Deck 15: Mood Disorders: Depression

Question 1

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."

Answer 1

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

Question 2

Which documentation indicates the treatment plan of a patient diagnosed with major depressive disorder was effective?

A) Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild.
B) Slept 10 hours uninterrupted. Attended craft group; stated "project was a failure, just like me."
C) Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound.
D) Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, "I feel tired all the time."

Answer 2

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

Question 3

A nurse teaching a patient about a tyramine-restricted diet would approve which meal?

A) Mashed potatoes, ground beef patty, corn, green beans, apple pie
B) Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
C) Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
D) Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

Answer 3

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

Question 4

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:

A) explain how to manage postural hypotension, and educate the patient that side effects go away after several weeks.
B) tell the patient that the side effects are a minor inconvenience compared with the feelings of depression.
C) withhold the drug, force oral fluids, and notify the health care provider to examine the patient.
D) teach the patient how to use pursed-lip breathing.

Question 5

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.

A) Make observations.
B) Ask the patient direct questions.
C) Phrase questions to require "yes" or "no" answers.
D) Frequently reassure the patient to reduce guilt feelings.

Question 6

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.

Question 7

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

Question 8

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."

Question 9

A patient being treated for major depressive disorder has taken 300 mg amitriptyline (Elavil) 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." The nurse should advise the patient:

A) "Go to the nearest emergency department immediately."
B) "Do not to be alarmed. Take two aspirin and drink plenty of fluids."
C) "Take one dose of the antidepressant. Come to the clinic to see the health care provider."
D) "Resume taking the antidepressant for 2 more weeks, and then discontinue it again."

Question 10

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:

A) avoid exposure to bright sunlight.
B) report increased suicidal thoughts.
C) restrict sodium intake to 1 g daily.
D) maintain a tyramine-free diet.

Question 11

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?"

Question 12

A nurse provided medication education for a patient who takes phenelzine (Nardil) for depression. Which behavior indicates effective learning? The patient:

A) monitors sodium intake and weight daily.
B) wears support stockings and elevates the legs when sitting.
C) consults the pharmacist when selecting over-the-counter medications.
D) can identify foods with high selenium content, which should be avoided.

Question 13

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 feelings of:

A) overinvolvement.
B) guilt and despair.
C) interest and pleasure.
D) ineffectiveness and frustration.

Question 14

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.

Question 15

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:

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).

Question 16

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." The priority nursing diagnosis is:

A) insomnia.
B) ineffective coping.
C) situational low self-esteem.
D) risk for other-directed violence.

Question 17

A patient diagnosed with major depressive disorder is receiving imipramine (Tofranil) 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?

A) Dry mouth
B) Blurred vision
C) Nasal congestion
D) Urinary retention

Question 18

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
B) Anhedonia
C) Euphoria
D) Anergia

Question 19

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?

A) Powerlessness
B) Defensive coping
C) Situational low self-esteem
D) Disturbed personal identity

Question 20

What is the focus of priority nursing care for the period immediately after a patient has an electroconvulsive therapy (ECT) treatment?

A) Supporting physiologic stability
B) Reducing disorientation and confusion
C) Monitoring pupillary responses
D) Assisting the patient to plan for the future

Question 21

A patient was started on escitalopram (Lexapro) 5 days ago and now says, "This medicine isn't working." The nurse's best intervention would be to:

A) discuss with the health care provider the need to change medications.
B) reassure the patient that the medication will be effective soon.
C) explain the time lag before antidepressants relieve symptoms.
D) critically assess the patient for symptom relief.

Question 22

Which beverage should the nurse offer to a patient diagnosed with major depressive disorder who refuses solid food?

A) Tomato juice
B) Orange juice
C) Hot tea
D) Milk

Question 23

A patient diagnosed with major depressive disorder will begin electroconvulsive therapy tomorrow. Which interventions are routinely implemented before the treatment? (Select all that apply.)

A) Administer pretreatment medication 30 to 45 minutes before treatment.
B) Withhold food and fluids for a minimum of 6 hours before treatment.
C) Remove dentures, glasses, contact lenses, and hearing aids.
D) Restrain the patient in bed with padded limb restraints.
E) Assist the patient to prepare an advance directive.

Question 24

A patient diagnosed with major depressive disorder shows vegetative signs of depression. Which nursing actions should be implemented? (Select all that apply.)

A) Offer laxatives, if needed.
B) Monitor food and fluid intake.
C) Provide a quiet sleep environment.
D) Eliminate all daily caffeine intake.
E) Restrict the intake of processed foods.

Question 25

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.

A) Powerlessness
B) Risk for suicide
C) Stress overload
D) Spiritual distress

Question 26

A student nurse caring for a patient diagnosed with major depressive disorder reads in the patient's medical record, "This patient shows vegetative signs of depression." Which nursing diagnoses most clearly relate to the vegetative signs? (Select all that apply.)

A) Imbalanced nutrition: less than body requirements
B) Chronic low self-esteem
C) Sexual dysfunction
D) Self-care deficit
E) Powerlessness
F) Insomnia

Question 27

A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate?

A) Arms crossed
B) Staring at the nurse
C) Smiling inappropriately
D) Eyes pointed downward

Question 28

A patient being treated with paroxetine (Paxil) 50 mg/day orally for major depressive disorder reports to the clinic nurse, "I took a few extra tablets earlier in the day and now I feel bad." Which aspects of the nursing assessment are most critical? (Select all that apply.)

A) Vital signs
B) Urinary frequency
C) Increased suicidal ideation
D) Presence of abdominal pain and diarrhea
E) Hyperactivity or feelings of restlessness

Question 29

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?

A) Affect depressed; mood flat
B) Affect flat; mood depressed
C) Affect labile; mood euphoric
D) Affect and mood are incongruent

Question 30

A disheveled patient with severe depression and psychomotor retardation has not bathed for several days. The nurse should:

A) avoid forcing the issue.
B) bring up the issue at the community meeting.
C) calmly tell the patient, "You must bathe daily."
D) firmly and neutrally assist the patient with showering.

Question 31

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.

A) Temporary memory impairments and confusion can be associated with electroconvulsive therapy.
B) Antidepressant medications alter catecholamine levels, which impair decision-making abilities.
C) Antidepressant medications may cause confusion related to a limitation of tyramine in the diet.
D) The patient needs time to reorient him or herself to a pressured work schedule.

Question 32

A nurse instructs a patient taking a drug that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of:

A) hypotensive shock.
B) hypertensive crisis.
C) cardiac dysrhythmia.
D) cardiogenic shock.

Question 33

The admission note indicates a patient diagnosed with major depressive disorder has anergia and anhedonia. For which measures should the nurse plan? (Select all that apply.)

A) Channeling excessive energy
B) Reducing guilty ruminations
C) Instilling a sense of hopefulness
D) Assisting with self-care activities
E) Accommodating psychomotor retardation