Question 1

A nurse is working with a client who has just been prescribed buproprion (Wellbutrin). Which statement by the client indicates that further education is necessary?

Accepted Answer

Taking two pills to catch up for a missed dose can increase the risk of side effects and is not recommended. It's important for the client to take the medication exactly as prescribed by the physician, and not make changes without consulting them first. The other statements indicate adequate understanding of the medication and its potential side effects.

Question 2

A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis?

Accepted Answer

An elevated TSH level may suggest hypothyroidism, which can cause symptoms similar to depression. Therefore, ruling out hypothyroidism may help confirm a diagnosis of major depressive episode. The other lab values listed are within normal limits and do not necessarily rule out the diagnosis of major depressive episode.

Question 3

Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client?

Accepted Answer

After ECT, the client should be placed on his or her side to prevent aspiration in case vomiting occurs, which is a common side effect of the procedure.

Question 4

A client diagnosed with major depressive episode hears voices commanding self-harm. Which should be the nurse's priority intervention at this time?

Accepted Answer

Placing the client on one-to-one observation will ensure immediate intervention if the client tries to harm themselves. This intervention is the most effective and least restrictive option. However, suicidal ideations must continue to be monitored.

Answer: A is incorrect because it is too restrictive and not the least restrictive option.

Answer: B is not sufficient to ensure safety because it only allows for 15-minute checks and may not prevent suicide attempts.

Answer: D is not appropriate because the priority is to ensure safety and prevent harm, not encourage expression of feelings at this time.

Question 5

A nurse assesses a client suspected of having the diagnosis of major depressive episode. Which client symptom would rule out this diagnosis?

Accepted Answer

Maxing out charge cards and exhibiting promiscuous behaviors may be indicative of bipolar disorder or another psychological disorder, but they do not necessarily rule out a diagnosis of major depressive episode. Choices A, B, and C are all common symptoms of major depressive episode.

Question 6

A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing response?

Accepted Answer

The combination of an MAOI and fluvoxamine can lead to a life-threatening hypertensive crisis. This is because both drugs can increase the levels of serotonin in the brain, which can cause dangerously high blood pressure. It is important to avoid this combination and explore other treatment options with the healthcare provider.

Question 7

A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms?

Accepted Answer

According to learning theory, depression can result from repeated failures and the individual's perception of being unable to change their circumstances, which aligns with the client's experiences of divorce, job loss, and family estrangement.

Question 8

A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this client, to address a behavioral symptom of this disorder?

Accepted Answer

Social isolation is a common behavioral symptom of major depressive disorder. Poor self-esteem often leads the client to withdraw from social situations and self-seclude. The nurse should assign the nursing diagnosis of social isolation to address this symptom and intervene accordingly.

Question 9

When planning care for a depressed client, which correctly written outcome should be a nurse's first priority?

Accepted Answer

The first priority when caring for a depressed client is to ensure their safety. Therefore, the option that states the client will remain safe during hospital stay is the correct choice. While establishing a trusting relationship with the nurse and discussing feelings with staff and family are important goals, they should not take priority over ensuring the client's physical safety.

Question 10

A nurse is planning care for a 13-year-old client who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents?

Accepted Answer

Escitalopram (Lexapro) is approved by the FDA for the treatment of depression in adolescents aged 12 and older.

Question 11

A client who has been newly diagnosed with depression is beginning tricyclic antidepressant therapy. The nurse has just completed teaching with this client. Which statement by the client indicates the need for further education?

Accepted Answer

Tricyclic antidepressants may interact with tobacco smoking and affect the metabolism of the drug, so it is important for the client to discuss this with their healthcare provider and consider quitting smoking. Therefore, the statement that the client does not need to quit smoking indicates a need for further education. The other statements are correct and indicate adequate understanding of tricyclic antidepressant therapy.

Question 12

A number of assessment rating scales are available for measuring severity of depressive symptoms. Which scale would a nurse practitioner use to assess a depressed client?

Accepted Answer

The Hamilton Depression Rating Scale is the most widely used clinical rating scale for measuring the severity of depression. It consists of 21 items that assess various symptoms of depression, including mood, anxiety, insomnia, and appetite changes. It provides a more comprehensive assessment of the severity of depression compared to some of the other scales.

Question 13

A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects a depressive disorder. What is the rationale for performing a mini-mental status exam?

Accepted Answer

Performing a mini-mental status exam can help to assess cognitive impairment and rule out neurocognitive disorder, which can be a potential cause of memory loss, confused thinking, and apathy. It is not used to diagnose or rule out bipolar disorder, schizophrenia, or personality disorder.

Question 14

The severity of depressive symptoms in the postpartum period varies from a feeling of the "blues," to moderate depression, to psychotic depression or melancholia. Which disorder is correctly matched with its presenting symptoms?

Accepted Answer

Postpartum depression is characterized by irritability, loss of libido, sleep disturbances, and concern about the ability to care for the baby.

Question 15

The nurse educator is lecturing a group of nursing students on depression in adolescents. Which statement indicates that teaching has been effective?

Accepted Answer

This statement indicates that the students understand that many symptoms of depression may be attributed to normal adolescent development, but it is important to recognize when depression may require intervention. Option A is incorrect because adolescents are at risk for depression. Option B is incorrect because many depressed adolescents do not seek treatment or may not be able to due to lack of resources or support. Option D is incorrect because suicide is a serious risk among depressed adolescents.

Question 16

What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive episode?

Accepted Answer

Depression can cause somatic symptoms that overlap with physical illnesses, making it difficult to differentiate between the two. A full physical health assessment can help identify any underlying medical conditions that may be contributing to the client's depression or causing physical symptoms. It can also help rule out any physical complications resulting from the client's depressive episode.

Question 17

A client, who is taking transdermal selegiline (Emsam) for depressive symptoms, states, "My physician told me there was no need to worry about dietary restrictions." Which would be the most appropriate nursing response?

Accepted Answer

The 6 mg/24 hr dose of transdermal selegiline (Emsam) does not require dietary restrictions, unlike higher doses or oral MAOIs.

Question 18

A nurse administers 100 percent oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure?

Accepted Answer

Electroconvulsive therapy treatment often involves the use of muscle relaxants which can lead to medication-induced paralysis of respiratory muscles. Administering 100 percent oxygen during and after the treatment can prevent anoxia resulting from this paralysis.

Question 19

A staff nurse is counseling a depressed client. The nurse determines that the client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives?

Accepted Answer

Discounting positives involves dismissing or minimizing positive aspects or achievements. The statement "I don't have a green thumb. Any old fool can grow a rose." reflects this distortion by downplaying the skill involved in growing a rose.

Question 20

An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why?

Accepted Answer

The symptoms listed in the question are consistent with serotonin syndrome, which can occur when two different SSRIs are taken together or when the dosage of an SSRI is increased. It is important to distinguish between serotonin syndrome and neuroleptic malignant syndrome, which is a different condition that typically occurs in response to antipsychotic medications. While paroxetine is an SSRI, it is not an MAOI, so choices B and C can be ruled out.

Quiz 16: Depressive Disorders

A nurse is working with a client who has just been prescribed buproprion (Wellbutrin) . Which statement by the client indicates that further education is necessary?