Depressive Disorders
A patient hospitalized for major depression has been taking sertraline for the past week and has verbalized increased energy and improved sleep. What is the highest priority question the nurse should ask? "Do you think your depression is less severe?" "Are you having any thoughts of harming yourself?" "Have you experienced any side effects from this drug?" "How has your appetite changed since starting this drug?"
"Are you having any thoughts of harming yourself?" The patient is starting to experience increased energy, but suicidal thoughts may still remain. The patient may now have the energy for self-harm. It is important to assess for other side effects, such as appetite changes and depression, but suicide is the highest priority. p. 253
Which individual has the highest risk for major depression? 35-year-old married male who recently lost his job 6-year-old child who suffers from frequent ear infections 55-year-old single female recently diagnosed with rheumatoid arthritis 16-year-old male whose family recently moved from one state to another
55-year-old single female recently diagnosed with rheumatoid arthritis The correct response incorporates the most risk factors for depression. Primary risk factors include female gender, being unmarried, low socioeconomic class, early childhood trauma, a negative life event (especially loss and humiliation), family history of depression, ineffective coping ability, postpartum time period, medical illness, absence of social support, and alcohol or substance abuse. p. 246, Box 14.1
Which statement made by a depressed patient would provide insight into a common feeling associated with depression? "I still pray and read my Bible every day." "I've heard others say that depression is a sign of weakness." "My mother wants to move in with me, but I want to be independent." "I still feel bad about my sister dying of cancer. I should have done more for her!"
"I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; wanting independence and feeling that depression is a weakness do not describe a common accompaniment to depression. p. 251
An adult was hospitalized three days ago with a diagnosis of major depression with suicidal ideation. Which comment by this patient best reflects an improvement in the depression? "I am hungry all the time." "My family can get along fine without me." "Group therapy may be helpful to others but I find it tiresome to listen." "I talked with my family about ways we can celebrate holidays together."
"I talked with my family about ways we can celebrate holidays together." The correct response indicates this patient is looking toward the future, which would not occur in the presence of continued suicidal thinking. An improved appetite is a positive finding but could be attributed to medication side effects or other events; it is not the best answer. Saying one's family can get along without him or her and not wanting to go to group therapy indicate hopelessness and continued severe depression. p. 254, Table 14.2
Which complaint regarding sleep would the nurse expect from a patient diagnosed with major depression? "I usually take a nap for about 30 minutes in the afternoon." "It takes me about 15 minutes to fall asleep. I often have vivid dreams." "I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." "I often fall asleep in the middle of an activity. When I wake up, I feel better."
"I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." Change in sleep patterns is a cardinal sign of depression. Often, people experience insomnia, wake frequently, and have a total reduction in sleep, especially deep-stage sleep. One of the hallmark symptoms of depression is waking at 3 or 4 AM and then staying awake or sleeping for only short periods. Napping, vivid dreams, and falling asleep in the middle of an activity identify normal sleep variations and narcolepsy. p. 252
Which statement by a patient indicates understanding of the medication teaching provided concerning a prescribed selective serotonin reuptake inhibitor (SSRI)? "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." "I will not take any over-the-counter medication while on this medication." "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." "I will report increased thirst and urination to my health care provider."
"I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." High fever, fast heartbeat, or abdominal pain describe symptoms of serotonin syndrome, a life-threatening complication of SSRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over the counter medications if sanctioned by the health care provider, and would not have been educated to report increased thirst and urination as a side effect of SSRI. pp. 258-260
Which statement would show acceptance of a depressed, mute patient? "I will be spending time with you each day to try to improve your mood." "I would like to sit with you for 15 minutes now and again this afternoon." "Each day we will spend time together to talk about things that are bothering you." "It is important for you to share your thoughts with someone who can help you evaluate your thinking."
"I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the patient without making demands is a good way to show acceptance. pp. 253-254
Which statements are associated directly with Beck's cognitive triad? "I'm not worth much; I can't do anything right." "Things will only get worse; they never get better." "I'll never find anyone who loves or values me." "I don't think other people are worthless." "Good luck happens to good people."
"I'm not worth much; I can't do anything right." "Things will only get worse; they never get better." "I'll never find anyone who loves or values me." Three assumptions constitute 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. Statements such as "I don't think other people are worthless" and "Good luck happens to good people" lack the negative assumptions associated with the cognitive triad. p. 248
A patient has been taking citalopram for two years for depression. The patient's outcomes have been achieved and the patient wants to discontinue the medication. Which information should the nurse provide? "Citalopram is an antidepressant medication that usually is taken for life." "Stopping this medication all of a sudden can cause serotonin syndrome." "Because your depression is alleviated, you may discontinue the medication." "It's important for you to gradually stop taking this drug over two to four weeks."
"It's important for you to gradually stop taking this drug over two to four weeks." Selective serotonin reuptake inhibitors (SSRIs) should be tapered off gradually over a period of two to four weeks to avoid a withdrawal syndrome. Symptoms of the withdrawal syndrome include headache, gastrointestinal upset, dizziness, insomnia, anxiety, and flulike symptoms. Serotonin syndrome is a potentially life-threatening consequence of drug interactions with SSRIs. p. 259, Table 14.6
A patient diagnosed with chronic severe depression has been prescribed a series of electroconvulsive therapy (ECT) treatments. The nurse's initial intervention is to ask: "Would you feel more relaxed about the treatments if I stayed with you?" "What can I do to help you feel more comfortable about these treatments?" "Do you know very much about the benefits and drawbacks of ECT treatments?" "Will you let me know if you want or need to talk about these ECT treatments?"
"Will you let me know if you want or need to talk about these ECT treatments?" An essential role of the nurse is to allow the patient an opportunity to express feelings, including concerns associated with myths or fantasies involving ECT. "Will you let me know if you want or need to talk about these ECT treatments?" does not present any barriers to communication and so allows the patient to express his or her feelings and concerns. The question about the nurse staying with the patient makes assumptions about the patient's concerns and so is a barrier to effective communication. The questions about helping the patient feel more comfortable and concerning the benefits and drawbacks of ECT make assumptions about the patient's needs and so are barriers to effective communication. p. 264
Which child or teenager is demonstrating classic depression-related behavior? A 4-year-old who cries frequently for no apparent physical reason A 6-year-old who demands to sleep with mom when dad is away An 8-year-old who consistently declines offers to play with schoolmates An 11-year-old who cries when a beloved family pet runs away A 15-year-old who becomes verbally abusive to siblings
A 4-year-old who cries frequently for no apparent physical reason An 8-year-old who consistently declines offers to play with schoolmates A 15-year-old who becomes verbally abusive to siblings As children grow and develop, they may display a wide range of moods and behaviors, making it easy to overlook signs of depression. For example, a very young child may cry, a school-age child might withdraw, and a teenager may become irritable in response to feeling sad or hopeless. The 6-year-old who demands to sleep with mom when dad is away and an 11-year-old who cries when a beloved family pet runs away are examples of acute grief or anxiety rather that depression. p. 252
Which individual demonstrates the greatest risk for experiencing major depression? A teenaged male who failed to make the football team A young adult female who recently gave birth to her first child An older adult female who retired after 25 years of factory work A middle-aged male who is a self-employed small business owner
A young adult female who recently gave birth to her first child The lifetime risk for major depression is 7% to 12% for men and 20% to 30% for women. Among women, rates peak between adolescence and early adulthood. It is particularly important to screen for depression among women of reproductive age, especially those who have children or plan to become pregnant. Although the teenaged male and the retired female do have characteristics that put them at risk for depression (e.g. disappointment, being a teenager, retirement, being female), they are less at risk than the young adult female who recently gave birth. The middle-aged male's risk for major depression is relatively small. p. 246, Box 14.1
A primary health care provider prescribes electroconvulsive therapy to a patient who is not responding to antidepressant medications. What interventions should the nurse perform before the therapy is administered to the patient? Administer captopril. Administer acetaminophen. Avoid informing the patient's guardians. Administer atropine sulfate before the therapy.
Administer atropine sulfate before the therapy. Electroconvulsive therapy (ECT) is used for the patients who have major depression and psychotic symptoms, and for patients who don't respond to medication. Atropine sulfate is a short-acting barbiturate and is administered to the patient to induce sleep before initiating ECT. Permission must be taken from the patient's guardians before doing electroconvulsive therapy. Captopril is an angiotensin-converting enzyme inhibitor which is generally prescribed during hypertension. Acetaminophen is a nonsteroidal antiinflammatory drug and is unrelated to electroconvulsive therapy. p. 264
A depressive patient is prescribed tricyclic antidepressants. What appropriate advice does the nurse give to the patient's family? Stop the medication if hypotension occurs. Do not give full dose to the patient at bedtime. Advise the patient to be cautious while driving. Double the dose if the patient forgets to take the bedtime dose.
Advise the patient to be cautious while driving. Tricyclic antidepressants (TCAs) cause side effects such as drowsiness or dizziness. So the patient must be advised to be cautious while crossing the road, driving, or working with machines. The patient must take a full dose at bed time, so that the side effects are less during the day. If the patient forgets to take the dose, the next dose should be taken at the scheduled time. A double dose should be avoided. The medication should not be stopped if there is reduction in blood pressure as it can cause nausea, altered heartbeat, cold sweats, and nightmares. p. 261, Box 14.5
A patient 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? Anergia Euthymia Anhedonia Self-deprecation
Anhedonia Anhedonia means that there is no pleasure or joy in life. It is a common finding with depression. Anergia refers to a lack of energy or physical passivity. Euthymia refers to a mood state that is normal and moderate, with neither depression nor mania. Self-deprecation refers to negative statements about self. p. 252
A patient is diagnosed with major depressive disorder. Which assessment findings are categorized as vegetative symptoms? Anorexia Insomnia Joint pain Headache Constipation
Anorexia Insomnia Constipation Vegetative signs of depression include changes in bowel movements and eating habits, sleep disturbances, and disinterest in sex. Pain is not usually classified as a vegetative symptom. p. 252
Which antidepressant drug can be prescribed to depressed patients who also suffer from narrow-angle glaucoma? Bupropion Amitriptyline Desipramine Isocarboxazid Tranylcypromine
Bupropion Isocarboxazid Tranylcypromine Bupropion is a norepinephrine dopamine reuptake inhibitor that can be prescribed to treat depression in patients with narrow angle glaucoma. It blocks the synaptic reuptake of norepinephrine and dopamine instead of the muscarinic receptors. Isocarboxazid is a monoamine oxidase inhibitor that inhibits the monoamine oxidase enzyme. It does not antagonize the muscarinic actions, so it can be prescribed to patients with narrow angle glaucoma. Tranylcypromine is a monoamine oxidase inhibitor. It does not cause side effects like blurred vision, so it is safe to be prescribed. Tricyclic antidepressants such as desipramine and amitriptyline must be avoided in depressed patients with narrow angle glaucoma. Tricyclic antidepressants are muscarinic receptor antagonists and thus cause blurred vision. These drugs would worsen the condition of narrow angle glaucoma. p. 261
What are the side effects of vagus nerve stimulation (VNS)? Cough Delusions Neck pain Paresthesia Tachycardia
Cough Neck pain Paresthesia Patients who have undergone VNS may have side effects, including paresthesia, neck pain, and cough due to the position and implantation of the VNS device on the vagus nerve. The electrode used for stimulation is placed close to the laryngeal and pharyngeal branch of the left vagus nerve. Stimulation of these nerves causes coughing. The vagus nerve has an inhibitory effect on the heart; therefore bradycardia, not tachycardia, is a symptom associated with vagus nerve stimulation. Vagus nerve stimulation does not alter the neurotransmitter levels in the brain, so the patient does not have delusions. p. 265
What statement about the comorbidity of depression is accurate? Depression most often exists in an individual as a single entity. Depression commonly is seen in individuals with medical disorders. Substance abuse and depression are seldom seen as comorbid disorders. Depression may coexist with other disorders, but is rarely seen with schizophrenia.
Depression commonly is seen in individuals with medical disorders. Depression commonly accompanies medical disorders. Depression existing most often as a single entity, seldom seen with substance abuse, and rarely seen with schizophrenia are false statements. p. 246
What statement regarding how depression affects both children and older adults is true? Children and older adults share similar symptoms of depression. Depression among older adults is believed to be a normal occurrence related to aging. Depression increases the risk for suicide among those older adults experiencing the disorder. Incidence of depression among children between ages 13 and 17 warrant screening of that population. The younger one is when the initial episode of depression occurs, the higher the risk of recurring episodes.
Depression increases the risk for suicide among those older adults experiencing the disorder. Incidence of depression among children between ages 13 and 17 warrant screening of that population. The younger one is when the initial episode of depression occurs, the higher the risk of recurring episodes.
A teenage patient was admitted several weeks ago after a suicide attempt. Despite family therapy, one of the parents is still struggling to cope with the child's behavior. Which teaching point would be most beneficial for the parents? Depression is beyond voluntary control, but it can be managed. The patient needs to be able to express anger directly at the parents. The parents should also seek therapeutic help because depression is hereditary. The patient should stop taking prescribed medicines if the patient mentions suicide.
Depression is beyond voluntary control, but it can be managed. Family support is key to improving the prognosis for depressed teenagers. Crucial to this is the parents' understanding that depression is involuntary but can be managed. The patient should not stop taking prescribed medications without consulting the doctor. The patient does need to find ways to express feelings, but expressing anger is not always a solution. Depression can be hereditary, but this does not address the parent's concern. p. 255
Subsyndromal depression primarily occurs in which population? Adults Elderly Children Teenagers
Elderly Subsyndromal depression is most prevalent in older adults. It occurs when the patient experiences some, but not all, of the symptoms that are seen in a major depressive episode. Children, adolescents, and adults are less susceptible to subsyndromal depression. p. 246
The nurse cares for a patient diagnosed with major depressive disorder. Assessment findings include psychosis and repeated threats to murder members of the immediate family. Which treatment modality is most likely for this patient? Light therapy St. John's wort Electroconvulsive therapy Cognitive behavioral therapy
Electroconvulsive therapy The patient described in this scenario demonstrates psychosis and homicidal thinking. While medication is generally the first line of treatment for ease of use, electroconvulsive therapy may be a primary treatment when a patient is suicidal, homicidal, or psychotic. Light therapy is appropriate for a person diagnosed with seasonal affective disorder. Cognitive behavioral therapy is used in the treatment of depression, but is more effective in the maintenance phase. St. John's wort is an over-the-counter herb sometimes used for its antidepressant effects; however, the urgency and acuity of this patient's symptoms necessitate use of an intervention that will produce more immediate effects. pp. 263-264, Figure 14.3
A nurse counsels a patient diagnosed with depression to begin a mild exercise regime. What is the physiologic basis of the nurse's recommendation? Exercise reduces inflammation. Exercise stimulates serotonin production. Exercise will stabilize the client's sleep pattern. Exercise eliminates toxins from the client's body.
Exercise stimulates serotonin production. Exercise stimulates serotonin production, which will help improve the patient's mood. Exercise has biological, social, and psychological effects on symptoms of depression. Inflammation may be a factor in depression, but exercise is not targeted at this aspect of the disorder. While exercise may contribute to improved sleep, it will not necessarily stabilize the sleep pattern. Exercise improves circulation, but does not necessarily eliminate toxins. p. 266
A patient who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The patient mentions that he or she will take the medication along with the St. John's wort he or she uses daily. The nurse should Explain the high possibility of an adverse reaction Suggest that the patient also use a sun lamp daily Caution the patient to drink several glasses of water daily Agree that taking the drugs at the same time will help the patient to remember them daily
Explain the high possibility of an adverse reaction Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. p. 266
A young adult patient reports to the nurse that her premenstrual symptoms have worsened. She has read about premenstrual dysphoric disorder (PMDD) and thinks she may have the condition. Which statement about the disorder is true? PMDD symptoms worsen after menopause. Fluoxetine is one potential treatment option. The disorder will not resume after a pregnancy. PMDD means she will always have severe depression.
Fluoxetine is one potential treatment option. Fluoxetine can be used to treat PMDD. PMDD does not necessarily mean a patient will always have severe depression. The disorder can manifest as long as a woman is menstruating, including during the postnatal period. Symptoms generally decrease after menopause unless the patient receives hormone replacement therapy. p. 244
What is the recommended starting dose of selective serotonin reuptake inhibitors in geriatric patients with depression? The lowest adult dose The normal adult dose Half the lowest adult dose Half the normal adult dose
Half the lowest adult dose Geriatric patients with depression must be prescribed selective serotonin reuptake inhibitors as a first line treatment. They must be administered half the lowest adult dose to avoid adverse effects due to drug accumulation. In geriatric patients the concentration of these drugs in the blood is high due to low glomerular filtration rate and reduced clearance of the drug. This is caused by impaired renal function, which can be caused by polypharmacy. The lowest adult dose, normal adult dose, and half the normal adult should not be administered to geriatric patients. These doses would cause severe toxic effects in geriatric patients. p. 263
What is the best question for the nurse to ask when attempting to assess for the presence of depression in an elderly patient? Are you having crying spells every day? What is your family history related to depressive illnesses? Would you say you are currently having a major depressive episode? How do you compare your activities and health now to six months ago?
How do you compare your activities and health now to six months ago? Elderly patients may not acknowledge depression directly. Changes in somatic and interpersonal activities often give clearer evidence of depression. pp. 252-253
A nurse is teaching a group of nursing students about antidepressants that act by increasing the availability time of noradrenaline and serotonin at the postsynaptic receptors. Which medication would you expect to see prescribed? Bupropion Vilazodone Sertraline Imipramine
Imipramine Imipramine belongs to the class of tricyclic antidepressants that act by increasing the availability time of noradrenaline and serotonin at the postsynaptic receptors. An increase in the serotonin and norepinephrine levels can cause mood elevation. Bupropion belongs to norepinephrine dopamine reuptake inhibitors. It blocks the synaptic reuptake of norepinephrine and dopamine. Vilazodone is a selective serotonin reuptake inhibitor and serotonin receptor agonist. It acts by blocking the synaptic reuptake of serotonin and activated serotonin receptors. Sertraline is a selective serotonin reuptake inhibitor. It blocks the synaptic reuptake of serotonin. p. 260, Table 14.6
A pregnant patient is diagnosed with seasonal affective disorder. What appropriate action does the nurse include in the patient's treatment plan? Administer St. John's wort (Hypericum perforatum) regularly. Administer selective serotonin reuptake inhibitors regularly. Advise the patient to rest and avoid strenuous activity. Instruct the patient to get exposed to a light source for 30 to 45 minutes daily.
Instruct the patient to get exposed to a light source for 30 to 45 minutes daily. Light therapy is the best treatment for seasonal affective disorder. It increases the melatonin secretion by the pineal gland. It is ideal to expose the patient to a light source for 30 to 45 minutes. It helps in elevating the mood of the patient with seasonal affective disorder. St. John's wort (Hypericum perforatum), though it is an herb, should not be given to pregnant patients as it may not be safe. Selective serotonin reuptake inhibitors must not be used as they may have teratogenic effects on the fetus. Exercise enhances the mood, so the nurse must encourage the patient to exercise regularly. p. 266
Antidepressants administered alone can cause an adverse reaction in patients with bipolar disorder. What additional drug class should be prescribed? Sedative Anxiolytic Antipsychotic Mood stabilizer
Mood stabilizer When administered solely to patients with bipolar disorder antidepressants can cause a psychotic episode. A mood-stabilizing drug should be given concurrently. Anxiolytic medication may be prescribed as well, but only if symptoms of anxiety are present. Sedatives serve no purpose in this situation. Antipsychotics would be of use if a psychotic episode occurs but not as a prophylactic measure. p. 258
Beck's cognitive theory suggests that the etiology of depression is related to Sleep abnormalities Serotonin circuit dysfunction Negative processing of information A belief that one has no control over outcomes
Negative processing of information Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue. p. 248
Which statement about antidepressant medications, in general, can serve as a basis for patient and family teaching? They tend to be more effective for men. Onset of action is from one to six weeks. Recent memory impairment is observed commonly. They often cause the patient to have diurnal variation.
Onset of action is from one to six weeks. People are accustomed to fast results from medication: 30 minutes for aspirin, 24 hours for antibiotics. Information is necessary to prevent discouragement and maintain compliance. p. 258
Which food is safe for a patient taking monoamine oxidase inhibitors (MAOIs)? Avocados Pineapple Chocolate Cheddar cheese
Pineapple Patients taking MAOIs must avoid foods containing tyramine. Most fruits, like pineapple, are safe to eat while taking MAOIs, as they have low levels of tyramine. Avocados, especially overripe ones, are high in tyramine. Almost all dairy products like cheddar cheese contain tyramine. Chocolate is also a food to avoid. p. 262
A depressed patient is noted to pace most of the time, pull at his or her clothes, and wring his or her hands. These behaviors are consistent with Senile dementia Hypertensive crisis Psychomotor agitation Central serotonin syndrome
Psychomotor agitation These behaviors describe the psychomotor agitation sometimes seen in patients with the agitated type of depression. p. 252
Which assessment data are associated with monoamine oxidase inhibitor (MAOI) therapy? Reports dizziness when standing up Weight gain of five pounds in last four weeks Heart rate 100 beats per minute and irregular Facial twitch noted in left cheek Diarrhea for last three days
Reports dizziness when standing up Weight gain of five pounds in last four weeks Heart rate 100 beats per minute and irregular Facial twitch noted in left cheek Some common and troublesome long-term side effects of the MAOIs are orthostatic hypotension, weight gain, change in cardiac rate and rhythm, constipation, and muscle twitching. p. 263, Table 14.8
What will the nurse do to address the potential risk for depression among a population? Provide a depression screening at a local afterschool program site. Present educational programming on depression to a senior citizen group. Routinely assess all chronically ill patients for depression during their admission interview. Include the signs of postpartum depression in the discharge packet for each new mother.
Routinely assess all chronically ill patients for depression during their admission interview. A high incidence of depression is found among all patients hospitalized for medical illnesses. These depressions are largely unrecognized and untreated by general health care providers. Studies suggest that about one third of medical inpatients report mild or moderate symptoms of depression and up to one fourth may have major depression. Chronic medical conditions often are associated with depression. A depression screening is becoming more common because research suggests the incidence of depression in school age children is significant. Presenting educational programs on depression to senior citizens is becoming more common because research suggests the incidence of depression in the older adult is significant. Including depression information to new mothers is becoming more common because research suggests the incidence of depression in postpartum women is significant. p. 267
An older adult patient being treated for depression has multiple medications. The family finds the patient delirious, spasmodic, hyperpyrexic, and hypertensive. The patient may have overdosed on which class of drugs? Selective serotonin reuptake inhibitors (SSRIs) Serotonin norepinephrine reuptake inhibitors (SNRIs) Norepinephrine and dopamine reuptake inhibitors (NDRIs) Noradrenergic and specific serotonergic antidepressant (NaSSAs)
Selective serotonin reuptake inhibitors (SSRIs) SSRIs work by preventing the reuptake of serotonin. An overdose would cause a drastic rise in serotonin, causing delirium, spasms, hyperpyrexia, and hypertension. SNRIs and NaSSAs may cause this problem but to a lesser extent. NDRIs have no effect on serotonin. pp. 258-260
Assessment of the thought processes of a patient diagnosed with depression is most likely to reveal Good memory and concentration Delusions of persecution Self-deprecatory ideation Sexual preoccupation
Self-deprecatory ideation Depressed patients never feel good about themselves. They have a negative, self-deprecating view of the world. p. 248
In a clinical study for a new antidepressant drug, the nurse was asked to select patients for the study. Which parameters should the nurse assess to include the patient in the study? Blood pressure Serotonin levels Cortisol levels in urine Urine output and fluid intake Corticotrophin-releasing hormone
Serotonin levels Cortisol levels in urine Corticotrophin-releasing hormone Patients with depression have increased cortisol levels in the urine and elevated corticotrophin-releasing hormone. Depression is also caused due to the dysregulation of neurotransmitters, mainly serotonin levels. Blood pressure, urine output, and fluid intake levels are not related to depression. p. 247
It is likely that a patient diagnosed with seasonal affective disorder will begin to experience fewer symptoms in the Fall Winter Spring Summer
Spring Seasonal affective disorder occurs during the months when sunlight diminishes. Patients may begin to feel effects in the late fall and will be affected throughout the winter. They improve during the spring and feel well during the summer. p. 266
A depressed, socially withdrawn patient tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by Asking, "Is this part of the reason you think no one likes you?" Saying, "That is the most unrealistic thing I have ever heard." Querying, "Tell me what things you think you are not able to do correctly." Suggesting, "Let's look at what you just said, that you can 'never do anything right.'"
Suggesting, "Let's look at what you just said, that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the patient's willingness to participate. p. 255, Table 14.4
What is the major reason for hospitalization for depressed patients? Inability to go to work Suicidal ideation Loss of appetite Psychomotor agitation
Suicidal ideation Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. Inability to go to work, loss of appetite, and psychomotor agitation describe symptoms of major depression but are not by themselves the major reason for hospitalization. p. 248
What information will be included in medication education for a patient prescribed an antidepressant? The goal of antidepressant therapy is the remission of symptoms. It generally takes one to three weeks of antidepressant therapy for mood to improve. It may require a change in prescription to identify the most effective antidepressant. Antidepressant therapy is contraindicated in individuals diagnosed with bipolar disorder. Antidepressant therapy may trigger psychosis in patients diagnosed with schizophrenia.
The goal of antidepressant therapy is the remission of symptoms. It generally takes one to three weeks of antidepressant therapy for mood to improve. It may require a change in prescription to identify the most effective antidepressant. Antidepressant therapy may trigger psychosis in patients diagnosed with schizophrenia. A drawback of antidepressant drugs is that improvement in mood may take one to three weeks or longer. The goal of antidepressant therapy is the complete remission of symptoms. Often, the first antidepressant prescribed is not the one that ultimately will bring about remission. Antidepressants may precipitate a psychotic episode in a person with schizophrenia. Patients with bipolar disorder often receive a mood stabilizing drug along with an antidepressant. p. 258
Which statements about the physical activity of a patient diagnosed with major depression are true? Psychomotor agitation results in purposeful, goal-oriented activity. The individual may present with a reduction in psychomotor activity. Psychomotor agitation is demonstrated in cases of major depression. A slow pace and stooped posture is characteristic of psychomotor retardation. Fidgeting is a characteristic psychomotor activity associated with depression.
The individual may present with a reduction in psychomotor activity. Psychomotor agitation is demonstrated in cases of major depression. A slow pace and stooped posture is characteristic of psychomotor retardation. Fidgeting is a characteristic psychomotor activity associated with depression. Physical activity also is affected in major depression. Normally one thinks of depressed patients as having psychomotor retardation, a reduction in the amount of physical activity. This type of symptom results in less motor movement; when the patients do move, they move more slowly and posture frequently is stooped with the head down; however, patients with major depression also may have psychomotor agitation. When this occurs, the patient appears restless, changes position often, and may wring his or her hands and fidget. This is not goal-directed activity, and the patient does not feel energized. p. 245
When preparing a patient for electroconvulsive therapy (ECT), the nurse discusses with the patient that: Maintenance treatments are seldom required. The initial course of therapy requires 6 to 12 treatments. This form of therapy is particularly successful for positive symptoms of schizophrenia. The initial therapy involves an ECT treatment repeated once a week for a prescribed time period.
The initial course of therapy requires 6 to 12 treatments. A usual course is 6 to 12 treatments given two or three times per week. Maintenance ECT usually involves weekly treatments for the first month after remission, with gradual tapering to monthly ECT treatments. ECT is not typically used in the treatment of schizophrenia. p. 264
A patient who had undergone a hysterectomy has low self-esteem and avoids taking food. Which appropriate method does the nurse choose to reduce anorexia? The nurse allows family members to remain with the patient during meals. The nurse gives food low in fiber to the patient. The nurse gives a large quantity of low-calorie food to the patient. The nurse gives tea and coffee frequently to the patient.
The nurse allows family members to remain with the patient during meals. Low self-esteem and reduced food intake are symptoms of depression. Patients can be encouraged to take food in the presence of their family members as it increases their self-esteem. Taking food rich in fiber helps reduce constipation. Small amounts of high-calorie and high-protein food should be given frequently to meet the patient's nutritional demands. The patient must not be given tea or coffee frequently as they cause insomnia. p. 256, Table 14.5
A nurse is caring for a patient with anorexia. The primary health care provider praises the nurse for providing effective care, as the patient is energetic and has an improved appetite. Which effective nursing intervention did the nurse likely use with the patient? The nurse offered foods that the patient liked. The nurse instructed the patient to avoid exercising. The nurse offered three high-calorie meals during the day. The nurse provided high fat foods to help the patient gain weight.
The nurse offered foods that the patient liked. Anorexia is characterized by reduced appetite and low body weight. The nurse should follow proper nursing interventions to provide good nutrition to the patient, which may include offering foods that the patient prefers. The patient may not be able to eat one complete meal at a time. Therefore, the nurse should give the patient high-calorie foods in small quantities to meet the nutritional demands of the body. The nurse should provide the patient high-protein foods like tofu and beans, rather than high fat foods since poor nutrition may worsen the illness in the patient. A patient with anorexia may benefit from light (but not excessive) physical activity as it may stimulate the appetite. p. 256, Table 14.5
A depressive patient is prescribed monoamine oxidase inhibitors. The nurse gives the diet chart to the patient. Which food does the patient consume according to the diet chart? The patient eats lot of cheese. The patient eats bananas. The patient eats yogurt. The patient eats dried fish.
The patient eats yogurt. The patient eats yogurt as it contains less or no tyramine and is safe. Monoamine oxidase inhibitors (MAOIs) increase the levels of tyramine. So a patient on MAOIs should consume foods which have no or very low levels of tyramine, as an increase in tyramine levels can cause high blood pressure and hypertensive crisis. The patient avoids eating cheese, bananas, and dried fish as they contain high levels of tyramine. p. 262, Table 14.7
A nurse is performing an assessment of a patient with depression who is prescribed antidepressants. The patient reports to the nurse, "I have to drink a lot of water now as I am feeling very thirsty and I'm not able to pass urine properly." What does the nurse interpret from these observations? The patient is nonadherent to the medications. The patient is experiencing food-drug interactions. The patient is experiencing side effects of mirtazapine. The patient is experiencing side effects of amitriptyline.
The patient is experiencing side effects of amitriptyline. The patient with depression may be prescribed amitriptyline, which is a tricyclic antidepressant. The side effects of amitriptyline are dry mouth, urinary retention, and hypotension, which may make the patient crave water. If the patient is nonadherent to the medications, then the patient will have depressive symptoms, like loss of appetite and insomnia rather than dry mouth and urinary retention. Photosensitivity or rash would be indications of food-drug interaction. The side effects of norepinephrine and mirtazapine, or serotonin-specific antidepressants, include weight gain and sexual dysfunction rather than dry mouth. p. 260, Table 14.6
A nurse caring for a patient with depression instructs the patient to rest after group activity. The nurse provides warm milk to the patient in the morning and at night. What change does the nurse find in the patient after implementation of this these interventions? The patient sleeps properly. The patient interacts with the nurse. The patient maintains good hygiene. The patient has an increased appetite.
The patient sleeps properly. Depressive patients often have insomnia. The nurse should ensure that patients rest adequately after group activity. This helps to reduce fatigue, which can intensify the symptoms of depression. The patient can be given warm milk at night to induce sleep. Encouraging the patient to interact with the nurse or practice good hygiene or improving the patient's appetite may be treatment goals but they are not directly related to the nurse's intervention with warm milk. p. 256, Table 14.5
A patient with late-luteal-phase dysphoric disorder is prescribed fluoxetine. What information should the nurse give the patient? To stop the medication immediately if the side effects are severe To consult their primary healthcare provider if there is loss of libido To take acetaminophen if there is fever The drug may cause dry mouth and blurred vision
To consult their primary healthcare provider if there is loss of libido Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), which is a class of drug known for having low side effects. The nurse should advise the patient to consult the primary healthcare provider about any side effects, such as loss of libido or sexual dysfunction. Stopping the drug abruptly may cause serotonin withdrawal, so the patient should be advised not to stop the drug without first consulting the healthcare provider. Acetaminophen or any other over-the-counter drugs should not be taken without consulting the primary healthcare provider, as it can lead to drug interactions. SSRIs are known to have low occurrence of side effects, and they do not cause dry mouth or low vision as some older antidepressants do. p. 261, Box 14.4
A depressed male patient tells the nurse he is in the 'acute phase' of his treatment for depression. The nurse recognizes that the client has been in treatment For more than four months That is directed toward relapse prevention That focuses on prevention of future depression To reduce depressive symptoms
To reduce depressive symptoms The acute phase of depression therapy (6-12 weeks) is directed toward the reduction of symptoms and restoration of psychosocial and work function and may require some hospitalization. p. 253
When the nurse remarks to a depressed patient, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to Wait quietly for the patient to reply Prompt the patient if the reply is slow Repeat the question if the patient does not answer promptly Review the patient's medical record to support the patient's response
Wait quietly for the patient to reply Depressed patients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply. p. 254, Table 14.3
A nurse is performing an assessment of a patient with breast cancer. During the assessment, the nurse says to the patient, "You are wearing a pretty dress." What is the reason for giving this statement? The patient was irritable looking very worried not interacting with the nurse frequently looking at her outfit
not interacting with the nurse Patients with depression tend to remain silent and are unwilling to interact with people. By telling the patient that she is wearing a pretty dress, the nurse is encouraging the patient to interact by drawing her attention to the surroundings. This helps the patient to emphasize and focus on reality. If the patient is frequently looking at her attire, then the nurse should draw the patient's attention to the present discussion by saying, "It's time to discuss your illness." If the patient looks worried, the nurse should ask the patient, "What is bothering you?" This can help the nurse to know the patient's perceptions and feelings. If the patient looks irritable, the nurse should ask, "What are you irritated at?" This would help the nurse understanding the patient's feelings. p. 254, Table 14.3