Depressive disorder Questions (Unit IV)

The nurse is caring for a patient receiving a tricyclic antidepressant and is monitoring for anticholinergic side effects. Anticholinergic effects include which of the following? a) Blurred vision b) Hyperactive bowel sounds c) Urinary incontinence d) Moist skin

Blurred vision Explanation: Anticholinergic effects are prominent with tricyclic antidepressants. These include potentiation of CNS drugs, dry mucous membranes, warm and dry skin, blurred vision, decreased bowel motility, and urinary retention.

A nurse is preparing a presentation for family members of clients who have been diagnosed with depression. When describing the family response to depression, which of the following would the nurse include? a) Family members typically can understand how disabling depression can be. b) Abuse of the depressed person is a rare occurrence in families. c) Depression in one family member affects the entire family. d) Families of women older than 55 years of age with depression experience the majority of problems.

Depression in one family member affects the entire family. Explanation: Depression in one member affects the whole family. Spouses, children, parents, siblings, and friends experience frustration, guilt, and anger when the family member is immobilized and cannot function. It is often hard for others to understand the depth of the mood and how disabling it can be. The lack of understanding and difficulty of living with a depressed person can lead to abuse. Women between the ages of 18 and 45 years constitute the majority of those experiencing depression, and thus their families experience the majority of problems.

Which disorder is characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode? a) Dysthymic disorder b) Seasonal affective disorder c) Cyclothymic disorder d) Hypomania

Dysthymic disorder Explanation: Dysthymic disorder is characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode. Cyclothymic disorder is characterized by 2 years of numerous periods of hypomanic symptoms that do not meet the criteria for bipolar disorder. Seasonal affective disorder occurs in the winter or spring. Hypomania is a period of abnormally and persistently elevated, expansive, or irritable mood lasting 4 days.

A client with severe depression after immigrating to the United States and the loss of an infant expresses increasing suicidal ideation to the primary nurse. The priority nursing intervention should be: a) Ensuring that the client is not permitted to use anything that would be potentially dangerous. b) Encouraging the client to express feelings of isolation following the recent immigration. c) Encouraging attendance at group cognitive-behavioral therapy on the unit. d) Exploring the grief and loss issues concerning the baby's death.

Ensuring that the client is not permitted to use anything that would be potentially dangerous. Explanation: Although grief, loss, and isolation may be influencing the client's depressed state, the priority intervention is to prevent self-harm. All the interventions listed are appropriate, but ensuring safety from potential danger is the priority

Which of the following antidepressant medications is classified as a selective serotonin reuptake inhibitor (SSRI)? a) Tranylcypromine (Parnate) b) Phenelzine (Nardil) c) Isocarboxazid (Marplan) d) Fluoxetine (Prozac)

Fluoxetine (Prozac) Explanation: The SSRIs include Lexapro, Prozac, Zoloft, Luvox, Paxil, and Celexa. The monoamine oxidase inhibitors include Nardil, Marplan, and Parnate.

After teaching a group of nursing students about the neurobiologic theories of depression, the instructor determines the need for additional teaching when the students identify which neurotransmitter as playing a role? a) Dopamine b) Gamma-amino butyric acid (GABA) c) Norepinephrine d) Serotonin

Gamma-amino butyric acid (GABA) Explanation: According to the neurobiologic theories, major depression is caused by a deficiency or dysregulation in central nervous system concentrations of the neurotransmitters norepinephrine, dopamine, and serotonin or in their receptor functions. GABA has not been implicated

The nurse is caring for a client with major depression. The client tells the nurse that she "just isn't sure that life is worth living." The nurse documents which nursing diagnosis as the priority? a) Hopelessness related to symptoms of depression b) Thought Processes, Disturbed, related to memory loss and depression c) Self-esteem, Low, related to depressive episode d) Anxiety related to lack of energy for self-care activities

Hopelessness related to symptoms of depression Explanation: The priority nursing diagnosis is Hopelessness related to symptoms of depression. There is no evidence to suggest Low Self-Esteem, Anxiety, or Disturbed Thought Processes.

Which of the following would not be associated with learned helplessness? a) Negative expectations b) Hopelessness c) Passivity d) Impulsivity

Impulsivity Explanation: Behaviors that define learned helplessness include passivity, negative expectations, and feelings of helplessness, hopelessness, and powerlessness.

Electroconvulsive therapy (ECT) has been shown to be an effective treatment for people with severe depression. However, ECT is contraindicated in which of the following disease processes? a) Anxiety disorder b) Diabetes mellitus c) Hypertension d) Increased intracranial pressure

Increased intracranial pressure Explanation: ECT is contraindicated for patients with increased intracranial pressure. Other high-risk groups include those with recent myocardial infarction, recent cerebrovascular accident, retinal detachment, or pheochromocytoma. ECT is prescribed as a treatment modality for depression.

The nurse makes a home visit to a client who has dysthymic disorder. Which of the following would the nurse expect to assess? a) Agitation b) Normal appetite c) Intense concentration d) Low energy

Low energy Explanation: Dysthymic disorder is milder but more chronic and is diagnosed when the depressed mood is present for most days for at least 2 years. Two or more of the following symptoms should be present for this disorder: poor appetite or overeating, low energy or fatigue, low self-esteem, poor concentration, and feelings of hopelessness.

A client's physician has prescribed paroxetine (Paxil) for the treatment of her depression. Which of the following teaching points should the nurse include in the client education related to this treatment? a) "Make sure that you don't change the quantity or timing of your medication without first consulting your doctor." b) "The advantage of Paxil is that it will normally relieve depression in a few weeks and it has no side effects." c) "If you don't feel noticeably better within three weeks, increase your dose by 50 %." d) "If you forget to take a dose one day, take a double dose the next day and be sure to let your doctor know."

Make sure that you don't change the quantity or timing of your medication without first consulting your doctor." Explanation: During client education, it is necessary to stress the importance of consulting the prescriber before discontinuing or changing the dosing of any medication. Paxil, like all drugs, carries the potential of adverse side effects.

Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with which one of the following? a) Moderate depression b) Postpartum psychosis c) A mood disorder due to a general medical condition d) Anaclitic depression

Moderate depression Explanation: Cognitive psychotherapy is as effective as antidepressant medication in the treatment of mild-to-moderate depression. It is less likely to address depression that has a demonstrated medical etiology. The primary treatment for postpartum psychosis is medication. Therapy is not relevant in cases of anaclitic depression since the problem occurs in infants.

According to the Learned Helplessness behavioral theory, the psychiatric nurse shows an understanding of therapeutic supportive care of a client depressed over the loss of employment when a) Providing a list of community services to reassure the client that resources are available to help until employment is found b) Determining how the client reacted to stressors like this before in order to evaluate the effectiveness of his coping skills c) Providing positive reinforcement concerning the client's ability to find another job by helping him identify his employable skills d) Helping the client realize he was not responsible for the loss of his job but rather it is a result of circumstances outside of his control

Providing positive reinforcement concerning the client's ability to find another job by helping him identify his employable skills Explanation: According to the Learned Helplessness behavioral theory, the psychiatric nurse shows an understanding of therapeutic supportive care of a client depressed over the loss of employment when providing positive reinforcement concerning the client's ability to find another job by helping him identify his employable skills

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which of the following nursing diagnoses has the highest priority? a) Hopelessness related to recent divorce b) Ineffective coping related to inadequate stress management c) Spiritual distress related to conflicting thoughts about suicide and sin d) Risk for suicide related to highly lethal plan

Risk for suicide related to highly lethal plan Explanation: Safety is the priority. The overall goals for the client who is suicidal is to first keep the client safe and later to help him or her to develop new coping skills that do not involve self-harm. Answers A, B, and C would not be the priority diagnosis for this client.

Which type of antidepressants is rarely fatal in overdose? a) SSRIs b) MAOIs c) Tricyclics d) Atypical

SSRIs Explanation: SSRIs are rarely fatal in overdose, but cyclic and MAOI antidepressants are potentially fatal. Prescriptions may need to be limited to only a 1-week supply at a time if concerns linger about overdose.

The priority concern for people with mood disorders is which of the following? a) Occupational functioning b) Basic care c) Safety d) Social functioning

Safety Explanation: The overriding concern for people with mood disorders is safety because these individuals may experience self-destructive thoughts and suicidal ideation. Social and occupational functioning and basic care would not take priority.

A client has been diagnosed with major depressive disorder. A common symptom would include which of the following? a) Assertiveness b) Increased energy c) Ability to sleep without interruption d) Self-blame

Self-blame Explanation: Symptoms of major depressive disorder include self-blame, feelings of worthlessness, decreased energy, insomnia, and difficulty making decisions.

A client with depression is prescribed fluoxetine. On a return visit to the clinic, the client tells the nurse that he also just started taking St. John's wort to feel better. The nurse assesses the client for which of the following? a) Serotonin syndrome b) Water intoxication c) Hypertensive crisis d) Increased depressive symptoms

Serotonin syndrome Explanation: Fluoxetine is a selective serotonin reuptake inhibitor that when combined with St. John's wort can lead to serotonin syndrome. Water intoxication is possible with mood stabilizers such as lithium. The combination of fluoxetine and St. John's wort leads to an increase in intrasynaptic serotonin. Thus, a potential for toxicity is present. Hypertensive crisis occurs when MAOIs are taken with tyramine rich foods

A father of four small children lost his wife in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since his wife's death, his mood has been somber; until now, he has refused treatment. For what is this patient at high risk? a) Schizophrenia b) Dysthymic disorder c) Bipolar disorder d) Suicide

Suicide Explanation: If depression persists over time and is left untreated, it has a significant negative effect on quality of life and increases the risk of suicide.

The nurse is teaching a 70-year-old man about his depression. Which of the following statements by the client would indicate that teaching has been effective? a) "I never knew depression could just happen for no specific reason." b) "All old people get depressed at times." c) "I'm glad I'll feel better in 2 or 3 days." d) "When I reduce the stress in my life, the depression will go away."

"I never knew depression could just happen for no specific reason." Explanation: Depression can be endogenous, with no external cause or event. Clients must understand that depression is an illness, not a lack of willpower or motivation. Major depression typically involves 2 or more weeks of a sad mood or lack of interest in life activities with at least four other symptoms of depression

A client has been recently diagnosed with depression and has just begun medication management. Which of the client's following statements indicates an accurate understanding of this aspect of treatment? a) "I know that few people actually see an improvement in their mood with antidepressants, but I suppose I'll try anyhow." b) "I understand that I probably won't feel much better for a couple of weeks after I start the drugs." c) "I can tell that I get a lift each morning after I take my antidepressant." d) "I'm still trying to decide whether antidepressants will be helpful in my treatment."

"I understand that I probably won't feel much better for a couple of weeks after I start the drugs." Correct Explanation: Antidepressants are proven therapy in the treatment of depression, but effects are not normally observable or felt until 2 to 3 weeks after treatment starts.

The nurse working on a mental health unit is precepting a nursing student learning about depression. The student asks the preceptor about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response? a) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present." b) "Depression is a mood variation to life events." c) "The physician diagnosis depression when a patient has feelings of sadness several times a year." d) "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression."

"The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present." Explanation: Normal variations in mood (such as sadness, euphoria, and anxiety) occur in response to life events; they are time limited and not usually associated with significant functional impairment. The primary diagnostic criterion for major depressive disorder is one or more major depressive episodes (either a depressed mood or a loss of interest of pleasure in nearly all activities) for at least 2 weeks. Four of seven other symptoms must be present. Thus, the best response from the nurse is "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

A client comes to the emergency department complaining of a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and his pulse is racing. The client states that he is being treated for depression with selegiline. Which question by the nurse would be most important to ask at this time? a) "Are you having any chest pain?" b) "What have you had to eat or drink today?" c) "Do you use any herbal remedies?" d) "When did you last have blood drawn to check your drug level?"

"What have you had to eat or drink today?" Explanation: The client is exhibiting signs of a hypertensive crisis, which can occur when a client is receiving MAOI therapy (selegiline) and ingests food or other substances that contain tyramine. Thus, the nurse should ask the client what he has had to eat or drink. Drug levels are used to monitor tricyclic antidepressants. Asking about chest pain would be appropriate after obtaining information related to what the client has ingested. Herbal remedies can interact with medications, but this information would be obtained after determining if the client has ingested tyramine-containing foods and fluids

Research has shown that risk of suicide increases within which timeframe for initiation of antidepressant therapy? a) 35 days b) 42 days c) 28 days d) 14 days

14 days Explanation: Studies have shown that the risk for suicide increases within the first 2 to 3 weeks after starting antidepressant medication, usually because the client's mood has not lifted as quickly as physical energy has returned. (less)

When completing discharge medication education for the client, he asks how long it will take before the effects of his prescribed SSRI could be felt. The nurse states that it will likely take? a) 3 to 4 weeks b) 5 to 7 days c) 1 to 2 days d) 2 to 3 weeks

2 to 3 weeks Explanation: Most antidepressant medications do not become effective or reach a therapeutic level for at least 2 or 3 weeks.

The mental health nurse appropriately provides education on phototherapy to a a) 45-year-old lawyer whose medication therapy needs an additional treatment b) 50-year-old farmer whose major depression has not responded to any treatment modality c) 58-year-old showing signs of early Alzheimer's disease d) 20-year-old college student who reports being "too tired, sad and unfocused" to enroll for classes in the winter term

20-year-old college student who reports being "too tired, sad and unfocused" to enroll for classes in the winter term Explanation: Phototherapy—-or the exposure to bright artificial light-—can markedly reverse the symptoms of seasonal affective disorder (SAD), which occurs in the fall and winter. Phototherapy would be most appropriate for a 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

A client is prescribed phenelzine (Nardil) to treat her depression. She is at a local café for lunch with a friend. Which of the following items on the menu would be least appropriate for the client to order? a) A Cobb salad with blue cheese and Roquefort salad dressing b) Medium-well steak, French fries, and broccoli c) Scrambled eggs, toast, and grape jelly d) Roast beef, mashed potatoes, and gravy

A Cobb salad with blue cheese and Roquefort salad dressing Explanation: Phenelzine is a monoamine oxidase inhibitor (MAOI). If co-administered with food or other substances containing tyramine (e.g., aged cheese, beer, red wine), MAOIs can trigger a hypertensive crisis that may be life threatening. The blue cheese is aged, and the Roquefort salad dressing contains aged cheese.

A client has been diagnosed with major depressive disorder. The clinical symptoms that would be included when the clinician makes this diagnosis are what? a) A significant decrease in appetite b) Demonstrated examples of unwise decisions c) A significant failure in an occupational or relational setting d) Claims by family, friends, or coworkers that the client is depressed

A significant decrease in appetite Explanation: Among the nine clinical symptoms of a major depressive episode is a significant increase or decrease in appetite. Failures may precipitate or exacerbate decisions and others may confirm the client's depression, but these are not diagnostic criteria. Unwise decision making is not a hallmark of depression, but indecisiveness is a diagnostic criterion.

Which of the following clients is most likely to benefit from electroconvulsive therapy (ECT)? a) A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy b) A woman whose major depression has not responded appreciably to antidepressants c) A client whose recent strange behavior has been attributed to cyclothymic disorder d) A man with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode

A woman whose major depression has not responded appreciably to antidepressants Explanation: While ECT is used to treat an increasing range of psychiatric-mental health problems, individuals with major depression are often among the best candidates for the treatment. ECT would not be used as a response to noncompliance, and a person who is currently experiencing a manic episode is less commonly treated with ECT. Cyclothymic disorder is less severe than bipolar II disorder and is consequently less likely to warrant ECT.

A client diagnosed with depression is being treated with Phenelzine (Nardil). The nurse should teach the client to avoid which of the following foods? a) Aged cheese b) Chicken c) Oranges d) Rice

Aged cheese Explanation: Hypertensive crisis is the most serious side effect and is life-threatening when a client prescribed an MAOI ingests tyramine-containing foods, such as aged cheese.

Suicide is the intentional act of killing oneself. Which characteristic is most common among suicidal clients? a) Anger b) Remorse c) Ambivalence d) Psychosis

Ambivalence Explanation: Suicide involves ambivalence. Many fatal accidents may be impulsive suicides. It is impossible to know, for example, whether the person who drove into a telephone pole did this intentionally.

The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should a) Assess for depression in the client's family history b) Prepare the client for diagnostic genetic testing to confirm the diagnosis c) Encourage the client to seek genetic counseling before considering a pregnancy d) Educate the client regarding the symptoms of related physical disorders

Assess for depression in the client's family history Explanation: The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should assess for depression in the client's family history.

Which of the following is a true statement regarding depressive disorders? a) They are more prevalent in men than women. b) The monoamines norepinephrine, dopamine, and serotonin have been implicated. c) Depression in older adults is easier to diagnosis. d) It is the leading cause of U.S. disability in clients older than 44 years of age.

The monoamines norepinephrine, dopamine, and serotonin have been implicated. Explanation: The monoamines that have been implicated in depression are norepinephrine (NE), dopamine (DA), and serotonin (5-HT). Disturbances in mood may result when absolute concentrations of NE, 5-HT, or both are deficient. Depressive disorders are more prevalent in women than in men. Depression in older adults may be difficult to diagnose because many older people have co-morbid diseases. It is currently the leading cause of U.S. disability in clients 15 to 44 years of age.

A patient is admitted to the hospital. When the nurse takes a medication history, the patient reports use of St. John's wort. The nurse knows that this herb is used for which of the following? a) To fight high cholesterol b) To prevent cancer c) To fight depression d) To prevent enlarged prostate

To fight depression Explanation: St. John's wort is a herb used to fight depression. When taken with an antidepressant that affects serotonin regulation, the combination may cause serotonin syndrome, which includes altered mental status and autonomic dysfunction

The patient is taking an MAOI for depression. The nurse teaches the patient to avoid foods containing which of the following while taking this medication? a) Sugar b) Tyramine c) Calcium d) Potassium

Tyramine Explanation: If co-administered with food or other substances containing tyramine, MAOIs can trigger a hypertensive crisis, which may be life threatening. MAOIs given with foods containing calcium, potassium, or sugar do not cause a hypertensive crisis.

Susan was abandoned by her parents at age 3, resulting in her perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of a) a biophysiological explanation for Susan's depressive disorder. b) a psychodynamic interpretation of Susan's major depressive disorder. c) why Susan has become lesbian at the age of 23. d) a feminist viewpoint of depression.

a psychodynamic interpretation of Susan's major depressive disorder. Explanation: Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. Such anger begins in childhood when basic developmental needs are not met. They cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.

Carrie, age 20, was admitted to your unit following a suicide attempt. She is disheveled, disorganized, and dehydrated. The priority for her care during the first 24 hours of her admission is a) assisting Carrie with her activities of daily living, including a shower and clean clothing. b) assessing Carrie's current suicidal ideation and putting her on suicide precautions. c) rehydrating Carrie by forcing fluids. d) assessing Carrie's recent suicide attempt and identifying factors that may have contributed to it.

assessing Carrie's current suicidal ideation and putting her on suicide precautions. Explanation: The first step is to provide for Carrie's safety by assessing her risk for suicide. Because Carrie has attempted suicide, the nurse immediately places her on suicide precautions with frequent or continuous one-to-one observation and reassessment.

The monoamine hypothesis of depression a) holds that depression is caused by sociocultural and psychological factors. b) holds that depression is caused by only one of the biogenic amines. c) relates to bipolar disorders, not to depression. d) holds that depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines.

holds that depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines. Explanation: The major monoamine hypothesis about depression is that absolute concentrations of norepinephrine, 5-HT, or both are deficient

A nurse taking an admission history from a patient suspects that they physician will diagnose major depression. For the physician to make this diagnosis, the patient will have to demonstrate at least four of seven symptoms. The nurse knows that some of these symptoms include which of the following? (Select all that apply.) a) Obsessive desire to exercise b) Disruption in concentration c) Disruption in sleep d) Excessive guilt e) Disruption in appetite

• Disruption in concentration • Disruption in sleep • Excessive guilt • Disruption in appetite Explanation: Four of seven symptoms must be present along with the episodes of depressed mood to qualify for a diagnosis of major depressive disorder. Symptoms include disruption in sleep, appetite, concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation.

A nurse taking an admission history from a patient suspects that they physician will diagnose major depression. For the physician to make this diagnosis, the patient will have to demonstrate at least four of seven symptoms. The nurse knows that some of these symptoms include which of the following? (Select all that apply.) a) Disruption in concentration b) Disruption in appetite c) Excessive guilt d) Obsessive desire to exercise e) Disruption in sleep

• Disruption in sleep • Disruption in appetite • Disruption in concentration • Excessive guilt Explanation: Four of seven symptoms must be present along with the episodes of depressed mood to qualify for a diagnosis of major depressive disorder. Symptoms include disruption in sleep, appetite, concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation.

A group of nursing students is reviewing information about the epidemiology of depressive disorders. The students demonstrate understanding of the information when they identify which of the following as possible risk factors? Select all that apply. a) Inadequate coping skills b) Prior episode of anxiety disorder c) Concomitant medical illnesses d) History of substance abuse as a teenager e) Little social support

• Little social support • Inadequate coping skills • Concomitant medical illnesses Explanation: Generally agreed-upon risk factors for depression include a prior episode of depression, family history of depressive disorder, lack of social support, lack of coping abilities, presence of life and environmental stressors, current substance use or abuse, and medical comorbidity.

To best minimize the risk of a client's noncompliance with new drug therapy for a mood disorder, the nurse discusses (Select all that apply.) a) Social barriers against psychiatric treatments b) Detailed description of possible side effects c) Importance of staying in touch with mental health care provider d) That the length of time treatment is anticipated e) That there is a possibility that two or more drugs will be prescribed

• That the length of time treatment is anticipated • That there is a possibility that two or more drugs will be prescribed • Detailed description of possible side effects • Importance of staying in touch with mental health care provider Explanation: To best minimize the risk of a client's noncompliance with new drug therapy for a mood disorder, the nurse discusses anticipated length of treatment time, the possibility of two more drugs being prescribed, possible side effects of the drug(s), and the importance of staying in touch with a mental health care provider.