14 (Depressive Disorders) Flashcards
The major reason for hospitalization for depressed patients is:
a. ) inability to go to work.
b. ) suicidal ideation.
c. ) loss of appetite.
d. ) psychomotor agitation.
b.) suicidal ideation.
Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm.
The other options describe symptoms of major depression but aren’t by themselves the major reason for hospitalization.
Sasha is a 38-year-old patient admitted with major depression. Which of the following statements Sasha makes alerts you to a common accompaniment to depression?
a. ) “I still pray and read my Bible every day.”
b. ) “My mother wants to move in with me, but I want to independent.”
c. ) “I still feel bad about my sister dying of cancer. I should have done more for her!”
d. ) “I’ve heard others say that depression is a sign of weakness.”
c.) “I still feel bad about my sister dying of cancer. I should have done more for her!”
Guilt is a common accompaniment to depression. A person may ruminate over present or past failings.
Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.
Sasha has been having angry outbursts with staff and peers on the unit. You are talking with Sasha on her third day of admission. You ask whether she is having any thoughts of suicide. Sasha becomes angry and defensive, shouting, “I’m sick of you people! Are you ever do is ask me the same question over and over. Get out of here!” Your response is based on the knowledge that:
a. ) Sasha is getting better because she is able to be assertive.
b. ) Sasha may be at high risk for self-harm.
c. ) Sasha is probably experiencing transference.
d. ) Sasha may be angry at someone else and projecting that anger to staff.
b.) Sasha may be at high risk for self-harm.
Overt hostility is highly correlated with suicide; therefore the patient may be considered high risk, and appropriate precautions should be taken.
The other responses are incorrect with no evidence to support them.
Sasha is started on fluoxetine. Which statement by Sasha indicates that she understands the medication teaching you have provided?
a. ) “I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction.”
b. ) “I will not take any over-the-counter medication while on the fluoxetine.”
c. ) “I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away.”
d. ) “I will report increased thirst and urination to my provider.”
c.) “I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away.”
This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication.
The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.
Sasha’s roommate Kate was admitted with major depression and suicidal ideation with a plan to overdose. Kate is preparing for discharge and asks you, “Why did Dr. Travis give me a prescription for only 7 days of amitriptyline?” Your response is based on the knowledge that:
a. ) amitriptyline (Elavil) is very expensive, so the patient may have to buy fewer at a time.
b. ) Dr. Travis is going to see how Kate responds to the first week of medication to evaluate its effectiveness.
c. ) Dr. Travis wants to see whether any minor side effects occur within the first week of administration.
d. ) amitriptyline (Elavil) is lethal in overdose.
d.) amitriptyline (Elavil) is lethal in overdose.
Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants.
Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider’s office more often for monitoring of suicidal ideation and plan.
Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only one week.
Side effects are always a consideration but not the most important consideration with TCAs.
What statement about the comorbidity of depression is accurate?
a. ) Depression most often exists in an individual as a single entity.
b. ) Depression is commonly seen in individuals with medical disorders.
c. ) Substance abuse and depression are seldom seen as comorbid disorders.
d. ) Depression may coexist with other disorders but is rarely seen with schizophrenia.
b.) Depression is commonly seen in individuals with medical disorders.
Depression commonly accompanies medical disorders. The other options are false statements.
The nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client diagnosed with severe depression. The most reliable evaluation of outcomes will be based on the client’s
a. ) energy level.
b. ) weekly weights.
c. ) observed eating patterns.
d. ) statement of appetite.
b.) weekly weights.
The client’s body weight is the most reliable and objective evaluation of success in treating this nursing diagnosis.
It is likely that a client diagnosed with seasonal affective disorder will begin to experience fewer symptoms in the
a. ) fall.
b. ) winter.
c. ) spring.
d. ) summer.
c.) spring.
Seasonal affective disorder occurs during the months when sunlight diminishes.
Clients may begin to feel effects in the late fall and will be affected throughout the winter.
They improve during the spring and feel well during the summer.
Dysthymia cannot be diagnosed unless it has existed for
a. ) at least 3 months.
b. ) at least 6 months.
c. ) at least 1 year.
d. ) at least 2 years.
d.) at least 2 years.
Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years.
Which nursing diagnosis would be least useful for a depressed client who shows psychomotor retardation?
a. ) Constipation
b. ) Death anxiety
c. ) Activity intolerance
d. ) Self-care deficit: bathing/hygiene
b.) Death anxiety
A client with psychomotor retardation has vegetative signs of depression and is often constipated, too tired to engage in activities, and lacks the energy to attend to personal hygiene.
Depressed clients usually do not have death anxiety. They are more likely to welcome the idea of dying.
When the nurse remarks to a depressed client, “I see you are trying not to cry. Tell me what is happening.” The nurse should be prepared to
a. ) wait quietly for the client to reply.
b. ) prompt the client if the reply is slow.
c. ) repeat the question if the client does not answer promptly.
d. ) review the client’s medical record to support the client’s response.
a.) wait quietly for the client to reply.
Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.
An statement that would show acceptance of a depressed, mute client would be
a. ) “I will be spending time with you each day to try to improve your mood.”
b. ) “I would like to sit with you for 15 minutes now and again this afternoon.”
c. ) “Each day we will spend time together to talk about things that are bothering you.”
d. ) “It is important for you to share your thoughts with someone who can help you evaluate your thinking.”
b.) “I would like to sit with you for 15 minutes now and again this afternoon.”
Spending time with the client without making demands is a good way to show acceptance.
Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with post-partum depression.
a. ) Impaired parenting
b. ) Ineffective role performance
c. ) Health-seeking behaviors
d. ) Risk for impaired parent/infant/child attachment
c.) Health-seeking behaviors
A client with severe depression of any etiology will not have the mental or physical energy to engage in health-seeking behaviors. Further, her negative view of self and the world would preclude such thinking.
A depressed client tells the nurse, “There is no sense in trying. I am never able to do anything right!” The nurse can identify this cognitive distortion as an example of
a. ) self-blame.
b. ) catatonia.
c. ) learned helplessness.
d. ) discounting positive attributes.
c.) learned helplessness.
Learned helplessness results in depression when the client feels no control over the outcome of a situation.
A depressed, socially withdrawn client tells the nurse, “There is no sense in trying. I am never able to do anything right!” The nurse can best begin to attack this cognitive distortion by
a. ) suggesting, “Let’s look at what you just said, that you can ‘never do anything right.’”
b. ) querying, “Tell me what things you think you are not able to do correctly.”
c. ) asking, “Is this part of the reason you think no one likes you?”
d. ) saying, “That is the most unrealistic thing I have ever heard.”
a.) suggesting, “Let’s look at what you just said, that you can ‘never do anything right.’”
Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client’s willingness to participate.
