Chapter 18: Emotional Responses and Mood Disorders Flashcards
- According to the Stuart Stress Adaptation Model, which person can be assessed as being the closest to the maladaptive responses end of the continuum of emotional responses?
a. A patient whose child died of sudden infant death syndrome (SIDS) 2 weeks ago, who states, “I can’t believe I’ll never hold my baby in my arms again.”
b. A patient whose spouse died 2 years ago, who states, “Strong people don’t mourn. I’ve kept busy and focused on supporting the kids.”
c. A patient whose spouse died 6 months ago, who states, “I hate the fact that my spouse died and left me alone after all the years we shared.”
d. A patient whose fiancée died 6 weeks ago, who tells the nurse, “My life will never be the same. I find myself crying every day when I think of my fiancée.”
ANS: B
Suppression of emotions for a prolonged period is less adaptive than showing emotional responsiveness to loss.
- The initial response of a steelworker who was fired from a job was disbelief. At home the steelworker told family members about the firing but retreated to the bedroom, saying, “I’m too choked up to talk about it right now.” These behaviors are characteristic of:
a. disbelief.
b. depression.
c. normal grief reaction.
d. delayed grief reaction.
ANS: C
Loss of one’s job can precipitate a grief reaction. The steelworker is showing emotional responsiveness to the loss as evidenced by initial disbelief, anger, and pain.
- Which coping mechanism should a nurse expect to see a patient initially use to mourn the death of a spouse?
a. Denial
b. Introjection
c. Suppression
d. Dissociation
ANS: B
Mourning begins with introjection of the lost object. Denial, suppression, and dissociation are seen in delayed grief reactions.
- A patient was widowed 8 months ago. The patient has never cried and speaks of the spouse as if they were still together. The prominent defense mechanism exhibited by the patient is:
a. denial.
b. projection.
c. introjection.
d. sublimation.
ANS: A
Inability to cry or express emotions and speaking of the deceased in the present tense suggest the use of denial.
- A patient’s husband is distraught over his wife’s behavior since their child died in a car accident 1 month ago. He says, “She still cries herself to sleep each night. Help my wife control herself.” The nurse’s most therapeutic response would be:
a. “I wonder why it is that you are so bothered by her crying.”
b. “I’m more concerned that you don’t seem to be grieving.”
c. “I’ll spend some time with her to help her see that crying is counterproductive.”
d. “It’s hard to see her so upset, but crying is one way of expressing her feelings.”
ANS: D
This reply is empathetic and allows the nurse to begin teaching the spouse the value of expressing feelings related to loss.
- While talking with a nurse, a patient remarks, “My father’s been dead for months. I think Mom needs to get on with her life.” The most appropriate response by the nurse is:
a. “Giving her support will be more helpful than being critical.”
b. “Have you thought of ways you might help her find more pleasure in her life?”
c. “It’s possible that she still needs more time. Grieving often takes 1 year or more.”
d. “A death is usually a crisis for the whole family. How has his death affected you?”
ANS: C
It is appropriate to help the patient understand the grieving process, including the fact that normal grieving can take 1 year or more. The process is unique to the individual.
- A patient shares, “My mood is really low, and even though I get plenty of sleep, I’m tired all the time. It seems like it happens every fall and winter.” This patient is most likely experiencing:
a. poor REM sleep.
b. acute depression.
c. chronic depression.
d. seasonal affective disorder.
ANS: D
Seasonal affective disorder is a fall and winter disorder thought to be associated with shortened hours of daylight and abnormal melatonin metabolism.
- The critical element a nurse must consider when completing a behavioral assessment of a patient with a mood disturbance is:
a. the level of anxiety present.
b. the degree of agitation noted.
c. the depth of depression reported.
d. a change in usual patterns and responses.
ANS: D
The key element is change. In depression, patients and family see the depression as a change from their usual selves. In mania, others note major changes in usual patterns and responses while patients may indicate they are more creative or active. Present anxiety again must be compared to a baseline level of anxiety.
- A patient hospitalized 3 weeks ago with major depressive disorder presented with suicidal ideations but no suicide plan. Sertraline (Zoloft) was prescribed, and the patient now reports that the feelings of depression have somewhat lessened. The guiding factor the nurse considers when planning care is that there is:
a. little risk for injury if the patient has no plan.
b. an increased risk for suicide as the depression lifts.
c. little suicide risk after 3 weeks on an antidepressant.
d. an increase in patient compliance with sertraline (Zoloft).
ANS: B
Patients with severe depression may have suicidal ideation but lack the cognitive ability to plan an attempt and the energy to implement a plan. As depression lifts, the patient may be better able to plan a suicide attempt and may have sufficient energy to carry out a plan. Self-report of feeling less depressed does not mean the risk for self-injury is diminished. Vigilance continues to be necessary.
- A patient paces continuously while repeatedly mumbling, “I’m worthless. It’s all hopeless.” Which nursing measure would be most helpful in establishing a relationship with this patient?
a. Greet the patient with a cheerful smile.
b. Insist that the patient go to a room to talk with the nurse.
c. Walk with the patient, and make occasional empathic observations.
d. Tell the patient, “I don’t agree with your assessment of worthlessness.”
ANS: C
Rapport is best established through shared time and supportive companionship, even if the patient talks little. The nurse’s presence indicates his or her belief that the patient has worth.
- A patient being treated for severe depression shows resistance to involvement in the nurse-patient relationship by being withdrawn and unresponsive. There is also preoccupation with guilt and hopelessness. When interacting with the patient, which response would have the greatest therapeutic impact?
a. “Everything will work out.”
b. “Let’s explore the origins of your pessimism.”
c. “It’s very likely that you will feel better as your treatment continues.”
d. “You have to help yourself by getting rid of your negative thoughts.”
ANS: C
Patients with depression need reassurance that their current pain and despair are not permanent. Nurses can convey a sense of hope that treatment will produce change, albeit slowly. Providing false reassurance that “everything will work out” is not therapeutic since the nurse cannot truly promise that outcome. The remaining options are negative and somewhat condescending.
- A patient with depression recently lost 8 pounds. After only a few bites the patient refuses to eat more, saying, “I’m full. All that food makes me sick just to look at it.” The most effective way for the nurse to help increase the patient’s dietary intake would be to:
a. provide a high-calorie liquid diet.
b. serve six small, calorie-dense meals daily.
c. take the patient to the hospital cafeteria for meals.
d. have the patient’s family bring some favorite foods from home.
ANS: B
Patients with depression often say they feel too full to eat. Fullness may be related to slow stomach emptying. Seeing large portions and thinking one is expected to eat a large amount can be overwhelming. Serving six small, calorie-dense meals often helps the patient increase caloric intake while reducing the patient’s negative response to food.
- A patient hospitalized for depression demonstrates dysfunctional thinking as evidenced by persistent pessimism and predictions of disastrous outcomes. A nurse using cognitive therapy will focus on:
a. uncovering unconscious conflicts that affect the “here and now” behavior.
b. finding an area of mutual understanding to serve as a basis for therapy.
c. patient recognition and replacement of automatic negative evaluations.
d. analyzing and enhancing relationships with significant others.
ANS: C
Cognitive therapy focuses on changing distortions and negative thinking patterns that affect the patient’s feelings and behaviors.
- Select the most appropriate goal for a patient with depression. The patient will be:
a. experiencing less severe signs of being depressed.
b. physically recovered and able to take on new responsibilities.
c. emotionally responsive and functioning at the pre-illness level.
d. able to tolerate high levels of stress and exceeding pre-illness hardiness.
ANS: C
The expected outcome for a patient with depression is that he or she will be emotionally responsive and return to a pre-illness level of functioning.
- A patient diagnosed with severe depression exhibits psychomotor retardation and a sense of worthlessness manifested in poor personal hygiene. The patient refuses to shower, stating, “I can’t.” The nurse should:
a. not force the issue before a nurse-patient relationship has been established.
b. matter-of-factly assist the patient to shower and dress in clean clothes.
c. state that the patient will be required to shower the following morning.
d. explain that others respond negatively to those with poor hygiene.
ANS: B
When depression leads to inadequate hygiene, nurses must matter-of-factly assist the patient in bathing and dressing, explaining that the nurse is helping because the patient is unable to do it independently.
