Deck 14: Depressive Disorders

Question 1

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

A) dysthymia.
B) anhedonia.
C) euphoria.
D) anergia.

Answer 1

anhedonia.

Question 2

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy (ECT) 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 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."

Answer 3

"I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you."

Question 4

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 5

A nurse provided medication education for a patient diagnosed with major depressive disorder who began a new prescription for phenelzine (Nardil). 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) can identify foods with high selenium content that should be avoided.
D) confers with a pharmacist when selecting over-the-counter medications.

Question 6

A patient diagnosed with major depressive disorder 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 7

A patient diagnosed with major depressive disorder 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

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) Desensitization techniques
D) Use of complementary therapy

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

Priority interventions for a patient diagnosed with major depressive disorder and feelings of worthlessness should include

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 11

Major depressive disorder 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 12

A patient diagnosed with depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about

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 13

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. The patient will

A) verbalize realistic positive characteristics about self by (date).
B) agree to take an 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 14

A patient diagnosed with major depressive disorder 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

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 15

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

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

Question 16

Which documentation for a patient diagnosed with major depressive disorder 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 17

A patient diagnosed with major depressive disorder is receiving imipramine 200 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 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 being treated for depression has taken sertraline daily for a year. The patient calls the clinic nurse and says, "I stopped taking my antidepressant 2 days ago. Now I am having nausea, nervous feelings, and I can't sleep." The nurse will advise the patient to:

A) "Go to the nearest emergency department immediately."
B) "Do not to 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 20

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. 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.

Question 21

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

Question 22

A patient diagnosed with major depressive disorder 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 23

A disheveled patient in the acute phase of major depressive disorder is withdrawn, has psychomotor retardation, and has not showered for several days. The nurse will

A) bring up the issue at the community meeting.
B) calmly tell the patient, "You must bathe daily."
C) make observations about the patient's poor personal hygiene.
D) firmly and neutrally assist the patient with showering.

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 intake of processed foods.

Question 25

A patient diagnosed with major depressive disorder received six ECT sessions and aggressive doses of antidepressant medication. 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) Antidepressant medications alter catecholamine levels, which impairs decision-making abilities.
B) Antidepressant medications may cause confusion related to limitation of tyramine in the diet.
C) Temporary memory impairments and confusion may occur with ECT.
D) The patient needs time to readjust to a pressured work schedule.

Question 26

A patient diagnosed with major depressive disorder began taking escitalopram 5 days ago. The patient 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 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 27

A 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 this documentation? (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 28

Transcranial Magnetic Stimulation (TCM) is scheduled for a patient diagnosed with major depressive disorder. Which comment by the patient indicates teaching about the procedure was effective?

A) "They will put me to sleep during the procedure so I won't know what is happening."
B) "I might be a little dizzy or have a mild headache after each procedure."
C) "I will be unable to care for my children for about 2 months."
D) "I will avoid eating foods that contain tyramine."

Question 29

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 are incongruent.

Question 30

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

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

Question 31

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 of

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

Question 32

A patient diagnosed with major depressive disorder refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient?

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

Question 33

A patient is experiencing psychomotor agitation associated with major depressive disorder. Which observation would the nurse associate with this symptom? The patient

A) paces aimlessly around the room.
B) asks the nurse to repeat instructions.
C) complains of prickly skin sensations.
D) demonstrates slowed verbal responses.