Deck 13: Depressive Disorders

Question 1

An adult diagnosed with major depression was treated with medication and cognitive-behavioural 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) Desensitization techniques
D) Use of complementary therapy

Answer 1

Social skills training

Question 2

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment?

A) Nutrition and hydration
B) Supporting physiological stability
C) Reducing disorientation and confusion
D) Assisting the patient to identify and test negative thoughts

Answer 2

Supporting physiological stability

Question 3

A patient diagnosed with major depression does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgemental acceptance and support for the patient. Which communication technique will be effective?

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.

Answer 3

Make observations.

Question 4

A nurse provided medication education for a patient diagnosed with major depression who began a new prescription for phenelzine (Nardil). Which behaviour indicates effective learning?

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

Question 5

Which documentation for a patient diagnosed with major depression indicates the treatment plan 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."

Question 6

A patient became depressed after the last of the family's six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment.

A) The patient will verbalize realistic positive characteristics about self by (date).
B) The patient will agree to take an antidepressant medication regularly by (date).
C) The patient will initiate social interaction with another person daily by (date).
D) The patient will identify two personal behaviours that alienate others by (date).

Question 7

A patient diagnosed with major depression says, "No one cares about me anymore. I'm not worth anything." Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient?

A) "You look nice this morning."
B) "You're wearing a new shirt."
C) "I like the shirt you are wearing."
D) "You must be feeling better today."

Question 8

A patient being treated for depression 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." What will the nurse advise the patient to do?

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

Question 9

A patient was diagnosed with seasonal affective disorder (SAD). During which month would this patient's symptoms be most acute?

A) January
B) April
C) June
D) September

Question 10

A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today 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 will do which of the following?

A) Limit the patient's activities to those that can be performed in a sitting position
B) Withhold the drug, force oral fluids, and notify the health care provider
C) Teach the patient strategies to manage postural hypotension
D) Update the patient's mental status examination

Question 11

A patient became severely depressed when the last of the family's 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) "Our staff members care about you and want to try to help you get better."
C) "It is difficult for others to care about you when you repeatedly say the same negative things."
D) "I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you."

Question 12

A patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of which of the following?

A) Dysthymia
B) Anhedonia
C) Euphoria
D) Anergia

Question 13

Priority interventions for a patient diagnosed with major depression and feelings of worthlessness should include which of the following?

A) Distracting the patient from self-absorption
B) Careful, unobtrusive observation around the clock
C) Allowing the patient to spend long periods alone in meditation
D) Opportunities to assume a leadership role in the therapeutic milieu

Question 14

When counselling patients diagnosed with major depression, an advanced practice nurse will address the negative thought patterns by using which of the following?

A) Psychoanalytic therapy
B) Desensitization therapy
C) Cognitive-behavioural therapy
D) Alternative and complementary therapies

Question 15

Major depression resulted after a patient's employment was terminated. The patient now says to the nurse, "I'm not worth the time you spend with me. I am 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 16

A nurse worked with a patient diagnosed with major depression, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for which of the following?

A) Feelings of guilt and despair
B) Feelings of over-involvement
C) Feelings of interest and pleasure
D) Feelings of ineffectiveness and frustration

Question 17

A patient diagnosed with major depression tells the nurse, "Bad things that happen are always my fault." Which response by the nurse will best assist the patient to reframe this overgeneralization?

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 extremely hard on yourself. Try to have a positive focus."
D) "Are you saying that you don't have any good things happen?"

Question 18

A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve?

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

Question 19

A patient diagnosed with depression is receiving amitriptyline (Elavil) 50 mg qhs. 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 20

A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about which of the following?

A) Restricting sodium intake to 1 gram daily
B) Minimizing exposure to bright sunlight
C) Reporting increased suicidal thoughts
D) Maintaining a tyramine-free diet

Question 21

Which falls within the parameters of the normal course of treatment of depression with ECT?

A) Daily for 7 days
B) Three times per week for 10 weeks
C) Once a week for 8 weeks
D) Twice a week for 4 weeks

Question 22

A disheveled patient with severe depression and psychomotor retardation has not showered for several days. What will the nurse do?

A) Bring up the issue at the community meeting.
B) Calmly tell the patient, "You must bathe daily."
C) Avoid forcing the issue in order to minimize stress.
D) Firmly and neutrally assist the patient with showering.

Question 23

A patient diagnosed with major depression takes a monoamine oxidase inhibitor and refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient?

A) Imported beer
B) Protein dietary supplement beverage
C) Hot tea
D) Milk

Question 24

A patient diagnosed with major depression began taking escitalopram (Cipralex) 5 days ago. The patient now says, "This medicine isn't working." The nurse's best intervention would be which of the following?

A) Discuss with the health care provider the need to increase the dose
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 symptoms of improvement

Question 25

During a psychiatric assessment, the nurse observes a patient's facial expression is without emotion. The patient says, "Life feels so hopeless to me. I've been feeling sad for several months." How will 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 incongruent

Question 26

A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, "I took a few extra tablets earlier today and now I feel bad." Which assessments are most critical?

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

Question 27

A patient diagnosed with major depression shows vegetative signs of depression. Which nursing actions should be implemented?

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 intake of processed foods.

Question 28

The admission note indicates a patient diagnosed with major depression has anergia and anhedonia. For which measures should the nurse plan?

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

Question 29

How long after a patient stops a monoamine oxidase inhibitor does he or she need to maintain the dietary restrictions followed when taking this medication?

A) Can resume normal diet immediately
B) 48 hours after the last dose
C) 1 week after the last dose
D) 2 weeks after the last dose

Question 30

A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk for which of the following?

A) Hypotensive shock
B) Hypertensive crisis
C) Cardiac dysrhythmia
D) Cardiogenic shock

Question 31

A patient diagnosed with depression repeatedly tells staff, "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 32

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

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