Ch. 23 - Depression

The nurse is working with a client who has been diagnosed with depression. When performing a strength assessment with the client, what is the nurse's best statement or question? 1) "How have you dealt with feelings like this in the past?" 2) "It's important that you remember that you're an exceptionally strong and capable person." 3) "Do you consider yourself to be a strong person overall?" 4) "What can the care team do to help you become a stronger person?"

1) "How have you dealt with feelings like this in the past?"

Research has shown that risk of suicide increases within which time frame for initiation of antidepressant therapy? 1) 14 days 2) 28 days 3) 35 days 4) 42 days

1) 14 days

The mental health nurse appropriately provides education on light therapy to which client? 1) 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term 2) 58-year-old showing signs of early Alzheimer's disease 3) 45-year-old lawyer whose medication therapy needs an additional treatment 4) 50-year-old farmer whose major depression has not responded to any treatment modality

1) 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

A 46-year-old client has been diagnosed with major depressive disorder. The client is seeing a nurse practitioner who is deciding on an appropriate treatment regimen. The nurse practitioner knows that which will be the most effective treatment for this client's depressive disorder? 1) A combination of psychotherapy and medication 2) A combination of medication and electroconvulsive therapy 3) Psychotherapy alone 4) Medication alone

1) A combination of psychotherapy and medication

A client was abandoned by the parents at age 3, resulting in the client's perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of what? 1) A psychodynamic interpretation of the client's major depressive disorder. 2) A reason the client has become lesbian at the age of 23. 3) A biological explanation for the client's depressive disorder. 4) A feminist viewpoint of depression.

1) A psychodynamic interpretation of the client's major depressive disorder.

A client has just been diagnosed with a major depressive disorder following recent problems with the client's mood, work performance, and sleep quality. When planning this client's care, the nurse should anticipate what interventions? Select all that apply. 1) Administration of a selective serotonin reuptake inhibitor (SSRI) 2) Administration of a monoamine oxidase inhibitor (MAOI) 3) Phototherapy 4) Cognitive therapy 5) Repetitive transcranial magnetic stimulation (rTMS)

1) Administration of a selective serotonin reuptake inhibitor (SSRI) 4) Cognitive therapy

A loss of pleasure or interest in a client diagnosed with depression would be documented as what? 1) Anhedonia 2) Flat affect 3) Hopelessness 4) Discouragement

1) Anhedonia

A client is admitted for major depression. The client has stated that nothing seems to bring the client pleasure anymore. What should the nurse expect to find during assessment? 1) Anhedonia, feelings of worthlessness, and difficulty focusing 2) Depressed mood, guilt, and pressured speech 3) Changes in sleep pattern, fatigue, and grandiose mood 4) Difficulty focusing, feelings of helplessness, and flight of ideas

1) Anhedonia, feelings of worthlessness, and difficulty focusing

A client's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action? 1) Assess the client's blood pressure 2) Perform a Mini Mental Status Examination (MMSE) 3) Assess the client's jugular venous pressure 4) Call an emergency code

1) Assess the client's blood pressure

A nurse is caring for a client receiving a tricyclic antidepressant and is monitoring for anticholinergic side effects. Anticholinergic effects include which of the following? 1) Blurred vision 2) Hyperactive bowel sounds 3) Urinary incontinence 4) Moist skin

1) Blurred vision

Which disorder is characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode? 1) Dysthymic disorder 2) Cyclothymic disorder 3) Seasonal affective disorder 4) Hypomania

1) Dysthymic disorder

A client has been taking a tricyclic antidepressant (TCA) for several months and is now reporting urinary hesitation. What is the nurse's best action? 1) Encourage the client to increase fluid intake 2) Ask the primary care provider to prescribe a diuretic 3) Encourage the client to use a low dose of an over the counter diuretic 4) Encourage the client to drink low-pH beverages

1) Encourage the client to increase fluid intake

Which antidepressant medication is classified as a selective serotonin reuptake inhibitor (SSRI)? 1) Fluoxetine 2) Phenelzine 3) Isocarboxazid 4) Tranylcypromine

1) Fluoxetine

Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? 1) Increase hydration 2) Take medication with food 3) Get daily exercise 4) Eat a nutritionally balanced diet

1) Increase hydration

A client is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also reports having felt unhappy most of the time for "as long as I can remember." Which diagnosis should the nurse anticipate for this client? 1) Persistent depressive disorder 2) Bipolar disorder 3) Rapid cycling disorder 4) Mild depressive disorder

1) Persistent depressive disorder

A client with major depression and a suicide attempt is admitted to the inpatient facility. The client is started on antidepressant therapy. The next day, the client demonstrates significantly higher energy and says, "I'll feel much better." The nurse would interpret this behavior as suggesting what? 1) Possible decision to complete a suicide attempt 2) Effectiveness of the drug therapy 3) An act to cover up the client's true feelings 4) A typical response to the medication

1) Possible decision to complete a suicide attempt

Which type of antidepressants are rarely fatal in overdose? 1) SSRIs 2) MAOIs 3) Tricyclics 4) Atypical

1) SSRIs

The priority concern for people with mood disorders is what? 1) Safety 2) Social functioning 3) Occupational functioning 4) Basic care

1) Safety

A client with major depression is prescribed paroxetine. The nurse develops an education plan for the client based on the understanding that this drug belongs to which class of drugs? 1) Selective serotonin reuptake inhibitors 2) Serotonin-norepinephrine reuptake inhibitors 3) Monoamine oxidase inhibitors 4) Tricyclic antidepressants

1) Selective serotonin reuptake inhibitors

Which outcome would be appropriate to determine an early favorable response to antidepressant medication? 1) The client will establish a balance of rest, sleep, and activity. 2) The client will demonstrate assertive communication skills. 3) The client will describe signs and symptoms of major depression. 4) The client will make plans to attend one community social activity a week.

1) The client will establish a balance of rest, sleep, and activity.

The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should ... 1) assess for depression in the client's family history. 2) educate the client regarding the symptoms of related physical disorders. 3) encourage the client to seek genetic counseling before considering a pregnancy. 4) prepare the client for diagnostic genetic testing to confirm the diagnosis.

1) assess for depression in the client's family history.

Electroconvulsive therapy would be contraindicated for a client with: 1) increased intracranial pressure. 2) myocardial infarction, five years ago. 3) stroke, 10 years ago. 4) hypertension.

1) increased intracranial pressure.

The nurse working on a mental health unit is teaching a nursing student. The student asks the nurse about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response? 1) "Depression is a mood variation to life events." 2) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present." 3) "The physician diagnoses depression when a client has feelings of sadness several times a year." 4) "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression."

2) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

A psychiatric-mental health nurse is providing care to a client with depression. The client spends most of the day in bed and only gets up to go to the bathroom or get a drink from the kitchen. The nurse is working with the client to increase activity. Which suggestion would be most appropriate? 1) "Set your alarm for 7am each day and get up and go for a run outside" 2) "Try getting dressed every day and then go for a 5-minute walk." 3) "Instead of sleeping in your bed, sleep on your sofa so it's easier to get up and move." 4) "Talk with an exercise trainer to get ideas for what activities are best."

2) "Try getting dressed every day and then go for a 5-minute walk."

A client who is depressed begins to cry and states, "I'm just really sick of feeling this way. Nothing ever seems to go right in my life." Which would be the most appropriate response by the nurse? 1) "Don't cry. Try to look at the positive side of things." 2) "You are feeling really sad right now. It's a hard time." 3) "Hang in there. Your medication will start helping in a few days." 4) "Nothing ever goes right?"

2) "You are feeling really sad right now. It's a hard time."

A client who was receiving a monoamine oxidase inhibitor (MAOI) is to be switched to a selective serotonin reuptake inhibitor (SSRI). The nurse would expect to begin administering the SSRI how many days after the MAOI is discontinued? 1) 7 days 2) 14 days 3) 21 days 40 28 days

2) 14 days

Which statement regarding depression and gender is correct? 1) Depressive disorders are more common in men than women. 2) Depressive disorders are more common in women than men. 3) Depressive disorders equally affect men and women. 4) Depressive disorders affect young men more than older women.

2) Depressive disorders are more common in women than men.

Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what? 1) Anaclitic depression 2) Moderate depression 3) A mood disorder due to a general medical condition 4) Postpartum psychosis

2) Moderate depression

Before a client became depressed, the client was an active, involved parent with three children, often attending their school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals that the client feels like an unnecessary burden on the client's family. Which nursing diagnosis is most appropriate? 1) Anxiety related to side effects of medication 2) Situational low self-esteem 3) Ineffective coping related to marital disagreements 4) Ineffective activity planning related to depression

2) Situational low self-esteem

A client who has been discharged home on citalopram calls the nurse reporting that the medication causes the client to feel too drowsy. The nurse should make which suggestion? 1) Make an appointment to change to a different medication. 2) Take the medication at night. 3) Be patient while this early side effect subsides. 4) Skip a dose if drowsiness is excessive.

2) Take the medication at night.

A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis? 1) The client will discuss the cause of the fatigue. 2) The client will reframe negative thoughts in a more positive way. 3) The client will identify factors that contribute to depression. 4) The client will differentiate between reality and fantasy.

2) The client will reframe negative thoughts in a more positive way.

A psychiatric-mental health nurse is assessing a client who is suspected of experiencing depression. During the interview, the client says, "I just don't care any more. I used to enjoy doing all sorts of things outdoors, but now, I don't. Nothing seems to make me happy." The nurse interprets this statement as: 1) labile mood. 2) anhedonia. 3) affect. 4) aphasia.

2) anhedonia.

A 46-year-old client comes to the community mental health center because the client thinks they might be suffering from depression. When assessing this client, which symptom would the nurse identify as being necessary for the diagnosis of major depressive disorder to be made? 1) Euphoria along with poor decision making ability 2) Disregard for personal hygiene including cleanliness and appearance 3) A loss of interest or inability to derive pleasure for previously enjoyed activities 4) A stooped posture and nonverbal signs of a depressed mood

3) A loss of interest or inability to derive pleasure for previously enjoyed activities

Following a change in job position, a minister asks a client how the client likes the new job. The client states, "Oh everything is great. I can really see myself going far in this new position." However, the client's voice is monotone and the client's face is nearly absent of affective expression. The minister is worried about this client and describes this facial expression as what? 1) Inappropriate 2) Blunted 3) Flat 4) Constricted

3) Flat

A client with severe depression has experienced anhedonia for the past 3 months. The nurse caring for this client understands that this term describes what? 1) Feelings of sadness 2) Feelings of hopelessness 3) Loss of interest or pleasure 4) Loss of sexual drive

3) Loss of interest or pleasure

A nursing student is caring for an elderly client who is taking sertraline for depression. The instructor quizzes the student about the medication and its actions. To what classification of drugs should the student assign sertraline? 1) Cyclic antidepressant 2) Monoamine-oxidase inhibitor 3) Selective serotonin reuptake inhibitor 4) Serotonin 2 antagonist

3) Selective serotonin reuptake inhibitor

A client with depression is admitted to an inpatient psychiatric unit. The nurse provides a unit orientation. While observing the client's unpacking, the nurse can expect the client to exhibit what? 1) A desire to initiate conversation with roommates 2) Expansive and dramatic movements 3) Slow movements and flat affect 4) Overly excited interest in the admission

3) Slow movements and flat affect

A nurse is preparing a presentation about suicide for a local community group. What would the nurse most likely include? 1) Men often use pills to commit suicide. 2) Women typically use firearms in their attempts. 3) Suffocation is a common means of suicide among children. 4) Hispanic individuals have the highest rates of suicide.

3) Suffocation is a common means of suicide among children.

A client who is taking paroxetine reports to the nurse that the client has been nauseated since beginning the medication. Which action is indicated initially? 1) Instruct the client to stop the medication for a few days to see if the nausea goes away. 2) Reassure the client that this is an expected side effect that will improve with time. 3) Suggest that the client take the medication with food. 4) Tell the client to contact the physician for a change in medication.

3) Suggest that the client take the medication with food.

A client with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation? 1) The client is tolerating the initial drug therapy. 2) The level of depression is mild to moderate. 3) The client is experiencing catatonia. 4) Suicidality is of little concern.

3) The client is experiencing catatonia.

Which is a true statement regarding depressive disorders? 1) They are more prevalent in men than women. 2) Depression in older adults is easier to diagnose. 3) The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated. 4) It is the fourth leading cause of years lost because of disability.

3) The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated.

When completing a baseline assessment of a client with depression, which diagnostic tests would the nurse anticipate? 1) Renal function tests 2) Coagulation profile 3) Thyroid function tests 4) Abdominal ultrasound

3) Thyroid function tests

The client has been diagnosed with severe depression. During the assessment of the client, the nurse is aware of which primary consideration with clients taking antidepressants? 1) decreased mobility 2) emotional changes 3) suicide 4) increased sleep

3) suicide

A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which is the nurse's priority intervention for this client? 1) Exploring the grief and loss issues concerning the baby's death. 2) Encouraging the client to express feelings of isolation following the recent immigration. 3) Encouraging attendance at group cognitive-behavioral therapy on the unit. 4) Ensuring that the client is not permitted to use anything that would be potentially dangerous.

4) Ensuring that the client is not permitted to use anything that would be potentially dangerous.

A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition? 1) Antidepressant therapy 2) Psychotherapy 3) Electroconvulsive therapy 4) Light therapy

4) Light therapy

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what? 1) Initial insomnia 2) Terminal insomnia 3) Hypersomnia 4) Middle insomnia

4) Middle insomnia

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has priority? 1) Hopelessness related to recent divorce 2) Ineffective coping related to inadequate stress management 3) Spiritual distress related to conflicting thoughts about suicide and sin 4) Risk for suicide related to highly lethal plan

4) Risk for suicide related to highly lethal plan

A psychiatric-mental health nurse is conducting a pharmacology review class for a group of nurses. The topic is antidepressant medications. The nurse determines that the review was successful when the group identifies which class of antidepressant as associated with fewer side effects? 1) Tricyclic antidepressants (TCAs) 2) Monoamine oxidase inhibitors (MAOIs) 3) Serotonin norepinephrine reuptake inhibitors (SNRIs) 4) Selective serotonin reuptake inhibitors (SSRIs)

4) Selective serotonin reuptake inhibitors (SSRIs)

Carrie, age 20, was admitted to your unit following a suicide attempt. She is disheveled, disorganized, and dehydrated. The priority for her care during the first 24 hours of her admission is ... 1) rehydrating Carrie by forcing fluids. 2) assisting Carrie with her activities of daily living, including a shower and clean clothing. 3) assessing Carrie's recent suicide attempt and identifying factors that may have contributed to it. 4) assessing Carrie's current suicidal ideation and putting her on suicide precautions.

4) assessing Carrie's current suicidal ideation and putting her on suicide precautions.