed toward parents and teachers.
Which symptoms can be seen upon the blockade of norepinephrine reuptake?
Sedation, weight gain, and hypotension Sedation, weight gain, and hypotension occur if histamine is blocked. Dry mouth, blurred vision, constipation, and urinary retention Dry mouth, blurred vision, constipation, and urinary retention occur if acetylcholine is blocked. Gastrointestinal (GI) disturbances, increased agitation, and sexual dysfunction GI disturbances, increased agitation, and sexual dysfunction occur if serotonin is blocked. Tremors, cardiac arrhythmias, sexual dysfunction, and hypertension If norepinephrine reuptake is blocked, the most common symptoms are tremors, cardiac arrhythmias, sexual dysfunction, and hypertension.
For which condition would a black-box warning be issued for antidepressant use in young adults under 25, teens, and children?
Seizures There is not a black-box warning regarding seizures for antidepressants. Suicidal thoughts A black-box warning issued by the Food and Drug Administration for young adults under 25, teens, and children states that these individuals may experience suicidal thoughts or behavior while taking antidepressants, especially in the first few weeks or when the dose is changed. Weight gain Although some medications can cause weight gain or loss, there is not a black-box warning. Insomnia Although some medications can cause insomnia, there is not a black-box warning.
Which neurotransmitter level in the mesolimbic system of the brain is thought to exert a strong influence over human mood and behavior?
Serotonin Serotonin-containing neurons are mainly involved in psychobiological functions. Dopamine Dopamine levels in the mesolimbic system of the brain are thought to exert a strong influence over human mood and behavior. Acetylcholine Cholinergic agents such as acetylcholine have a strong effect on electroencephalograms, neuroendocrine function, and mood. Norepinephrine Norepinephrine is known to be a key component in the mobilization of the body to deal with stressful situations.
A nurse suspects that the client is experiencing low self-esteem. Which objective data would support the nurse's suspicion?
The client does not make eye contact. Avoiding eye contact is a sign of low self-esteem. The client has lost weight. Weight loss is supportive of imbalanced nutrition in which the client receives less than body requirements. The client has difficulty concentrating. Difficulty concentrating is indicative of insomnia. The client appears not to have combed his or her hair in days. An unkempt appearance supports a diagnosis of a self-care deficit
The nurse is caring for a client with complicated grieving. Which action of the client would be monitored to evaluate the effectiveness of the nursing care?
The client is expressing appropriate anger about the loss. When the client expresses appropriate anger about the loss, the nursing care is effective. The client is able to attempt new activities. Attempting new activities would indicate effective nursing care in the client with low self-esteem. The client is participating in daily living activities. Participating in daily living activities shows the effectiveness of nursing care in the client with powerlessness. The client is able to make decisions for his or her self-care. If the client is able to make decisions concerning self-care, it shows the effectiveness of nursing care in the client with powerlessness.
The nurse is explaining the side effects of electroconvulsive therapy (ECT) to the guardian of a client with depression. Which relevant information would the nurse provide?
The client may exhibit confusion for a short period of time. Confusion and memory loss for a short time are the major side effects of ECT. The client will experience short-term memory loss. Short-term memory loss does not occur due to ECT. The client usually regains his or her memory quickly. The client may develop photosensitivity for a period of time. Light therapy may cause photosensitivity as a side effect. The client may have hypertensive crisis after the therapy. Hypertensive crisis is not observed due to ECT.
A client is prescribed duloxetine. Which client education is most appropriate for the nurse to provide?
The client should use sunblock lotion. The client should use sunblock lotion in case of photosensitivity, which usually occurs due to tricyclic and heterocyclic medications. The client should not consume cheese. Cheese contains tyramine. Consuming tyramine with monoamine oxidase inhibitor therapy causes complications, but this is not the case with duloxetine. The medication should not be discontinued abruptly. The medication should not be discontinued abruptly because duloxetine causes withdrawal symptoms. The client should rise slowly from a lying or a sitting position. The client should rise slowly from a lying or sitting position in the case of orthostatic hypotension. Orthostatic hypotension usually occurs due to tricyclic and heterocyclic medications.
The nurse is caring for a client with major depressive disorder who verbalizes statements that reflect low self-esteem. The nurse tries to teach assertive techniques to the client. Which outcome can be expected in the client if the nursing intervention is successful?
The client will focus more on personal grooming. Teaching assertive techniques to a client with major depressive disorder will not help the client focus more on personal grooming. The client will develop trust in the nurse. The nurse would assure and reinforce a sense of security in the client to develop a trustful relationship. Teaching only assertive techniques will not help the nurse develop a trustful relationship with the client. The client will try new activities without the fear of failure. Assertive techniques will help the client enhance his or her self-esteem. This will help the client interact with others in an assertive manner, enabling him or her to attempt new activities without the fear of failure. The client will able to understand both the positive and negative effects of divorce. The client will not be able to understand both the positive and negative effects of divorce by learning about assertive techniques.
The nurse is caring for a client who lost a brother in a plane crash. Which statement indicates effectiveness of the nursing care?
The client will not harm himself or herself. A sign of effective nursing care in a client who has attempted suicide is that the client will not harm himself or herself. The client participates in daily activities. While caring for a client with a feeling of powerlessness, the nurse would expect the participation of the client in daily activities to be the effective outcome of the therapy. The client expresses anger about the loss. In complicated grieving, the client is depressed due to loss of a significant person. The nursing care would be effective if the client is able to express anger about the loss. The client will be able to take control of his or her life situations. When the client is able to effectively solve problems and take control of his or her life situations, it shows the effectiveness of therapy in a client with low self-esteem.
At which age would a child experience symptoms of depression that include morbid thoughts, excessive worrying, and poor self-esteem?
Up to age 3 Signs of depression in children up to age 3 may include feeding problems, tantrums, lack of playfulness and emotional expressiveness, failure to thrive, or delays in speech and gross motor development. Ages 3 to 5 Common symptoms of depression in children ages 3 to 5 may include accident proneness, phobias, aggressiveness, and excessive self-reproach for minor infractions. Mood-congruent auditory hallucinations are also not uncommon. Ages 6 to 8 Children ages 6 to 8 with depression may have vague physical complaints and aggressive behavior. They may cling to parents and avoid new people and challenges. They may lag behind their classmates in social skills and academic competence. Ages 9 to 12 From ages 9 to 12, a child may experience symptoms of depression that include morbid thoughts, excessive worrying, and poor self-esteem.
What is meant by the phrase off-label use of medications?
Use of medications that are not prescribed Medications used "off-label" are prescribed by the primary health-care provider. Use of medications that are not approved by the Food and Drug Administration (FDA) Medications that are not approved by the FDA would not be used in clients. Use of medication for a purpose other than what is approved by the Food and Drug Administration (FDA) Off-label use indicates the use of medications for a purpose that is not approved by the FDA. These medications are approved by the FDA for a particular purpose, but at times the primary health-care provider can use the medication for some other purpose. Use of medications without the constant supervision of a competent health-care professional Off-label use does not indicate whether the medication would or would not be administered to the client with constant supervision. A medication with a black-box label needs constant supervision by a competent health-care professional.
The nurse reviews the prescription of a client with depression and informs the client, "You should make sure you slowly rise up from the sitting or lying-down position." What is the nurse expecting to control in the client?
Variation in blood pressure The nurse informs the client on antidepressant therapy to rise slowly from the sitting or lying position to prevent orthostatic hypotension. Orthostatic hypotension refers to a drop in blood pressure when the client rises from a sitting or lying position. Variation in urinary patterns Variations in urinary patterns are observed with urinary retention. The nurse suggests the client with urinary retention run water over the perineal area to obtain relief from the symptoms. Variation in serotonin levels Serotonin reuptake inhibitor drugs control serotonin levels. Variation in blood glucose levels Blood glucose levels are controlled by insulin and are unrelated to rising slowly from sitting and lying positions.
Which interventions would the nurse implement while applying a selegiline transdermal patch? Select all that apply.
Wet the skin before applying The transdermal patch would be applied to dry and intact skin for better absorption. Wash hands after applying After applying the patch, the nurse would wash his or her hands to prevent the medication from being absorbed into the skin. Avoid exposing the site of application to direct heat The site of application would not be exposed to direct heat because heat can affect the therapeutics of the drug. Apply a new patch to a new site if the patch falls off A new patch would be applied to a new site if the patch falls off, and the previous schedule must be resumed. Apply approximately at the same time each day to the same spot on the skin The transdermal patch would be applied at the same time each day to a new spot for better absorption.
While assessing a client for symptoms of depression, the psychiatrist assigns a score of three for psychic anxiety according to the Hamilton Depression Rating Scale. Which observation in the client enables the psychiatrist to give the score?
Worrying about minor matters The psychiatrist assigns a score of two for anxiety when the client is worrying about minor matters. Fears expressed without questioning The psychiatrist assigns a score of four for anxiety when the individual expresses fear without questioning. Subjective tension and irritable behavior The psychiatrist assigns a score of one when the client shows subjective tension and irritable behavior. Apprehensive attitude apparent in face and speech The psychiatrist assigns a score of three due to an apprehensive attitude that is reflected in the client's face and speech.
Which food item is safe to be consumed by a client who is on monoamine oxidase inhibitor (MAOI) therapy?
Yogurt Consumption of yogurt while on MAOI therapy may result in a life-threatening hypertensive crisis. Raisins Consumption of raisins while on MAOI therapy may result in a life-threatening hypertensive crisis. Grilled chicken breast Chicken is safe to consume while on MAOI therapy as long as it is not smoked and/or cured and processed. Chicken liver, however, is to be avoided. Red wine Consumption of red wine while on MAOI therapy may result in a life-threatening hypertensive crisis.
Which statement made by the student nurse regarding nutrition and symptoms of depression would require correction?
"I will ensure my client eats a diet high in iron because iron deficiency is linked to symptoms of depression." This statement does not require correction; iron deficiency is linked to depression symptoms. "I told my client to consume foods high in vitamin D or go outside because his or her level was a little bit low, and that could be causing him or her to be 'blue.'" This statement is accurate; vitamin D deficiency is linked to depression. "My client will need to avoid protein if he or she want to avoid symptoms of depression." This statement requires correction. Protein deficiency is linked to symptoms of depression. "My client told me he or she is on a carbohydrate-free diet, so I told him or her that his or her body needs some type of carbohydrate to avoid symptoms of depression." This is an accurate statement; deficiency of carbohydrates is linked to symptoms of depression.
While preparing a client for light therapy, the client asks the nurse, "I have read that ultraviolet (UV) rays are harmful. Will I be exposed to them during light therapy?" Which response by the nurse is appropriate?
"The fluorescent light tubes used in light therapy will not produce UV rays." The fluorescent light used in light therapy will produce all types of rays, including UV rays. "UV rays are not harmful to the eyes. Therefore, it's OK to look directly at the light." The nurse will tell the client to avoid looking directly at the light to minimize strain in the eyes. "You will be exposed to UV radiation for less than 10 to 15 minutes, which does not cause any harm." The client is exposed to light rays of all wavelengths during light therapy. However, a plastic screen is used to absorb UV rays that are produced from fluorescent light tubes. "The plastic screen covering the fluorescent light tubes blocks UV rays. Therefore, you will not be exposed to UV rays." A plastic screen is used to absorb UV rays that are produced from fluorescent light tubes. Therefore, the client will not be exposed to UV rays.
A postpartum client begins to cry during a checkup and reports to the nurse, "I feel so sad and tired after caring for my baby. I can't concentrate on anything." Which response by the nurse is appropriate?
"These symptoms last only for a couple of weeks if you interact with your child." The client is experiencing the symptoms of "maternity blues" that will usually subside within 2 weeks. Therefore, the nurse would assure the client not to worry about the symptoms of maternity blues. "Contact the primary health-care provider to get some medications." The symptoms of "maternity blues" do not require any intervention by the primary health-care provider. "Consider supportive psychotherapy with continuous assistance until the symptoms subside." Supportive psychotherapy with continuous assistance is provided for a postpartum client who is suffering from psychotic depression. "Don't worry. Take the medications as prescribed because they will help you to overcome this feeling." "Maternity blues" do not require any antidepressant medication. Antidepressants help treat psychotic depression.
Which suggestion is most appropriate for the nurse to give a client with transient depression?
"You have to think about reality to feel normal again." This suggestion by the nurse can be helpful to the client who has severe depression. "You should accept the loss and focus on daily activities." This suggestion can be helpful to the client who is in a state of mild depression due to loss. "Try to focus on your goals and achievements to overcome depression." This is the best suggestion given by the nurse because the symptoms of transient depression will subside quickly when the client focuses on other goals and achievements. "Let me know if you need any assistance in performing daily routines." This suggestion can be helpful to the client who is in a state of moderate depression and is unable to function without assistance.
A client who suffered a head injury reports frequent sleepiness and loss of appetite. Which part of the client's brain was most likely affected?
1 If the cerebellum were affected, the client would show symptoms of psychomotor retardation or become agitated. 2 If the hippocampus were affected, the symptoms would be memory impairment and feelings of worthlessness. 3 If the hypothalamus is affected, the symptoms are increased or decreased sleep and altered appetite. 4 If the prefrontal cortex were affected, the symptoms would include problems concentrating and a depressed mood in the client.
Which part of the brain mediates the symptoms of psychomotor retardation?
1 The amygdala mediates the symptoms of anhedonia, anxiety, and reduced motivation. 2 The cerebellum mediates the symptoms of psychomotor retardation or agitation. 3 The hypothalamus mediates the symptoms of increased or decreased sleep and appetite. 4 The prefrontal cortex mediates the symptoms of focusing attention, impulse control, and managing emotional reactions.
A nurse is caring for an adolescent client with major depressive disorder. Which medications will the nurse expect to be contraindicated in such clients? Select all that apply.
Fluoxetine Fluoxetine is a medication approved by Food and Drug Administration to treat depression in children or adolescents. Paroxetine Paroxetine is not recommended for use in children with depression. Thus, it would not be prescribed. Duloxetine Rationale: Duloxetine is not recommended for use in children with depression. Thus, it would not be prescribed. Citalopram Citalopram is not recommended for use in children with depression. Thus, it would not be prescribed. Escitalopram Escitalopram is a medication approved by Food and Drug Administration to treat depression in children or adolescents.
Which action would the nurse take during the first phase of individual psychotherapy?
Terminating the therapeutic alliance Termination of the therapeutic alliance is phase III intervention. Assisting in establishing new relationships Phase II of individual psychotherapy involves establishing new relationships. Helping the client resolve complicated grief reactions Helping resolve grief reactions is an activity of phase II psychotherapy. Encouraging the client to continue participating in regular activities During phase I psychotherapy, the client is encouraged to continue working and participating in regular activities.
