(N129) Depression

A client is found to have an adjustment disorder with mixed anxiety and depression. What should the nurse anticipate as the client's primary problem? 1. Low self-esteem 2. Deficient memory 3. Intolerance of activity 4. Disturbed personal identity

1. Rationale: When a client has an adjustment disorder, anxiety may be related to a disturbance in self-esteem and depression may be related to impaired social interaction. Problems with memory are not specifically related to an adjustment disorder. Activity intolerance, which is related to oxygenation problems, is not associated with adjustment disorders. A client with an adjustment disorder does not experience a disturbance in personal identity.

An adolescent has pinpoint pupils, respiratory depression, and cyanosis. Upon assessment, the school nurse observes needle marks on arms and legs. Which drug is the adolescent probably abusing? 1. Cocaine 2. Narcotics 3. Hallucinogens 4. Central nervous system (CNS) stimulants

2 Rationale: Opioids such as morphine, heroin, codeine, and fentanyl are grouped under narcotic drugs. Physical signs of narcotic abuse include constricted pupils, respiratory depression and cyanosis. Cocaine creates a state of indefinable high or euphoria; withdrawal signs include depression, irritability, seizures, and cardiovascular manifestations. Hallucinogens produce vivid hallucinations and euphoria; they do not produce physical dependence. Clients with acute intoxication of central nervous system (CNS) stimulants may display aggressive behavior along with psychotic episodes of agitation and restlessness.

A client diagnosed with depression is prescribed phenelzine. Which foods, if consumed along with this drug, may cause a hypertensive crisis? Select all that apply. 1. Yogurt 2. Red wine 3. Cream cheese 4. Aged meat 5.Aged cheese

2, 4, 5 Rationale: Monoamine oxidase inhibitors (MAOIs), including phenelzine, may cause hypertensive crisis if the client concurrently consumes foods rich in tyramine. Red wine, aged meat, and aged cheese contain high amounts of tyramine. Yogurt and cream cheese have a low tyramine content and are considered permissible.

A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? Select all that apply. 1. Dementia 2. Multiple losses 3. Declines in health 4. A milestone birthday 5. An injury requiring hospitalization

2,3 Rationale: Depression in the older adult is most often associated with the loss of family members and friends (e.g., death, relocation) and declines in mobility, health, and income. A decline in health, particularly when associated with a chronic illness, frequently precipitates depression in older adults. Dementia is a cognitive problem. Research does not correlate the onset of depression with a milestone birthday in older adults. A traumatic injury does not precipitate the onset of depression in the older adult as often as does a chronic illness.

A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client? 1. Sertraline 2. Fluoxetine 3. Amphetamine 4. Carbamazepine

1 Rationale: Sertraline is considered safe in lactating females. Dosing immediately after breast-feeding can reduce the risk of the drug excreted in the breast milk by the next feeding time. Fluoxetine and amphetamine are not recommended for breast-feeding clients. Carbamazepine is not used to treat depression.

Which priority assessments should be included by the nurse when caring for a client who is experiencing depression? Select all that apply. 1. Appetite 2. Irritability 3. Restlessness 4. Activity status 5. Emotional status

1, 4, 5 Rationale: The priority assessment for a client experiencing depression is to inquire about appetite, activity status, and emotional status. These helps determine the level of depression. Irritability and restlessness are secondary assessments for determining the depression level of a client.

A client in a psychiatric hospital with the diagnosis of major depression is tearful and refuses to eat dinner after a visit with a friend. What is the most therapeutic nursing action? 1. Allowing the client to skip the meal 2. Offering an opportunity to discuss the visit 3. Reinforcing the importance of adequate nutrition 4. Providing the client with adequate quiet thinking time

2 Rationale: Offering to discuss the visit shows support and provides the client with an opportunity to discuss feelings. Allowing the client to skip dinner does not address the client's depression. Teaching is inappropriate when a client is emotionally distressed. Providing quiet thinking time will limit further communication and may imply rejection.

A client is admitted to a mental health facility for depression. What action should a nurse take to help the client develop a positive self-regard? 1. Set limits on the client's negative behaviors. 2. Involve the client in activities that promote success. 3. Demonstrate approval of the client's efforts at every opportunity. 4. Encourage the client to participate in activities with other clients.

2 Rationale: Self-esteem and feelings of competence are increased when a person experiences success. Although setting limits on the client's negative behaviors is a necessary intervention when a depressed client tries to engage in self-harm, it will not promote feelings of self-esteem. Clients recognize unwarranted praise and often interpret such responses as a form of belittlement or pity. Encouraging the client to participate in activities with other clients may or may not increase self-esteem; also, the client may not have the physical or emotional energy to interact with other clients.

A client with chronic depression has a history of suicidal ideations. Place the following nursing assessment questions in the appropriate order to best ensure client safety. 1."Have you decided upon a plan to harm yourself?" 2."What is your plan for killing yourself?" 3."Are you thinking about hurting yourself?" 4."How would you get what you need to end your life?"

3, 1, 2, 4 Rationale: The initial action is to determine whether the client intends to commit suicide. The second step is to determine whether the client has made the intention specific by planning a method of suicide. The third step is to determine to what extend the client has decided on the details of the act of suicide. Finally it is necessary to determine whether the client has the means to actually complete the plan.

A client with a diagnosis of major depression refuses to participate in unit activities, claiming to be "just too tired." What is the best nursing approach? 1.Planning one rest period during each activity 2. Explaining why the staff believes that the activities are therapeutic 3. Encouraging the client to express negative feelings about the activities 4. Accepting the client's feelings about activities calmly while setting firm limits

4 Rationale: Fatigue and apathy are symptoms of depression and should be accepted; however, limits should be set to facilitate participation in unit activities. Planning one rest period during each activity allows the client to manipulate the environment. Explaining why the staff believes that the activities are therapeutic will not change the client's mind about them, and this response does not show an understanding of the client's needs. Encouraging the client to express negative feelings about the activities will reinforce negative feelings about participating in them.

An older client with depression is prescribed a tricyclic antidepressant. What is the priority nursing intervention in this situation?

request that the physician change the drug Rationale: Tricyclic antidepressants have anticholinergic properties that can cause acute confusion, severe constipation, and urinary incontinence in older adults. Therefore the priority nursing care for an older client who is prescribed a tricyclic antidepressant is to request that the physician change the drug. Providing psychotherapy is an alternate treatment, which is of medium priority. Teaching strategies to overcome depression is of low priority. Encouraging the client to walk for 30 minutes overcomes the feelings of depression, but it is not the priority.

What treatment should a nurse anticipate will be prescribed for a client with severe, persistent, intractable depression and suicidal ideation? 1. Electroconvulsive therapy 2. Short-term psychoanalysis 3. Nondirective psychotherapy 4. High doses of anxiolytic drugs

1 Rationale: Electroconvulsive therapy, which interrupts established patterns of behavior, helps relieve symptoms and limits suicide attempts in clients with severe, intractable depression that does not respond to antidepressant medication. The client's depressed mood limits participation in psychotherapy; feelings precipitated by therapy may lead to suicidal acting out. Psychotherapy is directed toward helping the person learn new coping mechanisms and better ways of coping with problems; the depressed client needs direction to accomplish this. Antianxiety medications are usually not prescribed for clients with depression.

A client with depression was prescribed fluoxetine. After two days, the client arrives at the hospital and reports restlessness, confusion, and poor concentration. Upon assessment, the nurse finds an elevated body temperature. Which intervention by the healthcare provider would be beneficial to the client? 1. Withdrawing the drug 2. Administering isocarboxazid 3. Reducing the dose of the drug 4. Informing the client that these are expected side effects

1 Rationale: Restlessness, confusion, poor concentration, and fever are symptoms of serotonin syndrome. The only treatment for serotonin syndrome is discontinuation of the drug. Isocarboxazid is a monoamine oxidase inhibitor that should not be used in a client with serotonin syndrome because it may lead to life-threatening conditions. Reducing the drug dosage may not reverse the symptoms completely. Informing the client that these are expected adverse effects is important, but the drug should be discontinued immediately.

A client with major depression that includes psychotic features tells the nurse, "All of my relatives have been killed because I've been sinful and need to be punished." What is the primary focus of nursing interventions? 1. Protecting the client against any suicidal impulses 2. Supporting the client's interest in the outside world 3. Helping the client manage the concern for family members 4. Reassuring the client that past behaviors are not being punished

1 Rationale: Suicidal impulses take priority, and the client must be stopped from acting on them while treatment is in progress; the client's safety is the focus of nursing interventions. Supporting the client's interest in the outside world is of very low priority. The client is focusing on the current personal situation, not the outside world. Helping the client manage the concern for family members is a secondary concern. Reassurance will not change the client's belief.

The nurse noticed increased blood pressure in a client on treatment for depression. Which antidepressant drug does the nurse ask the primary healthcare provider to reconsider? 1. Fluoxetine 2. Bupropion 3. Trazodone 4.Mirtazapine

2 Rationale: Bupropion is the antidepressant drug used in the treatment of depression. The adverse effect of this drug is increased blood pressure. Fluoxetine is used in the treatment of depression. Anxiety and insomnia are the adverse effects of this drug. Trazodone is used in the treatment of depression. Sedative effects are the adverse effects of this drug. Mirtazapine is used in the treatment of depression. Drowsiness and abnormal dreams are the adverse effects of this drug.

A client with phobias about elevators and large crowds comes to the clinic for help because of feelings of depression related to these fears. What is an appropriate short-term goal for this client? 1. Riding an elevator without anxiety when accompanied by the nurse 2.Describing the thoughts and feelings experienced in terrifying situations 3.Experiencing an elevation of mood and relief from feelings of depression 4.Identifying the early childhood conflicts that resulted in the development of these fears

2 Rationale: Describing the thoughts and feelings experienced in terrifying situations is a realistic essential first step. The problem and related feelings must be thoroughly explored before solutions can be developed. Riding an elevator without anxiety when accompanied by the nurse is a long-term goal. Experiencing an elevation of mood and relief from feelings of depression is a long-term goal. Identifying the early childhood conflicts leading to the development of the fears is an inappropriate goal; a direct connection to life events is often difficult to find.

Two weeks after a client has been admitted to the mental health hospital, the client's depression begins to lift. What is the primary reason the nurse encourages involvement with unit activities? 1. They support self-confidence. 2. They provide for group interaction. 3. They limit opportunities for suicide. 4. They allow verbalization of repressed feelings of hostility.

2 Rationale: Group interaction provides a sense of belonging and fosters the assumption of responsibility. Support of self-confidence and limitation of opportunities for suicide are not ensured by group interaction. The group is not the best arena for the expression of repressed hostility.

A nurse is discharging a client from the mental health unit who has been treated for major depression. Which statement is most therapeutic at this time? 1. "I'm going to miss you; we've become good friends." 2. "I know that you're going to be all right when you go home." 3. "Call the contact number we gave you if you have an emergency." 4."This is my phone number; call and let me know how you're doing."

3 Rationale: Instructing the client to call the contact number that was provided in case of emergency demonstrates an understanding that the newly discharged client needs to have a support system. Clients need to feel that in a crisis there will be someone there for them. The role of the nurse is not to become a good friend but instead to help the client become a functioning being again. The statement "I know you're going to be all right when you go home" provides false reassurance; the nurse does not know this. Saying "This is my phone number; call and let me know how you're doing" is unprofessional and blurs the roles of nurse and client.

A client is admitted to the psychiatric service with a diagnosis of severe depression. When approached by the nurse, the client says, "You know I'm a sorry, lazy person. I don't deserve a job. I'm just stupid and no good." What does the nurse conclude that the client is experiencing? 1. Nihilistic delusions 2. Delusions of persecution 3. Feelings of self-deprecation 4. Experiences of depersonalization

3 Rationale: The client's statements are self-derogatory and reveal low self-esteem. There is no evidence of feelings about nonexistence. There is no evidence that the client feels controlled or manipulated by others. There is no evidence that the client has a feeling of unreality or of alienation from the self.

A client has been hospitalized for 3 weeks while receiving a tricyclic medication for severe depression. One day the client says to the nurse, "I'm really feeling better; my energy level is up." After the encounter an aide tells the nurse that the client has given away a favorite jacket. What should the nurse conclude that the client's statement indicates? 1. Improved mood 2. Improved socialization 3. Increased risk for suicide 4. Heightened need for independence

3 Rationale: When the energy level improves in the depressed client, the risk for suicide increases; also, the client has given away a personal belonging, which may indicate a plan to commit suicide. Elevated mood may be true, but the gift of a cherished personal belonging decreases the possibility that the client's statement simply reflects an improvement in mood. The client's socialization may be improved, but the gift of a valuable personal belonging decreases the possibility that the act simply reflects an improved level of socialization. Giving something away is unrelated to independence.