Deck 13: Depressive Disorders

Question 1

A depressed patient who is taking a tricyclic antidepressant tells the nurse,"I don't think I can keep taking these pills.They make me very dizzy,especially when I stand up." The best nursing response is:

A) "That is annoying,but it is something most patients are able to learn to live with as time goes on.You'll get used to the medicine's side effects."
B) "The medicine can slow the body's adjustment of blood pressure when changing position;drinking more fluids and changing position slowly can help."
C) "Compared to the problems caused by the depression,it seems like a relatively small annoyance to have to put up with."
D) "All medicines have side effects,and this one is relatively mild.It could be that your depression is causing you to think negatively about the medicine."

Answer 1

"The medicine can slow the body's adjustment of blood pressure when changing position;drinking more fluids and changing position slowly can help."

Question 2

A depressed patient is receiving imipramine (Tofranil)300 mg daily.Which side effect requires seeking medical attention?

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

Answer 2

Urinary retention

Question 3

Planned interventions for a newly admitted severely depressed patient should include:

A) allowing the patient to be alone if he or she prefers.
B) encouraging the patient to sleep to regain energy.
C) careful,unobtrusive observation around the clock.
D) chances to enact a leadership role in the therapeutic milieu.

Answer 3

careful,unobtrusive observation around the clock.

Question 4

A disheveled,severely depressed patient with psychomotor retardation has not showered for several days.The nurse should:

A) provide rewards when the patient showers and withhold them when he doesn't.
B) assist him into the shower,provide soap,and direct him to wash his face first.
C) motivate the patient by noting that his body odor is beginning to offend his peers.
D) discuss hygiene at the community meeting,without mentioning specific patients.

Question 5

A woman became severely depressed when the last of her six children moved out of the home 4 months ago.She has withdrawn from others,neglected to care for herself,lost weight,and repeatedly states,"No one cares about me anymore." Before the onset of symptoms she had been gregarious,a meticulous housekeeper,was neatly groomed,and often participated in community activities.Upon admission to the mental health unit,the patient repeatedly tells nursing staff,"No one cares about me.I'm worthless." Which response by the nurse would be most therapeutic?

A) "I care about you,and I want to try to help you get better again soon."
B) "Things will look brighter soon.Everyone feels down once in a while."
C) "It is difficult for others to care when you say negative things over and over."
D) "I'll sit with you 10 minutes now,and again during lunch,and at 2:30 PM."

Question 6

A depressed patient does not converse except when addressed,and then only in monosyllables.Which response by the nurse is likely to be most helpful?

A) "Can you tell me how you're feeling today?"
B) "What would you like to talk about?"
C) "It would be helpful if you talked more."
D) "It seems rather cold in here today."

Question 7

A man with severe depression is admitted to the partial hospitalization program for mood disorders after exhibiting unintentional weight loss and refusal to go to work.He does not bathe or shave,sleeps poorly,and repeatedly states: "I'm useless,I'm no good to anyone." Which intervention would be best to include in the patient's initial care plan?

A) Involve patient in activities akin to those at his work to restore comfort.
B) Reinforce his interest in resuming work attendance when it returns.
C) Provide patient with nutrient-dense finger foods and weigh daily.
D) Provide activities that involve concentration and fine motor skills.

Question 8

Information given to a depressed patient and family when the patient begins selective serotonin reuptake inhibitor (SSRI)antidepressant therapy should include the directive to:

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

Question 9

A depressed patient repeatedly tells staff that he's evil and that his "insides are rotting" because God is punishing him.What would the priority nursing diagnosis for this patient be?

A) Spiritual distress
B) Disturbed thought process
C) Situational low self-esteem
D) Ineffective health maintenance

Question 10

A recently divorced man with severe depression exhibits poor sleep and impaired concentration,leading him to function poorly at work.Inattention to hygiene and irritability with others aggravate problems at work.Co-workers do not recognize that he is depressed and instead assume his behavioral changes are due to drug abuse.One day he is fired.Work had been his one remaining source of self-worth.The man presents at the emergency room seeking medication to help him sleep.Which of the following responses would be most important for the triage nurse to take at this time?

A) "Have you considered seeking treatment for the depression itself?"
B) "Tell me what you have already been trying to help improve your sleep."
C) "We usually don't prescribe sleep medications in the emergency room."
D) "You said you are depressed;have you thought about harming yourself?"

Question 11

A patient who became severely depressed after losing her job tells the nurse that she is not worth the time the nurse spends with her.The patient often mentions that she is "the worst person in the world." On the basis of this data,which nursing diagnosis is most appropriate?

A) Powerlessness
B) Defensive coping
C) Low self-esteem
D) Disturbed identity

Question 12

Which nursing progress note would most suggest that the treatment plan of a severely depressed and withdrawn patient has been effective?

A) "Slept 6 hours straight,sang with activity group,eager to see grandchild."
B) "Slept 8 hours,attended craft group,ate half of lunch,denies suicidal ideation."
C) "Slept 10 hours,personal hygiene adequate with assistance,lost one pound."
D) "Slept 7 hours on and off,reports "food has no taste",no self-harm noted."

Question 13

A student in the Mood Disorders Clinic states that everything he does is wrong and that nothing he tries ever works.Although he has never failed an exam,he believes he will fail the next one.Based on evidence-based research,which of the following interventions would best address a presentation of this type?

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

Question 14

A patient became severely depressed when the last of her six children moved out of the home 4 months ago.Since then she has neglected to care for herself,sleeps poorly,lost weight,and repeatedly states,"No one cares about me anymore.I'm not worth anything." Upon admission to the unit,the nursing diagnosis Situational low self-esteem related to feelings of abandonment was established.Which would be an appropriate intermediate outcome for this diagnosis? Patient will:

A) make one positive comment about self daily by (date).
B) agree to antidepressant medication regularly by (date).
C) interact with another person for 10 minutes daily by (date).
D) identify factors which increased her depression by (date).

Question 15

A patient with a history of heart failure is being assessed by the admitting nurse.Which of the following inquiries by the nurse reflects the research on the connection between heart disease and mental health?

A) "People with heart disease sometimes have nightmares.How do you sleep?"
B) "Heart failure can be frightening.Do you find yourself feeling fearful or worried?"
C) "Tell me,have you noticed any problems with your memory and concentration?"
D) "Heart failure and depression seem to be related.Tell me about your moods lately."

Question 16

A woman became severely depressed when the last of her six children moved out of the home 4 months ago.Since then she has neglected to care for herself,sleeps poorly,lost weight,and repeatedly states,"No one cares about me anymore.I'm worthless." After hospitalization,the nursing diagnosis of situational low self-esteem related to feelings of abandonment was identified.The nurse wishes to reinforce the patient's self-esteem by acknowledging the improvement in her personal appearance.She's wearing a new dress and has combed her hair.The most appropriate remark would be:

A) "You look very nice this morning,Mrs.J."
B) "I like the dress you're wearing,it's very pretty."
C) "What brought about this glamorous transformation?"
D) "You've combed your hair and are wearing a new dress."

Question 17

A depressed patient who is scheduled to receive electroconvulsive therapy this morning asks the nurse,"How is this treatment supposed to help me?" The best reply would be: "Electroconvulsive therapy seems to ____________."

A) increase the activity of brain chemicals involved in mood
B) interfere with one's memory of why he's feeling depressed
C) serve as a punishment so you can stop punishing yourself
D) open your mind to learning and trying new ways of coping

Question 18

A student nurse working with a depressed patient finds herself becoming angry with the patient when he responds slowly or not at all to her efforts to improve his mood.Which explanation most likely explains her emotional response?

A) The majority of depressed persons respond only partially to treatment interventions.
B) This depressed patient is responding more slowly than most,leading to frustration.
C) Depressed patients are often resistant to treatment and a source of frustration to staff.
D) Staff can have unrealistic expectations,believing depressed people should "cheer up."

Question 19

The priority nursing focus for the period immediately after electroconvulsive therapy treatment should be on:

A) monitoring for the return of the capacity for full range of motion.
B) assessing the degree of accumulating memory impairment.
C) making positive comments while the patient is more receptive.
D) assessing the level of consciousness and normal body functions.

Question 20

An elderly patient complains bitterly and repetitively about numerous somatic concerns,but he has been examined thoroughly by several different health care providers,and physical examinations suggest that he is in good health.The nurse should suspect that the patient's somatic complaints most likely are:

A) indications of a hidden physical illness.
B) a maladaptive way of coping with stress.
C) indications that he is feeling depressed.
D) typical responses to the aches of growing older.

Question 21

A nurse teaching a patient about a tyramine-restricted diet would approve a meal consisting of:

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

Question 22

A patient asks if exercise would help her depression.Which response best describes the relationship of exercise and depression? Select all that apply.

A) "It could help increase energy.It wouldn't hurt to try it,I guess-it might help."
B) "Exercise works similar to some antidepressants medications but without side effects."
C) "Exercise seems to increase the effectiveness of antidepressant medications."
D) "People who exercise report improved mood,more social comfort,and are happier."
E) "It can improve self-esteem and even help with problems like constipation."

Question 23

A patient being treated for depression has been taking 300 mg amitriptyline (Elavil)daily for nearly a year.She calls her case manager at the mental health clinic,stating she stopped taking her antidepressant 2 days ago and has developed something like the "flu," with cold sweats,nausea,a rapid heartbeat,terrible nightmares when she sleeps,but no other symptoms.How should the nurse respond?

A) Advise her to go to the nearest emergency department for an evaluation.
B) Tell her to take two aspirin,drink plenty of fluids,and call her family doctor.
C) Explain it may be withdrawal;tell her to take one Elavil and contact her doctor.
D) Direct her to take the medicine every other day for 2 weeks,then stop.

Question 24

A patient who has been taking fluoxetine (Prozac)60 mg daily for the past 6 months tells the nurse at the medication follow-up clinic that he is considering stopping the Prozac.He states his mood is fine,and now that he is living normally,his wife is concerned that he has no sex drive.Which response would be best?

A) "Without the medicine the depression will likely return;you and your wife will need to adjust to the sexual side effects."
B) "If we switch your medication time to the morning,the sexual side effects will be worn off in time for evening sexual activity."
C) "The problem is not likely due to the medicine.Often the depression itself,even after it improves,continues to dampen sex drive."
D) "Without an antidepressant,the depression is more likely to reoccur,but there are other medications that do not interfere so much with sex."

Question 25

A middle-aged patient who has been treated for depression with SSRIs and cognitive-behavioral therapy has identified that passivity probably contributed to her depression.Which treatment modality would be best for the nurse to suggest?

A) Social skills training
B) Assertive communication training
C) Relaxation training classes
D) Exercise therapy group

Question 26

A patient taking a monoamine oxidase inhibitor reports that he forgot he wasn't supposed to take over-the-counter drugs without prior approval and took some medication for his cold 6 hours ago.His wife,a nurse's aide,checked and reports that his blood pressure is 128/84,slightly above his usual blood pressure.He has not noticed any other changes or symptoms.Which of the following responses by the nurse would be most appropriate? Select all that apply.

A) "A single dose of the cold medicine will probably be OK,so you can relax."
B) "To be safe,have someone drive you to the emergency room to be checked."
C) "If you develop a headache,fever,stiff neck,nausea,or vomiting,go to the ER."
D) "Check your blood pressure each hour,and go to the ER if it goes over 140/100."
E) "Drink more fluid to reduce the medication concentration and you should be OK."

Question 27

A depressed patient tells the nurse,"The bad things that happen are always my fault." How should the nurse respond to 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) "You are being exceptionally hard on yourself when you imply you are a jinx."
C) "What about the good things that happen;are any of those ever your fault?"
D) "Let's look at one bad thing that happened to see if another explanation exists."

Question 28

A depressed patient is being seen in the clinic and started a selective serotonin reuptake inhibitor (SSRI)last week.She tells the nurse that she has some pills that she previously took for depression and that they are called MAOIs.She tells the nurse she thinks she should start taking them right now instead of her current medication,which isn't seeming to help her.The most important information the nurse should convey is:

A) the need to have her blood pressure carefully monitored on MAOIs.
B) that the SSRI antidepressant will be more effective as the weeks go by.
C) the dietary restrictions required to take MAOIs antidepressants.
D) the risk of a serious reaction if she begins the MAOIs on her own.

Question 29

A severely depressed patient with psychomotor retardation has begun activities therapy.His schedule is: 9 AM,ceramics;10 AM,exercise group;11 AM to noon,open;noon,lunch.The nurse creating the patient's schedule should opt to fill the hour block from 11 AM to noon with:

A) group therapy.
B) a rest period.
C) reminiscence group.
D) individual counseling.

Question 30

A depressed patient is to have his first electroconvulsive therapy (ECT)session tomorrow morning.Which intervention would routinely be implemented in preparing the patient for treatment?

A) Explaining that 20 or more treatments will be needed
B) Advising the patient that memory loss is usually transient
C) Preparing the patient to be restrained during the procedure
D) Educating the patient about how ECT will end his depression

Question 31

An experienced nurse is providing mentorship to a novice who is working with a depressed patient.Which of the following responses or feelings should the mentor anticipate in the novice? Select all that apply.

A) Frustration and inadequacy
B) Accomplishment and pride
C) Unrealistic or unmet expectations
D) Avoidance of the patient
E) Anxiety and hopelessness

Question 32

The spouse of a man being treated with sertraline (Zoloft)calls to report that he had a grand mal seizure.Prior to the seizure,he had seemed confused and his forehead felt hot.The man does not have a seizure-disorder history.Which action should the nurse direct the spouse to take?

A) Monitor the patient and notify the clinic if there are more seizures.
B) Hold all medications and call 911 for transportation to the hospital.
C) Hold tonight's sertraline and encourage him to drink more fluids.
D) Administer an antipyretic drug to lower his fever and prevent seizures.

Question 33

A patient is being treated with phenelzine (Nardil)for depression.Which indicator(s)would be useful to monitor the outcome Patient will understand the potential side effects of monoamine oxidase inhibitor (MAOI)antidepressants? Select all that apply.

A) Avoids sausages and chocolate
B) Wears elastic hose and supportive shoes
C) Avoids eating at Chinese restaurants
D) Maintains a stable intake of sodium
E) Avoids over-the-counter medications

Question 34

During assessment,the nurse is most likely to find the attitude of the depressed patient toward his illness to be:

A) "It's just a matter of time and I'll be well."
B) "I think the medicine will help in time."
C) "I can fight this,I don't have to be depressed."
D) "It's the way I am,I deserve to be this way."

Question 35

A 26-year-old woman who gave birth to a normal newborn 1 month ago reports she cannot cope with being a mom.She is unable to sleep,eats little,and says she feels like a failure because she can't take care of her baby.She has been thinking her baby is "the devil's work" and the cause of her problems.She sits and stares into space,her face a worried,perplexed mask.What would be the priority nursing diagnosis for this patient?

A) Risk for impaired attachment
B) Disturbed thought processes
C) Situational low self-esteem
D) Risk for other-directed violence

Question 36

A patient being treated for major depression is the CEO of her own business.She has shown significant improvement and is about to be discharged after completing a course of 15 electroconvulsive therapy sessions.She will continue on SSRI medications.The patient has been counseled not to make a major business decision for a month.The rationale for this is that:

A) SSRIs may cause confusion in susceptible persons.
B) ECT often causes temporary memory impairment.
C) Lingering depression makes the patient incompetent.
D) The patient needs months to readjust to work pressures.