Depressive disorders EAQ

When the nurse remarks to a depressed patient, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to: 1 - Wait quietly for the patient to reply 2 - Prompt the patient if the reply is slow 3 - Repeat the question if the patient does not answer promptly 4 - Review the patient's medical record to support the patient's response

1 Depressed patients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.

A nurse caring for a patient with depression instructs the patient to rest after group activity. The nurse provides warm milk to the patient in the morning and at night. What change does the nurse find in the patient after implementation of this these interventions? 1 - The patient sleeps properly. 2 - The patient interacts with the nurse. 3 - The patient maintains good hygiene. 4 - The patient has an increased appetite

1 Depressive patients often have insomnia. The nurse should ensure that patients rest adequately after group activity. This helps to reduce fatigue, which can intensify the symptoms of depression. The patient can be given warm milk at night to induce sleep. Encouraging the patient to interact with the nurse or practice good hygiene or improving the patient's appetite may be treatment goals but they are not directly related to the nurse's intervention with warm milk.

A teenage patient was admitted several weeks ago after a suicide attempt. Despite family therapy, one of the parents is still struggling to cope with the child's behavior. Which teaching point would be most beneficial for the parents? 1 - Depression is beyond voluntary control, but it can be managed. 2 - The patient needs to be able to express anger directly at the parents. 3 - The parents should also seek therapeutic help because depression is hereditary. 4 - The patient should stop taking prescribed medicines if the patient mentions suicide.

1 Family support is key to improving the prognosis for depressed teenagers. Crucial to this is the parents' understanding that depression is involuntary but can be managed. The patient should not stop taking prescribed medications without consulting the doctor. The patient does need to find ways to express feelings, but expressing anger is not always a solution. Depression can be hereditary, but this does not address the parent's concern.

A young adult patient is being evaluated for mental illness. What risk factor would most likely result in a diagnosis of depression? 1 - Neuroticism 2 - Parents' divorce 3 - Optimal physical health 4 - A cousin with depression

1 Neuroticism is a negative personality trait often seen in patients with major depressive disorder. Family history generally only extends to first-degree family members. Physical health would be a factor if the patient was in poor health. A divorce of the parents may have an impact on a child, but it is less of a risk factor than neuroticism.

An older adult patient being treated for depression has multiple medications. The family finds the patient delirious, spasmodic, hyperpyrexic, and hypertensive. The patient may have overdosed on which class of drugs? 1 - Selective serotonin reuptake inhibitors (SSRIs) 2 - Serotonin norepinephrine reuptake inhibitors (SNRIs) 3 - Norepinephrine and dopamine reuptake inhibitors (NDRIs) 4 - Noradrenergic and specific serotonergic antidepressant (NaSSAs)

1 SSRIs work by preventing the reuptake of serotonin. An overdose would cause a drastic rise in serotonin, causing delirium, spasms, hyperpyrexia, and hypertension. SNRIs and NaSSAs may cause this problem but to a lesser extent. NDRIs have no effect on serotonin.

A patient who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The patient mentions that he or she will take the medication along with the St. John's wort he or she uses daily. The nurse should: 1 - Explain the high possibility of an adverse reaction 2 - Suggest that the patient also use a sun lamp daily 3 - Caution the patient to drink several glasses of water daily 4 - Agree that taking the drugs at the same time will help the patient to remember them daily

1 Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants.

A depressive patient with comorbid anxiety was prescribed vagus nerve stimulation (VNS). What appropriate teachings does the nurse give to the patient's family? (SATA) 1 - The nurse informs them about voice alteration. 2 - The nurse advises "Turn off the device when needed." 3 - The nurse tells them "Caution: Never turn off the device." 4 - The nurse informs them about confusion in the patient. 5 - The nurse informs them that the patient may have paralysis.

1, 2 Vagus nerve stimulation (VNS) is a surgery in which a pacemaker is implanted into the left chest wall of the patient. Most of the patients may have voice alteration as a side effect, and they and their family should be informed about it. The patient should be advised to turn off the device when needed, such as during exercise. The device can be turned off by placing a special magnet over the implant. It is not necessary to keep the device on all the time. Side effects include neck pain, cough, paresthesia and dyspnea. The patient may not have paralysis or confusion.

Which statements are associated directly with Beck's cognitive triad? (SATA) 1 - "I'm not worth much; I can't do anything right." 2 - "Things will only get worse; they never get better." 3 - "I'll never find anyone who loves or values me." 4 - "I don't think other people are worthless." 5 - "Good luck happens to good people."

1, 2, 3 Three assumptions constitute Beck's cognitive triad: (1) a negative, self-deprecating view of self; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement (or no validation for the self) will continue in the future. Statements such as "I don't think other people are worthless" and "Good luck happens to good people" lack the negative assumptions associated with the cognitive triad.

Which assessment data are associated with monoamine oxidase inhibitor (MAOI) therapy? (SATA) 1 - Reports dizziness when standing up 2 - Weight gain of five pounds in last four weeks 3 - Heart rate 100 beats per minute and irregular 4 - Facial twitch noted in left cheek 5 - Diarrhea for last three days

1, 2, 3, 4 Some common and troublesome long-term side effects of the MAOIs are orthostatic hypotension, weight gain, change in cardiac rate and rhythm, constipation, and muscle twitching.

What information will be included in medication education for a patient prescribed an antidepressant? (SATA) 1 - The goal of antidepressant therapy is the remission of symptoms. 2 - It generally takes one to three weeks of antidepressant therapy for mood to improve. 3 - It may require a change in prescription to identify the most effective antidepressant. 4 - Antidepressant therapy is contraindicated in individuals diagnosed with bipolar disorder. 5 - Antidepressant therapy may trigger psychosis in patients diagnosed with schizophrenia

1, 2, 3, 5 A drawback of antidepressant drugs is that improvement in mood may take one to three weeks or longer. The goal of antidepressant therapy is the complete remission of symptoms. Often, the first antidepressant prescribed is not the one that ultimately will bring about remission. Antidepressants may precipitate a psychotic episode in a person with schizophrenia. Patients with bipolar disorder often receive a mood stabilizing drug along with an antidepressant.

What are the side effects of transcranial magnetic stimulation? (SATA) 1 - Seizures 2 - Dementia 3 - Headache 4 - Hallucinations 5 - Unconsciousness

1, 3 Patients who have undergone transcranial magnetic stimulation may have side effects, such as headache and mild seizures, due to the feeling of contraction of the scalp and a slight tapping sensation in the head. Neurological effects like dementia, hallucinations, and unconsciousness are not the associated side effects of transcranial magnetic stimulation.

Which statements are true regarding serotonin syndrome? (SATA) 1 - Discontinue all selective serotonin reuptake inhibitors (SSRIs) for two to five weeks before starting a monoamine oxidase inhibitor (MAOI) 2 - Believed to be associated with under-activation of serotonin receptors 3 - Symptoms include hypertension and delirium 4 - Death can result from severe symptomology 5 - Hypothermia and septic shock are severe manifestations of the disorder

1, 3, 4 A patient should discontinue all SSRIs for two to five weeks before starting an MAOI. Symptoms include abdominal pain, diarrhea, sweating, fever, tachycardia, elevated blood pressure, altered mental state (delirium), myoclonus (muscle spasms), increased motor activity, irritability, hostility, and mood change. Severe manifestations can induce hyperpyrexia (excessively high fever), cardiovascular shock, or death. Serotonin syndrome is thought to be related to over-activation of the central serotonin receptors caused by either too high a dose or interaction with other drugs.

What are the side effects of vagus nerve stimulation (VNS)? (SATA) 1 - Cough 2 - Delusions 3 - Neck pain 4 - Paresthesia 5 - Tachycardia

1, 3, 4 Patients who have undergone VNS may have side effects, including paresthesia, neck pain, and cough due to the position and implantation of the VNS device on the vagus nerve. The electrode used for stimulation is placed close to the laryngeal and pharyngeal branch of the left vagus nerve. Stimulation of these nerves causes coughing. The vagus nerve has an inhibitory effect on the heart; therefore bradycardia, not tachycardia, is a symptom associated with vagus nerve stimulation. Vagus nerve stimulation does not alter the neurotransmitter levels in the brain, so the patient does not have delusions.

Which antidepressant drug can be prescribed to depressed patients who also suffer from narrow-angle glaucoma? (SATA) 1 - Bupropion 2 - Amitriptyline 3 - Desipramine 4 - Isocarboxazid 5 - Tranylcypromine

1, 4, 5 Bupropion is a norepinephrine dopamine reuptake inhibitor that can be prescribed to treat depression in patients with narrow angle glaucoma. It blocks the synaptic reuptake of norepinephrine and dopamine instead of the muscarinic receptors. Isocarboxazid is a monoamine oxidase inhibitor that inhibits the monoamine oxidase enzyme. It does not antagonize the muscarinic actions, so it can be prescribed to patients with narrow angle glaucoma. Tranylcypromine is a monoamine oxidase inhibitor. It does not cause side effects like blurred vision, so it is safe to be prescribed. Tricyclic antidepressants such as desipramine and amitriptyline must be avoided in depressed patients with narrow angle glaucoma. Tricyclic antidepressants are muscarinic receptor antagonists and thus cause blurred vision. These drugs would worsen the condition of narrow angle glaucoma.

Which assessment technique will the nurse use when attempting to substantiate a patient's diagnosis of major depression? 1 - Assesses the patient for signs of anorexia 2 - Asks the patient, "Have you ever been depressed like this before?" 3 - Assesses the patient for behaviors associated with drug abuse 4 - Asks the patient, "Are you having any problems falling or staying asleep?"

2 Although most untreated episodes of major depression last 6 to 24 months, more than 50% of those who have one episode will eventually have another, and 25% of patients will have chronic, recurrent depression. Although anorexia, drug abuse, and dysfunctional sleep patterns may be comorbid conditions associated with depression, they are not strong risk factors for developing the disorder.

In the absence of a previous suicide attempt, the nurse is most concerned about a patient's risk for self-harm when the male patient shares which information? 1 - His wife divorced him six months ago. 2 - He was diagnosed with major depression 10 years ago. 3 - His mother experienced postpartum depression after his birth. 4 - He often spends days alone in a cabin located miles away from the main road.

2 Although previous suicide attempts indicate risk, the longer the time one spends depressed is a major factor in determining the long-term risk of suicide. Divorce triggers depression in some individuals but is not the greatest risk factor among those provided, as not all those experiencing a divorce become depressed. A history of depression in an immediate family member is considered a risk factor but is not the greatest risk factor provided as it does not affect the patient directly. Social isolation is considered a risk factor but is not the greatest risk factor among those provided. Episodic solitude may be normal in this individual.

A patient says to the nurse, "Life doesn't have any joy in it anymore. Things I once did for pleasure aren't fun." What term would the nurse use to document this complaint? 1 - Dysthymia 2 - Anhedonia 3 - Euphoria 4 - Psychomotor retardation

2 Anhedonia is a common finding in many types of depression. It refers to feelings of a loss of pleasure in formerly pleasurable activities. Dysthymic disorder is characterized by chronic low-level depression while euphoria is an extreme sense of joy. Psychomotor retardation is related to physical movement not emotion.

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed patients on the unit are older than 60 years." The reply by the nurse that clarifies the prevalence of this disease is: 1 - "Depression most often is seen among the middle adult age group." 2 - "Depression is seen in people of all ages, from childhood to old age." 3 - "The age of onset for most depressive episodes is given as 18 years." 4 - "That is a good observation. Depression does mostly strike people older than 50 years."

2 Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.

What statement about the comorbidity of depression is accurate? 1 - Depression most often exists in an individual as a single entity. 2 - Depression commonly is seen in individuals with medical disorders. 3 - Substance abuse and depression are seldom seen as comorbid disorders. 4 - Depression may coexist with other disorders, but is rarely seen with schizophrenia.

2 Depression commonly accompanies medical disorders. Depression existing most often as a single entity, seldom seen with substance abuse, and rarely seen with schizophrenia are false statements.

A young adult patient reports to the nurse that her premenstrual symptoms have worsened. She has read about premenstrual dysphoric disorder (PMDD) and thinks she may have the condition. Which statement about the disorder is true? 1 - PMDD symptoms worsen after menopause. 2 - Fluoxetine is one potential treatment option. 3 - The disorder will not resume after a pregnancy. 4 - PMDD means she will always have severe depression.

2 Fluoxetine can be used to treat PMDD. PMDD does not necessarily mean a patient will always have severe depression. The disorder can manifest as long as a woman is menstruating, including during the postnatal period. Symptoms generally decrease after menopause unless the patient receives hormone replacement therapy.

Which food is safe for a patient taking monoamine oxidase inhibitors (MAOIs)? 1 - Avocados 2 - Pineapple 3 - Chocolate 4 - Cheddar cheese

2 Patients taking MAOIs must avoid foods containing tyramine. Most fruits, like pineapple, are safe to eat while taking MAOIs, as they have low levels of tyramine. Avocados, especially overripe ones, are high in tyramine. Almost all dairy products like cheddar cheese contain tyramine. Chocolate is also a food to avoid.

Which statement about antidepressant medications, in general, can serve as a basis for patient and family teaching? 1 - They tend to be more effective for men. 2 - Onset of action is from one to six weeks. 3 - Recent memory impairment is observed commonly. 4 - They often cause the patient to have diurnal variation.

2 People are accustomed to fast results from medication: 30 minutes for aspirin, 24 hours for antibiotics. Information is necessary to prevent discouragement and maintain compliance.

Which statement would show acceptance of a depressed, mute patient? 1 - "I will be spending time with you each day to try to improve your mood." 2 - "I would like to sit with you for 15 minutes now and again this afternoon." 3 - "Each day we will spend time together to talk about things that are bothering you." 4 - "It is important for you to share your thoughts with someone who can help you evaluate your thinking."

2 Spending time with the patient without making demands is a good way to show acceptance.

Subsyndromal depression primarily occurs in which population? 1 - Adults 2 - Elderly 3 - Children 4 - Teenagers

2 Subsyndromal depression is most prevalent in older adults. It occurs when the patient experiences some, but not all, of the symptoms that are seen in a major depressive episode. Children, adolescents, and adults are less susceptible to subsyndromal depression.

What is the major reason for hospitalization for depressed patients? 1 - Inability to go to work 2 - Suicidal ideation 3 - Loss of appetite 4 - Psychomotor agitation

2 Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. Inability to go to work, loss of appetite, and psychomotor agitation describe symptoms of major depression but are not by themselves the major reason for hospitalization.

A patient hospitalized for major depression has been taking sertraline for the past week and has verbalized increased energy and improved sleep. What is the highest priority question the nurse should ask? 1 - "Do you think your depression is less severe?" 2 - "Are you having any thoughts of harming yourself?" 3 - "Have you experienced any side effects from this drug?" 4 - "How has your appetite changed since starting this drug?"

2 The patient is starting to experience increased energy, but suicidal thoughts may still remain. The patient may now have the energy for self-harm. It is important to assess for other side effects, such as appetite changes and depression, but suicide is the highest priority.

Which statements about the physical activity of a patient diagnosed with major depression are true? (SATA) 1 - Psychomotor agitation results in purposeful, goal-oriented activity. 2 - The individual may present with a reduction in psychomotor activity. 3 - Psychomotor agitation is demonstrated in cases of major depression. 4 - A slow pace and stooped posture is characteristic of psychomotor retardation. 5 - Fidgeting is a characteristic psychomotor activity associated with depression.

2, 3, 4, 5 Physical activity also is affected in major depression. Normally one thinks of depressed patients as having psychomotor retardation, a reduction in the amount of physical activity. This type of symptom results in less motor movement; when the patients do move, they move more slowly and posture frequently is stooped with the head down; however, patients with major depression also may have psychomotor agitation. When this occurs, the patient appears restless, changes position often, and may wring his or her hands and fidget. This is not goal-directed activity, and the patient does not feel energized.

In a clinical study for a new antidepressant drug, the nurse was asked to select patients for the study. Which parameters should the nurse assess to include the patient in the study? (SATA) 1 - Blood pressure 2 - Serotonin levels 3 - Cortisol levels in urine 4 - Urine output and fluid intake 5 - Corticotrophin-releasing hormone

2, 3, 5 Patients with depression have increased cortisol levels in the urine and elevated corticotrophin-releasing hormone. Depression is also caused due to the dysregulation of neurotransmitters, mainly serotonin levels. Blood pressure, urine output, and fluid intake levels are not related to depression.

A patient says to the nurse, "I once enjoyed going to parks and museums with my family but that is not fun anymore." How would the nurse document this complaint? 1 - Anergia 2 - Euthymia 3 - Anhedonia 4 - Self-deprecation

3 Anhedonia means that there is no pleasure or joy in life. It is a common finding with depression. Anergia refers to a lack of energy or physical passivity. Euthymia refers to a mood state that is normal and moderate, with neither depression nor mania. Self-deprecation refers to negative statements about self.

Which complaint regarding sleep would the nurse expect from a patient diagnosed with major depression? 1 - "I usually take a nap for about 30 minutes in the afternoon." 2 - "It takes me about 15 minutes to fall asleep. I often have vivid dreams." 3 - "I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." 4 - "I often fall asleep in the middle of an activity. When I wake up, I feel better."

3 Change in sleep patterns is a cardinal sign of depression. Often, people experience insomnia, wake frequently, and have a total reduction in sleep, especially deep-stage sleep. One of the hallmark symptoms of depression is waking at 3 or 4 AM and then staying awake or sleeping for only short periods. Napping, vivid dreams, and falling asleep in the middle of an activity identify normal sleep variations and narcolepsy.

Assessment of the thought processes of a patient diagnosed with depression is most likely to reveal: 1 - Good memory and concentration 2 - Delusions of persecution 3 - Self-deprecatory ideation 4 - Sexual preoccupation

3 Depressed patients never feel good about themselves. They have a negative, self-deprecating view of the world.

A patient is prescribed tricyclic antidepressants. What should the nurse check for in the patient's case history before administering the drug? 1 - Suicidal ideation 2 - Loss of appetite 3 - Oral contraceptive use 4 - Insomnia

3 Medications such as oral contraceptives, antihypertensive reagents, monoamine oxidase inhibitors and anticoagulants may react with tricyclic antidepressants. It can cause potent side effects due to drug interaction. The nurse should check for their administration in the patient's case history and inform the primary healthcare provider. Suicidal ideation, loss of appetite, and insomnia are common symptoms of depression.

A depressed patient is noted to pace most of the time, pull at his or her clothes, and wring his or her hands. These behaviors are consistent with: 1 - Senile dementia 2 - Hypertensive crisis 3 - Psychomotor agitation 4 - Central serotonin syndrome

3 These behaviors describe the psychomotor agitation sometimes seen in patients with the agitated type of depression.

Which assessment data supports the suspicion that a depressed patient is demonstrating self-directed anger? (SATA) 1 - Multiple failed marriages 2 - Declared bankruptcy twice 3 - Three pack a day cigarette smoker 4 - Diagnosed as being morbidly obese 5 - Hospitalized for alcohol detoxification

3, 4, 5 Anger in depression may be directed toward the self in the form of suicidal or otherwise self-destructive behaviors (e.g., alcohol abuse, substance abuse, overeating, smoking, etc.). Multiple marriages and financial problems are not characteristic examples of self-directed anger.

What statement regarding how depression affects both children and older adults is true? (SATA) 1 - Children and older adults share similar symptoms of depression. 2 - Depression among older adults is believed to be a normal occurrence related to aging. 3 - Depression increases the risk for suicide among those older adults experiencing the disorder. 4 - Incidence of depression among children between ages 13 and 17 warrant screening of that population. 5 - The younger one is when the initial episode of depression occurs, the higher the risk of recurring episodes.

3, 4, 5 Because symptoms vary by age and circumstance, depression in children, until recently, has been underrecognized. Children and adolescents between 13 and 18 years of age have an 11.2% prevalence of depression, and 3.3% have a severe form of the illness. If the first episode of depression occurs in childhood or adolescence, the likelihood of recurrence is high, setting the stage for recurrent depression. Although depression in older adults is common, it is not a normal result of aging. A disproportionate number of older adults with depression are likely to die by suicide.

A geriatric patient is diagnosed with depression. What appropriate method does the nurse take while administering the medications to the patient? (SATA) 1 - Administer a dose that is twice the highest adult dose 2 - Adjust the dose of the medications every month 3 - Check for cardiotoxicity in the patient 4 - Stop administering the medication when the patient is aggressive 5 - Administer a dose that is half the lowest adult dose

3, 5 Geriatric patients do not have normal metabolic process and may practice polypharmacy, or the use of multiple medications. The drug dosages administered should be less for geriatrics, at half the dose of the lowest adult dose. The nurse should check for the signs of cardiotoxicity in the patients who suffer from hypotension. The dose should never be doubled as it can cause toxicity. Dosage adjustments must be made every seven days based on the metabolism and other conditions of the patient. The nurse should not stop the medications even if the patient is aggressive, as it can lead to discontinuation syndrome.

A patient diagnosed with chronic severe depression has been prescribed a series of electroconvulsive therapy (ECT) treatments. The nurse's initial intervention is to ask: 1 - "Would you feel more relaxed about the treatments if I stayed with you?" 2 - "What can I do to help you feel more comfortable about these treatments?" 3 - "Do you know very much about the benefits and drawbacks of ECT treatments?" 4 - "Will you let me know if you want or need to talk about these ECT treatments?"

4 An essential role of the nurse is to allow the patient an opportunity to express feelings, including concerns associated with myths or fantasies involving ECT. "Will you let me know if you want or need to talk about these ECT treatments?" does not present any barriers to communication and so allows the patient to express his or her feelings and concerns. The question about the nurse staying with the patient makes assumptions about the patient's concerns and so is a barrier to effective communication. The questions about helping the patient feel more comfortable and concerning the benefits and drawbacks of ECT make assumptions about the patient's needs and so are barriers to effective communication.

When the health care provider mentions that a patient has anhedonia, the nurse can expect that the patient: 1 - Has poor retention of recent events 2 - Experienced a weight loss from anorexia 3 - Has difficulty with tasks requiring fine motor skills 4 - Obtains no pleasure from previously enjoyed activities

4 Anhedonia is the term for the lack of ability to experience pleasure.

The nurse cares for an adult who repeatedly says, "My dead relatives try to talk to me and penetrate my body." This comment is most associated with which of the following disorders? 1 - Seasonal affective disorder 2 - Disruptive mood dysregulation disorder 3 - Substance-induced depressive disorder 4 - Major depressive disorder with psychosis

4 Depressive disorders are classified according to symptoms or the situations under which they occur. During a major depressive episode, the person's ability to think clearly is negatively affected and evidence of delusional thinking may be seen. Delusional thinking is an aspect of psychosis. Seasonal affective disorder is characterized by marked seasonal differences in mood associated with decreased daylight. Substance-induced depressive disorder applies when symptoms of a major depressive episode arise in association with drug or alcohol intoxication or withdrawal. Disruptive mood dysregulation disorder relates to children and refers to situations in which a person has frequent temper tantrums, resulting in verbal or behavioral outbursts out of proportion to the situation.

What is the best question for the nurse to ask when attempting to assess for the presence of depression in an elderly patient? 1 - Are you having crying spells every day? 2 - What is your family history related to depressive illnesses? 3 - Would you say you are currently having a major depressive episode? 4 - How do you compare your activities and health now to six months ago?

4 Elderly patients may not acknowledge depression directly. Changes in somatic and interpersonal activities often give clearer evidence of depression.

A pregnant patient is diagnosed with seasonal affective disorder. What appropriate action does the nurse include in the patient's treatment plan? 1 - Administer St. John's wort (Hypericum perforatum) regularly. 2 - Administer selective serotonin reuptake inhibitors regularly. 3 - Advise the patient to rest and avoid strenuous activity. 4 - Instruct the patient to get exposed to a light source for 30 to 45 minutes daily.

4 Light therapy is the best treatment for seasonal affective disorder. It increases the melatonin secretion by the pineal gland. It is ideal to expose the patient to a light source for 30 to 45 minutes. It helps in elevating the mood of the patient with seasonal affective disorder. St. John's wort (Hypericum perforatum), though it is an herb, should not be given to pregnant patients as it may not be safe. Selective serotonin reuptake inhibitors must not be used as they may have teratogenic effects on the fetus. Exercise enhances the mood, so the nurse must encourage the patient to exercise regularly.

A patient and his or her spouse seek treatment for what they describe as severe depression. The spouse tells the nurse the patient goes on bouts of "wild gambling." The patient becomes excitable for days and eventually ends up losing large amounts of money. What can the nurse determine about this patient's depression? 1 - This is a classic case of major depressive disorder. 2 - The bouts of gambling are called depressive episodes. 3 - The patient may be experiencing early-onset schizophrenia. 4 - The patient may have a condition other than major depression.

4 One criterion for a diagnosis of major depressive disorder is the lack of a manic or hypomanic episode. The gambling episodes are more in line with the manic and compulsive traits seen in bipolar depression. This means it is not a typical case of major depressive disorder. Differentiating between depressive disorder and episodic depression is typically made based on frequency and duration. There is no mention of hallucinations or delusions, which is central to a diagnosis of schizophrenia.

A depressed male patient tells the nurse he is in the 'acute phase' of his treatment for depression. The nurse recognizes that the client has been in treatment: 1 - For more than four months 2 - That is directed toward relapse prevention 3 - That focuses on prevention of future depression 4 - To reduce depressive symptoms

4 The acute phase of depression therapy (6-12 weeks) is directed toward the reduction of symptoms and restoration of psychosocial and work function and may require some hospitalization.

An adult was hospitalized three days ago with a diagnosis of major depression with suicidal ideation. Which comment by this patient best reflects an improvement in the depression? 1 - "I am hungry all the time." 2 - "My family can get along fine without me." 3 - "Group therapy may be helpful to others but I find it tiresome to listen." 4 - "I talked with my family about ways we can celebrate holidays together."

4 The correct response indicates this patient is looking toward the future, which would not occur in the presence of continued suicidal thinking. An improved appetite is a positive finding but could be attributed to medication side effects or other events; it is not the best answer. Saying one's family can get along without him or her and not wanting to go to group therapy indicate hopelessness and continued severe depression.

A patient says to the nurse, "I had my first episode of depression after I got divorced about 10 years ago. I recognized what was happening to me because both of my parents suffer from depression." Which theory regarding the etiology of depression has the patient described? 1 - Cognitive theory 2 - Biochemical factors 3 - Learned helplessness 4 - Diathesis-stress model

4 The diathesis-stress model of depression takes into account the interplay between genetic and biological predisposition toward depression and life events. The physiological vulnerabilities, such as genetic predispositions, biochemical makeup, and personality structure, are referred to as a diathesis. The stress part of this model refers to the life events that impact individual vulnerabilities. Cognitive theory recognizes the role of early life experiences in the development of depression. Biochemical factors include genetic and biological variables in the etiology of depression. Learned helplessness refers to a theory about depression replacing anxiety.

While several different neurotransmitters are involved in mood stabilization, which are considered the main regulators? (SATA) 1 - Acetylcholine 2 - Dopamine 3 - Glutamate 4 - Norepinephrine 5 - Serotonin

4, 5 Two main neurotransmitters involved in mood are serotonin (5-hydroxytryptamine [5-HT]) and norepinephrine. Research suggests that depression results from the dysregulation of a number of neurotransmitter systems beyond serotonin and norepinephrine. The dopamine, acetylcholine, and glutamate also are believed to be involved in the pathophysiology of a major depressive episode.