NURS 3108 - Ch 15 Depression EAQs
Over the last two months a client made eight suicide attempts with increasing lethality. The health care provider informs the client and the client's family that electroconvulsive therapy (ECT) is needed. A family member whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." "Yes there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." "Electroconvulsive therapy is effective when urgent help is needed. Your family member will be carefully evaluated for possible risks."
"Electroconvulsive therapy is effective when urgent help is needed. Your family member will be carefully evaluated for possible risks." ECT is one of the most effective treatments for clients with major depression with self-harm, and it is safe despite years of stigma. The nurse's response should emphasize its effectiveness and that the client's safety will be of the highest importance. Bringing up the facility's record does not address the family's specific concerns with this individual client. Telling the family that the client's suicide attempts will be successful without treatment is insensitive and not necessarily accurate. It would be incorrect for the nurse to bring up hazards, because the treatment is safe.
Which statement made by a depressed client would provide insight into a common feeling associated with depression? "I still pray and read my Bible every day." "My mother wants to move in with me, but I want to be independent." "I still feel bad about my sister dying of cancer. I should have done more for her!" "I've heard others say that depression is a sign of weakness."
"I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible are coping mechanisms. Wanting independence and feeling that depression is a weakness are not feelings associated specifically with depression.
Which complaint regarding sleep would the nurse expect from a client diagnosed with major depression? "I usually take a nap for about 30 minutes in the afternoon." "It takes me about 15 minutes to fall asleep. I often have vivid dreams." "I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." "I often fall asleep in the middle of an activity. When I wake up, I feel better."
"I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." 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 and vivid dreams are normal sleep variations. Falling asleep in the middle of an activity is indicative of narcolepsy.
Which statement by a client indicates understanding of the client education provided about a prescribed selective serotonin reuptake inhibitor (SSRI)? "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." "I will not take any over-the-counter medication while on this medication." "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." "I will report increased thirst and urination to my health care provider."
"I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." High fever, fast heartbeat, and abdominal pain describe symptoms of serotonin syndrome, a life-threatening complication of SSRI medication. The other options are incorrect because the client should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the health care provider, and would not have been educated to report increased thirst and urination as a side effect of SSRI.
A client has taken citalopram for 2 years for dysthymic disorder. The client's outcomes have been achieved, and the client wants to discontinue the medication. Which information should the nurse provide to the client? "Citalopram is an antidepressant medication that is usually taken for life." "It's important for you to gradually stop taking this drug, over 2 to 4 weeks." "Because your depression is alleviated, you may now discontinue the medication." "Stopping this medication all of a sudden can cause neuroleptic malignant syndrome."
"It's important for you to gradually stop taking this drug, over 2 to 4 weeks." Selective serotonin reuptake inhibitor (SSRI) medications should not be discontinued abruptly. Abrupt cessation can lead to serotonin withdrawal. The duration of treatment with citalopram is individualized based on the client's symptoms and is usually not lifelong. Alleviation of symptoms is not necessarily an indication that medication may be discontinued. Neuroleptic malignant syndrome is an adverse effect associated with use of antipsychotic medications, not SSRIs.
A client experiencing depression tells 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 most appropriate response. "Which antidepressant medication do you think would be helpful?" "There are different types of talk therapy, and most clients find it beneficial." "Let's consider some ways to address your concerns with your health care provider." "Are you willing to give talk therapy a try before starting an antidepressant medication?"
"Let's consider some ways to address your concerns with your health care provider." It is important that the client address concerns with the health care provider, who is ultimately responsible for prescribing the client's medication or therapy. It is most appropriate for the nurse to encourage the client to speak with the health care provider rather than discussing the options with the client directly. Because not all antidepressants work for all individuals and the health care provider may need to try a variety or a combination, it is not helpful to ask the client what medication he or she thinks would be helpful. Telling the client that others find talk therapy helpful is dismissive of the individual's needs and feelings. Asking if the client is willing to give therapy a try first is secondary to helping the client communicate with the health care provider.
A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" What statement by the nurse will be most impactful against this cognitive distortion? "Let's look at what you just said, that you can 'never do anything right.'" "Tell me what things you think you are not able to do correctly." "Is this part of the reason you think no one likes you?" "That is the most unrealistic thing I have ever heard."
"Let's look at what you just said, that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate after suggesting that they look at what the client just said. Asking the client to tell the nurse what the client cannot do correctly, asking the client whether this is the reason others do not like him or her, and labeling the client's statement as unrealistic are not helpful to the client.
A client diagnosed with chronic severe depression has been prescribed a series of electroconvulsive therapy (ECT) treatments. What does the nurse ask during the initial intervention? "Would you feel more relaxed about the treatments if I stayed with you?" "What can I do to help you feel more comfortable about these treatments?" "Do you know very much about the benefits and drawbacks of ECT treatments?" "Will you let me know if you want or need to talk about these ECT treatments?"
"Will you let me know if you want or need to talk about these ECT treatments?" An essential role of the nurse is to allow the client 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 allows the client to express his or her feelings and concerns. The question about the nurse staying with the client makes assumptions about the client's concerns and is a barrier to effective communication. The questions about helping the client feel more comfortable and concerning the benefits and drawbacks of ECT make assumptions about the client's needs and are barriers to effective communication.
Which individual has the highest risk for major depression? 35-year-old married male who recently lost his job 6-year-old child who suffers from frequent ear infections 55-year-old single female recently diagnosed with rheumatoid arthritis 16-year-old male whose family recently moved from one state to another
55-year-old single female recently diagnosed with rheumatoid arthritis The 55-year-old single female has the most risk factors for depression. Primary risk factors include female gender, unmarried, low socioeconomic class, early childhood trauma, a negative life event, family history of depression, ineffective coping ability, postpartum time period, medical illness, absence of social support, and alcohol or substance abuse. The 35-year-old married male, 6-year-old child, and 16-year-old male have fewer risk factors.
Which individual has the highest risk for experiencing major depression? A teenaged male who failed to make the football team A young adult female who recently gave birth to her first child An older adult female who retired after 25 years of factory work A middle-aged male who is a self-employed small business owner
A young adult female who recently gave birth to her first child A young adult female who recently gave birth to her first child has the highest risk. The lifetime risk for major depression is 7% to 12% for men and 20% to 30% for women. Among women, rates peak between adolescence and early adulthood. It is particularly important to screen for depression among women of reproductive age, especially those who have children or plan to become pregnant. The teenaged male and the retired female do present with some risk for depression. The middle-aged male's risk for major depression is relatively small.
A depressive client is prescribed tricyclic antidepressants. What appropriate advice does the nurse give to the client's family? Do not give full dose to the client at bedtime. Double the dose if the client forgets to take the bedtime dose. Advise the client to be cautious while driving. Stop the medication if hypotension occurs.
Advise the client to be cautious while driving. Tricyclic antidepressants (TCAs) cause side effects such as drowsiness or dizziness. The client must be advised to be cautious while crossing the road, driving, or working with machines. The client must take a full dose at bedtime, so that the side effects are less during the day. If the client forgets to take the dose, the next dose should be taken at the scheduled time. A double dose should be avoided. The medication should not be stopped if there is reduction in blood pressure, because medication cessation can cause nausea, altered heartbeat, cold sweats, and nightmares.
A client 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? Anergia Euthymia Anhedonia Self-deprecation
Anhedonia 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 antidepressant drug can be prescribed to depressed clients who also suffer from narrow angle glaucoma? Select all that apply. Bupropion Isocarboxazid Tranylcypromine Desipramine Amitriptyline
Bupropion Isocarboxazid Tranylcypromine Bupropion is a norepinephrine dopamine reuptake inhibitor that can be prescribed to treat depression in clients 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 clients 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 clients 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 nursing diagnosis would be most useful for a depressed client who shows psychomotor retardation? <p>Which nursing diagnosis would be <b>most</b> useful for a depressed client who shows psychomotor retardation?</p> Constipation Death anxiety Diarrhea Imbalanced nutrition: more than body requirements
Constipation A client with psychomotor retardation has vegetative signs of depression and often is constipated. Depressed clients usually do not have death anxiety. They are more likely to welcome the idea of dying. Diarrhea is more likely to occur with psychomotor agitation. When imbalanced nutrition occurs, clients are more likely to have less than body requirements.
What statement regarding depression is true? Select all that apply. Depression can be present in association with other mental and physical disorders. While depression coexists with other disorders, it does not impact these disorders. The symptomology of depression is relatively similar regardless of age or culture. Social relationships can suffer when an individual is depressed. Depression can range from mild to severe in its effect on individuals.
Depression can be present in association with other mental and physical disorders. Social relationships can suffer when an individual is depressed. Depression can range from mild to severe in its effect on individuals. Depression can exist alone or in conjunction with other disorders and illnesses. Depression results in significant pain and suffering that disrupts social relationships, performance at school or on the job, and the ability for a person to live a full and happy life. Depression can manifest on a continuum from mild to severe. Depression can impact other comorbid disorders. Depression can present differently in different populations and different age groups.
Which statements are true regarding serotonin syndrome? Select all that apply. Discontinue all selective serotonin reuptake inhibitors (SSRIs) for 2 to 5 weeks before starting a monoamine oxidase inhibitor (MAOI). It is believed to be associated with under-activation of serotonin receptors. Symptoms include hypertension and delirium. Death can result from severe symptomology. Hypothermia and septic shock are severe manifestations of the disorder.
Discontinue all selective serotonin reuptake inhibitors (SSRIs) for 2 to 5 weeks before starting a monoamine oxidase inhibitor (MAOI). Symptoms include hypertension and delirium. Death can result from severe symptomology. A client should discontinue all SSRIs for 2 to 5 weeks before starting an MAOI. Symptoms of serotonin syndrome include hypertension and delirium, as well as abdominal pain, diarrhea, sweating, fever, tachycardia, 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 overactivation of the central serotonin receptors caused by either too high a dose or interaction with other drugs. Hypothermia and septic shock are not directly associated with serotonin syndrome.
The nurse cares for a client diagnosed with major depressive disorder. Assessment findings include psychosis and repeated threats to murder members of the immediate family. Which treatment modality is most likely for this client? Light therapy St. John's wort Electroconvulsive therapy Cognitive behavioral therapy
Electroconvulsive therapy The client described in this scenario demonstrates psychosis and homicidal thinking. While medication is generally the first line of treatment for ease of use, electroconvulsive therapy may be a primary treatment when a client is suicidal, homicidal, or psychotic. Light therapy is appropriate for a person diagnosed with seasonal affective disorder. St. John's wort is an over-the-counter herb sometimes used for its antidepressant effects; however, the urgency and acuity of this client's symptoms necessitate use of an intervention that will produce more immediate effects. Cognitive behavioral therapy is used in the treatment of depression, but is more effective in the maintenance phase.
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 most demonstrates the stress-diathesis model? Cold climate coupled with history of abuse Current age of 28 coupled with family history of depression Family history of mental illness coupled with history of abuse Female gender coupled with the stressful profession of teaching
Family history of mental illness coupled with history of abuse The stress-diathesis model explains depression from the perspective of environmental, interpersonal, and life events combined with biological vulnerability or predisposition. The client's family history of mental illness combined with her history of abuse best demonstrates this model. The teacher's age is not a factor in this model. The factors of climate and family history of abuse exclude predisposition, as does gender combined with the stress of her profession.
A client diagnosed with depression begins a new prescription for phenelzine. Which food is safe for this client to consume? Fresh fish Pepperoni Chocolate Guacamole
Fresh fish Phenelzine is a monoamine oxidase inhibitor antidepressant medication. It is important to avoid foods high in tyramine. Fresh fish is safe. Pepperoni and chocolate are foods high in tyramine, which may cause a hypertensive crisis. Guacamole is made from avocados, which are also high in tyramine.
Given a choice of the following entrees, what can the client prescribed a monoamine oxidase inhibitor (MAOI) safely eat? Avocado salad plate Fruit and cottage cheese plate Kielbasa and sauerkraut Liver and onion sandwich
Fruit and cottage cheese plate Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, hypertensive crisis, and eventually a cerebrovascular accident. Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat contain tyramine.
What assessment data are primary risk factors for depression? Select all that apply. Male gender History of physical abuse as a child Middle-class socioeconomic status History of alcohol abuse Married
History of physical abuse as a child History of alcohol abuse Primary risk factors of depression include early childhood trauma and history of alcohol or other substance abuse. Female gender, low socioeconomic class, and unmarried are other primary risk factors.
Which assessment data support the suspicion that a depressed client is demonstrating self-directed anger? Select all that apply. Hospitalized for alcohol detoxification Diagnosed as being morbidly obese Three-pack-a-day cigarette smoker Multiple failed marriages Declared bankruptcy twice
Hospitalized for alcohol detoxification Diagnosed as being morbidly obese Three-pack-a-day cigarette smoker 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.
A nurse is teaching a group of nursing students about antidepressants that act by increasing the availability time of noradrenaline and serotonin at the postsynaptic receptors. Which medication would you expect to see prescribed? Bupropion Vilazodone Sertraline Imipramine
Imipramine Imipramine belongs to the class of tricyclic antidepressants that act by increasing the availability time of noradrenaline and serotonin at the postsynaptic receptors. An increase in the serotonin and norepinephrine levels can cause mood elevation. Bupropion is a norepinephrine dopamine reuptake inhibitor. It blocks the synaptic reuptake of norepinephrine and dopamine. Vilazodone is a selective serotonin reuptake inhibitor and serotonin receptor agonist. It acts by blocking the synaptic reuptake of serotonin and activated serotonin receptors. Sertraline is a selective serotonin reuptake inhibitor. It blocks the synaptic reuptake of serotonin.
A pregnant client is diagnosed with seasonal affective disorder. What appropriate action does the nurse include in the client's treatment plan? Administer St. John's wort (Hypericum perforatum) regularly. Administer selective serotonin reuptake inhibitors regularly. Advise the client to rest and avoid exercising. Instruct the client to get exposed to a light source for 30 to 45 minutes daily.
Instruct the client to get exposed to a light source for 30 to 45 minutes daily. 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 client to a light source for 30 to 45 minutes. St. John's wort (Hypericum perforatum) should not be given to pregnant clients, because it may not be safe. Selective serotonin reuptake inhibitors must not be used in pregnant clients, because they may have teratogenic effects on the fetus. Exercise enhances mood, so the nurse should not discourage the client from exercising.
A client was admitted to an intensive care unit after reporting chest pain, an elevated heart rate, and a very high body temperature. The client's family reported to the nurse that the client was taking antidepressants. They also reported that the client started having chest pain after eating avocados and cheese. Which antidepressant medication was the client likely taking that would have caused this interaction? Isocarboxazid Desipramine Trazodone Duloxetine
Isocarboxazid Some foods, such as cheese, are rich sources of tyramine, which increases the production of serotonin in the body. Clients who are taking isocarboxazid, which is a monoamine oxidase inhibitor (MAOI), should avoid eating foods rich in tyramine because this substance can interact with MAOI drugs and cause adverse effects, such as hypertensive crisis and pyrexia (high body temperature). These reactions are seen within a few hours after consuming the contraindicated foods. The symptoms of hypertensive crisis are chest pain and increased or reduced heart rate. Desipramine is a tricyclic antidepressant and does not cause hypertensive crisis. Trazodone is a serotonin antagonist and reuptake inhibitor (SSRI), and its side effects are sedation and nausea. Hypertensive crisis is not a side effect associated with SSRI. Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI); its side effects are nausea, headache, and dry mouth.
A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" What does this cognitive distortion represent? Self-blame Catatonia Learned helplessness Discounting positive attributes
Learned helplessness Learned helplessness results in depression when the client feels no control over the outcome of a situation. Self-blame is an example of negative self-appraisal wherein the client believes that everything is his or her fault. Catatonia is abnormal physical movement. Discounting positive attributes occurs when clients are unable to recognize what they do well.
The nurse is caring for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescribes a low-dose antidepressant. In consideration of published warnings about use of antidepressant medications in younger clients, which action should the nurse employ? Notify the facility's client advocate about the new prescription. Teach the adolescent about black box warnings associated with antidepressant medication. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. Remind the health care provider about warnings associated with use of antidepressants in children and adolescents.
Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. The nurse's priority is to ensure client safety, so the nurse should monitor the adolescent closely for evidence of adverse effects of the medication. Notifying the advocate is not necessary because the health care provider determined the prescription was necessary and there is no conclusive evidence to support the labeling of all antidepressants. Teaching the adolescent about black box warnings does not fully address safety because the adolescent is unlikely to self-monitor. Reminding the health care provider of the warnings associated with the use of antidepressants in children does not fulfill the nurse's obligation to monitor client safety.
A client is prescribed tricyclic antidepressants. What should the nurse check for in the client's case history before administering the drug? Suicidal ideation Loss of appetite Oral contraceptive use Insomnia
Oral contraceptive use Medications such as oral contraceptives, antihypertensive reagents, monoamine oxidase inhibitors, and anticoagulants may react with tricyclic antidepressants. Potent side effects can occur due to drug interaction. The nurse should check for administration in the client's case history and inform the primary healthcare provider. Suicidal ideation, loss of appetite, and insomnia are common symptoms of depression.
A depressed client is noted to pace very often, pull at his or her clothes, and wring his or her hands. What do these behaviors indicate? Senile dementia Hypertensive crisis Psychomotor agitation Serotonin syndrome
Psychomotor agitation These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression. Senile dementia is a loss of cognitive function seen in older adults. Hypertensive crisis is extremely high blood pressure. Symptoms of serotonin syndrome, which is a medication side effect, 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.
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 disorder? Seasonal affective disorder Substance-induced depressive disorder Disruptive mood dysregulation disorder Psychotic depression
Psychotic depression Depressive disorders are classified according to symptoms or the situations under which they occur. Delusional thinking is an aspect of psychosis that may be present in cases of psychotic depression. 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 associated 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.
Which assessment data are associated with monoamine oxidase inhibitor (MAOI) therapy? Select all that apply. Reports dizziness when standing up Weight gain of 5 pounds in last 4 weeks Heart rate 100 beats per minute and irregular Facial twitch noted in left cheek Diarrhea for last 3 days
Reports dizziness when standing up Weight gain of 5 pounds in last 4 weeks Heart rate 100 beats per minute and irregular Facial twitch noted in left cheek Some common and troublesome long-term side effects of MAOIs are orthostatic hypotension, weight gain, change in cardiac rate and rhythm, and muscle twitching. Diarrhea is not a common side effect, although constipation may occur.
The nurse has developed a plan for a client with a severe sleep pattern disturbance to spend 20 minutes in the gym exercising each afternoon. Which intervention should be scheduled upon returning to the unit? Rest Group therapy Protein-based snack Unstructured private time
Rest A depressed client usually has little energy. After even a short exercise period, the client may feel exhausted and need rest. Group therapy could be counterproductive to this need, while a protein-based snack and unstructured private time may not directly address it.
What intervention can the nurse do to impact the most people at potential risk for depression among a population? Provide a depression screening at a local afterschool program site. Present educational programming on depression to a group of older adults. Routinely assess all chronically ill clients for depression during their admission interview. Include the signs of postpartum depression in the discharge packet for each new mother.
Routinely assess all chronically ill clients for depression during their admission interview. A high incidence of depression is found among all clients hospitalized for medical illnesses. These depressions are largely unrecognized and untreated by general health care providers. Studies suggest that about one third of medical inpatients report mild or moderate symptoms of depression and up to one fourth may have major depression. Chronic medical conditions often are associated with depression. While targeting school-age children, older adults, and postpartum mothers would be helpful for these specific populations as well, targeting chronically ill clients would impact the most people.
A client tells the nurse, "No matter what I do, I feel like there's always a dark cloud following me." What is the nurse's priority action? Assess the client's current sleep and eating patterns. Explain to the client, "Everyone feels down from time to time." Suggest alternative activities for times when the client feels depressed. Say to the client, "Tell me more about what you mean by 'a dark cloud.'"
Say to the client, "Tell me more about what you mean by 'a dark cloud.'" Inviting the client to elaborate on what he or she means by the "dark cloud" will help the nurse evaluate the client's thought processes and feelings. This will help ensure that care remains client centered. Assessing the client's sleeping and eating patterns is appropriate during the course of treatment, but this can happen after the nurse gets more information about the client's remark. Saying that everyone feels down is a platitude that minimizes the client's feelings. Suggesting alternate activities also does not address what the client has shared; the nurse should elicit more information before making recommendations.
An adult client diagnosed with depression and recently prescribed paroxetine reports, "My depression might be getting worse. I've started having more difficulty with sleep." Which information should the nurse provide to this client? The sleep problems are more likely to be associated with the depression than with the medication. The medication is stimulating dreaming, which will help the client resolve unconscious conflicts. Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, often cause sleep disturbances when first taken. The problem may be short-term. SSRIs, such as paroxetine, more commonly cause hypersomnolence rather than insomnia.
Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, often cause sleep disturbances when first taken. The problem may be short-term. Paroxetine is an SSRI commonly used to treat depression. Clients frequently report difficulty sleeping when first starting on one of these agents. Sleep problems often accompany depression, but timing of the client's reported problem indicates it is likely associated with beginning an SSRI. Dreaming relates to the rapid eye movement (REM) sleep stage and suggests that this client is moving through all the stages of sleep, but conflicts may or may not be resolved through dreaming. Clients who begin taking SSRIs commonly complain of the side effect of insomnia rather than hypersomnolence.
A client diagnosed with major depressive disorder has vegetative symptoms. Which nursing diagnosis is most applicable to these symptoms? Self-care deficit Spiritual distress Disturbed thought processes Risk for self-directed violence
Self-care deficit Vegetative signs of depression include grooming and hygiene deficiencies, significantly reduced appetite, and changes in sleeping, eating, elimination, and sexual patterns. Spiritual distress, disturbed thought processes, and risk for self-directed violence relate to assessment findings in depression associated with other symptoms.
What assessment of the thought processes of a client diagnosed with depression is most likely to reveal? Good memory and concentration Delusions of persecution Self-deprecatory ideation Sexual preoccupation
Self-deprecatory ideation Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world. Memory and concentration may be negatively affected in a depressed individual. Delusions of persecution are symptomatic of schizophrenia. Sexual preoccupation is unlikely in depressed clients, who are more likely to suffer from low libido.
When is a client diagnosed with seasonal affective disorder likely to begin experiencing fewer symptoms? Fall Winter Spring Summer
Spring Seasonal affective disorder occurs during the months when sunlight diminishes. Clients may begin to feel effects in the late fall and will be affected throughout the winter. They improve during the spring and feel well during the summer.
While caring for a client with HIV, the nurse finds that the client is at risk for self-mutilation. Which symptoms would have led the nurse to this conclusion? Select all that apply. The client has a reduced appetite. The client has a feeling of worthlessness. The client does not pray. The client has suicidal ideation. The client is unable to perform simple tasks.
The client has a feeling of worthlessness. The client has suicidal ideation. Comorbid depression can be seen in clients with HIV. Self-mutilation is a common indication of depression. It is associated with feelings of worthlessness and suicidal ideation. Depression can cause a decrease in appetite and nutritional imbalance. However, a decreased appetite does not indicate a risk for self-mutilation. The client not praying is also not a symptom of risk for self-mutilation. The inability to perform a simple task indicates reduced concentration and interest.
A nurse is performing an assessment of a client with depression who is prescribed antidepressants. The client reports to the nurse, "I have to drink a lot of water now, because I am feeling very thirsty and I'm not able to pass urine properly." What does the nurse interpret from these observations? The client is nonadherent to the medications. The client is experiencing side effects of amitriptyline. The client is experiencing food-drug interactions. The client is experiencing side effects of mirtazapine.
The client is experiencing side effects of amitriptyline. The client with depression may be prescribed amitriptyline, which is a tricyclic antidepressant. The side effects of amitriptyline include dry mouth, bladder problems, and constipation, which may make the client crave water. If the client is nonadherent to the medications, then the client will have depressive symptoms, like loss of appetite and insomnia, not dry mouth and urinary retention. Photosensitivity or rash would be indications of food-drug interaction. The side effects of norepinephrine and mirtazapine, or serotonin-specific antidepressants, include weight gain and sexual dysfunction, not dry mouth.
A client with late luteal phase dysphoric disorder is prescribed fluoxetine. What information should the nurse give the client? The client should stop the medication immediately if the side effects are severe. The client should consult their primary health care provider if there is loss of libido. The client should take acetaminophen if there is fever. The drug may cause dry mouth and blurred vision.
The client should consult their primary health care provider if there is loss of libido. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), which is a class of drug known for having low side effects. The nurse should advise the client to consult the primary health care provider about any side effects, such as loss of libido or sexual dysfunction. Stopping the drug abruptly may cause serotonin withdrawal, so the client should be advised not to stop the drug without first consulting the health care provider. Acetaminophen or any other over-the-counter drugs should not be taken without consulting the primary health care provider because of possible drug interactions. SSRIs do not cause dry mouth or low vision as some older antidepressants do.
A nurse caring for a client with depression instructs the client to rest after group activity. The nurse provides warm milk to the client in the morning and at night. What change does the nurse find in the client after implementation of these interventions? The client interacts with the nurse. The client maintains good hygiene. The client sleeps properly. The client has an increased appetite.
The client sleeps properly. Depressive clients often have insomnia. The nurse should ensure that clients rest adequately after group activity. This helps to reduce fatigue, which can intensify the symptoms of depression. The client can be given warm milk at night to induce sleep. Improving the client's interactions with the nurse, good hygiene, or appetite may be treatment goals but are not directly related to the nurse's intervention with encouraging rest.
What information will be included in medication education for a client prescribed an antidepressant? Select all that apply. The goal of antidepressant therapy is the remission of symptoms. Antidepressant therapy generally takes one to three weeks for mood to improve. Antidepressant therapy may require a change in prescription to identify the most effective antidepressant. Antidepressant therapy is contraindicated in clients diagnosed with bipolar disorder. Antidepressant therapy may trigger psychosis in clients diagnosed with schizophrenia.
The goal of antidepressant therapy is the remission of symptoms. Antidepressant therapy generally takes one to three weeks for mood to improve. Antidepressant therapy may require a change in prescription to identify the most effective antidepressant. Antidepressant therapy may trigger psychosis in clients diagnosed with schizophrenia. The goal of antidepressant therapy is the complete remission of symptoms. A drawback of antidepressant drugs is that improvement in mood may take 1 to 3 weeks or longer. Often, the first antidepressant prescribed is not the one that ultimately will bring about remission. Clients with bipolar disorder often receive a mood-stabilizing drug along with an antidepressant. Antidepressants may precipitate a psychotic episode in a person with schizophrenia.
When preparing a client for electroconvulsive therapy (ECT), what does the nurse discuss with the client? Maintenance treatments are seldom required. The initial course of therapy requires 6 to 12 treatments. This form of therapy is particularly successful for positive symptoms of schizophrenia. The initial therapy involves an ECT treatment repeated once a week for a prescribed time period.
The initial course of therapy requires 6 to 12 treatments. A usual course of ECT is 6 to 12 treatments. Maintenance ECT usually involves weekly treatments for the first month after remission, with gradual tapering to monthly ECT treatments. ECT is not typically used in the treatment of schizophrenia. Treatments are typically given two to three times per week
A client who had undergone a hysterectomy has low self-esteem and avoids taking food. Which appropriate method does the nurse choose to reduce anorexia? The nurse allows family members to remain with the client during meals. The nurse gives food low in fiber to the client. The nurse gives a large quantity of low-calorie food to the client. The nurse gives tea and coffee frequently to the client.
The nurse allows family members to remain with the client during meals. Low self-esteem and reduced food intake are symptoms of depression. Clients can be encouraged to take food in the presence of their family members to increase self-esteem. Taking food rich in fiber helps reduce constipation. Small amounts of high-calorie and high-protein food should be given frequently to meet the client's nutritional demands. The client must not be given tea or coffee frequently, because they can cause insomnia.
A nurse tries to communicate with a depressive client who is mute and avoids interaction. How should the nurse approach the client? The nurse should leave the client alone. The nurse should ask the client about their family members. The nurse should talk to the client about the weather. The nurse should tell the client everything will be fine and he or she shouldn't be upset.
The nurse should talk to the client about the weather. Depressed clients often avoid interacting with others. In such cases, the client's attention must be drawn towards the surrounding environment. This helps the client to focus on reality. Leaving the client alone may make the client feel lonely and cause withdrawal. Asking repeated questions to the client about his or her personal life can make the client feel aggressive and anxious. Making a remark or statement on the client's condition can make the client feel guilty.
A client admitted with a diagnosis of depression has been having angry outbursts with staff and peers on the unit since being admitted. Based on the client's behavior, what is the nurse's primary concern? The nurse should encourage the client's newfound assertiveness. This type of behavior places a depressed client at high risk for self-harm. The client who is angry and depressed is likely experiencing transference. The client is likely angry with someone else and projecting that anger to staff.
This type of behavior places a depressed client at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore, the client may be considered high risk, and appropriate precautions should be taken. There is no evidence to support encouraging the client's new found assertiveness or transference, or that the client is likely angry at someone else.
When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." What should the nurse be prepared to do? Wait quietly for the client to reply. Prompt the client if the reply is slow. Repeat the question if the client does not answer promptly. Review the client's medical record to support the client's response.
Wait quietly for the client to reply. Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply. The nurse should not rush or pressure the client by prompting the client to reply or repeating the question. There is no need to confirm the client's response with information in the medical record.
The nursing diagnosis of imbalanced nutrition—less than body requirements—has been identified for a client diagnosed with severe depression. On what will the most reliable evaluation of outcomes be based? Energy level Weekly body weight measurements Observed eating patterns Statement of appetite
Weekly body weight measurements The client's body weight is the most reliable and objective evaluation of success in treating this nursing diagnosis. Energy level, eating patterns, and appetite are subject to a number of variables and are not consistently reliable ways to evaluate this nursing diagnosis.
A depressive client is prescribed monoamine oxidase inhibitors. The nurse gives the diet chart to the client. Which food does the client consume according to the diet chart? Cheese Bananas Yogurt Dried fish
Yogurt Monoamine oxidase inhibitors (MAOIs) increase the levels of tyramine, so a client on MAOIs should consume foods that have no or very low levels of tyramine. An increase in tyramine levels can cause high blood pressure and hypertensive crisis. The client eats yogurt, which contains no or very low levels of tyramine. The client avoids cheese, bananas, and dried fish, which all contain high levels of tyramine.
