Module 5 Depression
A 25-year-old male patient has been in inpatient treatment for severe depression for three weeks. He will be discharged soon, and the nurse is evaluating the effectiveness of the plan of care. Which outcome is the most appropriate indicator that the patient's depression is resolving sufficiently for safe discharge? A. The patient has resumed caring for his physical appearance and always appears clean and well groomed. B. The patient denies wanting to commit suicide. C. The patient expresses willingness to begin tapering his medication. D. The patient will sit in the public areas and will speak when addressed.
A
A nurse teaching a patient about a tyramine-resticted diet would approve of which meal? A. Mashed potatoes, ground beef patty, corn, green beans, and apple pie B. Avocado salad, ham, creamed potatoes, asparagus, and chocolate cake C. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, and yeast roll D. Tofu stir-fry on rice
A
Dysthymia refers to: A. A less severe form of depressive disorder B. A less severe form of bipolar I disorder C. Normal sad moods that most people feel from time to time D. A mood disorder related to dysfunction of the thymus gland
A
The nurse is doing patient teaching for Prozac. Which statements should be included in teaching A. You may have a decreased libido while taking this medicine. B. You should take this medicine at bedtime to help promote sleep. C. You will have fewer urinary adverse effects if you urinate just before taking this medication. D. You should avoid fava beans and sausages.
A
Tricyclic antidepressant medications: A. Can result in cardiotoxicity B. Are used to treat schizophrenia C. Can result in tardive dyskinesia D. Have low monoamine dietary restrictions
A
Which medication is a tricyclic antidepressant that has a high risk for lethality if taken in an overdose? A. Elavil (amitriptyline) B. Celexa (citalopram) C. Paxil (paroxetine) D. Zoloft (sertraline)
A
A patient diagnosed with major depressive disorder is taking a tricyclic antidepressant. The patient says, I dont think I can keep taking these pills. They make me so dizzy, especially when I stand up. The nurse should: a. explain how to manage postural hypotension, and educate the patient that side effects go away after several weeks. b. tell the patient that the side effects are a minor inconvenience compared with the feelings of depression. c. withhold the drug, force oral fluids, and notify the health care provider to examine the patient. d. teach the patient how to use pursed-lip breathing.
A Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with tricyclic antidepressants. Postural hypotension can be managed by teaching the patient to stay well hydrated and rise slowly. Knowing these facts may be enough to convince the patient to remain medication compliant. The minor inconvenience of side effects as compared with feelings of depression is a convincing reason to remain on the medication. Withholding the drug, forcing oral fluids, and having the health care provider examine the patient are unnecessary steps. Independent nursing action is appropriate. Pursed-lip breathing is irrelevant.
What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment? a. Supporting physiologic stability b. Reducing disorientation and confusion c. Monitoring pupillary responses d. Assisting the patient to identify and test negative thoughts
A During the immediate post-treatment period, the patient is recovering from general anesthesia, hence the need to establish and support physiologic stability. Monitoring pupillary responses is not a priority. Reducing disorientation and confusion is an acceptable intervention but not the priority. Assisting the patient in identifying and testing negative thoughts is inappropriate in the immediate post-treatment period because the patient may be confused.
A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, No one cares about me anymore. Im not worth anything. Select an appropriate initial outcome for the nursing diagnosis: Situational low self-esteem, related to feelings of abandonment. The patient will: a. verbalize realistic positive characteristics about self by (date) . b. consent to take antidepressant medication regularly by (date) . c. initiate social interaction with another person daily by (date) . d. identify two personal behaviors that alienate others by (date) .
A Low self-esteem is reflected by making consistently negative statements about self and self-worth. Replacing negative cognitions with more realistic appraisals of self is an appropriate intermediate outcome. The incorrect options are not as clearly related to the nursing diagnosis. Outcomes are best when framed positively; identifying two personal behaviors that might alienate others is a negative concept.
A patient diagnosed with major depressive disorder does not interact with others except when addressed and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Select the nurses most effective approach to communication. a. Make observations. b. Ask the patient direct questions. c. Phrase questions to require yes or no answers. d. Frequently reassure the patient to reduce guilt feelings.
A Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations on the patient for answers. Acceptance and support are shown by the nurses presence. Direct questions may make the patient feel that the encounter is an interrogation. Open- ended questions are preferable if the patient is able to participate in dialog. Platitudes are never acceptable; they minimize patient feelings and can increase feelings of worthlessness.
A patient diagnosed with major depressive disorder was hospitalized for 8 days. Treatment included six electroconvulsive therapy sessions and aggressive dose adjustments of antidepressant medications. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling. a. Temporary memory impairments and confusion can be associated with electroconvulsive therapy. b. Antidepressant medications alter catecholamine levels, which impair decision-making abilities. c. Antidepressant medications may cause confusion related to a limitation of tyramine in the diet. d. The patient needs time to reorient himself or herself to a pressured work schedule.
A Recent memory impairment or confusion or both are often present during and for a short time after electroconvulsive therapy. An inappropriate business decision might be made because of forgotten and important details. The incorrect responses contain rationales that are untrue. The patient needing time to reorient himself or herself to a pressured work schedule is less relevant than the correct rationale.
An adult diagnosed with major depressive disorder was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? a. Social skills training b. Relaxation training classes c. Use of complementary therapy d. Learning desensitization techniques
A Social skills training is helpful in treating and preventing the recurrence of depression. Training focuses on assertiveness and coping skills that lead to positive reinforcement from others and the development of a patients support system. The use of complementary therapy refers to adjunctive therapies such as herbals. Assertiveness would be of greater value than relaxation training because passivity is a concern. Desensitization is used in the treatment of phobias.
A nurse teaching a patient about a tyramine-restricted diet would approve which meal? a. Mashed potatoes, ground beef patty, corn, green beans, apple pie b. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake c. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls
A The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine, and fresh ground beef and apple pie should be safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages and hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate.
A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority? A. Placing the client on one-to-one observation B. Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects
A The greatest risk for a client who has MDD and comorbid anxiety is injury due to self-harm. The highest priority intervention is placing theclient on one-to-one observation.
A patient diagnosed with major depressive disorder will begin electroconvulsive therapy tomorrow. Which interventions are routinely implemented before the treatment? Select all that apply. a. Administer pretreatment medication 30 to 45 minutes before treatment. b. Withhold food and fluids for a minimum of 6 hours before treatment. c. Remove dentures, glasses, contact lenses, and hearing aids. d. Restrain the patient in bed with padded limb restraints. e. Assist the patient to prepare an advance directive.
ABC The correct interventions reflect routine electroconvulsive therapy preparation, which is similar to preoperative preparation: sedation and anticholinergic medication before anesthesia, maintaining nothing-by-mouth status to prevent aspiration during and after treatment, airway maintenance, and general safety by removing prosthetic devices. Restraint is not part of the pretreatment protocol. An advance directive is prepared independent of this treatment.
A patient diagnosed with major depressive disorder shows vegetative signs of depression. Which nursing actions should be implemented? Select all that apply. a. Offer laxatives, if needed. b. Monitor food and fluid intake. c. Provide a quiet sleep environment. d. Eliminate all daily caffeine intake. e. Restrict the intake of processed foods.
ABC The correct options promote a normal elimination pattern. Although excessive intake of stimulants such as caffeine may make the patient feel jittery and anxious, small amounts may provide useful stimulation. No indication exists that processed foods should be restricted.
The nurse will encourage the client to engage in regular involvement with which formalized groups as an intervention directed toward the treatment of a primary risk factor associated with depression? (Select all that apply.) Select all that apply. A. Alcoholics Anonymous (AA) B. Senior citizens travel group C. Sexual assault survivors group D. New moms support group E. Church-associated men's group
ACD Primary risk factors for depression include experiencing a negative, stressful event (sexual assault), postpartum period (support group), and alcohol or substance abuse (AA). The remaining options do not focus on identified risk factors and so are social in their nature.
A student nurse caring for a patient diagnosed with major depressive disorder reads in the patients medical record, This patient shows vegetative signs of depression. Which nursing diagnoses most clearly relate to the vegetative signs? Select all that apply. a. Imbalanced nutrition: less than body requirements b. Chronic low self-esteem c. Sexual dysfunction d. Self-care deficit e. Powerlessness f. Insomnia
ACDF Vegetative signs of depression are alterations in the body processes necessary to support life and growth, such as eating, sleeping, elimination, and sexual activity. These diagnoses are more closely related to vegetative signs than to diagnoses associated with feelings about self.
A patient being treated with paroxetine (Paxil) 50 mg/day orally for major depressive disorder reports to the clinic nurse, I took a few extra tablets earlier in the day and now I feel bad. Which aspects of the nursing assessment are most critical? Select all that apply .a. Vital signs b. Urinary frequency c. Increased suicidal ideation d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness
ADE The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. Although assessing for suicidal ideation is never inappropriate, in this situation physiologic symptoms should be the initial focus. The patient may have urinary retention, but frequency would not be expected.
A patient is hospitalized for major depressive disorder. The nurse can expect to provide the patient with medication teaching about: A. Librium (chlordiazepoxide) B. Prozac (fluoxetine) C. Clozaril (clozapine) D. Cognex (tacrine
B
A patient reports that he quit taking Effexor (venlafaxine) because of which common side effect: A. Hypotension B. Sexual dysfunction C. Hepatotoxicity D. Sedation and lethargy
B
A priority nursing intervention for a patient diagnosed with major depressive disorder is: A. Distracting the patient from self-absorption B. Carefully and inconspicuously observing the patient around the clock C. Allowing the patient to spend long periods alone in self-reflection D. Offering opportunities for the patient to assume a leadership role in the therapeutic milieu
B
A psychiatric nurse is reviewing prescriptions for a patient with major depression. Since the patient has a mild intellectual disability, the nurse should question which classification of antidepressant medications? A. SSRIs (selective serotonin reuptake inhibitors) B. MAOIs (monamine oxidase inhibitors) C. Serotonin and norepinephrine reuptake inhibitors D. All of the above
B
Client is taking Zoloft (sertraline). Which of the following assessment findings should alert the nurse to possibility client is developing serotonin syndrome? A. Bruising B. Fever (>104) C. Abdominal pain D. Rash
B
For which medication is it important for a nurse to include periodic blood pressure monitoring for a patient with borderline hypertension? A. Paxil (paroxetine) B. Effexor (venlafaxine) C. Remeron (nitrazepam) D. Lexapro (escitalopram)
B
Select the most critical question for the nurse to ask an adolescent who has threatened to take an overdose of pills: A. Why do you want to kill yourself? B. Do you have access to medications? C. Have you a history of depression? D. Did something upsetting happen with your parents?
B
Which question would be a priority when assessing for symptoms of major depression? A."Tell me about any special powers you believe you have." B."You look very sad and mentioned you were depressed. Tell me how you have been feeling. C."Your family says you never stop. How much sleep do you get?" D."Do you ever find you don't remember where you have been or what you have done?"
B
You realize that your patient who is being treated for a major depressive disorder requires more teaching when she makes the following statement: A. "I've been on this antidepressant for three days. I realize that the full effect may not happen for a period of weeks." B. "I'm going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow." C. "I may ask to have my medication changed to Wellbutrin due to the problems I'm having being romantic with my wife." D. I realize there are many antidepressants and it might take me a while until we find the one that works best for me."
B
A patient diagnosed with major depressive disorder repeatedly tells staff members, I have cancer. Its my punishment for being a bad person. Diagnostic tests reveal no cancer. Select the priority nursing diagnosis. a. Powerlessness b. Risk for suicide c. Stress overload d. Spiritual distress
B A patient with depression who feels so worthless as to believe cancer is deserved is at risk for suicide. Safety concerns take priority over the other diagnoses listed.
A patient says to the nurse, My life does not have any happiness in it anymore. I once enjoyed holidays, but now theyre just another day. How would the nurse document the complaint? a. Vegetative symptom b. Anhedonia c. Euphoria d. Anergia
B Anhedonia is a common finding in many types of depression and refers to feelings of a loss of pleasure in formerly pleasurable activities. Vegetative symptoms refer to somatic changes associated with depression. Euphoria refers to an elated mood. Anergia means without energy.
A priority nursing intervention for a patient diagnosed with major depressive disorder is: a. distracting the patient from self-absorption. b. carefully and inconspicuously observing the patient around the clock. c. allowing the patient to spend long periods alone in self-reflection. d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu.
B Approximately two thirds of people with depression contemplate suicide. Patients with depression who exhibit feelings of worthlessness are at higher risk. Regularly planned observations of the patient with depression may prevent a suicide attempt on the unit.
A patient diagnosed with major depressive disorder tells the nurse, Bad things that happen are always my fault. To assist the patient in reframing this overgeneralization, the nurse should respond: a. I really doubt that one person can be blamed for all the bad things that happen. b. Lets look at one bad thing that happened to see if another explanation exists. c. You are being exceptionally hard on yourself when you say those things. d. How does your belief in fate relate to your cultural heritage?
B By questioning a faulty assumption, the nurse can help the patient look at the premise more objectively and reframe it as a more accurate representation of fact. The incorrect responses are judgmental, irrelevant to an overgeneralization, and cast doubt without requiring the patient to evaluate the statement.
A client diagnosed with depression has been prescribed various first-line antidepressant agents but has demonstrated only minimal improvement. In preparation for the prescription of a second-line agent, the nurse will educate the client on which classification of antidepressant? a. Atypical b. Monoamine oxidase inhibitors c. Tricyclic d Dual action
B First-line agents include cyclic antidepressants (e.g., TCAs), dual action antidepressants (SSRIs, SNRIs, and NDRIs), and atypical antidepressants while monoamine oxidase inhibitors (MAOIs) are considered second-line agents.
During a psychiatric assessment, the nurse observes a patients facial expressions that are without emotion. The patient says, Life feels so hopeless to me. Ive been feeling sad for several months. How should the nurse document the patients affect and mood? a. Affect depressed; mood flat b. Affect flat; mood depressed c. Affect labile; mood euphoric d. Affect and mood are incongruent
B Mood is a persons self-reported emotional feeling state. Affect is the emotional feeling state that is outwardly observable by others.
A nurse instructs a patient taking a drug that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: a. hypotensive shock. b. hypertensive crisis. c. cardiac dysrhythmia. d. cardiogenic shock.
B Patients taking MAOIs must be on a tyramine-free diet to prevent hypertensive crisis. In the presence of MAOIs, tyramine is not destroyed by the liver and, in high levels, produces intense vasoconstriction, resulting in elevated blood pressure.
A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder. Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate? a. You look nice this morning. b. You are wearing a new shirt. c. I like the shirt youre wearing. d. You must be feeling better today.
B Patients with depression usually see the negative side of things. The meaning of compliments may be altered to I didnt look nice yesterday or They didnt like my other shirt. Neutral comments such as an observation avoid negative interpretations. Saying You look nice or I like your shirt gives approval (nontherapeutic techniques). Saying You must be feeling better today is an assumption, which is nontherapeutic.
A patient diagnosed with major depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. Priority information given to the patient and family should include a directive to: a. avoid exposure to bright sunlight. b. report increased suicidal thoughts. c. restrict sodium intake to 1 g daily. d. maintain a tyramine-free diet.
B Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus close monitoring is necessary. Avoiding exposure to bright sunlight and restricting sodium intake are unnecessary. Tyramine restriction is associated with monoamine oxidase inhibitor (MAOI) therapy.
The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescribes a low-dose antidepressant. In consideration of published warnings about the use of antidepressant medications in younger patients, which action(s) should the nurse employ? (Select all that apply.) a. Notify the facility's patient advocate about the new prescription. b. Teach the adolescent about Black Box warnings associated with antidepressant medications. c. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior.
BC The possibility that antidepressant medication might contribute to suicidal behavior, especially in children and adolescents, has been a long-time concern, and all antidepressants include a Black Box warning. The use of selective serotonin reuptake inhibitors shows a strong association with a reduction in suicide. All treatments have potential risks; each patient should be considered individually when antidepressants are prescribed. All consumers of antidepressants should be observed carefully for worsening of depression and suicidal thoughts.
A nurse is caring for a client who has major depressive disorder. Which of the following should the nurse identify as a risk factorfor depression? (Select all that apply.) A. Male sex B. History of chronic bronchitis C. Recent death in client's family D. Family history of depression E. Personal history of panic disorder
BCDE Depressive disorders are more common in a client who has a chronic medical condition. Depressive disorders are more likely to occur in a client who is experiencing a high amount of stress (when grieving the death of a family member). Depressive disorders are more likely to occur in a client whose has a family history of depression. A history of an anxiety or personality disorder increases a client's risk for depressive disorder.
A 30-year-old physically fit female patient with a history of depression returns to the mental health clinic for follow-up care. She takes 100 mg of Zoloft (sertraline) daily. In addition she states that she tries to stay mentally and physically well by taking yoga classes, walking regularly, and taking vitamins and St. John's wort. She adds that she is a vegetarian and gets most of her protein from cheese. Given this data, what should the nurse tell the client? A. "You should avoid cheese because it can, in conjunction with you medication, precipitates hypertensive crises." B. "You're doing a great job of taking care of yourself. You've made several healthy lifestyle choices." C. "You should stop taking St. John's wort because it can, in conjunction with your medication, precipitate serotonin syndrome." D. "You're doing a great job with your lifestyle choices. I suggest you do more intensive aerobic exercise, since it has been shown to stabilize mood."
C
A nurse is teaching a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD).Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I'm menstruating." B. "I should avoid exercising when I am feeling depressed." C. "I am aware that my PMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active."
C A clinical finding of PMDD is emotional lability. The client can experience rapid changes in mood.
When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will address the negative thought patterns by using: a. psychoanalytic therapy. b. desensitization therapy. c. cognitive behavioral therapy. d. alternative and complementary therapies.
C Cognitive behavioral therapy attempts to alter the patients dysfunctional beliefs by focusing on positive outcomes rather than negative attributions. The patient is also taught the connection between thoughts and resultant feelings. Research shows that cognitive behavioral therapy involves the formation of new connections among nerve cells in the brain and that it is at least as effective as medication. Evidence does not support superior outcomes for the other psychotherapeutic modalities mentioned.
Which statement demonstrates a characteristic of depression-associated behaviors that is especially associated with children and adolescents? a. "I can't go on being so depressed." b. "Life is no fun since I lost my sister." c. "I don't care that friends say I'm grumpy." d. "I'm so very sad since my sister died."
C Depressed mood most of the day, nearly every day, is an indication of depression (e.g., sad, empty, hopeless). In children and adolescents, this can be demonstrated by an irritable mood.
A patient was started on escitalopram (Lexapro) 5 days ago and now says, This medicine isnt working. The nurses best intervention would be to: a. discuss with the health care provider the need to change medications. b. reassure the patient that the medication will be effective soon. c. explain the time lag before antidepressants relieve symptoms. d. critically assess the patient for symptom relief.
C Escitalopram is an SSRI antidepressant. Between 1 and 3 weeks of treatment are usually necessary before a relief of symptoms occurs. This information is important to share with patients.
A patient experiencing depression says to the nurse, "My health care provider said I need 'talk' therapy, but I think I need a prescription for an antidepressant medication. What should I do?" Select the nurse's best response. a. "Which antidepressant medication do you think would be helpful?" b. "There are different types of talk therapy. Most patients find it beneficial." c. "Let's consider some ways to address your concerns with your health care provider." d. "Are you willing to give 'talk therapy' a try before starting an antidepressant medication?"
C Helplessness is sometimes a finding in major depressive disorder. The nurse has a responsibility for patient advocacy. Helping the patient to advocate for self is empowering.
Which life event related to a client demonstrating depressive symptoms supports a diagnosis of persistent depressive disorder (PDD)? a. Lost employment as a result of frequent absences b. Two unsuccessful suicide attempts over the last year c. Recognized symptoms of depression over 2 years ago d. Abruptly ended a long-term romantic relationship
C In persistent depressive disorder (PDD), the symptoms last for at least 2 years and are usually considered mild to moderate. Usually, a person's social or occupational functioning is not as greatly impaired as they are in major depressive disorder (MDD), although they may cause significant distress or some impairment in these areas. The symptoms in a chronic/dysthymic depression (PDD) are often congruent with the person's usual pattern of functioning. The remaining options support a diagnosis of MDD.
A nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect? A. Wide fluctuations in mood B. Report of a minimum of five clinical findings of depression C. Presence of manifestations for at least 2 years D. Inflated sense of self-esteem
C Manifestations of persistent depressive disorder last for at least 2 years in adults.
A nurse provided medication education for a patient who takes phenelzine (Nardil) for depression. Which behavior indicates effective learning? The patient: a. monitors sodium intake and weight daily. b. wears support stockings and elevates the legs when sitting. c. consults the pharmacist when selecting over-the-counter medications. d. can identify foods with high selenium content, which should be avoided.
C Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.
A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The treatment of MDD during the maintenance phase lasts for 6 to 12 weeks." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are most effective during the acute phase of MDD."
C The client is at greatest risk for suicide during the acute phase of MDD.
A patient being treated for major depressive disorder has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares. The nurse should advise the patient: a. Go to the nearest emergency department immediately. b. Do not to be alarmed. Take two aspirin and drink plenty of fluids. c. Take one dose of the antidepressant. Come to the clinic to see the health care provider. d. Resume taking the antidepressant for 2 more weeks, and then discontinue it again.
C The patient has symptoms associated with abrupt withdrawal of the tricyclic antidepressant. Taking a dose of the drug will ameliorate the symptoms. Seeing the health care provider will allow the patient to discuss the advisability of going off the medication and to be given a gradual withdrawal schedule if discontinuation is the decision. This situation is not a medical emergency, although it calls for medical advice. Resuming taking the antidepressant for 2 more weeks and then discontinuing again would produce the same symptoms the patient is experiencing.
A patients employment is terminated and major depressive disorder results. The patient says to the nurse, Im not worth the time you spend with me. Im the most useless person in the world. Which nursing diagnosis applies? a. Powerlessness b. Defensive coping c. Situational low self-esteem d. Disturbed personal identity
C The patients statements express feelings of worthlessness and most clearly relate to the nursing diagnosis of Situational low self-esteem. Insufficient information exists to justify the other diagnoses.
A 28-year-old second-grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 years old. Which combination of factors in this scenario best demonstrates the stress-diathesis model? a. Cold climate coupled with history of abuse b. Current age of 28 coupled with family history of depression c. Family history of mental illness coupled with history of abuse d. Female gender coupled with the stressful profession of teaching
C The stress-diathesis model explains depression from an environmental, interpersonal, and life-events perspective combined with biological vulnerability or predisposition (diathesis). Psychosocial stressors and interpersonal events, such as abuse, trigger certain neurophysical and neurochemical changes in the brain. Early life trauma is a significant component in the stress reaction.
The admission note indicates a patient diagnosed with major depressive disorder has anergia and anhedonia. For which measures should the nurse plan? Select all that apply. a. Channeling excessive energy b. Reducing guilty ruminations c. Instilling a sense of hopefulness d. Assisting with self-care activities e. Accommodating psychomotor retardation
CDE Anhedonia refers to the inability to find pleasure or meaning in life; thus planning should include measures to accommodate psychomotor retardation, assist with activities of daily living, and instill hopefulness. Anergia is the lack of energy, not excessive energy. Anhedonia does not necessarily imply the presence of guilty ruminations.
A patient with depression states he is unable to sleep and eats very little. Finding it difficult to encourage him to eat more, a nurse decides that the most effective way to increase his dietary intake would be to: A. Ask him why he's not eating B. Have him take his meals in the cafeteria C. Do not reinforce his eating problem by drawing attention to it D. Serve him several small meals during the day
D
An adolescent female is readmitted for inpatient care after a suicide attempt. What is the most important nursing intervention to accomplish upon admission? A. Allowing the patient to return to her pervious room so she'll feel safe. B. Orienting the patient to the unit and introduce her to patients and staff. C. Building trust through therapeutic communication. D. Checking the patient's belongings for dangerous items.
D
If clients do not abide by their diet restrictions while taking a monoamine oxidase inhibitor, they likely will develop: A. Generalized urticaria B. Severe muscle spasms C. Sudden, severe hypotension D. Sudden, severe hypertension
D
Which of the following variables has the most impact on relapse prevention for patients with depressive or bipolar disorders? A. Strong social support B. High socioeconomic status C. Stress-management skills D. Medication adherence
D
9. A patient diagnosed with major depressive disorder is receiving imipramine (Tofranil) 200 mg every night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug? a. Dry mouth b. Blurred vision c. Nasal congestion d. Urinary retention
D All the side effects mentioned are the result of the anticholinergic effects of the drug. Only urinary retention and severe constipation warrant immediate medical attention. Dry mouth, blurred vision, and nasal congestion may be less troublesome as therapy continues.
Over the past 2 months a patient made eight suicide attempts, with increasing lethality. The health care provider informs the patient and family that electroconvulsive therapy (ECT) is needed. The family whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? a. "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." b. "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." c. "Yes, there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."
D ECT is safe and effective and can achieve a 70% to 90% remission rate in depressed patients within 1 to 2 weeks. ECT is especially indicated when there is a need for a rapid, definitive response when a patient is suicidal or homicidal as well as in selected other circumstances.
Which statement by a client scheduled for a series of electroconvulsive therapy (ECT) treatments indicates to the nurse that the client has an understanding of the goals of this treatment? a. "My prognosis is so much better since I didn't have any delusional symptoms." b. "If this works, I will likely be able to stop taking lithium." c. "I'm prepared to deal with the certain loss of my short-term memory." d. "It is expected that my chance for remission is very good."
D ECT is safe and effective, and can achieve a 70% to 90% remission rate in depressed patients within 1 to 2 weeks. ECT is useful in treating patients with major depressive disorder especially when psychotic symptoms are present (e.g., delusions of guilt, somatic delusions, or delusions of infidelity). On awakening from ECT, the patient may be confused and disoriented. Many patients state that they have memory deficits for the first few weeks after treatment. Memory usually, although not always, recovers. ECT is not a permanent cure for depression, and maintenance treatment with TCAs or lithium decreases the relapse rate.
Which beverage should the nurse offer to a patient diagnosed with major depressive disorder who refuses solid food? a. Tomato juice b. Orange juice c. Hot tea d. Milk
D Milk is the only beverage listed that provides protein, fat, and carbohydrates. In addition, milk is fortified with vitamins.
A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate? a. Arms crossed b. Staring at the nurse c. Smiling inappropriately d. Eyes pointed downward
D Nonverbal communication is usually considered more powerful than verbal communication. Downward-casted eyes suggest feelings of worthlessness or hopelessness.
A nurse worked with a patient diagnosed with major depressive disorder who was severely withdrawn and dependent on others. After 3 weeks, the patient did not improve. The nurse is at risk for feelings of: a. overinvolvement. b. guilt and despair. c. interest and pleasure. d. ineffectiveness and frustration.
D Nurses may have expectations for self and patients that are not wholly realistic, especially regarding the patients progress toward health. Unmet expectations result in feelings of ineffectiveness, anger, or frustration. Guilt and despair might be observed when the nurse experiences feelings about patients because of sympathy. Interest is possible but not the most likely result. The correct response is more global than overinvolvement.
A patient became severely depressed when the last of six children moved out of the home 4 months ago. The patient repeatedly says, No one cares about me. Im not worth anything. Which response by the nurse would be the most helpful? a. Things will look brighter soon. Everyone feels down once in a while. b. The staff here cares about you and wants to try to help you get better. c. It is difficult for others to care about you when you repeatedly say negative things about yourself. d. Ill sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this afternoon.
D Spending time with the patient at intervals throughout the day shows acceptance by the nurse and helps the patient establish a relationship with the nurse. The therapeutic technique is called offering self. Setting definite times for the therapeutic contacts and keeping the appointments show predictability on the part of the nurse, an element that fosters the building of trust. The incorrect responses would be difficult for a person with profound depression to believe, provide trite reassurance, and are counterproductive. The patient is unable to say positive things at this point.
A patient tells the nurse, "No matter what I do, I feel like there's always a dark cloud following me." Select the nurse's initial action. a. Assess the patient's current sleep and eating patterns. b. Explain to the patient, "Everyone feels down from time to time." c. Suggest alternative activities for times when the patient feels depressed. d. Say to the patient, "Tell me more about what you mean by 'a dark cloud.'"
D The correct response accomplishes two results: the nurse can further assess the patient's complaint, and the nurse uses clarification, a therapeutic communication technique.
A woman gave birth to a healthy newborn 1 month ago. The patient now reports she cannot cope and is unable to sleep or eat. She says, I feel like a failure. This baby is the root of my problems. The priority nursing diagnosis is: a. Insomnia b. Ineffective coping c. Situational low self-esteem d. Risk for other-directed violence
D When a new mother develops depression with a postpartum onset, ruminations or delusional thoughts about the infant often occur. The risk for harming the infant is increased; thus, it becomes the priority diagnosis. The other diagnoses are relevant but are of lower priority.
A disheveled patient with severe depression and psychomotor retardation has not bathed for several days. The nurse should: a. avoid forcing the issue. b. bring up the issue at the community meeting. c. calmly tell the patient, You must bathe daily. d. firmly and neutrally assist the patient with showering.
D When patients are unable to perform self-care activities, staff members must assist them rather than ignore the issue. Better grooming increases self-esteem. Calmly telling the patient to bathe daily and bringing up the issue at a community meeting are punitive.
Serotonin Syndrome symptoms include low BP, low HR, low temp.
F
SSRIs are generally seen as first line of treatment because of lower side effects and decreased potential for overdose. T/F
T
Tricyclic and tetracyclic antidepressants have anticholinergic side effects: dry moth, blurred vision, constipation, urinary hesitancy, orthostatic hypotension and drowsiness.
T
A nurse should instruct a patient prescribed Tofranil (imipramine) that which adverse anticholinergic effect might be experienced? A. Dry mouth B. Hypertension C. Dizziness D. Tremors
A
One major disadvantage of Wellbutrin (bupropion) is which potential side effect? A. Seizures B. Urinary frequency C. Palpitations D. Hallucinations
A
Which documentation indicates the treatment plan of a patient diagnosed with major depressive disorder was effective? a. Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild. b. Slept 10 hours uninterrupted. Attended craft group; stated project was a failure, just like me. c. Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound. d. Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, I feel tired all the time.
A Sleeping 6 hours, participating in a group activity, and anticipating an event are all positive happenings. All the other options show at least one negative finding.
Which assessment finding in a patient with major depression represents a vegetative sign? A. Restlessness B. Hypersomnia C. Feelings of guilt D. Frequent crying
B
Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages? A. SSRIs (selective serotonin reuptake inhibitors) B. Antipsychotics C. Benzodiazepines D. Tricyclic antidepressants
B
A 35-year-old male with depression lost his job and most of his investments because of his own unethical business practices. He states his family would be better off without him because of the shame he has caused them. How should the nurse respond to this statement? A. "Tell me more about the shame you feel." B. "Are you thinking of killing yourself?" C. "Has your wife told you she wants a divorce?" D. "You appear depressed."
B
A 48-year-old suicidal female has been admitted to the psychiatric unit after trying to shoot herself in the head. Her husband reports that she has seemed despondent since their youngest child left for college four months ago. Which nursing intervention would be the highest priority upon admission? A. Administering prescribed sedation B. Initiating suicide observation C. Intake assessment of her d. Orienting her to the unit
B
When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will address negative thought patterns by using: A. Psychoanalytic therapy B. Desensitization therapy C. Cognitive behavioral therapy D. Alternative and complementary therapies
C
A 30-year-old female patient is observed pacing continuously on the unit. She is wringing her hands and muttering about how hopeless life is and how worthless she is. Which nursing action would be most appropriate? A. Greet her with a friendly and cheerful smile B. Ignore the behavior since it is part of her illness C. Reassure her that life will seem better in a few days D. Walk with her as she paces
D
After taking the medication Celexa (citalopram) for three months, a patient abruptly stops. The patient may experience: A. Manic symptoms B. Serotonin Syndrome C. Sexual dysfunction D. Discontinuation Syndrome
D
Serotonin syndrome symptoms usually occur after months of use of drugs that cause a serotonin overload.
F
