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Chapter 14: Depressive Disorders
Terms in this set (30)
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?
d."I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you."
Spending time with the patient at intervals throughout the day shows acceptance by the nurse and will help the patient establish a relationship with the nurse.
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).
Low self-esteem is reflected by making consistently negative statements about self and self-worth.
A patient diagnosed with major depression 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?
"You're wearing a new shirt."
Patients with depression usually see the negative side of things.
An adult diagnosed with major depression was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?
Social skills training
Social skill training is helpful in treating and preventing the recurrence of depression.
Priority interventions for a patient diagnosed with major depression and feelings of worthlessness should include:
careful unobtrusive observation around the clock.
Approximately two-thirds of people with depression contemplate suicide.
When counseling patients diagnosed with major depression, an advanced practice nurse will address the negative thought patterns by using:
c.cognitive behavioral therapy.
Cognitive behavioral therapy attempts to alter the patient's dysfunctional beliefs by focusing on positive outcomes rather than negative attributions.
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:
Anhedonia is a common finding in many types of depression. It refers to feelings of a loss of pleasure in formerly pleasurable activities.
A patient diagnosed with major depression 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:
teach the patient strategies to manage postural hypotension.
Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with tricyclic antidepressants.
A patient diagnosed with depression is receiving imipramine (Tofranil) 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?
All the side effects mentioned are the result of the anticholinergic effects of the drug.
A patient diagnosed with major depression 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?
"Let's look at one bad thing that happened to see if another explanation exists."
By questioning a faulty assumption, the nurse can help the patient look at the premise more objectively and reframe it as a more accurate representation of fact.
A nurse worked with a patient diagnosed with major depression, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of:
ineffectiveness and frustration.
Nurses may have expectations for self and patients that are not wholly realistic, especially regarding the patient's progress toward health.
A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about:
reporting increased suicidal thoughts.
Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus, close monitoring is necessary.
A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve?
Mashed potatoes, ground beef patty, corn, green beans, apple pie
The correct answer describes a meal that contains little tyramine.
What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment?
Supporting physiological stability
During the immediate post-treatment period, the patient is recovering from general anesthesia; hence, the priority need is to establish and support physiological stability.
A nurse provided medication education for a patient diagnosed with major depression who began a new prescription for phenelzine (Nardil). Which behavior indicates effective learning? The patient:
confers with a pharmacist when selecting over-the-counter medications.
Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants.
Major depression 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?
Situational low self-esteem
The patient's statements express feelings of worthlessness and most clearly relate to the nursing diagnosis of situational low self-esteem.
A patient diagnosed with major depression 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?
Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations for answers on the patient.
A patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, "I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares." The nurse will advise the patient to:
"Take a dose of your antidepressant now and come to the clinic to see the health care provider."
The patient has symptoms associated with abrupt withdrawal of the tricyclic antidepressant.
Which documentation for a patient diagnosed with major depression indicates the treatment plan was effective?
Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild
Sleeping 6 hours, participating with a group, and anticipating an event are all positive events.
A patient was diagnosed with seasonal affective disorder (SAD). During which month would this patient's symptoms be most acute?
The days are short in January, so the patient would have the least exposure to sunlight.
A patient diagnosed with depression 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.
Risk for suicide
A patient diagnosed with depression who feels so worthless as to believe cancer is deserved is at risk for suicide.
A patient diagnosed with major depression refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient?
Milk is the only beverage listed that provides protein, fat, and carbohydrates.
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?
Affect flat; mood depressed
Mood refers to a person's self-reported emotional feeling state.
A disheveled patient with severe depression and psychomotor retardation has not showered for several days. The nurse will:
firmly and neutrally assist the patient with showering.
When patients are unable to perform self-care activities, staff must assist them rather than ignore the issue.
A patient diagnosed with major depression began taking escitalopram (Lexapro) 5 days ago. The patient now says, "This medicine isn't working." The nurse's best intervention would be to:
explain the time lag before antidepressants relieve symptoms.
Escitalopram is an SSRI antidepressant. One to three weeks of treatment is usually necessary before symptom relief occurs.
A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate from this patient?
Eyes pointed downward
Nonverbal communication is usually considered more powerful than verbal communication.
A patient diagnosed with major depression received six electroconvulsive therapy 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.
Temporary memory impairments and confusion may occur with electroconvulsive therapy.
Recent memory impairment and/or confusion is often present during and for a short time after electroconvulsive therapy.
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:
Patients taking MAO-inhibiting drugs must be on a tyramine-free diet to prevent hypertensive crisis.
Transcranial Magnetic Stimulation (TCM) is scheduled for a patient diagnosed with major depression. Which comment by the patient indicates teaching about the procedure was effective?
"I might be a little dizzy or have a mild headache after each procedure."
Transcranial Magnetic Stimulation (TCM) treatments take about 30 minutes.
Client Needs: Physiological Integrity
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