Chapter 16- Major depression disorders

The nurse is preparing a presentation about Beck's cognitive theory. Which cognitive distortion would the nurse include in the teaching session? 1. Negative expectation of the environment 2. Negative expectation of the present 3. Negative expectation of the career 4. Negative expectation of the family

1 Negative expectations of the environment is one of the three cognitive distortions in Beck's Cognitive Theory. The other two are negative expectations of the self and future.

Which action should the nurse take when a depressed client refuses electroconvulsive therapy (ECT)? 1. Accept the client's decision 2. Inform the client that the procedure is mandatory 3. Tell the client that the signature verifies informed consent 4. Call the family to receive approval

1 The nurse should accept the client's decision. Consent for ECT may be withdrawn at any time.

Which statement by a client who is beginning tricyclic antidepressant therapy indicates successful teaching? 1. "I will continue to take this medication even if the symptoms have not subsided." 2. "I will start to see results in about 2 weeks." 3. "I will continue to smoke." 4. "I will start to cut down on my alcohol intake and have only one glass of wine at supper."

1 This statement indicates successful teaching. Clients should continue to take the medication even if symptoms have not subsided. The therapeutic effect may not be seen for as long as 4 weeks.

The nurse is teaching about the diagnosis disruptive mood dysregulation disorder (DMDD). Which information should the nurse include? (Select all that apply.) 1. Symptoms include verbal rages or physical aggression toward people or property. 2. Temper outbursts must be present in at least two settings (at home, at school, or with peers). 3. DMDD is characterized by severe recurrent temper outbursts. 4. The temper outbursts are manifested only behaviorally. 5. Symptoms of DMDD must be present for 18 or more months to meet diagnostic criteria.

1,2,3

The depressed client is prescribed a monoamine oxidase inhibitor (MAOI). Which statements by the client should indicate to a nurse that the discharge teaching about this medication has been successful? (Select all that apply.) 1. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." 2. "I guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food labels." 4. "I'm going to drink my caffeinated coffee in the morning." 5. "I'll be sure not to stop this medication abruptly."

1,2,3,5

An older adult client has a diagnosis of dysthymic disorder. Which signs and symptoms should the nurse expect the client to exhibit? (Select all that apply.) 1. Sad mood on most days 2. Mood rating of 2 out of 10 for the past 6 months 3. Labile mood 4. Sad mood for the past 3 years after spouse's death 5. Pressured speech when communicating

1,4

Which characteristic would help a nurse distinguish between dysthymia and major depressive disorder (MDD)? 1. Dysthymia is associated with the menstrual cycle. 2. Dysthymia is a chronically depressed mood. 3. MDD lasts for at least 2 years. 4. MDD does not have delusions or hallucinations

2 Dysthymia is somewhat milder than MDD but the essential feature is a chronically depressed mood for most of the day, more days than not, for at least 2 years.

Which scale would a nurse practitioner use to assess a depressed client? 1. Zung Depression Scale 2. Hamilton Depression Rating Scale 3. Beck Depression Inventory 4. AIMS Depression Rating Scale

2 One of the most widely used clinician-administered scales is the Hamilton Depression Rating Scale. The original version contains 17 items and is designed to measure mood, guilty feelings, suicidal ideation, sleep disturbances, anxiety levels, and weight loss.

The nurse is caring for a client with major depressive disorder who is withdrawn, uncommunicative, and secludes self in room. Which nursing diagnosis should the nurse add to the plan of care? 1. Spiritual distress 2. Social isolation 3. Low self-esteem 4. Powerlessness

2 The client's withdrawn and uncommunicative behavior and secluding self in the room indicates social isolation. Other behaviors include seeks to be alone, dysfunctional interaction with others and discomfort in social situations.

The depressed client is receiving light therapy. Which instruction would the nurse share with the client? 1. "White LED lights will be used with protective glasses to block ultraviolet rays." 2. "You will sit in front of the light box with your eyes open." 3. "The light sessions will start out at 5 minutes and work up to 30 minute intervals." 4. "Vagal stimulation from the light waves will help release melatonin in the brain."

2 The individual sits in front of the box with the eyes open (although the client should not look directly into the light).

The nurse performs a full physical health assessment on an older adult client admitted with a diagnosis of major depressive disorder. What is the rationale for the nurse's assessment? 1. The attention during the assessment is beneficial in decreasing social isolation in the elderly. 2. Depression can generate somatic symptoms that can mask actual physical disorders. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed geriatric clients avoid addressing physical health and ignore medical problems.

2 The nurse should determine that an older adult client with a diagnosis of major depressive disorder needs a full physical health assessment, because depression can generate somatic symptoms that can mask actual physical disorders. Many medical conditions, including endocrinological, neurological, nutritional, and metabolic disorders, often present with classic symptoms of depression.

After 5 months of taking nortriptyline (Aventyl) for depressive symptoms, a client reports that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "When did you last eat yogurt?"

2 The nurse would ask this question. Nortriptyline is a tricyclic antidepressant. Smoking should be avoided while receiving tricyclic therapy. Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect.

The nurse is caring for a client with a postpartum emotional disorder. Which postpartum disorder is correctly matched with its presenting symptoms? 1. Baby blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions) 2. Moderate postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby) 3. Maternity blues (overprotection of infant, severe guilt, depressed mood, lack of concentration) 4. Postpartum depression with psychotic features (transient depressed mood, decisive, abnormal fear of child abduction, suicidal ideations)

2 The symptoms listed are characteristic of moderate postpartum depression and include fatigue, irritability, loss of appetite, sleep disturbances, loss of libido, and expressions of great concern about her inability to care for her baby.

The nurse is teaching the depressed client about bupropion (Wellbutrin). Which statement by the client indicates effective teaching? 1. "I will begin to wear short sleeves when outdoors." 2. "I will not take two pills if I miss a dose." 3. "I will discontinue the medication when my depression is gone." 4. "I will stand up smoothly and quickly to keep my balance."

2 This statement indicates effective teaching. Clients should never double up on a dose if they miss a day, as this could increase the risk of seizures or other adverse reactions.

The client experiences sadness and melancholia in September continuing through November. Which factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) 1. Gender differences in social opportunities 2. Increased production of melatonin 3. Hyposecretion of cortisol 4. Less exposure to natural sunlight 5. Blockade of histamine reuptake

2,4

The nurse assesses a client with major depressive disorder. Which assessment finding would the nurse observe? 1. Sadness subsides quickly 2. Promiscuous behaviors 3. Unable to feel any pleasure 4. Excessive spending sprees

3 The client being unable to feel any pleasure meets the diagnosis requirements of major depressive disorder.

The nurse is assisting with electroconvulsive therapy (ECT). What is the rationale for administering 100% oxygen to a client during and after ECT? 1. To prevent brain damage from the electrical impulse of the procedure 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles 4. To prevent blocked airway, resulting from seizure activity

3 The nurse administers 100 percent oxygen during and after ECT to prevent anoxia resulting from medication-induced paralysis of respiratory muscles. Because succinylcholine paralyzes respiratory muscles, the client is oxygenated with pure oxygen during and after the treatment, except for the brief interval of electrical stimulation, until spontaneous respirations return.

The nurse discovers a client has a history of divorce, job loss, family estrangement, and cocaine abuse. Which theory explains the etiology of this client's depressive symptoms? 1. Psychoanalytic theory 2. Object loss theory 3. Learning theory 4. Cognitive theory

3 The nurse should assess that, according to learning theory, this client's depressive symptoms may have resulted from repeated failures. The learning theory is a model of "learned helplessness" in which multiple life failures cause the client to abandon future attempts to succeed and leads to depression.

The client with major depressive episode is experiencing command hallucination for self-harm. Which intervention should be the nurse's priority at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal 2. Conducting 15-minute checks to ensure safety 3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations 4. Encouraging client to express feelings related to suicide

3 The nurse's priority intervention when a depressed client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideations. By providing one-to-one observation, the nurse will be able to interrupt any attempts at suicide.

A client is prescribed transdermal selegiline (Emsam) for depressive symptoms. Which action would the nurse take to administer this medication? 1. Apply new patch to the lower abdomen. 2. Apply new patch to inner surface of upper arm. 3. Place new patch on dry, intact skin. 4. Place direct heat to new patch for a tight seal.

3 The patch is applied to dry, intact skin at approximately the same time each day.

The nurse is preparing a staff education session about depression in adolescents. Which statement by a staff member indicates teaching has been effective? 1. "Adolescents are not likely to suffer from depression." 2. "Depressed adolescents normally seek immediate treatment." 3. "Many symptoms are attributed to normal adjustments of adolescents." 4. "Suicide is not common among depressed adolescents."

3 This statement would indicate effective teaching because many symptoms of depression may be attributed to normal adjustments of adolescents.

The nurse is preparing an antidepressant medication for a 13-year-old client who is experiencing major depressive disorder. Which FDA-approved medication should the nurse administer? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Escitalopram (Lexapro)

4 Escitalopram (Lexapro) was FDA approved in 2009 for treatment of major depression in adolescents aged 12 to 17 years. Fluoxetine (Prozac) has also been approved by the FDA to treat depression in children and adolescents. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents

The nurse determines that a depressed client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives? 1. "It's all my fault for trusting him." 2. "I don't play games. I never win." 3. "She never visits, because she thinks I don't care." 4. "Growing plants is so easy. Any old fool can grow a rose."

4 Stating, "Growing plants is so easy. Any old fool can grow a rose," is an example of discounting positives. Examples of automatic thoughts in depression include discounting positives; for example, "The other questions were so easy. Any dummy could have gotten them right."

A client is taking phenelzine (Nardil). Which statement by the client should cause the nurse to intervene? 1. "I cannot use over-the-counter medications for my colds." 2. "I have to cut out eating my raisin bran every morning." 3. "I will have to avoid pepperoni pizza when eating with my friends." 4. "I am taking diet pills to lose weight for my friend's wedding."

4 The nurse would have to intervene because this is an incorrect statement and needs to be corrected. The client cannot take diet pills and phenelzine, a MAOI, together because this could cause a life-threatening hypertensive crisis.

Which highest priority outcome would the nurse add to the plan of care for a depressed client? 1. The client will promise to remain safe. 2. The client will discuss feelings with staff and family by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will not harm self during hospital stay.

4 The nurse's highest priority should be that the client will not harm self during the hospital stay. Client safety should always be the nurse's highest priority.