Ch. 15 Flashcards
A patient became severely depressed when the last of 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.
“The staff here cares about you and wants 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 return for 10 minutes at lunchtime and again at 2:30 this afternoon.”
ANS: D
Spending time with the patient at intervals throughout the day shows acceptance by the nurse and helps the patient establish a relationship with the nurse. The therapeutic technique is called offering self. Setting definite times for the therapeutic contacts and keeping the appointments show predictability on the part of the nurse, an element that fosters the building of trust. The incorrect responses would be difficult for a person with profound depression to believe, provide trite reassurance, and are counterproductive. The patient is unable to say positive things at this point.
DIF: Cognitive Level: Application REF: Pages: 258-260
A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, “No one cares about me anymore. I’m not worth anything.” Select an appropriate 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.
consent to take 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) .
ANS: A
Low self-esteem is reflected by making consistently negative statements about self and self-worth. Replacing negative cognitions with more realistic appraisals of self is an appropriate intermediate outcome. The incorrect options are not as clearly related to the nursing diagnosis. Outcomes are best when framed positively; identifying two personal behaviors that might alienate others is a negative concept.
DIF: Cognitive Level: Application REF: Pages: 245-246
A patient with major depression says, “No one cares about me anymore. I’m not worth anything.” The nurse wants to reinforce positive self-esteem. Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate?
a.
“You look nice this morning.”
b.
“You’re wearing a new shirt.”
c.
“I like the shirt you’re wearing.”
d.
“You must be feeling better today.”
ANS: B
Patients with depression usually see the negative side of things. The meaning of compliments may be altered to “I didn’t look nice yesterday” or “They didn’t like my other shirt.” Neutral comments such as an observation avoid negative interpretations. Saying “You look nice” or “I like your shirt” gives approval (nontherapeutic techniques). Saying “You must be feeling better today” is an assumption, which is nontherapeutic.
DIF: Cognitive Level: Application REF: Pages: 258-260
An adult with 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?
a.
Social skills training
b.
Relaxation training classes
c.
Use of complementary therapy
d.
Learning desensitization techniques
ANS: A
Social skills training is helpful in treating and preventing the recurrence of depression. Training focuses on assertiveness and coping skills that lead to positive reinforcement from others and the development of a patient’s support system. The use of complementary therapy refers to adjunctive therapies such as herbals. Assertiveness would be of greater value than relaxation training because passivity is a concern. Desensitization is used in the treatment of phobias.
DIF: Cognitive Level: Analysis REF: Page: 250|Page: 272
A priority intervention for a patient with major depression is:
a.
distracting the patient from self-absorption.
b.
carefully and unobtrusively observing the patient around the clock.
c.
allowing the patient to spend long periods alone in meditation.
d.
offering opportunities for the patient to assume a leadership role in the therapeutic milieu.
ANS: B
Approximately two thirds of people with depression contemplate suicide. Patients with depression who exhibit feelings of worthlessness are at higher risk. Regularly planned observations of the patient with depression may prevent a suicide attempt on the unit.
DIF: Cognitive Level: Analysis REF: Pages: 256-257
When counseling patients with major depression, 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.
ANS: C
Cognitive behavioral therapy attempts to alter the patient’s dysfunctional beliefs by focusing on positive outcomes rather than negative attributions. The patient is also taught the connection between thoughts and resultant feelings. Research shows that cognitive behavioral therapy involves the formation of new connections among nerve cells in the brain and that it is at least as effective as medication. Evidence does not support superior outcomes for the other psychotherapeutic modalities mentioned.
DIF: Cognitive Level: Application REF: Pages: 259-260
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.” How would the nurse document the complaint?
a.
Dysthymia
b.
Anhedonia
c.
Euphoria
d.
Anergia
ANS: B
Anhedonia is a common finding in many types of depression and refers to feelings of a loss of pleasure in formerly pleasurable activities. Dysthymia is a diagnosis. Euphoria refers to an elated mood. Anergia means without energy.
DIF: Cognitive Level: Comprehension REF: Pages: 247-248|Page: 253|Pages: 262-263
A patient with depression is taking a tricyclic antidepressant. 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 should:
a.
explain how to manage hypotension, and educate the patient that side effects go away after several weeks.
b.
tell the patient that the side effects are a minor inconvenience compared with the feelings of depression.
c.
withhold the drug, force oral fluids, and notify the health care provider to examine the patient.
d.
update the patient’s mental status examination.
ANS: A
Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with tricyclic antidepressants. Postural hypotension can be managed by teaching the patient to stay well hydrated and rise slowly. Knowing these facts may be enough to convince the patient to remain medication compliant. The minor inconvenience of side effects as compared with feelings of depression is a convincing reason to remain on the medication. Withholding the drug, forcing oral fluids, and having the health care provider examine the patient are unnecessary steps. Independent nursing action is appropriate. Updating a mental status examination is unnecessary.
DIF: Cognitive Level: Application REF: Pages: 264-265
A patient with depression is receiving imipramine (Tofranil) 200 mg every night at bedtime. 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
ANS: D
All the side effects mentioned are the result of the anticholinergic effects of the drug. Only urinary retention and severe constipation warrant immediate medical attention. Dry mouth, blurred vision, and nasal congestion may be less troublesome as therapy continues.
DIF: Cognitive Level: Application REF: Page: 264
A patient with depression tells the nurse, “Bad things that happen are always my fault.” To assist the patient in reframing this overgeneralization, the nurse should respond:
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 exceptionally hard on yourself when you imply you are a jinx.”
d.
“What about the good things that happen; are any of them ever your fault?”
ANS: B
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. The incorrect responses cast doubt but do not require the patient to evaluate the statement.
DIF: Cognitive Level: Application REF: Pages: 258-260
A nurse worked with a patient with major depression who displayed severely withdrawn behavior and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is at risk for feelings of:
a.
overinvolvement.
b.
guilt and despair.
c.
interest and pleasure.
d.
ineffectiveness and frustration.
ANS: D
Nurses may have expectations for self and patients that are not wholly realistic, especially regarding the patient’s progress toward health. Unmet expectations result in feelings of ineffectiveness, anger, or frustration. Nurses rarely become overinvolved with patients with depression because of the patient’s resistance. Guilt and despair might be observed when the nurse experiences patient feelings because of empathy. Interest is possible but not the most likely result.
DIF: Cognitive Level: Comprehension REF: Page: 256
A patient with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy, and priority information is given to the patient and family. This information should include a directive to:
a.
avoid exposure to bright sunlight.
b.
report increased suicidal thoughts.
c.
restrict sodium intake to 1 g daily.
d.
maintain a tyramine-free diet.
ANS: B
Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus close monitoring is necessary. Avoiding exposure to bright sunlight and restricting sodium intake are unnecessary. Tyramine restriction is associated with monoamine oxidase inhibitor (MAOI) therapy.
DIF: Cognitive Level: Application REF: Page: 263|Page: 268
A nurse teaching a patient about a tyramine-restricted diet would approve which meal?
a.
Mashed potatoes, ground beef patty, corn, green beans, apple pie
b.
Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
c.
Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
d.
Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls
ANS: A
The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine, and fresh ground beef and apple pie should be safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages and hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate.
DIF: Cognitive Level: Application REF: Page: 270
What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment?
a.
Supporting physiologic stability
b.
Reducing disorientation and confusion
c.
Establishing random eye movement latency
d.
Assisting the patient to identify and test negative thoughts
ANS: A
During the immediate posttreatment period, the patient is recovering from general anesthesia, hence the need to establish and support physiologic stability. Establishing random eye movement latency is neither possible nor a priority. Reducing disorientation and confusion is an acceptable intervention but not the priority. Assisting the patient in identifying and testing negative thoughts is inappropriate in the immediate posttreatment period because the patient may be confused.
DIF: Cognitive Level: Application REF: Pages: 270-271
A nurse provided medication education for a patient who takes phenelzine (Nardil) for depression. 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.
Consults the pharmacist when selecting over-the-counter medications.
d.
Can identify foods with high selenium content, which should be avoided.
ANS: C
Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.
DIF: Cognitive Level: Analysis REF: Pages: 266-267|Page: 271
