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mental health chapter 27 depressive disorders
Terms in this set (15)
The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should ...
a) Prepare the client for diagnostic genetic testing to confirm the diagnosis
b) Encourage the client to seek genetic counseling before considering a pregnancy
c) Educate the client regarding the symptoms of related physical disorders
d) Assess for depression in the client's family history
Assess for depression in the client's family history
The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should assess for depression in the client's family history.
A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which of the following is the nurse's priority intervention for this client?
a) Ensuring that the client is not permitted to use anything that would be potentially dangerous.
b) Encouraging attendance at group cognitive-behavioral therapy on the unit.
c) Exploring the grief and loss issues concerning the baby's death.
d) Encouraging the client to express feelings of isolation following the recent immigration.
Ensuring that the client is not permitted to use anything that would be potentially dangerous.
Although grief, loss, and isolation may be influencing the client's depressed state, the priority intervention is to prevent self-harm. All the interventions listed are appropriate, but ensuring safety from potential danger is the priority.
The nurse working on a mental health unit is teaching a nursing student. The student asks the nurse about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response?
a) "The physician diagnosis depression when a client has feelings of sadness several times a year."
b) "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression."
c) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."
d) "Depression is a mood variation to life events."
"The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."
Normal variations in mood (such as sadness, euphoria, and anxiety) occur in response to life events; they are time limited and not usually associated with significant functional impairment. The primary diagnostic criterion for major depressive disorder is one or more major depressive episodes (either a depressed mood or a loss of interest of pleasure in nearly all activities) for at least 2 weeks. Four of seven other symptoms must be present. Thus, the best response from the nurse is "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."
Which disorder is characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode?
a) Seasonal affective disorder
b) Cyclothymic disorder
d) Dysthymic disorder
Dysthymic disorder is characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode. Cyclothymic disorder is characterized by 2 years of numerous periods of hypomanic symptoms that do not meet the criteria for bipolar disorder. Seasonal affective disorder occurs in the winter or spring. Hypomania is a period of abnormally and persistently elevated, expansive, or irritable mood lasting 4 days.
A client has been recently diagnosed with depression and has just started taking an antidepressant medication. Which of the client's following statements indicates an accurate understanding of this aspect of treatment?
a) "I'm still trying to decide whether antidepressants will be helpful in my treatment."
b) "I can tell that I get a lift each morning after I take my antidepressant."
c) "I know that few people actually see an improvement in their mood with antidepressants, but I suppose I'll try anyhow."
d) "I understand that I probably won't feel much better for a couple of weeks after I start the drugs."
"I understand that I probably won't feel much better for a couple of weeks after I start the drugs."
Antidepressants are proven therapy in the treatment of depression, but effects are not normally observable or felt until 2 to 3 weeks after treatment starts.
A patient is admitted to the hospital. When the nurse takes a medication history, the patient reports use of St. John's wort. The nurse knows that this herb is used for which of the following?
a) To fight depression
b) To prevent cancer
c) To prevent enlarged prostate
d) To fight high cholesterol
To fight depression
St. John's wort is a herb used to fight depression. When taken with an antidepressant that affects serotonin regulation, the combination may cause serotonin syndrome, which includes altered mental status and autonomic dysfunction
A father of four small children lost his wife in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since his wife's death, his mood has been somber; until now, he has refused treatment. For what is this client at high risk?
a) Dysthymic disorder
d) Bipolar disorder
If depression persists over time and is left untreated, it has a significant negative effect on quality of life and increases the risk of suicide.
Which of the following describes the monoamine hypothesis for the etiology of depression?
a) Depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines.
b) This relates to bipolar disorders, not to depression.
c) Depression is caused by only one of the biogenic amines.
d) Depression is caused by sociocultural and psychological factors.
Depression results from a deficiency in the concentrations or in metabolic dysregulation of the monoamines.
The major monoamine hypothesis about depression is that absolute concentrations of norepinephrine, 5-HT, or both are deficient.
A nurse is caring for a client who will undergo ECT for treatment of depression. When assessing a client immediately following ECT, the nurse expects which of the following?
b) Long-term memory impairment
c) Full of energy
d) Numbness and tingling in the extremities
After ECT treatment, the client may be mildly confused or briefly disoriented. He or she is very tired and often has a headache. The client will have some short-term memory impairment. Numbness and tingling in the extremities is not an expected symptom
The nurse is working with a 50-year-old woman admitted for major depressive episode. The client has remained isolated and withdrawn since her admission and is reluctant to speak. Which of the following therapeutic communication skills is most likely to encourage the client to verbalize her feelings?
a) Silence and active listening
b) Direct confrontation
c) Reality orientation
d) Projective identification
Silence and active listening
Silence and active listening are powerful tools for use with a client who is depressed and withdrawn. Direct confrontation can lead to feelings of shame or embarrassment. The client who is not psychotic does not need reality orientation, and projective identification is a primitive subconscious ego defense mechanism
When assessing a child with major depression, which of the following would the nurse need to keep in mind? Select all that apply.
a) The risk for suicide is less in children than adults.
b) Children more often have anxiety symptoms
c) Somatic complaints are rarely noted.
d) Children have more interaction with their peers than adults do.
e) Mood may be more irritable than sad.
• Children more often have anxiety symptoms
• Mood may be more irritable than sad.
Children with depressive disorders have similar symptoms to those seen in adults with a few exceptions. They are more likely to have anxiety symptoms, such as fear of separation, and somatic symptoms, such as stomach aches and headaches. They may have less interaction with their peers and avoid play and recreational activities that they previously enjoyed. Mood may be irritable, rather than sad, especially in adolescents. The risk of suicide, which peaks during the mid-adolescent years, is very real in children and adolescents.
For which of the following reasons is depression in older adults often undiagnosed and untreated?
a) Older adults are less likely to express their sadness.
b) Older adult depression is often seen as "normal aging."
c) Older adults do not enter the healthcare system as much as younger adults.
d) Older adults usually die prior to the onset of depression.
Older adult depression is often seen as "normal aging."
Depression is often considered normal in light of the multiple losses common to aging. Older clients, their families, or healthcare providers mistakenly confuse signs and symptoms of depression with "normal aging." Older adults are not less likely to express sadness or die prior to the onset of depression. Older adults enter the healthcare system more than do younger adults
A mental health nurse has formed a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. An appropriate outcome for this nursing diagnosis would include which of the following?
a) The client will discuss the cause of the fatigue.
b) The client will demonstrate improved ability to express self.
c) The client will differentiate between reality and fantasy.
d) The client will identify factors that reduce activity tolerance.
The client will demonstrate improved ability to express self.
An appropriate outcome would include demonstrating improved ability to express self.
Carrie, age 20, was admitted to your unit following a suicide attempt. She is disheveled, disorganized, and dehydrated. The priority for her care during the first 24 hours of her admission is ...
a) assisting Carrie with her activities of daily living, including a shower and clean clothing.
b) assessing Carrie's current suicidal ideation and putting her on suicide precautions.
c) rehydrating Carrie by forcing fluids.
d) assessing Carrie's recent suicide attempt and identifying factors that may have contributed to it.
assessing Carrie's current suicidal ideation and putting her on suicide precautions.
The first step is to provide for Carrie's safety by assessing her risk for suicide. Because Carrie has attempted suicide, the nurse immediately places her on suicide precautions with frequent or continuous one-to-one observation and reassessment
Research has shown that risk of suicide increases within which time frame for initiation of antidepressant therapy?
a) 42 days
b) 14 days
c) 35 days
d) 28 days
Studies have shown that the risk for suicide increases within the first 2 to 3 weeks after starting antidepressant medication, usually because the client's mood has not lifted as quickly as physical energy has returned.
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