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Chapter 25. Depressive Disorders

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Contributor: cloveb
Category: Psychology and Mental Health
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Chapter 25. Depressive Disorders MULTIPLE CHOICE 1. A client is diagnosed with persistent depressive disorder (PDD) (dysthymia). Which should the nurse classify as an affective symptom of this disorder? 1. Social isolation with a focus on self 2. Low energy level 3. Difficulty concentrating 4. Gloomy and pessimistic outlook on life ANS: 4 Chapter: Chapter 25, Depressive Disorders Objective: Identify symptomatology associated with depression and use this information in client assessment. Page: 495 Heading: Application of the Nursing Process > Background Assessment Data Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Knowledge [Remembering] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. Social isolation is a behavioral symptom. 2. This is incorrect. This is a physiological symptom of depression. 3. This is incorrect. Difficulty concentrating is a cognitive symptom. 4. This is correct. Symptoms of depression can be described as alterations in four areas of human functions: affective, behavioral, cognitive, and physiological. A gloomy and pessimistic outlook on life is an affective symptom of dysthymia. Affective symptoms are those that relate to the mood. CON: Mood 2. A client is diagnosed with major depressive disorder (MDD). Which nursing diagnosis should the nurse assign to the client to address a behavioral symptom of this disorder? 1. Altered communication related to (R/T) feelings of worthlessness as evidenced by (AEB) anhedonia 2. Social isolation R/T poor self-esteem AEB secluding self in room 3. Altered thought processes R/T hopelessness AEB persecutory delusions 4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Formulate nursing diagnoses and goals of care for clients with depression. Page: 495 Heading: Application of the Nursing Process > Background Assessment Data (Moderate/Severe Depression); Diagnosis/Outcome Identification Integrated Processes: Nursing Process: Analysis Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. Feelings of worthlessness are affective symptoms. 2. This is correct. The nursing diagnosis of social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of MDD. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, maintaining a fetal position, and no personal hygiene and/or grooming. 3. This is incorrect. Persecutory delusions are cognitive symptoms. 4. This is incorrect. Anorexia is a physiological symptom. CON: Mood 3. The nurse suspects the client of having MDD due to the client having psychomotor retardation. Which of the following would be an example of psychomotor retardation? 1. The client is disheveled and malodorous. 2. The client exhibits promiscuous behaviors. 3. The client ambulates independently. 4. The client has maxed-out charge cards. ANS: 1 Chapter: Chapter 25, Depressive Disorders Objective: Identify symptomatology associated with depression and use this information in client assessment. Page: 484 Heading: Application of the Nursing Process >Background Assessment Data Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Mood Difficulty: Moderate Feedback 1. This is correct. Psychomotor retardation can manifest as being disheveled and malodorous. 2. This is incorrect. Hypersexuality is a symptom of mania, not depression. 3. This is incorrect. This is not an example of psychomotor retardation. 4. This is incorrect. Excessive spending is a symptom of mania. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria indicate a diagnosis of MDD is appropriate when there is no history of manic behavior. CON: Mood 4. Which of the following best defines secondary depression? 1. Depressive symptoms that occur as a consequence of an adverse side effect of certain medications. 2. Depressive symptoms as a result of MDD exacerbation and elevated serotonin levels. 3. Depressive symptoms that occur as a result of psychomotor retardation. 4. Depressive symptoms that occur with abrupt discontinuation of antidepressants. ANS: 1 Chapter: Chapter 25, Depressive Disorders Objective: Identify symptomatology associated with depression and use this information in client assessment. Page: 485 Heading: Predisposing Factors > Biological Theories > Physiological Influences > Hormonal Disturbances Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Mood Difficulty: Difficult Feedback 1. This is correct. The DSM-5 stipulates that medical conditions should be identified before a psychiatric diagnosis is made, as symptoms of a medical condition may mimic those of psychiatric disorders. Depressive symptoms that occur as a consequence of a non-mood disorder or as an adverse effect of certain medications are known as secondary depression. Secondary depression may be related to medication side effects, neurological disorders, electrolyte or hormonal disturbances, nutritional deficiencies, and other physiological or psychological conditions. 2. This is incorrect. It has been theorized that since selective serotonin reuptake inhibitors (SSRIs) are drugs that elevate serotonin levels, low serotonin levels in the brain must be responsible for depression. However, SSRIs also seem to be beneficial in the treatment of anxiety, leading to the hypothesis that low serotonin levels are responsible for anxiety. Further, too much serotonin has also been implicated in anxiety states and schizophrenia. 3. This is incorrect. Psychomotor retardation is a symptom of MDD, not secondary depression. 4. This is incorrect. Abrupt discontinuation of an antidepressant will exacerbate the primary depressive state, not cause secondary depression. CON: Mood 5. A depressed client reports to the nurse a history of divorce, job loss, family estrangement, and cocaine abuse. According to learning theory, which is the cause of this client’s symptoms? 1. Depression is a result of anger turned inward. 2. Depression is a result of abandonment. 3. Depression is a result of repeated failures. 4. Depression is a result of negative thinking. ANS: 3 Chapter: Chapter 25, Depressive Disorders Objective: Identify predisposing factors in the development of depression. Page: 489 Heading: Psychosocial Theories > Learning Theory Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. Psychoanalytical theory (Freud, 1957) indicates depression is a result of anger turned inward. 2. This is incorrect. Object loss theory suggests that depressive illness occurs as a result of having been abandoned by or otherwise separated from a significant other during the first 6 months of life. 3. This is correct. Learning theory describes Seligman’s model (1973), which asserts a state of “learned helplessness” exists in humans who have experienced numerous failures and predisposes individuals to depression by imposing a feeling of lack of control over their life situations. 4. This is incorrect. Cognitive theory (Beck et al., 1979) suggests depression is the result of cognitive distortions that result in negative, defeated attitudes. CON: Mood 6. What is the priority reason for the nurse to perform a full physical health assessment on a client admitted with a diagnosis of MDD? 1. The attention during the assessment is beneficial in decreasing social isolation. 2. Depression is a symptom of several medical conditions. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed clients avoid addressing physical health and ignore medical problems. ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Identify predisposing factors in the development of depression. Page: 488 Heading: Predisposing Factors > Biological Theories > Physiological Influences Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. Although social interaction may be an unintended result, it is not a priority reason for this assessment. 2. This is correct. It is a priority to identify and treat medical conditions because depressive symptoms may occur as a consequence of a nonmood disorder related to medication side effects, neurological disorders, electrolyte or hormonal disturbances, nutritional deficiencies, and other physiological or psychological conditions. 3. This is incorrect. This is not the priority reason for the full assessment. Although many antidepressants may cause physical side effects, that is not the priority reason for completing a full physical assessment. 4. This is incorrect. Depressed clients may ignore chronic health issues, but that is not the priority for the full physical assessment. CON: Mood 7. The nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Fluoxetine (Prozac) ANS: 4 Chapter: Chapter 25, Depressive Disorders Objective: Discuss implications of depression related to developmental stage. Page: 492 Heading: Developmental Implications > Adolescence Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Knowledge [Remembering] Concept: Safety Difficulty: Moderate Feedback 1. This is incorrect. The SSRI paroxetine (Paxil) has not been approved for treatment of depression in children or adolescents. 2. This is incorrect. The SSRI sertraline (Zoloft) has not been approved for treatment of depression in children or adolescents. 3. This is incorrect. The SSRI citalopram (Celexa) has not been approved for treatment of depression in children or adolescents. 4. This is correct. Fluoxetine (Prozac) is FDA approved for the treatment of depression in children and adolescents. Fluoxetine is an SSRI used in the treatment of depression. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents. CON: Safety 8. The nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a Mini-Mental Status Examination? 1. To rule out bipolar disorder 2. To rule out schizophrenia 3. To rule out a neurocognitive disorder (NCD) 4. To rule out a personality disorder ANS: 3 Chapter: Chapter 25, Depressive Disorders Objective: Discuss implications of depression related to developmental stage. Page: 493 Heading: Developmental Implications > Senescence Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity Cognitive Level: Comprehension [Understanding] Concept: Cognition Difficulty: Moderate Feedback 1. This is incorrect. This is not a tool to diagnose or rule out bipolar disorder. 2. This is incorrect. This is not a tool to rule out or diagnose schizophrenia. 3. This is correct. A Mini-Mental Status Examination should be performed to rule out an NCD. Memory loss, confused thinking, or apathy may actually be the result of depression. This is often referred to as pseudodementia. 4. This is incorrect. This is not a tool to diagnose a personality disorder. CON: Cognition 9. Which of the following is considered a predisposing factor for depression? 1. Decreased serum cortisol levels 2. Decreased thyroid function 3. Decreased sodium levels 4. Genetic factors ANS: 4 Chapter: Chapter 25, Depressive Disorders Objective: Identify predisposing factors in the development of depression. Page: 485 Heading: Predisposing Factors Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analysis [Analyzing] Concept: Safety Difficulty: Difficult Feedback 1. This is incorrect. The normal system of hormonal inhibition fails in clients who are depressed, resulting in hypersecretion of cortisol. Elevated serum cortisol is the basis for the dexamethasone suppression test that is sometimes used to determine if an individual has somatically treatable depression. 2. This is incorrect. Hypothyroidism may mimic symptoms of depression; laboratory testing to evaluate TSH (thyroid-stimulating hormone) levels is relevant to distinguish between depressive disorders and thyroid disorders. The client would be treated with thyroid hormones instead of antidepressants. 3. This is incorrect. Hyponatremia (low serum sodium levels) may contribute to symptoms of confusion and may be a side effect of many medications but is not a predisposing factor in depression. 4. This is correct. Twin studies suggest a strong genetic factor in the etiology of affective illness, including depressive disorders and bipolar disorders. CON: Safety 10. A client who has been taking fluvoxamine (Luvox) without significant improvement asks the nurse, “I heard about something called monoamine oxidase inhibitors (MAOIs). Can’t my doctor add that to my medications?” Which is the most appropriate nursing reply? 1. “This combination of drugs can lead to delirium tremens.” 2. “A combination of an MAOI and fluvoxamine can lead to a life-threatening hypertensive crisis.” 3. “That’s a good idea. There have been good results with the combination of these two drugs.” 4. “The only disadvantage would be the exorbitant cost of the MAOI.” ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Identify topics for client and family teaching relevant to depression. Page: 508 Heading: Psychopharmacology > Client/Family Education Related to Antidepressants Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Application [Applying] Concept: Safety Difficulty: Difficult Feedback 1. This is incorrect. Delirium tremors are an indication of alcohol withdrawal. 2. This is correct. The nurse should explain that combining an MAOI and fluvoxamine can lead to a life-threatening hypertensive crisis. Fluvoxamine is an SSRI antidepressant. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of dread. 3. This is incorrect. This does not provide the client with adequate information about the potential dangers of mixing the two medications. 4. This is incorrect. This does not provide the client with information on the dangers of mixing the two medications, and there is no indication of expense being an issue with the medications. CON: Safety 11. A psychiatrist prescribes an MAOI for a client. Which foods should the nurse teach the client to avoid? 1. Pepperoni pizza and red wine 2. Bagels with cream cheese and tea 3. Apple pie and coffee 4. Potato chips and diet cola ANS: 1 Chapter: Chapter 25, Depressive Disorders Objective: Identify topics for client and family teaching relevant to depression. Page: 508 Heading: Psychopharmacology > Client/Family Education Related to Antidepressants Integrated Process: Teaching and Learning Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Knowledge [Remembering] Concept: Safety Difficulty: Moderate Feedback 1. This is correct. The nurse should instruct the client to avoid pepperoni pizza and red wine. Clients taking MAOIs should not eat foods containing tyramine. Examples of foods high in tyramine are aged cheese, red wine, beer, chocolate, and smoked and processed meats. Foods with high tyramine content can induce hypertensive crisis within 2 hours of ingestion. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of dread. This combination of pizza ingredients (including pepperoni) and red wine has the highest level of tyramine of the foods listed. 2. This is incorrect. Although tea is high in tyramine, bagels with cream cheese are not; there are other food combinations that are higher in tyramine. 3. This is incorrect. Although coffee is high in tyramine, the combination is not the highest level of tyramine listed. 4. This is incorrect. Although potato chips are processed, they are not considered to have high levels of tyramine. While cola has higher tyramine levels, the combination of the items does not result in the highest tyramine level of the foods listed. CON: Safety 12. A client is admitted to the psychiatric unit with a diagnosis of MDD. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this client’s plan of care? 1. A simple, structured daily schedule with limited choices of activities 2. A daily schedule filled with activities to promote socialization 3. A flexible schedule that allows the client opportunities for decision-making 4. A schedule that includes mandatory activities to decrease social isolation ANS: 1 Chapter: Chapter 25, Depressive Disorders Objective: Describe appropriate nursing interventions for behaviors associated with depression. Page: 499 Heading: Planning/Implementation > Powerlessness > Interventions Integrated Processes: Nursing Process: Planning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1. This is correct. A simple, structured daily schedule with limited choices of activities is more appropriate. 2. This is incorrect. A client with depression has difficulty concentrating and may be overwhelmed by activity overload. 3. This is incorrect. A client with depression has difficulty concentrating and may be overwhelmed by the expectation of independent decision-making. 4. This is incorrect. This may overwhelm the client with activity and sensory overload. CON: Mood 13. An isolative client was admitted 4 days ago with a diagnosis of MDD. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? 1. “We’ll go to the dayroom when you are ready for group.” 2. “I’ll walk with you to the dayroom. Group is about to start.” 3. “It must be difficult for you to attend group when you feel so bad.” 4. “Let me tell you about the benefits of attending this group.” ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Describe appropriate nursing interventions for behaviors associated with depression. Page: 503 Heading: Planning/Implementation > Powerlessness > Interventions Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. The client may have little to no motivation and poor decision-making abilities at this time. 2. This is correct. In the most acute stage of severe depression, clients may exhibit little to no motivation and have extreme difficulty making decisions; therefore, this function must be temporarily assumed by the staff. The nurse should use active communication to encourage the client to participate in therapy. 3. This is incorrect. It appears that the nurse is attempting to empathize with the client; at this time, however, the client may have little to no ability to make decisions and have little to no motivation. 4. This is incorrect. Any attempt to entice the client to make a decision when they have little to no motivation would be unsuccessful. CON: Mood 14. A client who is diagnosed with MDD asks the nurse what causes depression. Which is the nurse’s most accurate response? 1. “Depression is caused by a deficiency in neurotransmitters, including serotonin and norepinephrine.” 2. “The exact cause of depressive disorders is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role.” 3. “Depression is a learned state of helplessness caused by ineffective parenting.” 4. “Depression is caused by intrapersonal conflict between the id and the ego.” ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Recount historical perspectives of depression. Page: 480 Heading: Historical Perspective Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. This is not an accurate description of the causes of depression. Although there are no known causative factors, it has been hypothesized that depressive illness may be related to a deficiency in neurotransmitters. 2. This is correct. Depression is likely an illness that has varied and multiple causative factors; but at present, the exact cause of depressive disorders is not entirely understood. 3. This is incorrect. This is not an accurate description of the cause of depression; this is a theory that learned helplessness predisposes individuals to depression. Learned helplessness can be damaging in early life because the sense of mastery over one’s environment is an important foundation for future emotional development. 4. This is incorrect. Freud’s psychoanalytical theory postulated that melancholia is related to a conflict between the id and ego. CON: Mood 15. Which client information does the nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? 1. The client’s understanding of the need for regular blood work 2. The client’s mood and affect score, according to the facility’s mood scale 3. The client’s cognitive ability to understand information about the medication 4. The client’s access to a support network willing to participate in treatment ANS: 3 Chapter: Chapter 25, Depressive Disorders Objective: Identify topics for client and family teaching relevant to depression. Page: 508 Heading: Psychopharmacology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analysis [Analyzing] Concept: Safety Difficulty: Moderate Feedback 1. This is incorrect. Blood work is not necessary for clients taking MAOIs. 2. This is incorrect. Mood and affect would be assessed after the client began taking the medication. 3. This is correct. The nurse must assess the client’s cognitive ability to understand information about the medication. Phenelzine (Nardil) is an MAOI. To avoid a hypertensive emergency, clients taking MAOIs should not ingest foods high in tyramine, take certain medications, or use alcohol. 4. This is incorrect. Support networks may facilitate medication compliance but are not an initial nursing intervention. CON: Safety 16. A client diagnosed with MDD states, “I’ve been feeling ‘down’ for 3 months. Will I ever feel like myself again?” Which statement by the nurse best assesses this client’s affective symptoms? 1. “Have you been diagnosed with any physical disorder within the past 3 months?” 2. “Have you ever felt this way before? 3. “People who have mood changes often feel better when spring comes.” 4. “Help me understand what you mean when you say ‘feeling down’.” ANS: 4 Chapter: Chapter 25, Depressive Disorders Objective: Describe appropriate nursing interventions for behaviors associated with depression. Page: 495 Heading: Application of the Nursing Process > Background Assessment Data Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. This is a closed-ended question, which will yield a “yes” or “no” answer. 2. This is incorrect. Open-ended questions elicit more information than closed-ended questions. This is a closed-ended question, which will yield a “yes” or “no” answer. 3. This is incorrect. This statement is not an assessment. 4. This is correct. The nurse is using the therapeutic communication technique of clarifying to assess the client’s symptoms. Open-ended questions elicit more information than closed-ended questions. A closed-ended question will yield a “yes” or “no” answer. CON: Mood 17. The nurse is implementing a one-on-one suicide observation level with a client diagnosed with MDD. The client states, “I’m feeling a lot better, so you can stop watching me. I have taken up too much of your time already.” Which is the best nursing reply? 1. “I really appreciate your concern, but I have been ordered to continue to watch you.” 2. “Because we are concerned about your safety, we will continue to observe you.” 3. “I am glad you are feeling better. The treatment team will consider your request.” 4. “I will forward your request to your psychiatrist because it is his decision.” ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Describe appropriate nursing interventions for behaviors associated with depression. Page: 499 Heading: Risk for Suicide > Interventions Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Safety Difficulty: Moderate Feedback 1. This is incorrect. The nurse determines and implements the frequency of the observation of a client based on the nursing assessment. 2. This is correct. Suicidal clients often resist frequent observation and monitoring because it impedes the implementation of a suicide plan. The nurse should continually observe a client who is at risk for suicide. 3. This is incorrect. Clients are at a greater risk for suicide when they begin to feel better, as they have more energy to carry out a suicide plan. 4. This is incorrect. The nurse determines and implements the frequency of the observation of a client based on the nursing assessment. The nurse collaborates with the physician and the interdisciplinary treatment team. CON: Safety 18. A newly admitted client is diagnosed with MDD with suicidal ideations. Which is the priority nursing intervention for this client? 1. Teach about the effect of suicide on family dynamics. 2. Carefully observe at varied intervals. 3. Encourage the client to spend a portion of each day interacting within the milieu. 4. Set realistic achievable goals to increase self-esteem and increase energy. ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Describe appropriate nursing interventions for behaviors associated with depression. Page: 499 Heading: Risk for Suicide > Interventions Integrated Processes: Nursing Process: Implementation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Safety Difficulty: Moderate Feedback 1. This is incorrect. This is not a priority nursing intervention for a suicidal client. 2. This is correct. Risk for suicide is the priority concern for a client with MDD. The nurse should frequently assess for the presence and lethality risk of suicidal ideation. The intensity of suicide ideation can change over the course of hours or days. 3. This is incorrect. Having the client spend time within the milieu is not a priority for the client’s safety at this time. 4. This is incorrect. This is not a priority for the client’s safety at this time. CON: Safety 19. The nurse is providing counseling to clients diagnosed with MDD. The nurse chooses to help the clients alter their mood by learning how to change the way they think. The nurse is functioning under which theoretical framework? 1. Psychoanalytic theory 2. Interpersonal theory 3. Cognitive theory 4. Behavioral theory ANS: 3 Chapter: Chapter 25, Depressive Disorders Objective: Recount historical perspectives of depression. Page: 489 Heading: Psychosocial Theories > Cognitive Theory Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Mood Difficulty: Easy Feedback 1. This is incorrect. Psychoanalytical theory is attributed to Freud (1957), who asserted that melancholia occurs after the loss of a loved object, either actually by death or emotionally by rejection, or the loss of some other abstraction of value to the individual. 2. This is incorrect. Interpersonal psychotherapy focuses on the client’s current interpersonal relations. 3. This is correct. Beck and colleagues (1979) proposed a theory suggesting that the primary disturbance in depression is cognitive rather than affective. The underlying cause of the depression is cognitive distortions that result in negative thinking. 4. This is incorrect. Behavioral theory is a type of learning theory. CON: Mood 20. Which client statement expresses typical underlying feelings of clients diagnosed with MDD? 1. “It’s just a matter of time, and I will be well.” 2. “If I ignore these feelings, they will go away.” 3. “I can fight these feelings and overcome this disorder.” 4. “Nothing will help me feel better.” ANS: 4 Chapter: Chapter 25, Depressive Disorders Objective: Identify symptomatology associated with depression and use this information in client assessment. Page: 482 Heading: Types of Depressive Disorders > Major Depressive Disorder (MDD); Application of the Nursing Process > Background Assessment Data Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity Cognitive Level: Analysis [Analyzing] Concept: Mood Difficulty: Easy Feedback 1. This is incorrect. This is not an affective sign associated with MDD. 2. This is incorrect. Although clients with MDD often have low motivation, this is not an affective sign of MDD. 3. This is incorrect. This is a sign of optimism, which is not associated with MDD or depression. 4. This is correct. Hopelessness and helplessness are typical affective symptoms of clients diagnosed with MDD. CON: Mood 21. A 75-year-old client with a long history of depression is currently taking doxepin (Sinequan) 100 mg daily. The client also takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority? 1. Risk for ineffective thermoregulation R/T anhidrosis 2. Risk for constipation R/T excessive fluid loss 3. Risk for injury R/T orthostatic hypotension 4. Risk for infection R/T suppressed white blood cell count ANS: 3 Chapter: Chapter 25, Depressive Disorders Objective: Formulate nursing diagnoses and goals of care for clients with depression. Page: 509 Heading: Psychopharmacology > Client/Family Education Related to Antidepressants; Table 25–3; Chapter 4, Psychopharmacology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analysis [Analyzing] Concept: Safety Difficulty: Difficult Feedback 1. This is incorrect. Anhidrosis is the inability to sweat. This is not a side effect of the medications. 2. This is incorrect. Risk for injury is a priority over the risk for constipation. 3. This is correct. Orthostatic hypotension is a side effect of the tricyclic antidepressant doxepin (Sinequan), placing the client at risk for injury. Dehydration related to flu symptoms and a diuretic further increases the risk for orthostatic hypotension. 4. This is incorrect. Although doxepin can reduce the white blood cell count, this is not a priority for this client. CON: Safety 22. A client is admitted with a diagnosis of PDD. Which client statement describes a symptom consistent with this diagnosis? 1. “I have been sad most of the time for the past several years.” 2. “I find myself preoccupied with death.” 3. “Sometimes I hear voices telling me to kill myself.” 4. “I’m afraid to leave the house.” ANS: 1 Chapter: Chapter 25, Depressive Disorders Objective: Describe various types of depressive disorders. Page: 482 Heading: Types of Depression > Persistent Depressive Disorder (Dysthymia) Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1. This is correct. PDD is characterized by depressed mood for most of the day for more days than not, for at least 2 years. 2. This is incorrect. Preoccupation with death is a characteristic of MDD. 3. This is incorrect. Auditory hallucinations (hearing voices) are a symptom of psychosis, which most often occurs with schizophrenia. 4. This is incorrect. Fear of leaving the house is a symptom of agoraphobia. CON: Mood 23. A client diagnosed with MDD was raised in a strongly religious family where bad behavior was equated with sins against God. Which nursing intervention is most appropriate to help the client address spirituality as it relates to the illness? 1. Encourage the client to bring into awareness underlying sources of guilt. 2. Teach the client that religious beliefs should be put into perspective. 3. Confront the client with the irrational nature of the belief system. 4. Assist the client to modify his or her belief system to improve coping skills. ANS: 1 Chapter: Chapter 25, Depressive Disorders Objective: Describe appropriate nursing interventions for behaviors associated with depression. Page: 499 Heading: Planning/Implementation > Low Self-Esteem/Self-Care Deficit > Interventions Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Mood Difficulty: Moderate Feedback 1. This is correct. A client raised in an environment that reinforces one’s inadequacy may be at risk for experiencing guilt, shame, low self-esteem, and hopelessness, which can contribute to depression. Assisting the client to bring these feelings into awareness allows the client to appraise distorted responsibility and dysfunctional guilt realistically. 2. This is incorrect. Putting their religious beliefs in perspective is too vague to allow the client to examine their possible guilt. 3. This is incorrect. This would not be a therapeutic communication, as it would put the client in a defensive mode. 4. This is incorrect. Having the client modify their belief system is not therapeutic and may not help the client develop adequate coping skills. CON: Mood 24. The nurse is caring for four clients taking various medications, including imipramine (Tofranil), doxepin (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication? 1. Imipramine (Tofranil) 2. Doxepin (Sinequan) 3. Ziprasidone (Geodon) 4. Tranylcypromine (Parnate) ANS: 4 Chapter: Chapter 25, Depressive Disorders Objective: Describe appropriate nursing interventions for behaviors associated with depression. Page: 509 Heading: Psychopharmacology > Client/Family Education Related to Antidepressants; Table 25–3 Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Comprehension [Understanding] Concept: Safety Difficulty: Moderate Feedback 1. This is incorrect. Tofranil is a tricyclic antidepressant and does not require a special diet. 2. This is incorrect. Sinequan is a tricyclic antidepressant and does not require a special diet. 3. This is incorrect. Geodon is a medication to treat schizophrenia, not depression. 4. This is correct. The nurse should order a special diet for the client receiving the MAOI tranylcypromine (Parnate). Hypertensive crisis occurs in clients receiving an MAOI who consume foods or medications with a high tyramine content. CON: Safety 25. A client admitted to the psychiatric unit following a suicide attempt is diagnosed with MDD. Which behavioral symptoms should the nurse expect to assess? 1. Anxiety and unconscious anger 2. Lack of attention to grooming and hygiene 3. Guilt and indecisiveness 4. Low self-esteem ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Identify symptomatology associated with depression and use this information in client assessment. Page: 484 Heading: Application of the Nursing Process > Background Assessment Data > Severe Depression; Box 25–1 Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Knowledge [Remembering] Concept: Mood Difficulty: Easy Feedback 1. This is incorrect. Anxiety and anger are affective symptoms. 2. This is correct. Lack of attention to grooming and hygiene is a behavioral symptom of MDD. 3. This is incorrect. Guilt is an affective symptom, and indecisiveness is a cognitive symptom. 4. This is incorrect. Low self-esteem is an affective symptom. CON: Mood 26. A newly admitted client diagnosed with MDD states, “I have never considered suicide.” Later, the client confides to the nurse about plans to “end it all” by medication overdose. Which is the most helpful nursing reply? 1. “There is nothing to worry about. We will handle it together.” 2. “Bringing this up is a very positive action on your part.” 3. “We need to talk about the things you have to live for.” 4. “I think you should consider all of your options prior to taking this action.” ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Describe appropriate nursing interventions for behaviors associated with depression. Page: 499 Heading: Planning/Implementation > Risk for Suicide > Interventions Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. This statement minimizes the client’s feelings and the risk for self-harm. 2. This is correct. The most helpful reply is to convey an attitude of unconditional acceptance of the client by acknowledging sharing of a suicide plan was a positive action. The nurse will also encourage the client to participate actively in establishing a safety plan. 3. This is incorrect. This nontherapeutic statement demonstrates false reassurance and minimizes the client’s feelings. 4. This is incorrect. This statement is unethical and reinforces the client’s plan for self-harm. CON: Mood 27. The psychiatric-mental health nurse is creating a plan of care for a child diagnosed with a depressive disorder. The parents report the child does not seem to know how to make friends and does not seem to be doing as well in school as a family member who is in the same grade. Recently, their child started picking fights while waiting for the bus. The nurse recognizes that the child’s depressive symptoms occur among which age group? 1. 3 to 5 years 2. 6 to 8 years 3. 9 to 12 years 4. 11 to 14 years ANS: 2 Chapter: Chapter 25, Depressive Disorders Objective: Discuss implications of depression related to developmental stage. Page: 490 Heading: Developmental Implications > Childhood Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. Symptoms among children age 3 to 5 years may include accident proneness, phobias, aggressiveness, and excessive self-reproach for minor infractions. Mood congruent auditory hallucinations may also occur. 2. This is correct. Children ages 6 to 8 years may express vague physical complaints and display aggressive behavior. They often cling to parents, avoid new people and challenges, and lag behind their classmates in social skills and academic competence. MDD in children and adolescents can be identified using criteria similar to those used for adults. It is not uncommon, however, for the symptoms of depression to be manifested differently during different ages in childhood. 3. This is incorrect. Symptoms among children age 9 to 12 years include morbid thoughts, excessive worrying, poor self-esteem, and lack of interest in playing with friends. 4. This is incorrect. MDD in children and adolescents can be identified using criteria similar to those used for adults. It is not uncommon, however, for the symptoms of depression to be manifested differently during different ages in childhood. CON: Mood 28. Electroconvulsive therapy (ECT) is considered the treatment of choice for which client? 1. A 39-year-old man experiencing recurrent suicidal ideation 2. A 23-year-old woman experiencing postpartum depression 3. A 41-year-old woman describing a suicide plan 4. A 67-year-old man explaining a recent suicide attempt ANS: 4 Chapter: Chapter 25, Depressive Disorders Objective: Discuss implications of depression related to developmental stage. Page: 493 Heading: Senescence Integrated Processes: Nursing Process: Assessment Cognitive Level: Application [Applying] Core concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. ECT is not indicated for this client, as this client may benefit from psychotherapy and medication. 2. This is incorrect. Treatment of postpartum depression varies with the severity of the illness. Psychotic depression may be treated with antidepressant medication, along with supportive psychotherapy, group therapy, and possibly family therapy. 3. This is incorrect. This client may benefit from psychotherapy and medication; ECT is not indicated for this client. 4. This is correct. Research has identified ECT as generally safe for acute treatment of late-life depression and may be considered the treatment of choice for the elderly individual who is at acute suicidal risk or unable to tolerate antidepressant medications. CON: Mood 29. Which is associated with premenstrual dysphoric disorder (PMDD)? 1. Norepinephrine 2. Serotonin 3. Progesterone 4. Acetylcholine ANS: 3 Chapter: Chapter 25, Depressive Disorders Objective: Identify predisposing factors in the development of depression. Page: 485 Heading: Predisposing Factors > Physiological Influences > Hormonal Disturbances Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Knowledge [Remembering] Core concept: Mood Difficulty: Easy Feedback 1. This is incorrect. An imbalance of norepinephrine is a possible indicator for depression, not PMDD. 2. This is incorrect. One hypothesis for factors indicative of the cause of depression is an imbalance of serotonin. 3. This is correct. An imbalance of the hormones estrogen and progesterone has been implicated in the predisposition to PMDD. 4. This is incorrect. An imbalance with acetylcholine is thought to be a factor in depressive syndrome, not PMDD. CON: Mood MULTIPLE RESPONSE 30. A 20-year-old female has a diagnosis of PMDD. Which of the following should the nurse identify as consistent with this diagnosis? Select all that apply. 1. Symptoms are causing significant interference with daily activities. 2. Client-rated mood is 2/10 for the past 6 months. 3. Mood swings occur the week before onset of menses. 4. Client reports subjective difficulty concentrating. 5. Client manifests pressured speech when communicating. ANS: 1, 3, 4 Chapter: Chapter 25, Depressive Disorders Objective: Identify symptomatology associated with depression and use this information in client assessment. Page: 492 Heading: Premenstrual Dysphoric Disorder; Box 25–3 Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Knowledge [Remembering] Concept: Mood Difficulty: Moderate Feedback 1. This is correct. One of the essential features of PMDD is decreased interest in activities during the week prior to menses. 2. This is incorrect. Symptoms must be associated with significant distress. 3. This is correct. Two of the essential features of PMDD are markedly depressed mood and mood swings during the week prior to menses, improving shortly after the onset of menstruation and becoming minimal or absent in the week after menses. 4. This is correct. One of the essential features of PMDD is markedly depressed mood, such as decreased concentration, during the week prior to menses and improving shortly after the onset of menstruation. 5. This is incorrect. Pressured speech is a symptom of bipolar disorder. CON: Mood 31. An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should the nurse identify as most likely to contribute to the etiology of these symptoms? Select all that apply. 1. Gender differences in social opportunities that occur with age 2. Drastic temperature and barometric pressure changes 3. Increased levels of melatonin 4. Variations in serotonergic functioning 5. Inaccessibility of resources for dealing with life stressors ANS: 2, 3, 4 Chapter: Chapter 25, Depressive Disorders Objective: Discuss epidemiological statistics related to depression. Page: 480 Heading: Epidemiology Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Knowledge [Remembering] Concept: Mood Difficulty: Moderate Feedback 1. This is incorrect. These differences are not related to specific months or seasons. 2. This is correct. Drastic temperature and barometric pressure changes are contributing factors to the etiology of the client’s symptoms. 3. This is correct. An increase in melatonin levels is a contributing factor to the etiology of the client’s symptoms. 4. This is correct. Variations in serotonergic functioning are contributing to the etiology of the client’s symptoms. Several studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November). 5. This is incorrect. Access to resources is not related to specific months or seasons. CON: Mood 32. A client is prescribed phenelzine (Nardil). Which of the following client statements should indicate to the nurse that discharge teaching about this medication has been successful? Select all that apply. 1. “I’ll have to let my surgeon know about this medication before surgery.” 2. “Guess I will have to give up my glass of red wine with dinner.” 3. “I’ll have to be very careful about reading food and medication labels.” 4. “I’m going to limit my water intake.” 5. “I’ll be sure not to stop this medication abruptly.” ANS: 1, 2, 3, 5 Chapter: Chapter 25, Depressive Disorders Objective: Discuss various modalities relevant to treatment of depression. Page: 509 Heading: Psychopharmacology > Client/Family Education Related to Antidepressants; Table 25–3 Integrated Processes: Nursing Process: Evaluation Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analysis [Analyzing] Concept: Safety Difficulty: Moderate Feedback 1. This is correct. Clients should inform other prescribers that they are taking an MAOI. 2. This is correct. To avoid a hypertensive emergency, clients taking MAOIs, such as phenelzine (Nardil), should not use alcohol or ingest foods high in tyramine. Examples of foods high in tyramine are aged cheese, wine (especially Chianti), beer, chocolate, colas, coffee, tea, and smoked and processed meats. 3. This is correct. The client will need to be diligent with reading food and medication labels to avoid tyramine and notify other prescribers of their MAOI use. 4. This is incorrect. The client does not have to limit their fluid intake and will be encouraged to take frequent sips of water if dry mouth is a problem. 5. This is correct. MAOIs should not be stopped abruptly. CON: Safety 33. The nurse understands psychotic postpartum depression is characterized by which symptoms? Select all that apply. 1. Agitation 2. Fear the infant will be harmed 3. Loss of libido 4. Guilt 5. Sleep disturbances ANS: 1, 2, 4 Chapter: Chapter 25, Depressive Disorders Objective: Identify symptomatology associated with depression and use this information in client assessment. Page: 494 Heading: Postpartum Depression Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Core concept: Mood Difficulty: Moderate Feedback 1. This is correct. Postpartum depression with psychotic features is characterized by depressed mood, agitation, indecision, and an abnormal attitude toward bodily functions. The symptoms can be severe and incapacitating. 2. This is correct. The symptoms can be severe and incapacitating. There may be lack of interest in or rejection of the baby or a morbid fear that the baby may be harmed, accompanied by delusions and hallucinations. 3. This is incorrect. Loss of libido is a symptom of moderate postpartum depression. 4. This is correct. Postpartum depression with psychotic features is characterized by guilt. The symptoms can be severe and incapacitating. 5. This is incorrect. Sleep disturbances are among symptoms of moderate postpartum depression. CON: Mood 34. The nurse should frequently assess a client with a depressive disorder for lethality risk related to suicidal ideation. Which questions should the nurse include? Select all that apply. 1. “Are you thinking about hurting yourself or someone else?” 2. “Can you tell me your feelings about dying?” 3. “Where do you keep your gun?” 4. “Have you told your psychiatrist you feel like dying?” 5. “Have you thought about how you would hurt yourself?” ANS: 1, 3, 5 Chapter: Chapter 25, Depressive Disorders Objective: Identify symptomatology associated with depression and use this information in client assessment. Page: 497 Heading: Severe Depression > Planning/Implementation > Risk for Suicide > Interventions Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Core concept: Mood Difficulty: Moderate Feedback 1. This is correct. Ask the client directly, “Are you thinking about hurting yourself or someone else?” The risk of suicide is greatly increased if the client has developed a plan and has strong intentions, especially if means exist for the client to execute the plan. 2. This is incorrect. This will not provide an accurate assessment of the client’s plan to harm self. 3. This is correct. Asking the client where they may have weapons or a means to harm themself is an appropriate question. This may increase the likelihood of the client carrying out a plan of self-harm. 4. This is incorrect. This will not assess the client’s plan; at this time, it is imperative to keep the client safe. 5. This is correct. Ask the client directly, “Have you thought about how you would hurt yourself?” The risk of suicide is greatly increased if the client has developed a plan and has strong intentions, especially if means exist for the client to execute the plan. CON: Mood

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