Question 1

A patient is to have a dexamethasone suppression test in the morning. Which statement should be included in patient teaching?&#10;A) &#34;This test will determine whether or not you are clinically depressed.&#34;&#10;B) &#34;This test is like a computed tomography scan. It will take about 20 minutes and will be painless.&#34;&#10;C) &#34;You will be given an injection; then, blood and urine samples will be collected.&#34;&#10;D) &#34;You will not be allowed to eat or drink after midnight, and a fasting blood sample will be collected in the morning.&#34;

Accepted Answer

After the dexamethasone is given, periodic blood and urine samples are collected and sent to the laboratory to determine whether or not cortisol suppression has occurred.

Question 2

A clinic nurse assesses a new Latino patient who repeatedly reports feeling nervous and having headaches. No organic pathology is present. The symptoms began about 3 years ago when the patient's parent died. Select the nurse's best first action.

A) Explore the patient's grief.
B) Encourage the patient to take frequent rest periods.
C) Reassure the patient that these feelings are normal.
D) Screen for additional signs and symptoms of depression.

Accepted Answer

Latino patients often do not express depression as being related to their mood; rather, they present vague somatic symptoms. Nurses often have good understanding of cultural differences. The nurse should first screen for other signs and symptoms of depression. The patient's feelings are not normal when considered from a cultural viewpoint. Reassuring the patient that the feelings are normal would be nontherapeutic. Exploring grief may come later. Frequent rest periods would isolate the patient who actually needs support.

Question 3

After breakfast a depressed patient pleads with the nurse, &#34;Please let me go to my room to lie down for a while.&#34; The nurse should:&#10;A) explain that the patient must attend scheduled activities.&#10;B) bargain with the patient to attend the next activity, then rest.&#10;C) rearrange the patient's schedule to accommodate the request.&#10;D) explain that the team will be displeased if the schedule is not followed.

Accepted Answer

Depressed patients often want to lie down, whether or not they wish to sleep. Solitude permits self-defeating ruminations and should not be encouraged. Kind firmness in helping the patient adhere to the treatment program is necessary. Because the patient has only been up long enough to eat breakfast, rest should not be necessary. Bargaining is not therapeutic. Threatening the team's displeasure is not therapeutic as a motivator.

Question 4

The medical record notes that a newly admitted depressed patient has delusional thoughts. Which statement by this patient is most likely?&#10;A) &#34;I am a presidential advisor.&#34;&#10;B) &#34;Cancer is rotting my body.&#34;&#10;C) &#34;There are aliens chasing me.&#34;&#10;D) &#34;I discovered a cure for cancer.&#34;

Accepted Answer

Delusions associated with depression are congruent with the depressed mood. They often relate to somatic function or being a bad person, or they focus on faults. The other delusions are more likely to be present in an individual with schizophrenia.

Question 5

A depressed patient has just responded to the nurse in an overtly angry manner. Select the nurse's best response.&#10;A) &#34;I seem to have hit a raw nerve. I'm sorry.&#34;&#10;B) &#34;You are angry. Let's talk about the issue.&#34;&#10;C) &#34;Please watch your tone of voice when you speak to me.&#34;&#10;D) &#34;I don't think I deserved to be shouted at. What's really the matter?&#34;

Accepted Answer

To be of maximal benefit to the patient, anger should be accepted and explored. Apologies by the nurse are unnecessary. The other options are defensive and rigid reactions.

Question 6

The nurse sees a depressed patient who has psychomotor retardation leaving the dining room. The patient's shirt is soiled from spilled food. The nurse should:&#10;A) foster independence by suggesting changing shirts.&#10;B) ignore the spill to avoid embarrassing the patient.&#10;C) assist the patient to change into a clean shirt.&#10;D) notify the patient of the soiled shirt.

Accepted Answer

A patient with psychomotor retardation might need assistance with hygiene and grooming. It is important for the nurse to help the patient appear well groomed so as to avoid embarrassment. Ignoring the situation is nontherapeutic. The patient should be assisted by staff. The patient might not have the physical energy to respond to a suggestion.

Question 7

A patient diagnosed with depression paces and pulls at clothing constantly. The patient cannot sit for longer than 5 minutes, even at meals. How should the nurse document this behavior?&#10;A) Perseveration&#10;B) Hypomanic activity&#10;C) Catatonic excitement&#10;D) Psychomotor agitation

Accepted Answer

Psychomotor agitation is marked by increased, purposeless, repetitive motor activity, often performed with a sense of urgency. The description of the patient's behavior is consistent with this definition, rather than any of the other options.

Question 8

During an interview with a depressed person, it is important for the nurse to assess social interactions to determine:&#10;A) disruptions in relationships with others.&#10;B) needs for diversional-activities therapy.&#10;C) needs for implementation of a no-harm contract.&#10;D) the patient's ability to make decisions about care.

Accepted Answer

Assessing for altered social interactions will give the nurse information about whether relationships with significant others are intact or disrupted. Often, the depressed person has withdrawn to the extent that formerly supportive relationships have been disrupted, leaving the patient without situational support. Diversional activities are an integral part of management of the therapeutic milieu. The patient's ability to make decisions would be assessed in other ways. A no-harm contract relates to suicidal ideation.

Question 9

The sibling of a depressed patient says, "When we were children my sister always gave up easily. Now as an adult, everyone in the family takes advantage of her." What is the most appropriate nursing intervention?

A) Begin cognitive therapy to reduce negative thinking.
B) Plan measures to reduce inappropriate feelings of guilt.
C) Discuss the value of assertiveness training with the patient.
D) Invite the sibling to join the patient's group therapy sessions.

Accepted Answer

Depressed patients often allow people to violate their rights and then feel resentful or angry. Assertiveness training will help the patient change her interpersonal style from acquiescent to assertive and reduce resentfulness. Cognitive therapy and working on guilt feelings will not address the passive behavior. It would not be appropriate to include the sibling in the patient's group therapy.

Question 10

Which topics should be included by the nurse preparing psychoeducational groups for patients with MDD and their families? Select all that apply.&#10;A) Flight of ideas&#10;B) Changes in weight and sleep&#10;C) Feelings of importance or elation&#10;D) Psychomotor retardation or agitation&#10;E) Inability to concentrate or make decisions

Accepted Answer

Patients with MDD characteristically display weight change; anorexia produces weight loss, and excessive eating produces weight gain. Sleep disturbance is characteristically present in MDD, with many or early awakenings and hypersomnia seen. Changes in activity include psychomotor retardation and excessive motor agitation. Indecision and poor concentration are characteristic cognitive symptoms. Flight of ideas and increased energy, importance, and elated mood are seen in bipolar disorder, manic type.

Question 11

The plan for a depressed patient includes use of cognitive therapy. The nurse supports this therapy by:&#10;A) uncovering unconscious conflicts by encouraging description of childhood traumas.&#10;B) challenging pessimistic beliefs and recognizing the patient's accomplishments.&#10;C) determining areas of mutual understanding between the nurse and patient.&#10;D) using role-playing to rehearse new behaviors.

Accepted Answer

The answer of The plan for a depressed patient includes...

Question 12

A patient who started taking a selective serotonin reuptake inhibitor (SSRI) 3 days ago says, &#34;This medicine isn't working.&#34; The nurse's best intervention would be to:&#10;A) explain the time lag before antidepressants relieve symptoms.&#10;B) reassure the patient that the medication will be effective soon.&#10;C) critically assess the patient for lessening symptoms.&#10;D) explore the patient's self-concept.

Accepted Answer

The answer of A patient who started taking a selective...

Question 13

Which entry in the medical record best indicates that the treatment plan for a depressed patient was successful?&#10;A) Gained 2 lb; sleeping 8 hours nightly; states, &#34;I'm feeling better about my life situation&#34;&#10;B) Weight stable; sleeping 6 hours nightly; complains of frequent abdominal pain and headache&#10;C) Gained 6 lb; sleeping 10 hours nightly; sensitive to interpersonal conflicts&#10;D) Lost 2 lb; sleeping 5 hours nightly; shows minimal interest in activities

Accepted Answer

The answer of Which entry in the medical record best...

Question 14

A 74-year-old patient is admitted diagnosed with anhedonia, weight loss of 20 lb in 6 weeks, and pervasive guilt over issues that occurred in early adulthood. The patient is diagnosed with melancholic depression. Which intervention has the highest priority for inclusion in the care plan?

A) Assess history of seasonal variations of mood.
B) Observe for increased sensitivity to rejection.
C) Monitor and document sleep patterns.
D) Assess for echolalia and posturing.

Accepted Answer

The answer of A 74-year-old patient is admitted diagnosed with...

Question 15

A patient with depression paces, pulls at clothing constantly, and cannot sit for longer than 5 minutes. The patient ruminates about being a "bad" person. Select the most effective nursing intervention.

A) Reassure the patient.
B) Direct the patient to lie down every 2 hours.
C) Ask the patient to assist in a simple, repetitive activity.
D) Seek a prescription for a PRN antipsychotic medication.

Accepted Answer

The answer of A patient with depression paces, pulls at...

Question 16

A patient diagnosed with seasonal affective disorder asks, &#34;Will I ever feel better?&#34; Based on an understanding of this psychopathology, the nurse's best response is:&#10;A) &#34;Your depressed mood will probably spontaneously improve in 6 months to a year.&#34;&#10;B) &#34;People with seasonal affective disorder usually feel better in spring and summer, when there are longer periods of light.&#34;&#10;C) &#34;It's important to engage in community activities to improve your depressed mood. Activity stimulates important brain chemicals.&#34;&#10;D) &#34;Most people with seasonal affective disorder feel better during the fall and winter seasons as they experience the pleasure of the holidays.&#34;

Accepted Answer

The answer of A patient diagnosed with seasonal affective disorder...

Question 17

Which nursing diagnosis is almost universally applicable to persons with depression?&#10;A) Ineffective denial&#10;B) Disturbed body image&#10;C) Chronic low self-esteem&#10;D) Risk for other-directed violence

Accepted Answer

The answer of Which nursing diagnosis is almost universally applicable...

Question 18

Which adolescent would the nurse consider to have the highest priority for health promotion interventions aimed at reducing risk for depression, based on the person's history?&#10;A) Parents killed in an auto accident&#10;B) Lived with adoptive parents since birth&#10;C) Allergies to dust, pollen, and mold&#10;D) Frequent conflicts with siblings

Accepted Answer

The answer of Which adolescent would the nurse consider to...

Question 19

Which account of history and symptoms is most consistent with dysthymia?&#10;A) Depressed mood for 2 weeks; anhedonia; feelings of worthlessness&#10;B) Delusions of guilt and poverty; weight loss; agitation beginning 3 weeks ago&#10;C) Depressed mood for 3 months; suicidal ruminations; hypersomnia; sullen affect&#10;D) Depressed for 3 years; poor concentration; anhedonia; low self-esteem; indecision

Accepted Answer

The answer of Which account of history and symptoms is...

Question 20

A patient says, &#34;The doctor said I have dysthymic disorder.&#34; What priority assessment data should the nurse obtain to confirm the diagnosis?&#10;A) Changes in appetite and weight&#10;B) Presence of suicidal ideation&#10;C) How long symptoms have persisted&#10;D) Presence of delusions or hallucinations

Accepted Answer

The answer of A patient says, &#34;The doctor said I...

Deck 25: Depressive Disorders