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15. The primary health care provider prescribes fluoxetine (Prozac) orally every morning for a 72-year-old client with depression. Which transient adverse effect of this drug requires immediate action by the nurse? 1. Nausea. 2. Dizziness. 3. Sedation. 4. Dry mouth.

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8. The nurse is reviewing the laboratory report with the client's lithium level taken that morning prior to administering the 5 PM dose of lithium. The lithium level is 1.8 mEq/L (1.8 mmol/L). The nurse should: A. Administer the 5 PM dose of lithium. B. Hold the 5 PM dose of lithium. C. Give the client 8 oz (236 mL) of water with the lithium. D. Give the lithium after the client's supper.

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22. A client with major depression is to be discharged home tomorrow. When preparing the client's discharge plan, which of the following areas is most important for the nurse to review with the client? 1. Future plans for going back to work. 2. A conflict encountered with another client. 3. Results of psychological testing. 4. Medication management with outpatient follow-up.

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5. A client has been taking 30 mg of duloxetine hydrochloride (Cymbalta) twice daily for 2 months because of depression and vague aches and pains. While interacting with the nurse, the client discloses a pattern of drinking a six-pack of beer daily for the past 10 years to help with sleep. What should the nurse do first? A. Refer the client to the dual diagnosis program at the clinic. B. Share the information at the next interdisciplinary treatment conference. C. Report the client's beer consumption to the primary health care provider. D. Teach the client relaxation exercises to perform before bedtime.

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9. A nurse is conducting a psychoeducational group for family members of clients hospitalized with depression. Which family member's statement indicates a need for additional teaching? A.. "My husband will slowly feel better as his medicine takes effect over the next 2 to 4 weeks." B. "My wife will need to take her antidepressant medicine and go to group to stay well." C."My son will only need to attend outpatient appointments when he starts to feel depressed again." D. "My mother might need help with grocery shopping, cooking, and cleaning for a while."

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19. A male client who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse observes the client to be in need of grooming and hygiene. Which of the following nursing actions is most appropriate? 1. Explaining the importance of hygiene to the client. 2. Asking the client if he is ready to shower. 3. Waiting until the client's family can participate in the client's care. 4. Stating to the client that it's time for him to take a shower.

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24. A client with major depression and psychotic features is admitted involuntarily to the hospital. He will not eat because his "bowels have turned to jelly," which the client states is punishment for his wickedness. The client requests to leave the hospital. The nurse denies the request because commitment papers have been initiated by the primary health care provider. Which of the following should the nurse identify as a criterion for the client to be legally committable? 1. Evidence of psychosis. 2. Being gravely disabled. 3. Risk of harm to self or others. 4. Diagnosis of mental illness.

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14. A client is receiving paroxetine (Paxil) 20 mg every morning. After taking the first three doses, the client tells the nurse that the medication upsets the stomach. Which of the following instructions should the nurse give to the client? 1. "Take the medication an hour before breakfast." "Take the medication with some food." 3. "Take the medication at bedtime." 4. "Take the medication with 4 oz (120 mL) of orange juice."

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1. The nurse is planning care with a Mexican client who is diagnosed with depression. The client believes in "mal ojo" (the evil eye) and uses treatment by a root healer. The nurse should do which of the following? A. Avoid talking to the client about the root healer. B. Explain to the client that Western medicine has a scientific, not mystical, basis. C. Explain that such beliefs are superstitious and should be forgotten. 4. Involve the root healer in a consultation with the client, primary health care provider, and nurse.

4. Including the root healer gives credibility and respect to the client's cultural beliefs. Avoiding talking about the healer demonstrates either ignorance or disregard for the client's cultural values. Negative comparison of root healing with Western medicine not only denigrates the client's beliefs but is likely to alienate and cause the client to end treatment.

12. The client exhibits a flat affect, psychomotor retardation, and depressed mood. The nurse attempts to engage the client in an interaction, but the client does not respond to the nurse. Which response by the nurse is most appropriate? "I'll sit here with you for 15 minutes." 2. "I'll come back a little bit later to talk." 3. "I'll find someone else for you to talk with." 4. "I'll get you something to read."

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18. During a group session, a client who is depressed tells the group that he lost his job. Which of the following responses by the nurse is best? "It must have been very upsetting for you." 2. "Would you tell us about your job?" 3. "You'll find another job when you're better." 4. "You were probably too depressed to work."

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20. When developing the teaching plan for the family of a client with severe depression who is to receive electroconvulsive therapy (ECT), which of the following information should the nurse include? 1. Some temporary confusion and disorientation immediately after a treatment is common. 2. During an ECT treatment session, the client is at risk for aspiration. 3. Clients with severe depression usually do not respond to ECT. 4. The client will not be able to breathe independently during a treatment.

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7. The client is taking 50 mg of lamotrigine (Lamictal) daily for bipolar depression. The client shows the nurse a rash on his arm. What should the nurse do? A. Report the rash to the primary health care provider. B. Explain that the rash is a temporary adverse effect. C. Give the client an ice pack for his arm. D. Question the client about recent sun exposure.

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16. Which of the following statements by a client taking trazodone (Desyrel) as prescribed by the primary health care provider indicates to the nurse that further teaching about the medication is needed? 1. "I will continue to take my medication after a light snack." 2. "Taking Desyrel at night will help me to sleep." "My depression will be gone in about 5 to 7 days." 4. "I won't drink alcohol while taking Desyrel."

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17. A 62-year-old female client with severe depression and psychotic symptoms is scheduled for electroconvulsive therapy (ECT) tomorrow morning. The client's daughter asks the nurse, "How painful will the treatment be for Mom?" The nurse should respond by saying which of the following? 1. "Your mother will be given something for pain before the treatment." 2. "The primary health care provider will make sure your mother doesn't suffer needlessly." "Your mother will be asleep during the treatment and will not be in pain." 4. "Your mother will be able talk to us and tell us if she's in pain."

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10. A 16-year-old client is prescribed 10 mg of paroxetine (Paxil) at bedtime for major depression. The nurse should instruct the client and parents to monitor the client closely for which adverse effect? A.. Headache. B.Nausea. C. Fatigue. D.Agitation.

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13. After a few minutes of conversation, a female client who is depressed wearily asks the nurse, "Why pick me to talk to? Go talk to someone else." Which of the following replies by the nurse is best? 1. "I'm assigned to care for you today, if you'll let me." 2. "You have a lot of potential, and I'd like to help you." 3. "I'll talk to someone else later." "I'm interested in you and want to help you."

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4. The client is receiving 6 mg of selegiline transdermal system every 24 hours for major depression. The nurse should judge teaching about Emsam to be effective when the client makes which statement? A."I need to avoid using the sauna at the gym." B. "I can cut the patch and use a smaller piece." C. "I need to wait until the next day to put on a new patch if it falls off." D. "I might gain at least 10 lb (4.5 kg) from the medication."

A

2. After a period of unsuccessful treatment with Elavil (amitriptyline), a woman diagnosed with depression is switched to Parnate (tranylcypromine). Which statement by the client indicates the client understands the side effects of Parnate? A. "I need to increase my intake of sodium." B. "I must refrain from strenuous exercise." C. "I must refrain from eating aged cheese or yeast products." D. "I should decrease my intake of foods containing sugar."

C

11. A client diagnosed with major depression spends most of the day lying in bed with the sheet pulled over his head. Which of the following approaches by the nurse is most therapeutic? 1. Wait for the client to begin the conversation. 2. Initiate contact with the client frequently. 3. Sit outside the client's room. 4. Question the client until the client responds.

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21. Which of the following comments indicates that a client understands the nurse's teaching about sertraline (Zoloft)? 1. "Zoloft will probably cause me to gain weight." "This medicine can cause delayed ejaculations." 3. "Dry mouth is a permanent side effect of Zoloft." 4. "I can take my medicine with St. John's wort."

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6. A client was admitted to the inpatient unit 3 days ago with a flat affect, psychomotor retardation, anorexia, hopelessness, and suicidal ideation. The primary health care provider prescribed 75 mg of venlafaxine extended release (Effexor XR) to be given every morning. The client interacted minimally with the staff and spent most of the day in his room. As the nurse enters the unit at the beginning of the evening shift, the client is smiling and cheerful and appears to be relaxed. What should the nurse interpret as the most likely cause of the client's behavior? A. The Effexor is helping the client's symptoms of depression significantly. B. The client's sudden improvement calls for close observation by the staff. C. The staff can decrease their observation of the client. D. The client is nearing discharge due to the improvement of his symptoms.

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