depressive disorders Flashcards
- A patient became severely depressed when the last of the family’s 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.“Our staff members care about you and want 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 10 minutes after lunch to help you feel that I care about you.”
ANS: D
Spending time with the patient at intervals throughout the day shows acceptance by the nurse and will help the patient establish a relationship with the nurse. The therapeutic technique is “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 trust building. The incorrect responses would be difficult for a person with profound depression to believe, provide false reassurance, and are counterproductive. The patient is unable to say positive things at this point.
- A patient became depressed after the last of the family’s six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment.
a.The patient will verbalize realistic positive characteristics about self by (date).
b.The patient will agree to take an antidepressant medication regularly by (date).
c.The patient will initiate social interaction with another person daily by (date).
d.The patient will identify two personal behaviours 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 behaviours that might alienate others is a negative concept.
- A patient diagnosed with major depression says, “No one cares about me anymore. I’m not worth anything.” Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient?
a.
“You look nice this morning.”
b.
“You’re wearing a new shirt.”
c.
“I like the shirt you are 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 making 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.
- An adult diagnosed with major depression was treated with medication and cognitive-behavioural 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.Desensitization techniques
d.Use of complementary therapy
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 development of a patient’s support system. Use of complementary therapy refers to adjunctive therapies such as herbals, which would be less helpful than social skill training. Assertiveness would be of greater value than relaxation training because passivity was a concern. Desensitization is used in the treatment of phobias.
- Priority interventions for a patient diagnosed with major depression and feelings of worthlessness should include which of the following?
a.Distracting the patient from self-absorption
b.Careful, unobtrusive observation around the clock
c.Allowing the patient to spend long periods alone in meditation
d.Opportunities 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. Regular, planned observations of the patient diagnosed with depression may prevent a suicide attempt on the unit.
- When counselling patients diagnosed with major depression, an advanced practice nurse will address the negative thought patterns by using which of the following?
a.Psychoanalytic therapy
b.Desensitization therapy
c.Cognitive-behavioural therapy
d.Alternative and complementary therapies
ANS: C
Cognitive-behavioural 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-behavioural therapy involves the formation of new connections between nerve cells in the brain and that it is at least as effective as medication. Evidence is not present to support superior outcomes for the other psychotherapeutic modalities mentioned.
- A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today 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 will do which of the following?
a.Limit the patient’s activities to those that can be performed in a sitting position
b.Withhold the drug, force oral fluids, and notify the health care provider
c.Teach the patient strategies to manage postural hypotension
d.Update the patient’s mental status examination
ANS: C
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 this information may convince the patient to continue the medication. Activity is an important aspect of the patient’s treatment plan and should not be limited to activities that can be done in a sitting position. Withholding the drug, forcing oral fluids, and notifying the health care provider are unnecessary actions. Independent nursing action is called for. Updating a mental status examination is unnecessary.
- 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.” The nurse documents this report as an example of which of the following?
a.Dysthymia
b.Anhedonia
c.Euphoria
d.Anergia
ANS: B
Anhedonia is a common finding in many types of depression. It 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.”
- A patient diagnosed with depression is receiving amitriptylin (Elavil) 50 mg qhs. 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.
- A patient diagnosed with major depression tells the nurse, “Bad things that happen are always my fault.” Which response by the nurse will best assist the patient to reframe this overgeneralization?
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 extremely hard on yourself. Try to have a positive focus.”
d.“Are you saying that you don’t have any good things happen?”
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.
A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about which of the following?
a.Restricting sodium intake to 1 gram daily
b.Minimizing exposure to bright sunlight
c.Reporting increased suicidal thoughts
d.Maintaining a tyramine-free diet
ANS: C
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.
What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment?
a.Nutrition and hydration
b.Supporting physiological stability
c.Reducing disorientation and confusion
d.Assisting the patient to identify and test negative thoughts
ANS: B
During the immediate post-treatment period, the patient is recovering from general anesthesia; hence, the priority need is to establish and support physiological stability. 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 post-treatment period because the patient may be confused.
Major depression resulted after a patient’s employment was terminated. The patient now says to the nurse, “I’m not worth the time you spend with me. I am the most useless person in the world.” Which nursing diagnosis applies?
a.Powerlessness
b.Defensive coping
c.Situational low self-esteem
d.Disturbed personal identity
ANS: C
The patient’s statements express feelings of worthlessness and most clearly relate to the nursing diagnosis of situational low self-esteem. Insufficient information exists to lead to other diagnoses.
A patient diagnosed with major depression does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgemental acceptance and support for the patient. Which communication technique will be effective?
a.Make observations.
b.Ask the patient direct questions.
c.Phrase questions to require yes or no answers.
d.Frequently reassure the patient to reduce guilt feelings.
ANS: A
Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations for answers on the patient. Acceptance and support are shown by the nurse’s presence. Direct questions may make the patient feel that the encounter is an interrogation. Open-ended questions are preferable if the patient is able to participate in dialogue. Platitudes are never acceptable. They minimize patient feelings and can increase feelings of worthlessness.
Which documentation for a patient diagnosed with major depression indicates the treatment plan was effective?
a.Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild.
b.Slept 10 hours uninterrupted. Attended craft group; stated “project was a failure, just like me.”
c.Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound.
d.Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, “I feel tired all the time.”
ANS: A
Sleeping 6 hours, participating with a group, and anticipating an event are all positive events. All the other options show at least one negative finding.
