Chapter 15 - Depression

Beck's cognitive triad

(1) a negative, self-deprecating view of self; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement (or no validation for the self) will continue in the future.

Zung Depression Scale

A 20 question exam that rates 4 features of depression. There are 10 negative & 10 positive questions that are scored 1-4. The individual scores are added together, and the higher the score then the more depressed the individual.

2

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? 1 The nurse should encourage the client's newfound assertiveness. 2 This type of behavior places a depressed client at high risk for self-harm. 3 The client who is angry and depressed is likely experiencing transference. 4 The client is likely angry with someone else and projecting that anger to staff

4

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? 1 "Would you feel more relaxed about the treatments if I stayed with you?" 2 "What can I do to help you feel more comfortable about these treatments?" 3 "Do you know very much about the benefits and drawbacks of ECT treatments?" 4 "Will you let me know if you want or need to talk about these ECT treatments?"

1

A client diagnosed with major depressive disorder has vegetative symptoms. Which nursing diagnosis is most applicable to these symptoms? 1 Self-care deficit 2 Spiritual distress 3 Disturbed thought processes 4 Risk for self-directed violence

3

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. 1 "Which antidepressant medication do you think would be helpful?" 2 "There are different types of talk therapy, and most clients find it beneficial." 3 "Let's consider some ways to address your concerns with your health care provider." 4 "Are you willing to give talk therapy a try before starting an antidepressant medication?"

2

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? 1 "Citalopram is an antidepressant medication that is usually taken for life." 2 "It's important for you to gradually stop taking this drug, over 2 to 4 weeks." 3 "Because your depression is alleviated, you may now discontinue the medication." 4 "Stopping this medication all of a sudden can cause neuroleptic malignant syndrome."

3

A client is prescribed tricyclic antidepressants. What should the nurse check for in the client's case history before administering the drug? 1 Suicidal ideation 2 Loss of appetite 3 Oral contraceptive use 4 Insomnia

4

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? 1 Assess the client's current sleep and eating patterns. 2 Explain to the client, "Everyone feels down from time to time." 3 Suggest alternative activities for times when the client feels depressed. 4 Say to the client, "Tell me more about what you mean by 'a dark cloud.'"

1

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? 1 The nurse allows family members to remain with the client during meals. 2 The nurse gives food low in fiber to the client. 3 The nurse gives a large quantity of low-calorie food to the client. 4 The nurse gives tea and coffee frequently to the client.

1

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? 1 "Let's look at what you just said, that you can 'never do anything right.'" 2 "Tell me what things you think you are not able to do correctly." 3 "Is this part of the reason you think no one likes you?" 4 "That is the most unrealistic thing I have ever heard."

3

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? 1 Cheese 2 Bananas 3 Yogurt 4 Dried fish

3

A depressive client is prescribed tricyclic antidepressants. What appropriate advice does the nurse give to the client's family? 1 Do not give full dose to the client at bedtime. 2 Double the dose if the client forgets to take the bedtime dose. 3 Advise the client to be cautious while driving. 4 Stop the medication if hypotension occurs.

2,4

A depressive client with comorbid anxiety was prescribed vagus nerve stimulation (VNS). What appropriate teachings does the nurse give to the client's family? Select all that apply. 1 The nurse cautions them to never turn off the device. 2 The nurse informs them about voice alteration. 3 The nurse informs them that the client may have paralysis. 4 The nurse advises them to turn off the device when needed. 5 The nurse informs them about the confusion in the client

3

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? 1 The client interacts with the nurse. 2 The client maintains good hygiene. 3 The client sleeps properly. 4 The client has an increased appetite.

1

A nurse is performing an assessment of a client in the local community clinic. The nurse observes that the client looks older than the age mentioned in the medical record. The client avoids making eye contact with the nurse and speaks in a monotone. On examination the nurse does not find any signs and symptoms of a physical illness. Which assessment tool does the nurse use to assess the client's behavior? 1 Zung Depression Scale 2 Geriatric Depression Scale 3 Psychogeriatric Assessment Scale 4 Montreal Cognitive Assessment

3

A nurse tries to communicate with a depressive client who is mute and avoids interaction. How should the nurse approach the client? Incorrect1 The nurse should leave the client alone. 2 The nurse should ask the client about their family members. 3 The nurse should talk to the client about the weather. 4 The nurse should tell the client everything will be fine and he or she shouldn't be upset.

b

A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder. Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate? a. "You look nice this morning." b. "You are wearing a new shirt." c. "I like the shirt you're wearing." d. "You must be feeling better today."

a

A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, "No one cares about me anymore. I'm not worth anything." Select an appropriate initial outcome for the nursing diagnosis: Situational low self-esteem, related to feelings of abandonment. The patient will: a. verbalize realistic positive characteristics about self by (date) . b. consent to take antidepressant medication regularly by (date) . c. initiate social interaction with another person daily by (date) . d. identify two personal behaviors that alienate others by (date)

d

A patient became severely depressed when the last of six children moved out of the home 4 months ago. The patient repeatedly says, "No one cares about me. I'm not worth anything." Which response by the nurse would be the most helpful? a. "Things will look brighter soon. Everyone feels down once in a while." b. "The staff here cares about you and wants to try to help you get better." c. "It is difficult for others to care about you when you repeatedly say negative things about yourself." d. "I'll sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this afternoon."

b

A patient diagnosed with major depressive disorder tells the nurse, "Bad things that happen are always my fault." To assist the patient in reframing this overgeneralization, the nurse should respond: a. "I really doubt that one person can be blamed for all the bad things that happen." b. "Let's look at one bad thing that happened to see if another explanation exists." c. "You are being exceptionally hard on yourself when you say those things." d. "How does your belief in fate relate to your cultural heritage?"

b

A patient says to the nurse, "My life does not have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." How would the nurse document the complaint? a. Vegetative symptom b. Anhedonia c. Euphoria d. Anergia

4

A pregnant client is diagnosed with seasonal affective disorder. What appropriate action does the nurse include in the client's treatment plan? 1 Administer St. John's wort (Hypericum perforatum) regularly. 2 Administer selective serotonin reuptake inhibitors regularly. 3 Advise the client to rest and avoid exercising. 4 Instruct the client to get exposed to a light source for 30 to 45 minutes daily.

b

A priority nursing intervention for a patient diagnosed with major depressive disorder is: a. distracting the patient from self-absorption. b. carefully and inconspicuously observing the patient around the clock. c. allowing the patient to spend long periods alone in self-reflection. d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu.

3

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? Incorrect1 The sleep problems are more likely to be associated with the depression than with the medication. 2 The medication is stimulating dreaming, which will help the client resolve unconscious conflicts. 3 Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, often cause sleep disturbances when first taken. The problem may be short-term. 4 SSRIs, such as paroxetine, more commonly cause hypersomnolence rather than insomnia.

a

An adult diagnosed with major depressive disorder was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? a. Social skills training b. Relaxation training classes c. Use of complementary therapy d. Learning desensitization techniques

schizophrenia

Antidepressant therapy may trigger psychosis in clients diagnosed with ___________

4

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? 1 Seasonal affective disorder 2 Substance-induced depressive disorder 3 Disruptive mood dysregulation disorder 4 Psychotic depression

1

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? 1 Rest 2 Group therapy 3 Protein-based snack 4 Unstructured private time

3

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? 1 Notify the facility's client advocate about the new prescription. 2 Teach the adolescent about black box warnings associated with antidepressant medication. 3 Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. 4 Remind the health care provider about warnings associated with use of antidepressants in children and adolescents.

2

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? 1 Energy level 2 Weekly body weight measurements 3 Observed eating patterns 4 Statement of appetite

3

What assessment of the thought processes of a client diagnosed with depression is most likely to reveal? 1 Good memory and concentration 2 Delusions of persecution 3 Self-deprecatory ideation 4 Sexual preoccupation

1,2,3,5

What information will be included in medication education for a client prescribed an antidepressant? Select all that apply. 1 The goal of antidepressant therapy is the remission of symptoms. 2 Antidepressant therapy generally takes one to three weeks for mood to improve. 3 Antidepressant therapy may require a change in prescription to identify the most effective antidepressant. 4 Antidepressant therapy is contraindicated in clients diagnosed with bipolar disorder. 5 Antidepressant therapy may trigger psychosis in clients diagnosed with schizophrenia.

3

What intervention can the nurse do to impact the most people at potential risk for depression among a population? 1 Provide a depression screening at a local afterschool program site. 2 Present educational programming on depression to a group of older adults. 3 Routinely assess all chronically ill clients for depression during their admission interview. 4 Include the signs of postpartum depression in the discharge packet for each new mother.

1,4,5

What statement regarding depression is true? Select all that apply. 1 Depression can be present in association with other mental and physical disorders. 2 While depression coexists with other disorders, it does not impact these disorders. 3 The symptomology of depression is relatively similar regardless of age or culture. 4 Social relationships can suffer when an individual is depressed. 5 Depression can range from mild to severe in its effect on individuals.

c

When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will address the negative thought patterns by using: a. psychoanalytic therapy. b. desensitization therapy. c. cognitive behavioral therapy. d. alternative and complementary therapies.

2

When preparing a client for electroconvulsive therapy (ECT), what does the nurse discuss with the client? Incorrect1 Maintenance treatments are seldom required. 2 The initial course of therapy requires 6 to 12 treatments. 3 This form of therapy is particularly successful for positive symptoms of schizophrenia. 4 The initial therapy involves an ECT treatment repeated once a week for a prescribed time period.

1

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? 1 Wait quietly for the client to reply. 2 Prompt the client if the reply is slow. 3 Repeat the question if the client does not answer promptly. 4 Review the client's medical record to support the client's response.

1,2,3,4

Which assessment data are associated with monoamine oxidase inhibitor (MAOI) therapy? Select all that apply. 1 Reports dizziness when standing up 2 Weight gain of 5 pounds in last 4 weeks 3 Heart rate 100 beats per minute and irregular 4 Facial twitch noted in left cheek 5 Diarrhea for last 3 days

1,2,3

Which assessment data support the suspicion that a depressed client is demonstrating self-directed anger? Select all that apply. 1 Hospitalized for alcohol detoxification 2 Diagnosed as being morbidly obese 3 Three-pack-a-day cigarette smoker 4 Multiple failed marriages 5 Declared bankruptcy twice

2

Which assessment technique will the nurse use when attempting to substantiate a client's diagnosis of major depression? 1 Assess the client for signs of anorexia. 2 Ask the client if he or she has ever been depressed like this before. 3 Assess the client for behaviors associated with drug abuse. 4 Ask the client if he or she is having any problems falling or staying asleep.

1,3,5

Which child or teenager is demonstrating classic depression-related behavior? Select all that apply. 1 A 4-year-old cries frequently for no apparent physical reason. 2 A 6-year-old demands to sleep with one parent when the other is away. 3 An 8-year-old consistently declines offers to play with schoolmates. 4 An 11-year-old cries when a beloved family pet runs away. 5 A 15-year-old becomes verbally abusive to siblings.

3

Which complaint regarding sleep would the nurse expect from a client diagnosed with major depression? 1 "I usually take a nap for about 30 minutes in the afternoon." 2 "It takes me about 15 minutes to fall asleep. I often have vivid dreams." 3 "I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." 4 "I often fall asleep in the middle of an activity. When I wake up, I feel better."

2

Which individual has the highest risk for experiencing major depression? 1 A teenaged male who failed to make the football team 2 A young adult female who recently gave birth to her first child 3 An older adult female who retired after 25 years of factory work 4 A middle-aged male who is a self-employed small business owner

3

Which individual has the highest risk for major depression? 1 35-year-old married male who recently lost his job 2 6-year-old child who suffers from frequent ear infections 3 55-year-old single female recently diagnosed with rheumatoid arthritis 4 16-year-old male whose family recently moved from one state to another

1

Which nursing diagnosis would be most useful for a depressed client who shows psychomotor retardation? 1 Constipation 2 Death anxiety 3 Diarrhea 4 Imbalanced nutrition: more than body requirements

3

Which statement by a client indicates understanding of the client education provided about a prescribed selective serotonin reuptake inhibitor (SSRI)? 1 "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." 2 "I will not take any over-the-counter medication while on this medication." 3 "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." 4 "I will report increased thirst and urination to my health care provider."

3

Which statement made by a depressed client would provide insight into a common feeling associated with depression? 1 "I still pray and read my Bible every day." 2 "My mother wants to move in with me, but I want to be independent." 3 "I still feel bad about my sister dying of cancer. I should have done more for her!" 4 "I've heard others say that depression is a sign of weakness."

1,2,3

Which statements are associated directly with Beck's cognitive triad? Select all that apply. 1 "I'm not worth much; I can't do anything right." 2 "Things will only get worse; they never get better." 3 "I'll never find anyone who loves or values me." 4 "I don't think other people are worthless." 5 "Good luck happens to good people."

2,4

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. 1 The client has a reduced appetite. 2 The client has a feeling of worthlessness. 3 The client does not pray. 4 The client has suicidal ideation. 5 The client is unable to perform simple tasks

vagus nerve stimulation

a surgery in which a pacemaker is implanted into the left chest wall of the client.

cognitive behavioral therapy

attempts to alter the patient's dysfunctional beliefs by focusing on positive outcomes rather than negative attributions

3

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? 1 Anergia 2 Euthymia 3 Anhedonia 4 Self-deprecation

primary risk factors of depression

early childhood trauma, history of alcohol or other substance abuse, Female gender, low socioeconomic class, and unmarried

4,5

hereas several different neurotransmitters are involved in mood stabilization, which are considered the main regulators?Select all that apply. 1 Acetylcholine 2 Dopamine 3 Glutamate 4 Norepinephrine 5 Serotonin

vegetative signs of depression

include grooming and hygiene deficiencies, significantly reduced appetite, and changes in sleeping, eating, elimination, and sexual patterns.

Norepinephrine, serotonin

two main neurotransmitters in mood stanilization

4

ver 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? 1 "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." 2 "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." 3 "Yes there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." 4 "Electroconvulsive therapy is effective when urgent help is needed. Your family member will be carefully evaluated for possible risks.