MH 15

A nurse worked with a patient diagnosed with major depressive disorder who was severely withdrawn and dependent on others. After 3 weeks, the patient did not improve. The nurse is at risk for what emotional response? Overinvolvement Guilt and despair Disinterest and apathy Ineffectiveness and frustration

Ineffectiveness and frustration

A patient diagnosed with major depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. Priority information given to the patient and family should include a directive to do what? Avoid exposure to bright sunlight. Report increased suicidal thoughts. Restrict sodium intake to 1 g daily. Maintain a tyramine-free diet.

Report increased suicidal thoughts.

A woman gave birth to a healthy newborn 1 month ago. The patient now reports she cannot cope and is unable to sleep or eat. She says, "I feel like a failure. This baby is the root of my problems." What is the priority nursing diagnosis? Insomnia Ineffective coping Situational low self-esteem Risk for other-directed violence

Risk for other-directed violence

A patient diagnosed with major depressive disorder repeatedly tells staff members, "I have cancer. It's my punishment for being a bad person." Diagnostic tests reveal no cancer. Select the priority nursing diagnosis. Powerlessness Risk for suicide Stress overload Spiritual distress

Risk for suicide

A patient's employment is terminated, and major depressive disorder develops shortly afterward. The patient says to the nurse, "I'm not worth the time you spend with me. I'm the most useless person in the world." Which nursing diagnosis applies? Powerlessness Defensive coping Situational low self-esteem Disturbed personal identity

Situational low self-esteem

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? "Things will look brighter soon. Everyone feels down once in a while." "The staff here cares about you and wants to try to help you get better." "It is difficult for others to care about you when you repeatedly say negative things about yourself." "I'll sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this afternoon."

"I'll sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this afternoon."

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, how should the nurse respond? "I really doubt that one person can be blamed for all the bad things that happen." "Let's look at one bad thing that happened to see if another explanation exists." "You are being exceptionally hard on yourself when you say those things." "How does your belief in fate relate to your cultural heritage?"

"Let's look at one bad thing that happened to see if another explanation exists."

A patient being treated for major depressive disorder has taken 300 mg amitriptyline daily for a year. The patient calls the case manager at the clinic and says, "I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares." How should the nurse advise the patient? "Go to the nearest emergency department immediately." "Do not to be alarmed. Take two aspirin and drink plenty of fluids." "Take one dose of the antidepressant, and then come to the clinic to see the health care provider." "Resume taking the antidepressant for 2 more weeks, and then discontinue it again."

"Take one dose of the antidepressant, and then come to the clinic to see the health care provider."

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? "You look nice this morning." "You are wearing a new shirt." "I like the shirt you're wearing." "You must be feeling better today."

"You are wearing a new shirt."

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 patient's statement?a. Vegetativeb. Anhedonia c. Euphoria d. Anergia

Anhedonia

During a psychiatric assessment, the nurse observes a patient's facial expressions that are without emotion. The patient says, "Life feels so hopeless to me. I've been feeling sad for several months." How should the nurse document the patient's affect and mood? Affect depressed; mood flat Affect flat; mood depressed Affect labile; mood euphoric Affect and mood are incongruent

Affect flat; mood depressed

What is a priority nursing intervention for a patient diagnosed with major depressive disorder? Distracting the patient from self-absorption Carefully and inconspicuously observing the patient around the clock Allowing the patient to spend long periods alone in self-reflection Offering opportunities for the patient to assume a leadership role in the therapeutic milieu

Carefully and inconspicuously observing the patient around the clock

When counseling patients diagnosed with major depressive disorder, how will an advanced practice nurse likely address the negative thought patterns? Psychoanalytic therapy Desensitization therapy Cognitive behavioral therapy Alternative and complementary therapies

Cognitive behavioral therapy

A nurse provided medication education for a patient who is prescribed phenelzine for depression. Which patient behavior indicates effective learning? Monitors sodium intake and weight daily. Wears support stockings and elevates the legs when sitting. Consults the pharmacist when selecting over-the-counter medications. Can identify foods with high selenium content, which should be avoided.

Consults the pharmacist when selecting over-the-counter medications.

A patient diagnosed with major depressive disorder is taking a tricyclic antidepressant. The patient says, "I don't think I can keep taking these pills. They make me so dizzy, especially when I stand up." The nurse should implement what intervention? Explain how to manage postural hypotension and educate the patient that side effects go away after several weeks. Tell the patient that the side effects are a minor inconvenience compared with the feelings of depression. Withhold the drug, force oral fluids, and notify the health care provider to examine the patient. Teach the patient how to use pursed-lip breathing.

Explain how to manage postural hypotension and educate the patient that side effects go away after several weeks.

A patient was started on escitalopram 5 days ago and now says, "This medicine isn't working." What is the nurse's best intervention? Discussing with the health care provider the need to change medications Reassuring the patient that the medication will be effective soon Explaining the time lag before antidepressants relieve symptoms Critically assessing the patient for symptom relief

Explaining the time lag before antidepressants relieve symptoms

A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate? Arms crossed Staring at the nurse Smiling inappropriately Eyes casted downward

Eyes casted downward

A disheveled patient with severe depression and psychomotor retardation has not bathed for several days. What action should the nurse take? Avoid forcing the issue. Bringing up the issue at the community meeting. Calmly telling the patient, "You must bathe daily." Firmly and neutrally assisting the patient with showering.

Firmly and neutrally assisting the patient with showering.

A nurse instructs a patient taking a drug that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of what risk? Hypotensive shock Hypertensive crisis Cardiac dysrhythmia Cardiogenic shock

Hypertensive crisis

A patient diagnosed with major depressive disorder does not interact with others except when addressed and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Select the nurse's most effective approach to communication. Make observations on neutral topics. Ask the patient direct questions. Phrase questions to require "yes" or "no" answers. Frequently reassure the patient to reduce guilt feelings.

Make observations on neutral topics.

A nurse teaching a patient about a tyramine-restricted diet would approve which meal? Mashed potatoes, ground beef patty, corn, green beans, apple pie Avocado salad, ham, creamed potatoes, asparagus, chocolate cake Macaroni and cheese, hot dogs, banana bread, caffeinated coffee Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

Mashed potatoes, ground beef patty, corn, green beans, apple pie

Which beverage should the nurse offer to a patient diagnosed with major depressive disorder who refuses solid food? Tomato juice Orange juice Hot tea Milk

Milk

Which documentation indicates the treatment plan of a patient diagnosed with major depressive disorder was effective? Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild. Slept 10 hours uninterrupted. Attended craft group; stated "project was a failure, just like me." Slept 5 hours with brief interruptions.

Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild.

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? Social skills training Relaxation training classes Use of complementary therapy Learning desensitization techniques

Social skills training

What is the focus of priority nursing care for the period immediately after a patient has an electroconvulsive therapy (ECT) treatment? Supporting physiological stability Reducing disorientation and confusion Monitoring pupillary responses Assisting the patient to plan for the future

Supporting physiological stability

A patient diagnosed with major depressive disorder was hospitalized for 8 days. Treatment included six electroconvulsive therapy sessions and aggressive dose adjustments of antidepressant medications. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling. Temporary memory impairments and confusion can be associated with electroconvulsive therapy. Antidepressant medications alter catecholamine levels, which impair decision-making abilities. Antidepressant medications may cause confusion related to a limitation of tyramine in the diet. The patient needs time to reorient him or herself to a pressured work schedule.

Temporary memory impairments and confusion can be associated with electroconvulsive therapy.

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. The patient will verbalize realistic positive characteristics about self by (date). The patient will consent to take antidepressant medication regularly by (date). The patient will initiate social interaction with another person daily by (date). The patient will identify two personal behaviors that alienate others by (date).

The patient will verbalize realistic positive characteristics about self by (date).

A patient diagnosed with major depressive disorder is receiving imipramine 200 mg every night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug? Dry mouth Blurred vision Nasal congestion Urinary retention

Urinary retention