Chapter 14: Depressive Disorders

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 14-27, 57 (Table 14-4) | Page 14-16 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

2. 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. The patient will a. verbalize realistic positive characteristics about self by (date). b. agree to take an antidepressant medication regularly by (date). c. initiate social interaction with another person daily by (date). d. identify two personal behaviors 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 behaviors that might alienate others is a negative concept.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 14-27, 53 (Table 14-2) | Page 14-16 (Case Study and Nursing Care Plan) | Page 274

TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Psychosocial Integrity 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.”

3. A patient diagnosed with major depressive disorder 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?

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 14-53 (Table 14-2) | Page 14-16 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. Social skills training b. Relaxation training classes c. Desensitization techniques d. Use of complementary therapy

4. An adult diagnosed with major depressive disorder was treated with medication and cognitive-behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?

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 skills training. Assertiveness would be of greater value than relaxation training because passivity was a concern. Desensitization is used in treatment of phobias.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 14-16 (Case Study and Nursing Care Plan), 43 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

5. Priority interventions for a patient diagnosed with major depressive disorder and feelings of worthlessness should include 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 eBay: testbanks_and_xanax

Approximately two-thirds of people with depression contemplate suicide. Patients with depressive disorder 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 14-5 (DSM 5 Criteria), 53 (Table 14-2) | Page 14-16 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment

6. When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will address the negative thought patterns by using a. psychoanalytic therapy. b. desensitization therapy. c. cognitive-behavioral therapy. d. alternative and complementary therapies.

ANS: C

Cognitive-behavioral 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-behavioral 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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 14-43 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

7. 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 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.”

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 14-7 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

8. A patient diagnosed with major depressive disorder 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 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 14-35, 60 (Table 14-6), 73 (Box 14-5)

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity a. Dry mouth b. Blurred vision c. Nasal congestion d. Urinary retention

9. A patient diagnosed with major depressive disorder is receiving imipramine 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?

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.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 14-34, 60 (Table 14-6) | Page 14-73 (Box 14-5)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 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?”

10. A patient diagnosed with major depressive disorder 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?

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 14-27, 57 (Table 14-4) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity