Major Depressive Disorder

Question 1

What is a nurse’s top priority when caring for a patient with major depressive disorder?

Answer 1

Individuals with depression have a high risk for suicide

Question 2

Why is depression so difficult to diagnose and recognize in patients older than 65 years old?

Answer 2

Differentiate between early dementia and depression

Question 3

What are some common contributors to someone being diagnosed with major depressive disorder?

Answer 3

Stressful life events, medical illness, woman’s postpartum periods, poor social network, substance abuse, being unmarried, trauma occurring early in life

Question 4

What are the most common medications that are linked to depression?

Answer 4

Digoxin, Beta-blockers, PPI & H2 blockers

Question 5

If a patient is taking a medication that affects their serotonin levels, what is most likely to be affected?

Answer 5

Mood, sexual behavior, sleep cycles, hunger, and pain perception

Question 6

If a patient is taking medication that modifies their norepinephrine, what is most likely going to change about them?

Answer 6

attention and behavior

Question 7

What are the parameters that allow a patient to be diagnosed with major depressive disorder?

Answer 7

A single episode or recurrent episodes of depression resulting in a significant change in a client’s normal functioning accompanied by at least 5 clinical findings. Must also occur almost every day for a minimum of 2 weeks and last most of the day

Question 8

What are some common symptoms that are found in patients with major depressive disorder?

Answer 8

Anhedonia, Fatigue, sleep disturbances, changes in appetite (weight increase/decrease of more than 5% of total body weight over 1 month), feelings of hopelessness or worthlessness, persistent thoughts of death or suicide, inability to concentrate or make decisions, change in physical activity.

Question 9

What are the expected findings of someone with MDD?

Answer 9

Somatic reports, slowed speech, delayed response, 5 A’s, anxiety, sluggishness, change in eating patterns/constipation, decreased libido, poor grooming, social isolation

Question 10

What are some common clinical findings that are indicative of major depressive disorder?

Answer 10

Suicidality, interest loss, guilty feelings, energy changes, concentration difficulties, appetite changes, psychomotor changes, sleep disturbances

Question 11

What are the parameters for a patient with Persistent Depressive Disorder (Dysthymia)

Answer 11

Chronically depressed mood that lasts >2 years, reports of at least 3 clinical findingsless severe symptoms than MDD

Question 12

When does PDD typically occur and how does the duration differ between adults and children?

Answer 12

Early onset, such as in childhood or adolescence lasts 2 years for adults and 1 year in children

Question 13

How many clinical findings of depression is required to diagnose PDD?

Answer 13

Contains at least 3 clinical findings of depression and can later lead to MDD

Question 14

A patient is said to have premenstrual dysphoric D/O, what clinical findings indicates that this patient has this disorder?

Answer 14

Severe depression and irritability in the week or two before menstruation

Question 15

What is the most commonly used screen tool when assessing patients with MDD?

Answer 15

Colombia Suicide Rating Scale

Question 16

What are the questions that are asked in the Colombia Suicide Rating Scale?

Answer 16

1. Have you wished you were dead or wished you could go to sleep and not wake up?
2. Have you actually had any thoughts of killing yourself?
3. Have you been thinking about how you might kill yourself?
4. Have you had these thoughts and had some intention of acting on them?
5. Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?
6. Have you ever done anything, started to do anything, or prepared to do anything to end your life? (If YES, ask How long ago did you do any of these?)

Question 17

What is the nurse’s priority in treating a patient with MDD

Answer 17

Risk for suicide - safety is always the highest priority

Question 18

If a patient is at risk for committing suicide, what is the nurse’s priority?

Answer 18

Implement 1:1 observation for patients at risk for suicide

Question 19

A nurse is assigning a patient that had a very high risk for suicide, what parameters should this nurse follow when assigning the patient to a room?

Answer 19

DO NOT assign a private room. Place the patient in the room close to the nurse’s station. With a room-mate. DO NOT allow patient any of their personal belongings and they should be monitored when using the restroom

Question 20

What are some of the most commonly used SSRI’s?

Answer 20

Citalopram, Escitalopram, Fluoxetine, Flucoxamine, Paroxetine, Sertraline

Question 21

What are the most common SE associated with SSRI’s?

Answer 21

nausea, weight gain, nervousness, HA, constipation, CNS stimulation, sexual dysfunction, diaphoresis

Question 22

What are some manifestations of serotonin syndrome?

Answer 22

Labile BP, mental confusion, agitation, fever, hallucinations, incoordination

Question 23

If a patient were to abruptly stop their antidepressants, what would happen to them?

Answer 23

Discontinuation syndrome: pins and needles, flu-like symptoms, zapper like s/s

Question 24

What are the most commonly used SNRI’s?

Answer 24

Venlafaxine (Effexor), and Duloxetine (Cymbalta), Desvenlafaxine, Levomilnaciprain

Question 25

What is the main nursing assessment for a patient taking SNRI’s?

Answer 25

Monitor blood pressure, especially at higher doses and with a history of hypertension… discontinuation syndrome

Question 26

What are some commonly used TCA’s?

Answer 26

Amitriptyline, Amoxapine, Clomipramine, Despiramine, Doxepin, Imipramine, Maprotiline, Nortriptyline, Trimipramine

Question 27

If a patient is taking TCA’s, what side effects should the nurse be wary of?

Answer 27

orthostatic hypotension and anticholinergic effects: urinary retention, constipation, dry mouth, blurred vision

Question 28

What anticholinergic effect requires immediate medical intervention?

Answer 28

Urinary retention and severe constipation warrant immediate medical attention

Question 29

What are the most commonly used MAOI’s?

Answer 29

Phenelzine, Tranyclopromine, Isocarboxazid, Selegiline

Question 30

What unique effect do MAOI’s have that SSRI’s and SNRI’s don’t?

Answer 30

Increase dopamine, epinephrine, and serotonin

Question 31

If a patient is taking an MAOI, what are the side effects that a nurse should keep an eye out for?

Answer 31

SE: dizziness, ORTHOSTATIC HYPOTENSION, constipation, dry moutn, and HYPERTENSIVE CRISIS

Question 32

If a patient is prescribed a MAOI, what are some contraindications that would cause the nurse to withhold this medication?

Answer 32

MAOI’s interact with many meds: OTC cold meds and other SSRI’s (for 2 to 5 weeks before starting an MAOI) HYPERTENSIVE CRISIS

Question 33

What foods should be avoided if a patient is taking a MAOI? What can eating this type of food lead to?

Answer 33

TYRAMINE RICH FOODS: avocados, figs, fermented/smoked meats, liver, cured fish, aged cheese, beer/wine, protein dietary supplements, bananas, chocolate. Can cause hypertensive crisis

Question 34

What are some of the most commonly used atypical antidepressants?

Answer 34

Buproprion (Wellbutrin), Mirtazapine (remeron), Nefazodone (Serzone), and Trazadone (Desyrel)

Question 35

A patient is being treated with Bupropion for their depression. What are some contraindications for bupropion?

Answer 35

Be careful in people with history of seizure disorder, head trauma, and eating disorders (bupropion is a weight reducing drug)

Question 36

If a patient is taking an SSRI, they are unable to take St. John’s Wort because of what contraindication?

Answer 36

Fatale Serotonin Syndrome can occur if St. John’s wort is taken with SSRI’s

Question 37

When would a patient be qualified to undergo ECT therapy?

Answer 37

Use for patients who have depressive disorder and are unresponsive to other treatments

Question 38

What medications would be administered to a patient undergoing ECT therapy?

Answer 38

Atropine or Robinul (anticholinergic), propofol (anesthetic agent), and Succinylcholine Anectine (Neuromuscular blocking agent)

Question 39

What are the prerequisites that a nurse must confirm are completed before a patient can undergo ECT therapy?

Answer 39

Consent forms completed, keep patient NPO for at least 4 hours (at midnight), anticonvulsants discontinued prior, ask patient to void and remove contact lenses, jewlery, hairpins, and dentures prior to treatment, assess EEG and EKG continously

Question 40

What is the post-operative care that a nurse would perform on a patient that has just undergone ECT therapy?

Answer 40

Lateral recumbant position, orient to time, place, and situration, offer food, and offer medication for headache

Question 41

What are the Kubler-Ross Five stages of Grief?

Answer 41

1. Denial - rejection of reality 2. Anger - short temper, blaming others 3. Bargaining - negotiation that occurs as the individual seeks control over the situation 4. Depression - sadness, fatigue, anhedonia 5. Acceptance - acknowledgement of loss (or impending loss)

Question 42

What are Worden’s Four tasks of mourning?

Answer 42

TEAR: Task 1 to accept the reality of the loss - accepting, task II - experience the pain of the loss and express it without judgement - coping, Task III - adjust to the new reality without the loss - changing environment, Task IV - re-establisha and re-invest in emotional ties - moving forward

Question 43

A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of MDD. Which of the following statements by the newly licensed nurse indicates understanding?

Answer 43

“ECT is effective for clients who are non-responsive to pharmacological interventions.”

Question 44

A client diagnosed with MDD is being considered for ECT. Which client teaching should the nurse prioritize?

Answer 44

Discuss with the client and family expected short-term memory loss

Question 45

Which symptoms would the nurse expect to assess in a client experiencing serotonin syndrome?

Answer 45

Confusion, restless, tachycardia, labile BP, and diaphoresis

Question 46

The patient is taking an MAOI. Which will the nurse teach the patient to avoid?

Answer 46

cheese

Question 47

A client has been taking bupropion for more than 1 year. The client has been in a car accident with loss of consciousness and is brought to the ED. For which reason would the nurse question the continued use of this medication?

Answer 47

The client is at risk for seizures from a potential closed head injury

Question 48

A nurse is prpoviding teaching to a client who has new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching?

Answer 48

I may experience inability to urinate and constipation when taking this medication

Question 49

A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? SATA

Answer 49

My family will be better off if I’m dead, I wish my life was over, If I kill myself then my problems will go away

Question 50

A nurse is caring for a client who states, “I plan to commit suicide.” Which of the following assessments should the nurse identify as the priority?

Answer 50

Lethality of the method and availability of means

Question 51

A nurse is caring for a client who has end-stage lung cancer. Which of the following client statements should the nurse identify as an indication that the client is experiencing the bargaining stage of Kubler-Ross stages of grief?

Answer 51

I would give anything to live to see my grandchild born

Question 52

A school nurse is providing care to a student who is angry and states, “My parents don’t know I’m gay so I can’t visit my girlfriend in the hospital while she receives cancer treatment.” Which of the following forms of grief id the client experiencing?

Answer 52

Disenfranchised Grief

Question 53

Aside from the Colombia Rating Scale, what are some commonly used screening tools for those with MDD?

Answer 53

Hamilton, Geriatric, and Zung Self-rating depression scale. Patient Health Questionaire-9 and SAD PERSONS Scale