ch 31 Flashcards
A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant. After taking the new medication, the patient states, “This medication isn’t working. I don’t feel any different.” What is the best response by the nurse?
a. “I will call your care provider. Perhaps you need a different medication.”
b. “Don’t worry. You can try taking it at a different time of day to help it work
better.”
c. “It usually takes a few weeks for you to notice improvement from this
medication.”
d. “Your life is much better now. You will feel better soon.”
ANS: C
Seeing a response to antidepressants takes 3–6 weeks. No change in medications is indicated at this point of treatment because there is no report of adverse effects from the medication. If nausea is present, taking the medication with food may help, but this is not reported by the patient, so a change in administration time is not needed. Telling a depressed patient that their life is better does not acknowledge their feelings.
A patient who has been diagnosed with depression is scheduled for cognitive therapy in addition to receiving prescribed antidepressant medication. The nurse understands that the goal of cognitive therapy will be met when what is reported by the patient?
a. “I will tell myself that I am a good person when things don’t go well at work.”
b. “My medications will make my problems go away.”
c. “My family will help take care of my children while I am in the hospital.”
d. “This therapy will improve my response to neurotransmitter impulses.”
ANS: A
Cognitive therapy helps patients restructure their patterns of thinking to various events or thoughts in a more healthy way. Medication alters neurotransmitters but does not make problems go away. Family support is important but is not the goal of cognitive therapy. Neurotransmitters are affected by medication and brain stimulation therapy, not by cognitive therapy.
A patient has been resistant to treatment with antidepressant therapy. The care provider prescribes a monoamine oxidase inhibitor (MAOI) medication. What teaching is critical for the nurse to give the patient?
a. Serum blood levels must be regularly monitored to assess for toxicity.
b. To prevent side effects, the medication should be administered as an
intramuscular injection.
c. Eating foods such as blue cheese or red wine will cause side effects.
d. This medication class may only be used safely for a few days at a time.
ANS: C
MAOIs have serious food interactions when ingested with tyramine-containing foods such as aged or processed foods. Serum levels are routinely monitored when mood stabilizers such as lithium carbonate are prescribed. It is not necessary to administer this class intramuscularly. This medication takes several weeks to show effectiveness and should not be stopped abruptly; short-term use will not be effective.
A patient with a diagnosis of depression and suicidal ideation was started on an antidepressant 1 month ago. When the patient comes to the community health clinic for a follow-up appointment he is cheerful and talkative. What priority assessment must the nurse consider for this patient?
a. The medication dose needs to be decreased.
b. Treatment is successful, and medication can be stopped.
c. The patient is ready to return to work.
d. Specific assessment for suicide plan must be evaluated.
ANS: D
Energy levels increase as depression lifts; this may increase the risk of completing a suicide plan. An increase in mood would not indicate a decrease or discontinuation of prescribed medication. The patient may be ready to return to work, but assessment for suicide risk in a patient who has had suicidal ideation is the priority assessment.
A patient who is taking prescribed lithium carbonate is exhibiting signs of diarrhea, blurred vision, frequent urination, and an unsteady gait. Which serum lithium level would the nurse expect for this patient?
a. 0–0.5 mEq/L
b. 0.6–0.9 mEq/L
c. 1.0–1.4 mEq/L
d. 1.5 or higher mEq/L
ANS: D
Diarrhea, blurred vision, ataxia, and polyuria are all signs of lithium toxicity, which generally occurs at serum levels above 1.5 mEq/L. Serum levels within the normal range of 0.8–1.4 mEq/L are not likely to cause signs of toxicity.
A patient newly diagnosed with depression states, “I have had other people in my family say that they have depression. Is this an inherited problem?” What is the nurse’s best response?
a. “There are a lot of mood disorders that are caused by many different causes.
Inheriting these disorders is not likely.”
b. “Current research is focusing on fluid and electrolyte disorders as a cause for
mood disorders.”
c. “All of your family members raised in the same area have probably learned to
respond to problems in the same way.”
d. “Members of the same family may have the same biological predisposition to
experiencing mood disorders.”
ANS: D
Research is showing a genetic or hereditary role in the predisposition of experiencing mood disorders. These tendencies can be inherited by family members. Fluid and electrolyte imbalances cause many problems, but neurotransmitters in the brain are more directly linked to mood disorders. Mood disorders are not a learned behavior, but are linked to neurotransmitters in the brain.
As a nurse in the emergency department, you are caring for a patient who is exhibiting signs of depression. What is a priority nursing intervention you should perform for this patient?
a. Assess for depression and ask directly about suicide thoughts.
b. Ask the care provider to prescribe blood lab work to assess for depression.
c. Focus on the presenting problems and refer the patient for a mental health evaluation.
d. Interview the patient’s family to identify their concerns about the patient’s behaviors.
ANS: A
Assessing directly for thoughts of harm to self or others is a priority intervention for any patient exhibiting signs of a mental health disorder. It is estimated that 50% of individuals who succeed in suicide had visited a healthcare provider within the previous 24 hours. Currently there is no serum lab that identifies depression. The risk of self-harm is a priority safety issue that is monitored in all health care within the scope of the nurse. It is important to obtain information directly from the patient when possible, and then validate the information from family or other secondary sources.
An older adult has experienced severe depression for many years and is unable to tolerate most antidepressant medications due to adverse effects of the medications. He is scheduled for electroconvulsive therapy (ECT) as a treatment for his depression. What teaching should the nurse give the patient regarding this treatment?
a. There are no special preparations needed before this treatment.
b. Common side effects include headache and short-term memory loss.
c. One treatment will be needed to cure the depression.
d. This treatment will leave you unconscious for several hours.
ANS: B
Common side effects of ECT include headache, sleepiness, short-term memory loss, nausea, and muscle aches. Preparations before and after the procedure are the same as any operative procedure involving the patient receiving anesthesia. Treatment is typically three sessions a week for 4 weeks, not once. Patients are not unconscious after the procedure due to the use of precisely placed electrodes and the use of anesthesia.
A nurse is developing a plan of care for a patient admitted with a diagnosis of bipolar disorder, manic phase. Which nursing diagnoses address priority needs for the patient? (Select all that apply.)
a. Risk for caregiver strain
b. Impaired verbal communication
c. Risk for injury
d. Imbalanced nutrition, less than body requirements
e. Ineffective coping
f. Sleep deprivation
ANS: C, D, F
Risk for injury, poor nutrition, and impaired sleep are priority needs of the patient experiencing mania related to their impulsivity, inability to attend to activities of daily living such as diet and hygiene, and disruption of sleep. Caregiver strain is important to be addressed but is not a priority need on admission for the patient. Verbal communication improves when the mania is managed, and racing thoughts return to normal patterns. Ineffective coping will require stabilization of the acute phase along with cognitive therapy over time.
