Ch 25: Depression: Management of Depressive Moods and Suicidal Behavior

c) The client is experiencing catatonia Pg. 428 Electroconvulsive therapy is an effective treatment for clients with severe depression. It is generally reserved for those whose disorder is refractory or intolerant to initial drug treatments and who are so severely ill that rapid treatment is required (e.g., clients with malnutrition, catatonia, or suicidality).

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

c) 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term Pg. 428 Phototherapy—or the exposure to bright artificial light—can markedly reverse the symptoms of seasonal affective disorder, which occurs in the fall and winter. Phototherapy would be most appropriate for a 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term.

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

c) Suicide Pg. 410 If depression persists over time and is left untreated, it has a significant negative effect on quality of life and increases the risk of suicide.

11. A parent of four small children lost a spouse in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since the spouse's death, the client's mood has been somber; until now, the client has refused treatment. What is this client at high risk for? a) Dysthymic disorder b) Schizophrenia c) Suicide d) Bipolar disorder

c) "I might experience an increased appetite" Pg. 426 Side effects associated with SNRIs include abnormal dreams, anticholinergic effects, decreased appetite, dizziness, gastrointestinal distress, hypertension, insomnia or sedation, irritability, jitteriness, photosensitivity, and sexual dysfunction. Based on these side effects the client statement that indicates a need for additional teaching is, "I might experience an increased appetite." because this medication often decreases appetite. Sugar-free gum for dry mouth is appropriate because of the anticholinergic effects associated with this medication classification. Sunscreen should be encouraged due to the risk for photosensitivity, and position changes should be implemented slowly to decrease the risk for falls due to the dizziness that can occur with this medication classification.

12. The nurse provides medication teaching to a client who is newly prescribed a serotonin norepinephrine reuptake inhibitor (SNRI) for the treatment of depression. Which client statement indicates a need for additional teaching? a) "I can use sugar-free gum to treat dry mouth" b) "I should wear sunscreen due to photosensitivity" c) "I might experience an increased appetite" d) "I should change positions slowly to decrease my risk for falls"

b) Selective serotonin reuptake inhibitors (SSRIs) Pg. 425 Of the classes listed, SSRIs tend to be safer and have fewer side effects than the other medications, such as TCAs, MAOIs, and SNRIs.

13. 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? a) Tricyclic antidepressants (TCAs) b) Selective serotonin reuptake inhibitors (SSRIs) c) Monoamine oxidase inhibitors (MAOIs) d) Serotonin norepinephrine reuptake inhibitors (SNRIs)

b) Light therapy Pg. 428 Phototherapy has proven effective for clients with symptoms of depression associated with a seasonal pattern. This condition, called seasonal affective disorder, may be related to lack of light and decreased melatonin production.

14. 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? a) Psychotherapy b) Light therapy c) Electroconvulsive therapy d) Antidepressant therapy

d) Increased intracranial pressure Pg. 428 ECT is contraindicated for clients with increased intracranial pressure. Other high-risk groups include those with recent myocardial infarction, recent cerebrovascular accident, retinal detachment, or pheochromocytoma. ECT is prescribed as a treatment modality for depression.

15. Electroconvulsive therapy (ECT) has been shown to be an effective treatment for people with severe depression. However, ECT is contraindicated in which of the following disease processes? a) Hypertension b) Diabetes c) Anxiety disorder d) Increased intracranial pressure

a) Ensuring that the client is not permitted to use anything that would be potentially dangerous Pg. 429 Although grief, loss, and isolation may be influencing the client's depressed state, the priority intervention is to prevent self-harm. All the interventions listed are appropriate, but ensuring safety from potential danger is the priority.

16. 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? a) Ensuring that the client is not permitted to use anything that would be potentially dangerous b) Encouraging the client to express feelings of isolation following the recent immigration c) Encouraging attendance at group cognitive-behavioral therapy on the unit d) Exploring the grief and loss issues concerning the baby's death

b) A psychodynamic interpretation of the client's major depressive disorder Pg. 414 Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. Such anger begins in childhood when basic developmental needs are not met. Clients cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.

17. 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? a) A biological explanation for the client's depressive disorder b) A psychodynamic interpretation of the client's major depressive disorder c) A feminist viewpoint of depression d) A reason the client has become lesbian at the age of 23

a) 14 days Pg. 424 To prevent possible interactions, 14 days should elapse between the discontinuation of the MAOI and the start of the SSRI.

18. 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? a) 14 days b) 28 days c) 7 days d) 21 days

b) Psychomotor retardation Pg. 412 Associated signs and symptoms of depression include an inability to think or concentrate, increased complaints of pain, psychomotor retardation, and lack of energy and fatigue.

19. A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client's feelings of sadness and hopelessness, the nurse would expect to assess what? a) Increased focus b) Psychomotor retardation c) Decreased complaints of pain d) Increased energy level

b) Anhedonia Pg. 419 The patient's statement reflects a loss of interest or pleasure in activities that previously brought enjoyment . This is termed anhedonia. Labile mood is the outward emotional expression that is varied, rapid, and abruptly shifts. Affect is the outward emotional expression of a person that gives clues to the person's mood. Aphasia involves a difficulty with speaking or communicating.

2. 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: a) Labile mood b) Anhedonia c) Affect d) Aphasia

d) Middle insomnia Pg. 416 The most common sleep disturbance associated with major depression is insomnia, which is categorized according to three categories: initial insomnia (difficulty falling asleep), middle insomnia (waking up during the night and having difficulty returning to sleep), and terminal insomnia (waking too early and being unable to return to sleep). Less frequently, the sleep disturbance is hypersomnia (prolonged sleep episodes at night or increased daytime sleep).

20. 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? a) Hypersomnia b) Initial insomnia c) Terminal insomnia d) Middle insomnia

a) The client will establish a balance of rest, sleep, and activity Pg. 412 Ability to balance rest, sleep, and activity demonstrates improvement in major depression. Understanding the disorder may occur later when client cognition has improved enough to be able to process information. Initiation of community social activity occurs when the client has increased energy. Assertive communication is learned and practiced after the depression lifts.

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

a) Increase hydration Pg. 411 Increasing hydration and sitting or standing up slowly are nonpharmacologic interventions for orthostatic hypotension. Taking medications with food would counteract nausea and vomiting. Daily exercise and eating a nutritionally balanced diet would help with weight gain that occurs in clients taking antidepressants.

22. Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? a) Increase hydration b) Get daily exercise c) Eat a nutritionally balanced diet d) Take medication with food

a) Acceptance, honesty, empathy, and patience Pg. 421 When working with depressed individuals, it is most therapeutic to maintain an attitude of acceptance, honesty, empathy, and patience. Being too cheerful can convey a nongenuine approach. Being too businesslike can convey the attitude of not having time to care for the client, and confrontation is not necessary under the condition of depression.

23. Nursing interventions for the depressed person should include which approach? a) Acceptance, honesty, empathy, and patience b) Cheerfulness, gregariousness, and happiness c) Decisiveness and businesslike efficiency d) Confrontation, questioning, and authority

c) The client will reframe negative thoughts in a more positive way Pg. 417-418 An appropriate outcome for hopelessness would be for the client to reframe and redefine an event positively rather than negatively, which can help the client view the situation in an alternative way, thereby fostering hope. Discussing the cause of fatigue is unrelated to hopelessness. Identifying factors contributing to depression would reflect a knowledge deficit. The ability to differentiate reality from fantasy would be inappropriate for this client. There is nothing to support that the client is not focused in the here and now.

24. 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? a) The client will identify factors that contribute to depression b) The client will differentiate between reality and fantasy c) The client will reframe negative thoughts in a more positive way d) The client will discuss the cause of the fatigue

c) A significant decrease in appetite Pg. 416 Among the nine clinical symptoms of a major depressive episode is a significant increase or decrease in appetite. Failures may precipitate or exacerbate decisions and others may confirm the client's depression, but these are not diagnostic criteria. Unwise decision making is not a hallmark of depression, but indecisiveness is a diagnostic criterion.

25. A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what? a) Demonstrated examples of unwise decisions b) Claims by family, friends, or coworkers that the client is depressed c) A significant decrease in appetite d) Self-report of being sad after a break up

d) "You are feeling really sad right now. It's a hard time" Pg. 421 Do not cut off interactions with cheerful remarks or platitudes. Do not belittle the client's feelings. Accept the client's verbalizations of feelings as real, and give support for expressions of emotions, especially those that may be difficult for the client (like anger). Allow (and encourage) the client to cry. It is important that the nurse does not attempt to "fix" the client's difficulties.

26. 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? a) "Don't cry. Try to look at the positive side of things" b) "Hang in there. Your medication will start helping in a few days" c) "Nothing ever goes right?" d) "You are feeling really sad right now. It's a hard time"

b) Anxiety symptoms are more commonly noted in children who are depressed Pg. 410 Children with depressive disorders have symptoms similar to those seen in adults with a few exceptions. They are more likely to have anxiety symptoms, such as fear of separation, and somatic symptoms, such as stomach aches and headaches. They may have less interaction with their peers and avoid play and recreational activities that they previously enjoyed. Mood may be irritable, rather than sad, especially in adolescents. In addition, the risk of suicide, which peaks during the midadolescent years, is very real in children and adolescents.

27. A psychiatric-mental health nurse is working at a community mental health center that serves a large pediatric population. When assessing children for depression, which information would be most important for the nurse to keep in mind? a) Children commonly experience the same symptoms of depression as adults b) Anxiety symptoms are more commonly noted in children who are depressed c) The mood observed in children with depression is more often sad than irritable d) The risk of suicide is low in children and adolescents

a) A loss of interest or inability to derive pleasure for previously enjoyed activities Pg. 412 Clients with major depressive disorder must have either a depressed mood or a loss of interest or inability to derive pleasure from previously enjoyed activities for diagnosis.

28. 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? a) A loss of interest or inability to derive pleasure for previously enjoyed activities b) Euphoria along with poor decision making ability c) A stooped posture and nonverbal signs of a depressed mood d) Disregard for personal hygiene including cleanliness and appearance

b) Observe the client for cheeking of medications c) Ask the client about the use of any herbal supplements e) Assess orthostatic vital signs before beginning therapy Pg. 425 When administering and monitoring a client receiving antidepressant therapy, the nurse should observe the client for cheeking or saving medications for a later suicide attempt. Orthostatic vital signs should be obtained as a baseline before initiating therapy, and regularly after therapy begins. Laboratory testing should occur periodically; it does not need to be assessed at least once a week. Specimens for monitoring plasma drug concentrations should be drawn as close as possible to 12 hours away from the last dose. Herbal substances can interact with antidepressants and their use should be avoided.

29. When administering and monitoring antidepressant therapy in a client, what would be most appropriate for the nurse to do? Select all that apply. a) Obtain liver function studies at least once a week b) Observe the client for cheeking of medications c) Ask the client about the use of any herbal supplements d) Check plasma drug concentrations 1 hour before the next dose e) Assess orthostatic vital signs before beginning therapy

d) Anhedonia Pg. 419 A person with depression has a sustained period of feeling depressed, sad, or hopeless and may experience anhedonia (loss of interest or pleasure). The client may report "not caring anymore" or not feeling any enjoyment in activities that were previously considered pleasurable. Flat affect is the complete or near absence of affective expression. Hopelessness and discouragement would not be the correct documentation for this symptom.

3. A loss of pleasure or interest in a client diagnosed with depression would be documented as what? a) Hopelessness b) Discouragement c) Flat affect d) Anhedonia

a) Advocate with the physician to consider changing the medication c) Recommend a nutritionally balanced diet e) Recommend daily exercise Pg. 411 To relieve the side effect of weight gain from an antidepressant, appropriate nursing interventions are to help the client explore a change in medication, promote a nutritionally balanced diet, and recommend regular exercise.

30. A client taking an antidepressant has experienced a 12-pound weight gain in 1 month as a side effect of the medication. Which of the following are nursing interventions to help this patient with this problem? Select all that apply. a) Advocate with the physician to consider changing the medication b) Reassure the patient that the weight gain is not that significant c) Recommend a nutritionally balanced diet d) Remind the patient that weight gain is better than feeling depressed e) Recommend daily exercise

b) Situational low self-esteem Pg. The client does not express anxiety, issues with marital disagreements, or problems with activity planning. Instead, the client has experienced a change from being an involved, interested parent to feeling as though the client is a burden, which would be reflective of a disturbance of self-esteem. The self-esteem changes the client is experiencing are related to feelings of worthlessness brought on by the depressive episode.

31. 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? a) Ineffective activity planning related to depression b) Situational low self-esteem c) Ineffective coping related to marital disagreements d) Anxiety related to side effects of medication

d) "I started taking diet pills to assist with weight loss" Pg. 427 Serotonin syndrome is a potentially serious side effect caused by drug-induced excess of intrasynaptic serotonin, 5-hydroxytryptamine (5-HT). Combining medications that increase CNS serotonin levels, such as SSRIs + MAOIs, St. John's wort, diet pills, dextromethorphan, or alcohol (especially red wine) or an SSRI + street drugs (e.g., LSD, MMDA, or ecstasy). The client statement "I started taking diet pills to assist with weight loss." requires the nurse to assess the client for symptoms of serotonin syndrome, which include mental status changes, agitation, ataxia, myoclonus, hyperreflexia, fever, shivering, diaphoresis, and diarrhea. The other client statements do not indicate that the client is at risk for serotonin syndrome.

32. The nurse reviews the medication list for a client who is newly prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which client statement indicates a need to assess the client for serotonin syndrome? a) "I used to enjoy taking ecstasy, but I know it isn't safe with my new medication" b) "I stopped taking St. John's wort 4 weeks ago" c) "I stopped drinking red wine when I started taking my new prescription" d) "I started taking diet pills to assist with weight loss"

a) Attention b) Memory c) Thought processes and content d) Cognition e) Mood and affect Pg. 419 The psychosocial assessment for persons who have major depressive disorder includes the mental status, coping skills, developmental history, psychiatric family history, patterns of relationships, quality of support system, education, work history, and impact of physical or sexual abuse on interpersonal function. Specific topics explored when determining the client's mental status include mood and affect, thought processes and content, cognition, memory, and attention.

33. Which topics should the nurse explore when determining mental status during the psychosocial assessment process? Select all that apply. a) Attention b) Memory c) Thought processes and content d) Cognition e) Mood and affect

c) Catatonia Pg. 428 Catatonia is a state of motor or physical activity associated with manic states in bipolar illness. Catatonia is also seen in clients with schizophrenia who have periods of immobility interrupted by episodes of extreme agitation. Fatigue is a lack of energy common during a severely depressed state. Severely depressed clients frequently have difficulty falling asleep or wake early in the morning and are unable to go back to sleep as with insomnia. Feelings of worthlessness or excessive/inappropriate guilt are commonly associated with depression.

34. A psychiatric-mental health nurse is conducting a refresher class for a group of psychiatric-mental health nurses returning to the field. After teaching about depressive disorders, the nurse determines a need for additional teaching when the class identifies which physical or psychological symptom as being associated with depression? a) Worthlessness b) Insomnia c) Catatonia d) Fatigue

b) Life and environmental stressors c) Current substance use or abuse d) Lack of coping abilities Pg. 412 Risk factors for depression include prior history of depression, family history of depressive disorder, lack of social support, lack of coping abilities, presence of life and environmental stressors, current substance use or abuse, and medical comorbidity. This client's assessment findings include a recent life stressor in the form of divorce and excessive use of alcohol. In addition, the client's social isolation and heavy drinking indicate lack of healthy coping abilities. The client's data do not include a family history or prior history of depression or any other health issues.

35. A client who otherwise is healthy is admitted for depression and reports feeling "all alone." The client reports recently losing a spouse to divorce. The client admits to drinking at least 12 beers every day. The client has which risk factors for the depression? Select all that apply. a) History of depression b) Life and environmental stressors c) Current substance use or abuse d) Lack of coping abilities e) Medical comorbodity

d) "Try getting dressed every day and then go for a 5-minute walk" Pg. 421 Activity and exercise are also important for improving depressed mood state. Most people find that regular exercise is hard to maintain. People who are depressed may find it impossible. When teaching about exercise, it is important to start with the current level of client activity and increase it slowly. For example, if the client is spending most of the time in bed, encouraging the patient to get dressed every day and walk for 5 or 10 minutes may be all that patient can tolerate. Gradually, patients should be encouraged to have a regular exercise program and to slowly increase their food intake. Suggesting a run or talking with an exercise trainer would be most likely be too much for the patient to handle at this point. The patient needs adequate sleep, so sleeping on the couch instead of the bed would be inappropriate.

36. 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? a) "Talk with an exercise trainer to get ideas for what activities are best" b) "Set your alarm for 7am each day and get up and go for a run outside" c) "Instead of sleeping in your bed, sleep on your sofa so it's easier to get up and move" d) "Try getting dressed every day and then go for a 5-minute walk"

d) Dehydration Pg. 416 When there is a significant wight loss in older adults with moderate to severe depression, they need to be assessed for dehydration as well as weight changes. They also need to be monitored for suicide, sleep disturbance, and decreased energy, but they are not related to nutrition and the weight loss.

37. An elderly client is admitted to the hospital with fatigue and weight loss of 20 pounds in 1 month. Upon further assessment, the client is diagnosed with depression. What other thing should the nurse assess this client for based on the weight loss? a) Decreased energy b) Sleep disturbance c) Suicide d) Dehydration

c) Suffocation is a common means of suicide among children Pg. 420 There are ethnic and cultural differences regarding suicide behavior. Men often use firearms, and women often use of pills or other poisonous substances to commit suicide. Children often use suffocation. Data on suicide completion rates are reported highest in people of American Indian, Alaskan Natives, and non-Hispanic white descent. These rates are lowest for people of Hispanic, non-Hispanic black, and Asian and Pacific Islander descent.

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

d) Moderate depression Pg. 416 Cognitive psychotherapy is as effective as antidepressant medication in the treatment of mild to moderate depression. It is less likely to address depression that has a demonstrated medical etiology. The primary treatment for postpartum psychosis is medication. Therapy is not relevant in cases of anaclitic depression since the problem occurs in infants.

39. Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what? a) Anaclitic depression b) Postpartum psychosis c) A mood disorder due to a general medical condition d) Moderate depression

d) Assess the client's blood pressure Pg. 426 Combining phenelzine with beer can precipitate a hypertensive crisis. There is no immediate indication that an emergency code is needed. The client's jugular venous pressure is less likely to be affected and is not a priority for assessment. Performing the MMSE is not a short-term priority.

4. 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? a) Perform a Mini Mental Status Examination (MMSE) b) Assess the client's jugular venous pressure c) Call an emergency code d) Assess the client's blood pressure

c) "I didn't realize so many factors could cause depression" Pg. 414-415 Depression has long been understood as a multifactorial disorder that occurs when environmental factors (e.g., death of family member) interact with the biologic and psychological makeup of the individual. Most older clients with symptoms of depression do not meet the full criteria for major depression. However, it is estimated that 8% to 20% of older adults in the community and as many as 37% in primary care settings experience depressive symptoms. Treatment is successful in 60% to 80%, but response to treatment is slower than in younger adults.

40. The nurse is providing teaching to a client with depression. Which statement by the client would indicate that the education has been effective? a) "When I reduce the stress in my life, the depression will go away" b) "I'll begin to feel better in about 3 or 4 days" c) "I didn't realize so many factors could cause depression" d) "All old people get depressed. It's a natural part of aging"

c) Depression is twice as common in women than in men Pg. 412 Depression is twice as common in women than in men. The onset of depression can happen at any age; onset is more commonly seen in the 20s. Depression is not correlated with low intellectual ability.

41. After teaching a group of nursing students about major depression, the instructor determines that the education was successful when the group identifies which information is accurate? a) Onset of depression is common in adolescence b) Depression is correlated with low intellectual ability c) Depression is twice as common in women than in men d) Onset of depression is most common in middle-aged persons

c) "How many of the sleeping pills do you have at home right now?" Pg. 429 All of the listed assessment questions are valid, but asking about the client's supply of medication is a priority because of the safety risk associated with a potential suicide attempt.

42. A client with a history of self-harm reports lethargy, loss of appetite and insomnia to the nurse. The client states that she relies heavily on sleep medications that her primary care provider prescribed. What is the nurse's priority assessment question? a) "How do you feel about having to take medication to help you sleep?" b) "Are there any strategies you've tried so that you wouldn't need sleeping pills?" c) "How many of the sleeping pills do you have at home right now?" d) "Have you ever had to take sleeping pills at any other point in your life?"

a) Biologic Pg. Biologic interventions center around education, pharmacologic interventions, and other somatic interventions. Activity and exercise are directly related to the body or somatic experience.

43. A patient with severe depression is being treated with medications and is told to increase activity and to exercise at least 4 times a week. Which of the following domains would these nursing interventions address? a) Biologic b) Social c) Spiritual d) Psychological

d) Psychotherapy Pg. 415-416 For people with severe or recurrent major depressive disorder, the combination of psychotherapy (including interpersonal, cognitive behavioral, behavior, brief dynamic, or dialectical behavioral therapies) and pharmacotherapy has been found to be superior to treatment using a single modality.

44. A nurse is providing care to a client with recurrent major depression. The nurse would most likely expect a combination of medications and which treatment to be used to achieve maximum effectiveness? a) Vagal nerve stimulation b) ECT c) Deep brain stimulation d) Psychotherapy

a) Patients at risk for complications of anesthesia b) Patients with recent cerebrovascular accidents (CVAs) c) Patients with recent retinal detachment e) Patients with increased intracranial pressure f) Patients who had recent myocardial infarctions (MIs) Pg. 428 ECT is contraindicated in patients who have increased intracranial pressure; who have had a recent CVA, MI, or retinal detachment; and who are at risk for complications from anesthesia.

45. Although its therapeutic mechanism of action is unknown, electroconvulsive therapy (ECT) is effective treatment for severe depression in some clients. The nurse is aware that ECT would be contraindicated in which of the following clients? Select all that apply. a) Patients at risk for complications of anesthesia b) Patients with recent cerebrovascular accidents (CVAs) c) Patients with recent retinal detachment d) Patients who had acute renal failure e) Patients with increased intracranial pressure f) Patients who had recent myocardial infarctions (MIs)

d) Risk for suicide related to highly lethal plan Pg. 429 Safety is the priority. The overall goals for the client who is suicidal is first to keep the client safe and later to help him or her develop new coping skills that do not involve self-harm. Hopelessness related to recent divorce, ineffective coping related to inadequate stress management, and spiritual distress related to conflicting thoughts about suicide and sin would not be the priority diagnosis for this client.

5. 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? a) Spiritual distress related to conflicting thoughts about suicide and sin b) Hopelessness related to recent divorce c) Ineffective coping related to inadequate stress management d) Risk for suicide related to highly lethal plan

d) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present" Pg. 410 Normal variations in mood (such as sadness, euphoria, and anxiety) occur in response to life events; they are time limited and not usually associated with significant functional impairment. The primary diagnostic criterion for major depressive disorder is one or more major depressive episodes (either a depressed mood or a loss of interest of pleasure in nearly all activities) for at least 2 weeks. Four of seven other symptoms must be present. Thus, the best response from the nurse is "the primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

6. 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? a) "Depression is a mood variation to life events" b) "The physician diagnoses depression when a client has feelings of sadness several times a year" c) "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression" d) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present"

d) "It sounds like this is a really difficult time for you" Pg. 421 "It sounds like this is a really difficult time for you" is an empathetic response that signifies that the nurse understands the client's ideas and feelings. Stating "I can understand what is going on with you" blocks effective communication because the nurse is minimizing the client's feelings. It indicates that the nurse cannot empathize with the client. Asking about if the client feels abandoned names the feelings and does not convey empathy. Asking what the client is thinking is not an empathetic response but is a therapeutic technique called exploring.

7. A client with major depression is admitted to the health facility and expresses feelings of worthlessness and abandonment by significant others. Which replies by the nurse would convey empathy? a) "Are you feeling like others have abandoned you?" b) "I can understand what is going on with you" c) "Can you tell me what you are thinking right now?" d) "It sounds like this is a really difficult time for you"

a) Fluoxetine (Prozac) Pg. 426 Fluoxetine is included among the SSRIs. Phenelzine, isocarboxazid, and tranylcypromine are monoamine oxidase inhibitors (MAOIs).

8. Which antidepressant medication is classified as a selective serotonin reuptake inhibitor (SSRI)? a) Fluoxetine b) Isocarboxazid c) Phenelzine d) Tranylcypromine

d) Encourage the client to increase fluid intake Pg. 424 Urinary hesitation is best addressed by increasing fluid intake. Diuretics are not normally necessary and acidic beverages are of no particular benefit.

9. 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? a) Encourage the client to use a low dose of an over the counter diuretic b) Encourage the client to drink low-pH beverages c) Ask the primary care provider to prescribe a diuretic d) Encourage the client to increase fluid intake