Chapter 21

Question 1

MULTIPLE CHOICE

1. A prolonged emotional state that influences one’s whole personality and life functioning is called:
   a. Mood
   b. Feeling
   c. Attitude
   d. Intellectual response

Answer 1

ANS: A

This is the definition of mood. Moods range from elation to despair and can be either adaptive or maladaptive.

Question 2

2. The moods of adolescents:
   a. Are stable
   b. Vary widely
   c. Develop slowly
   d. Are not related to growth and development

Answer 2

ANS: B

N U R S I N G T B.C O M

The moods of adolescents commonly swing from depression to elation. This is a time of hormonal changes and a time when teens are trying to develop their identity and both gain control over and express their emotions.

Question 3

3. Depression in the elderly is:
   a. Rare
   b. Common
   c. Nonexistent
   d. Seen occasionally

Answer 3

ANS: B

Major depression affects as many as 40% of older Americans and is seen most often in women, persons with medical illnesses, and those individuals who are living in long-term care facilities.

Question 4

4. Theories that view depression as a group of learned responses are called ____ theories.
   a. Social
   b. Behavioral
   c. Biological
   d. Psychoanalytical

Answer 4

ANS: B

Behaviorists view depression as a group of learned responses. Social theorists view depression as the result of flawed social interactions; biological theory focuses on causes of depression such as biochemical imbalances and genetics; and psychoanalytical theorists believe that mood disorders occur as a result of anger turned inward.

Question 5

5. Severe, prolonged depression affects a person’s risk for physical illness by ____ the risk.
   a. Decreasing
   b. Increasing
   c. Not affecting
   d. Having little effect on

Answer 5

ANS: B

Severe, prolonged depression results in many physical changes and increases one’s risk for illness by lowering an individual’s immune response.

Question 6

6. A disorder defined as daily moderate depression that lasts longer than 2 years is called a(n) ____ disorder.
   a. Anxiety
   b. Bipolar
   c. Dysthymic
   d. Major depressive

Answer 6

ANS: C

A dysthymic disorder is daily moderate depression that lasts for longer than 2 years. Anxiety refers to a vague uneasy feeling; bipolar disorder is manic-depressive disorder; and major depressive disorder refers to severe depression.

Question 7

7. The client lives his life by rapidly bouncing from feelings of deep sadness to great joy. The client’s diagnosis is most likely:
   a. Bipolar disorder
   b. Major depression
   c. An anxiety disorder
   d. Dysthymic disorder

Answer 7

ANS: A

The hallmark of a bipolar disorder is sudden and dramatic shifts in emotional extremes.

Question 8

8. Recent studies have demonstrated that daily exposure to full-spectrum light (phototherapy) is most effective in improving symptoms in people who are experiencing:
   a. Bipolar disorder
   b. Moderate depression
   c. Postpartum depression
   d. Seasonal affective disorder

Answer 8

ANS: D

Daily exposure to full-spectrum light reduces the symptoms of seasonal affective disorder, which is also known as winter depression and typically occurs from October to April.

Question 9

9. The goal of treatment during the first phase of depression is to:
   a. Develop a plan for treatment
   b. Reduce uncooperative behaviors
   c. Help the client to adjust to antidepressants
   d. Reduce symptoms and inappropriate behaviors

Answer 9

ANS: D

N U R S I N G T B.C O M

The goal during the first phase (acute phase) is to reduce symptoms and inappropriate behaviors. This phase may last 6 to 12 weeks and may require hospitalization. Developing a treatment plan and helping the client to adjust to antidepressants refers to the second phase, which is known as the continuation phase; and reducing uncooperative behaviors may or may not occur with depression.

Question 10

10. The nurse must be alert to signs of suicidal thoughts with clients in whom major depressive disorders have been diagnosed because approximately __________ die from suicide.
    a. 5%
    b. 15%
    c. 25%
    d. 35

Answer 10

ANS: B

This figure makes it vitally important to monitor these individuals for suicidal thoughts.

Question 11

11. During the continuation phase of therapy, a client with a diagnosis of depression asks, “What is the goal of therapy during this 4- to 9-month period?” What is the nurse’s best response?
    a. “We are going to work together to try to reduce your symptoms.”
    b. “Our goal is to determine the cause of your depression and cure it.”
    c. “We want to prevent you from ever having any depressive episodes in the future.”
    d. “Our goal is to prevent you from relapsing and experiencing distressing emotional

states.

Answer 11

ANS: D

The continuation phase is the second phase of therapy for clients with depression. Working together to try to reduce symptoms occurs during the acute phase of treatment. Determining the cause of depression and preventing future depression most likely are not possible.

Question 12

12. A client with major depressive disorder is scheduled for electroconvulsive therapy (ECT).

Which point will the nurse teach the client?

a. “ECT treatments take about 1 hour.”
b. “You will most likely receive between 6 and 12 treatments over several weeks.”
c. “ECT often is used as one of the first treatments for major depression.”
d. “ECT treatments help your depression by decreasing levels of the neurotransmitter
norepinephrine. ”

Answer 12

ANS: B

This is the normal duration for N ECT R I treatments. G B.C ECT M treatments usually take only about 15 U S N T O minutes, so it is incorrect to tell the client that they will last 1 hour. ECT is an invasive treatment that is usually a last resort rather than one of the first selected treatments. ECT raises levels of norepinephrine rather than lowering them.

Question 13

13. A client asks the nurse which types of antidepressants have the fewest side effects. What is the nurse’s most accurate response?
    a. “Tricyclic antidepressants”
    b. “Nontricyclic antidepressants”
    c. “Monoamine oxidase inhibitors (MAOIs)”
    d. “Selective serotonin reuptake inhibitors (SSRIs)”

Answer 13

ANS: D

SSRIs are the most widely prescribed antidepressants now because of their low incidence of side effects. MAOIs are the last group of choice because of their severe and potentially fatal side effects.

Question 14

14. A male client with bipolar disorder who takes lithium tells the nurse that he has been “nauseous a lot lately”, “feels tired”, and has had “some blurry vision.” The client most likely is suffering from what level of lithium toxicity?
    a. Insignificant
    b. Mild
    c. Moderate
    d. Severe

Answer 14

ANS: C

These are signs of symptoms of moderate lithium toxicity, with blood serum levels of 1.5 to 2.5 MEq/L. Additional signs and symptoms of moderate toxicity include ringing in the ears, irregular tremors, and frank muscle twitching. “Insignificant” is not a level of toxicity. Mild and severe levels of toxicity have signs and symptoms different from those of moderate toxicity.

Question 15

15. Which one of the following is a biological cause of mood disorders?
    a. Anger turned inward
    b. Impaired nurturing
    c. Reaction to external stressors
    d. Imbalance of neurotransmitters

Answer 15

ANS: D

Biological evidence points to several links to mood disorders including neurotransmitters which excite or inhibit brain N circuits U R S I involved N G T B.C in mood O M regulation. When an imbalance occurs with the neurotransmitters, depression can occur. Anger turned inward is a psychoanalytic theory belief. Impaired nurturing and reactions to external stressors are supported by social theorists.

Question 16

6. A client seen in the community mental health clinic appears for one appointment in multiple layers of brightly colored clothing. Her speech is very pressured, and she is telling everyone in the waiting room about a date she had the previous evening. The next visit she is dressed in old, drab clothes without makeup. She has flat affect and is not making eye contact. The most probable cause of her behaviors is which of the following conditions?
   a. Bipolar I disorder
   b. Psychosis
   c. Bipolar II disorder
   d. Major depressive episode

Answer 16

ANS: A

Bipolar I disorder is characterized by episodes of depression alternating with episodes of mania. Bipolar II disorder is characterized by episodes of depression alternating with episodes of hypomania. Depression and psychosis are not characterized by the signs exhibited in the scenario.

Question 17

17. Which client would be a candidate for ECT?
    a. A client with mild depression
    b. A severely depressed client with congestive heart failure
    c. A client with severe, long-lasting depression
    d. A severely depressed client with history of a brain tumor

Answer 17

ANS: C

ECT is indicated for clients with severe long-lasting depression after attempts to stabilize with other therapies are unsuccessful. It is contraindicated in clients with recent heart disease, high or low blood pressure, stroke, or congestive heart failure.

Question 18

18. Which client is suffering from a major depressive episode?
    a. An adolescent who expresses feeling lost after the death of his mother last week
    b. A 50-year-old who has been depressed for a month and is contemplating suicide
    c. A 30-year-old female who is being treated for episodes of depression she has

suffered since the age of 21

d. An elderly adult who feels like she is in a fog after the diagnosis of terminal cancer given to her 8 days ago

Answer 18

ANS: B

N U R S I N G T B.C O M

A major depressive episode is one in which the depression lasts more than two weeks and encompasses every part of the person’s functioning. Suicide is entertained. Feeling lost one week after the death of a parent is considered minor depression. Major depressive episodes that repeat for more than 2 years is considered a major depressive disorder.

Question 19

MULTIPLE RESPONSE

1. Which statements regarding depression are correct? (Select all that apply.)
   a. It occurs in all age groups.
   b. It rarely occurs in the elderly.
   c. It occurs in men more often than in women.
   d. It occurs in women more often than in men.
   e. It is rarely seen but is severe when it occurs.
   f. It is common in those who must cope with illness.
   g. It is one of the most common and treatable mental disorders.

Answer 19

ANS: A, D, F, G

Question 20

2. In which groups does postpartum depression occur more frequently? (Select all that apply.)
   a. Older mothers
   b. Younger mothers
   c. Women who do not have a husband
   d. Women who have had a difficult delivery
   e. Women who experienced complicated pregnancies
   f. Those who are also coping with illness
   g. Women who are not emotionally prepared for motherhood

Answer 20

ANS: D, E, G

These women are at higher risk for postpartum depression. Postpartum depression is connected to a hormonal imbalance. The incorrect options are not characteristic of postpartum depression.

Question 21

3. A client is experiencing an episode at the level of mania. Which behaviors are characteristic of this level? (Select all that apply.) N U R S I N G T B.C O M
   a. Outgoing, happy, and worry free
   b. Decreased ability to concentrate
   c. Confident
   d. Disoriented
   e. Unstable affect
   f. Pressured speech
   g. Poor hygiene

Answer 21

ANS: E, F

Unstable affect and pressured speech are seen most frequently at the mania level of manic behavior. Outgoing behavior, decreased ability to concentrate, and increased confidence are seen at the level of hypomania; disorientation and poor hygiene are seen at the level of delirium.

Question 22

4. Which of the following statements are true regarding depression in the elderly? (Select all that apply.)
   a. The highest rates are among individuals who receive long-term care.
   b. It is a normal consequence of aging.
   c. Most depressed older adults volunteer to share their feelings.
   d. Depression is higher in elderly women than elderly men.
   e. Older adults express feelings of depression in more subtle ways than younger persons.

Answer 22

ANS: A, D, E

Depression is highest in elderly persons who are women, medically ill, and receiving long-term care. Many older adults do not complain or volunteer to share their feelings. It is important to carefully assess and observe the older adult for signs of depression as they express in subtler ways such as changes in daily routine and sleeping and eating patterns.

Question 23

5. Which group of medications for depression will the nurse tell the client to take at bedtime?

(Select all that apply.)

a. Tricyclic antidepressants
b. Nontricyclic antidepressants
c. Monoamine oxidase inhibitors (MAOIs)
d. Selective serotonin reuptake inhibitors (SSRIs)

Answer 23

ANS: A, D

Tricyclic antidepressants often have the side effect of sedation soon after the dose is given, so they should be taken at bedtime. SSRIs may also cause drowsiness and dizziness and should also be encouraged to be taken at bedtime. The other medications should be taken early.

Question 24

ANS: A, D

Tricyclic antidepressants often have the side effect of sedation soon after the dose is given, so they should be taken at bedtime. SSRIs may also cause drowsiness and dizziness and should also be encouraged to be taken at bedtime. The other medications should be taken early.

Answer 24

ANS:

Sodium