28.A Depression
The nurse notes a behavior change in a client. Which manifestation should the nurse identify that is a less obvious symptom of depression? (Select all that apply.) A. Insomnia B. Aches and pains C. Excessive sleep D. Sadness E. Anger
B, E Rationale: Anger and physical complaints are less obvious symptoms of depression. Sadness, insomnia, and excessive sleep are considered major symptoms of depression.
Which expected outcome should the nurse document for a client with a depressive disorder? (Select all that apply.) A. The client does not express suicidal ideation. B. The client returns to work or school. C. The client describes hopefulness for the future. D. The client sleeps 8 hours a night. E. The client reports no side effects from medication.
A, B, C, D Rationale: Expected outcomes for clients with any of the depressive disorders include having adequate rest, returning to routine activities, not expressing suicide ideation, and feeling hopeful about the future. It is expected that the client who adheres to the medication regimen will report a few side effects; it is not expected that the client will experience no side effects at all from medication.
The nurse is completing a health history on a client with seasonal affective disorder (SAD). Which data should the nurse obtain during this interview? (Select all that apply.) A. Feelings of guilt B. Sleep disturbances C. Medical history D. Sexual history E. Anhedonia
A, B, C, E Rationale: When completing a health history on a client with seasonal affective disorder, the nurse needs to obtain information regarding sleep disturbances, medical history, feelings of guilt, and anhedonia (decreased ability to experience pleasure). The client's sexual history is not pertinent when completing the health history on this client.
The nurse is teaching a group at a community event on depression. Which primary prevention strategy should the nurse emphasize? (Select all that apply.) A. Family dynamics B. Age-related issues C. Dietary management D. Socialization E. Stress management
A, C, D, E Rationale: A number of approaches can be useful in preventing depression. Individuals should be encouraged to eat a healthy diet, engage in regular exercise, avoid smoking, and obtain adequate sleep. Other primary prevention strategies include providing teaching about stress management and healthy emotional functioning; encouraging clients to participate in meaningful social relationships; providing targeted teaching and support to individuals who have experienced traumatic or otherwise life-altering events; and using family-based cognitive-behavioral interventions to reduce the likelihood of depression among children with depressed parents. Age-related issues are not a strategy to prevent depression.
The nurse is preparing an educational seminar on depression for a community health fair. Which strategy should the nurse include to reduce depressive episodes? (Select all that apply.) A. Obtain adequate rest. B. Ingest alcohol on a daily basis. C. Have regular visits with the healthcare provider. D. Build a strong support system. E. Be aware of family risk factors.
A, C, D, E Rationale: Strategies to reduce the onset of depressive episodes include obtaining adequate rest, building a strong support system, being aware of family risk factors, and having regular appointments with the healthcare provider to detect symptoms of depression early. Alcohol intake should be limited to prevent the onset of substance abuse disorders.
A client is being discharged after a suicide attempt. Which action should the nurse include when designing a home safety plan with the client? (Select all that apply.) A. A list of triggers B. Medications that should be taken C. A list of useful coping strategies D. Memorandum from previous depressive episodes E. Contact information for family members
A, C, E Rationale: Information for a home safety plan includes a list of triggers, a list of coping strategies, and contact information for family. Medications are not a part of a home safety plan. Information about previous depressive episodes is not essential for this plan.
Which should the nurse identify as a risk factor for the development of depression? (Select all that apply.) A. Family member with depression B. Caucasian C. Dysfunctional family relationship D. Male sex E. Childhood sexual abuse
A, C, E Rationale: A dysfunctional family relationship, having a family member with depression, and having been sexually abused as a child are all risk factors for the development of depression. Male sex or Caucasian is not considered a risk factor for the development of depression.
A client with major depressive disorder (MDD) no longer wants to participate in activities that once were a source of pleasure. In which way should the nurse document this finding? A. Anhedonia B. Anorexia C. Psychomotor retardation D. Hypersomnia
A. Anhedonia Rationale: No longer enjoying activities that previously brought pleasure is termed anhedonia. Hypersomnia is sleeping for prolonged periods during the day and night. Anorexia is a loss of the desire for food. Psychomotor retardation is slowed body movements.
An older client with severe depression and suicide ideation is prescribed an antidepressant medication. Which home safety issue should the nurse discuss with the client and spouse? A. Discussing any herbal medications with the healthcare provider B. Disposing of all medications at home C. Allowing client to drive the car D. Taking antidepressant medication as needed
A. Discussing any herbal medications with the healthcare provider Rationale: Herbal medications such as St. John's wort may be used to treat symptoms of depression, but can cause serotonin syndrome when used with a selective serotonin reuptake inhibitor (SSRI). The nurse should emphasize first discussing the use of any herbal preparation with the healthcare provider. Driving would depend upon the effects of the medication. There is no reason to dispose of all medications in the home unless the client used medications for a previous suicide attempt. Antidepressant medication should be taken as prescribed.
A client reports feeling depressed most days for the last 2 years. Which health problem should the nurse associate with these symptoms? A. Dysthymia B. Seasonal affective disorder (SAD) C. Situational disorder D. Major depressive disorder (MDD)
A. Dysthymia Rationale: The term persistent depressive disorder, also known as dysthymia or dysthymic disorder, describes chronic depression for most days for at least 2 years (1 year for children and adolescents). Throughout those 2 years, no more than 2 months can be described as symptom free. The symptoms of dysthymic disorder tend to be less severe than those in MDD, with fewer physiologic symptoms. But the degree of impact on individual functioning can be as great or greater than that of MDD. The client's symptoms are not associated with situational disorder or SAD.
A client is being treated for a major depressive disorder. Which symptom should the nurse expect to assess in this client? A. Insomnia B. Euphoria C. Enhanced energy D. Increased libido
A. Insomnia Rationale: Insomnia is a symptom of a major depressive disorder. Euphoria, increased libido, and enhanced energy are not symptoms of a major depressive disorder.
A client with depression is admitted to the mental health unit because of attempted suicide. Which short-term goal should be given the highest priority for this client? A. The client will seek out the nurse when feeling self-destructive. B. The client will learn strategies to promote relaxation and self-care. C. The client will establish healthy and mutually caring relationships. D. The client will identify and discuss actual and perceived losses.
A. The client will seek out the nurse when feeling self-destructive. Rationale: By seeking out a nurse when feeling self-destructive, the client can feel safe and begin to discover coping skills to assist in dealing with her self-destructive tendencies. Identifying actual and perceived losses, learning strategies to promote relaxation and self-care, and developing healthy caring relationships are all important for the client with depression to achieve, but safety is the priority goal for this client at this time.
The nurse reviews the importance of accepting a client's negative feelings with a group of colleagues. Which statement should indicate to the nurse that teaching was effective? A. "I should limit the amount of time spent on the negative." B. "I can turn all the negatives into positives for the client." C. "I should share my past failures with the client." D. "I will write down the positives and negatives for the client."
A. "I should limit the amount of time spent on the negative." Rationale: The nurse should be accepting of clients' negative feelings but set limits on the amount of time spent discussing accounts of past failures. The nurse should also be alert for opportunities to interrupt negative conversational patterns with more neutral ones.
A client who has been depressed most of the time for the past 2 years is unable to cope with family responsibilities, and has frequent thoughts of suicide and death. For which disorder should the nurse plan care for this client? A. Bipolar B. Dysthymic C. Cyclothymic D. Seasonal affective
B. Dysthymic Rationale: Manifestations of a dysthymic disorder include a depressed mood most of the time for 2 years (for adults), inability to cope with responsibilities, and having thoughts of suicide and death. Bipolar disorders are a group of mood disorders that include manic episodes, hypomanic episodes, and mixed episodes. Cyclothymic disorder symptoms include fluctuating mood disturbances involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms. Seasonal affective disorder occurs when the individual experiences depression during the fall and winter seasons.
During the physical assessment of a mental health client, it is important for the nurse to thoroughly assess for any medical conditions, because clients who are depressed are at greater risk for comorbidities. Which rationale explains the above statement? A. Impaired circulation B. Impaired self-care C. Impaired oxygen exchange D. Impaired sensory function
B. Impaired self-care Rationale: Assess for the presence of medical illnesses. This is important not only to rule out the possibility of an underlying medical condition causing the client's symptoms of depression, but also to identify illnesses that may trigger depression. These include autoimmune, oncologic, metabolic, and endocrine disorders. Chronic illnesses, such as asthma and diabetes, are associated with increased risk of depression. A diagnosis of a chronic or life-threatening illness may also trigger a depressive episode.
A client with severe depression reports waking up almost every night and being unable to fall back asleep. Which symptom should the nurse realize this client is describing? A. Hypersomnia B. Middle insomnia C. REM sleep D. Narcolepsy
B. Middle insomnia Rationale: Middle insomnia refers to waking up during the night and having difficulty falling asleep again. The client is not described REM, narcolepsy, or hypersomnia.
A recently widowed client is experiencing memory loss, insomnia, loss of appetite, and irritability over the last few months. Which data should the nurse obtain when assessing this client? A. Anhedonia B. Suicidal ideations C. Medication history D. Alcohol use
B. Suicidal ideations Rationale: The client is likely experiencing a major depressive disorder and is at risk for suicidal ideations or recurring thoughts of death. To ensure the client's safety, the nurse needs to identify if he is having any suicidal ideations. Once it has been identified that the client is safe, the nurse can determine whether he is experiencing anhedonia or has been drinking alcohol and can obtain his medication history.
A client with major depressive disorder (MDD) has not gotten out of bed for weeks and has not gone outside of the home for a month. Which should the nurse recall about this disorder? A. Depression will eventually resolve in this particular client. B. The course of MDD can be extremely variable in this client. C. The client seems to be on the upswing of this depressive episode. D. The risk of suicide decreases as the client begins to get back into society.
B. The course of MDD can be extremely variable in this client. Rationale: Onset of MDD generally occurs gradually, with symptoms progressing from anxiety and mild depression to a major depressive episode over a period of days, weeks, or months. The course of MDD is extremely variable, with some individuals experiencing remission for a period of months and others experiencing many years between episodes. Individuals who experience MDD in the context of another disorder, such as substance abuse or borderline personality disorder, often experience symptoms that are more difficult to treat.
A client is experiencing sadness and anhedonia. Which clinical manifestation indicates that the client may be grieving and not experiencing depression? A. May dwell on past failures B. Displays low self-esteem and confidence C. Actively feels their emotional pain and emptiness D. Lacks interest in previously enjoyed activities
C. Actively feels their emotional pain and emptiness Rationale: Clients who are experiencing grief tend to actively feel their emotional pain and emptiness, in which a client with depression will have a generalized feeling of helplessness and hopelessness. Clients experiencing grief can be persuaded to participate in activities, have intact self-esteem and confidence, unless a sense of failure relates directly to the loss.
The nurse reviews the symptoms of a major depressive disorder (MDD) with a new colleague. Which statement should the nurse identify that indicates teaching was effective? A. "A person with MDD will not have problems concentrating." B. "A person with MDD will be aggressive." C. "A person with MDD may sleep excessively." D. "A person with MDD will more than likely be using substances."
C. "A person with MDD may sleep excessively." Rationale: Major depressive disorder (MDD) may consist of a single episode or may exhibit as recurrent major depression at various points in life. Signs and symptoms of MDD include sleep disturbances, ranging from excessive sleeping to no sleep, feelings of despair, sadness, crying, and recurrent thoughts of suicide. Aggression, problems with concentrating, and use of substances are not typically associated with MDD.
