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11. A nurse worked with a patient diagnosed with major depressive disorder, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of a. guilt and despair. b. over-involvement. c. interest and pleasure. d. ineffectiveness and frustration.

ANS: D

Nurses may have expectations for self and patients that are not wholly realistic, especially regarding the patient’s progress toward health. Unmet expectations result in feelings of ineffectiveness, anger, or frustration. Nurses rarely become over-involved with patients with depression because of the patient’s resistance. Guilt and despair might be seen when the nurse experiences the patient’s feelings because of empathy. Interest is possible, but not the most likely result.

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

REF: Pages 14-16 (Case Study and Nursing Care Plan), 25 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

12. A patient diagnosed with depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about 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.

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

REF: Pages 14-25, 32, 72 (Box 14-4) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee b. Mashed potatoes, ground beef patty, corn, green beans, apple pie c. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

13. A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve?

ANS: B

The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine. Fresh ground beef and apple pie are safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages/hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate.

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

REF: Pages 14-37, 60 (Table 14-6), 66 (Table 14-7)

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Evaluation eBay: testbanks_and_xanax a. Nutrition and hydration b. Supporting physiological stability c. Reducing disorientation and confusion d. Assisting the patient to identify and test negative thoughts

14. What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy (ECT) treatment?

ANS: B

During the immediate posttreatment 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 posttreatment period because the patient may be confused.

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

REF: Page 14-36 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

15. A nurse provided medication education for a patient diagnosed with major depressive disorder who began a new prescription for phenelzine (Nardil). Which behavior indicates effective learning? The patient a. monitors sodium intake and weight daily. b. wears support stockings and elevates the legs when sitting. c. can identify foods with high selenium content that should be avoided. d. confers with a pharmacist when selecting over-the-counter medications.

ANS: D

Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.

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

REF: Pages 14-36, 60 (Table 14-6), 66 (Table 14-7)

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Evaluation a. Powerlessness b. Defensive coping c. Situational low self-esteem d Disturbed personal identity

16. Major depressive disorder 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?

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.

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

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

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity 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.

17. A patient diagnosed with major depressive disorder does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective?

ANS: A

Making observations about neutral topics 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.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Page 14-56 (Table 14-3) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

18. A patient being treated for depression has taken sertraline daily for a year. The patient calls the clinic nurse and says, “I stopped taking my antidepressant 2 days ago. Now I am having nausea, nervous feelings, and I can’t sleep.” The nurse will advise the patient to: a. “Go to the nearest emergency department immediately.” b. “Do not to be alarmed. Take two aspirin and drink plenty of fluids.” c. “Take a dose of your antidepressant now and come to the clinic to see the health care provider.” d. “Resume taking your antidepressants for 2 more weeks and then discontinue them again.”

ANS: C

The patient has symptoms associated with abrupt withdrawal of the antidepressant. Taking a dose of the drug will ameliorate the symptoms. Seeing the health care provider will allow the patient to discuss the advisability of going off the medication and to be given a gradual withdrawal schedule if discontinuation is the decision. This situation is not a medical emergency, although it calls for medical advice. Resuming taking the antidepressant for 2 more weeks and then discontinuing again would produce the same symptoms the patient is experiencing.

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

REF: Pages 14-60 (Table 14-6), 72 (Box 14-4)

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 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.”

19. Which documentation for a patient diagnosed with major depressive disorder indicates the treatment plan was effective?

ANS: A

Sleeping 6 hours, participating with a group, and anticipating an event are all positive findings that suggest effectiveness of the plan of care. All the other options show at least one negative finding.

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

REF: Pages 14-16 (Case Study and Nursing Care Plan), 26, 44 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity a. January b. April c. June d. September

20. A patient was diagnosed with seasonal affective disorder (SAD). During which month would this patient’s symptoms be most acute?

ANS: A

The days are short in January, so the patient would have the least exposure to sunlight. SAD is associated with disturbances in circadian rhythm. Days are longer in spring, summer, and fall.

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

REF: Page 14-42 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Powerlessness b. Risk for suicide c. Stress overload d. Spiritual distress

21. A patient diagnosed with major depressive disorder repeatedly tells staff, “I have cancer. It’s my punishment for being a bad person.” Diagnostic tests reveal no cancer. Select the priority nursing diagnosis.

ANS: B

A patient diagnosed with major depressive disorder who feels so worthless as to believe cancer is deserved is at risk for suicide. Safety concerns take priority over the other diagnoses listed.

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

REF: Pages 14-8, 16 (Case Study and Nursing Care Plan), 53 (Table 14-2)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity a. Tomato juice eBay: testbanks_and_xanax b. Orange juice c. Hot tea d. Milk

22. A patient diagnosed with major depressive disorder refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient?

ANS: D

Milk is the only beverage listed that provides protein, fat, and carbohydrates. In addition, milk is fortified with vitamins.

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

REF: Page 14-57 (Table 14-4) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. Affect depressed; mood flat b. Affect flat; mood depressed c. Affect labile; mood euphoric d. Affect and mood are incongruent.

23. During a psychiatric assessment, the nurse observes a patient’s facial expression is without emotion. The patient says, “Life feels so hopeless to me. I’ve been feeling sad for several months.” How will the nurse document the patient’s affect and mood?

ANS: B

Mood refers to a person’s self-reported emotional feeling state. Affect is the emotional feeling state that is outwardly observable by others. When there is no evidence of emotion in a person’s expression, the affect is flat.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 14-21, 22 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

24. A disheveled patient in the acute phase of major depressive disorder is withdrawn, has psychomotor retardation, and has not showered for several days. The nurse will a. bring up the issue at the community meeting. b. calmly tell the patient, “You must bathe daily.” c. make observations about the patient’s poor personal hygiene. d. firmly and neutrally assist the patient with showering.

ANS: D

When patients are unable to perform self-care activities, staff must assist them rather than ignore the issue. Better grooming increases self-esteem. The patient needs assistance, not simply making an observation. Calmly telling the patient to bathe daily and bringing up the issue at a community meeting are punitive.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 14-53 (Table 14-2), 58 (Table 14-5) | Page 14-16 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

25. A patient diagnosed with major depressive disorder began taking escitalopram 5 days ago. The patient now says, “This medicine isn’t working.” The nurse’s best intervention would be to a. discuss with the health care provider the need to increase the dose. b. reassure the patient that the medication will be effective soon. c. explain the time lag before antidepressants relieve symptoms. eBay: testbanks_and_xanax d. critically assess the patient for symptoms of improvement.

ANS: C

Escitalopram is an SSRI antidepressant. One to three weeks of treatment is usually necessary before symptom relief occurs. This information is important to share with patients.

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

REF: Pages 14-32, 60 (Table 14-6) | Page 14-72 (Box 14-4)

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

26. A patient is experiencing psychomotor agitation associated with major depressive disorder. Which observation would the nurse associate with this symptom? The patient a. paces aimlessly around the room. b. asks the nurse to repeat instructions. c. complains of prickly skin sensations. d. demonstrates slowed verbal responses.

ANS: A

Psychomotor agitation may be evidenced by constant pacing and wringing of hands. Slowed movements and responses are aspects of psychomotor retardation. Complaints of the unusual skin sensations may represent a delusion or hallucination. Asking the nurse to repeat instructions indicates difficulty with concentration.

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

REF: Pages 14-8, 16 (Case Study and Nursing Care Plan), 21

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. Antidepressant medications alter catecholamine levels, which impairs decision-making abilities. b. Antidepressant medications may cause confusion related to limitation of tyramine in the diet. c. Temporary memory impairments and confusion may occur with ECT. d. The patient needs time to readjust to a pressured work schedule.

27. A patient diagnosed with major depressive disorder received six ECT sessions and aggressive doses of antidepressant medication. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling.

ANS: C

Recent memory impairment and/or confusion may be present during and for a short time after ECT. An inappropriate business decision might be made because of forgotten important details. The rationales are untrue statements in the incorrect responses. The patient needing time to reorient to a pressured work schedule is less relevant than the correct rationale.

PTS: 1

DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 14-39, 40

TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

28. A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of a. hypotensive shock. b. hypertensive crisis. c. cardiac dysrhythmia. eBay: testbanks_and_xanax d. cardiogenic shock.

ANS: B

Patients taking MAO-inhibiting drugs must be on a tyramine-free diet to prevent hypertensive crisis. In the presence of MAOIs, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.

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

REF: Pages 14-36, 60 (Table 14-6), 68 (Table 14-8), 75 (Box 14-7)

TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity a. “They will put me to sleep during the procedure so I won’t know what is happening.” b. “I might be a little dizzy or have a mild headache after each procedure.” c. “I will be unable to care for my children for about 2 months.” d. “I will avoid eating foods that contain tyramine.”

29. Transcranial Magnetic Stimulation (TCM) is scheduled for a patient diagnosed with major depressive disorder. Which comment by the patient indicates teaching about the procedure was effective?

ANS: B

TCM treatments take about 30 minutes. Treatments are usually 5 days a week. Patients are awake and alert during the procedure. After the procedure, patients may experience a headache and lightheadedness. No neurological deficits or memory problems have been noted. The patient will be able to care for children.

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

REF: Page 14-40 TOP: Nursing Process: Evaluation

MSC: Client Needs: Physiological Integrity

Multiple Response

1. The admission note indicates a patient diagnosed with major depressive disorder has anergia and anhedonia. For which measures should the nurse plan? (Select all that apply.)

a. Channeling excessive energy b. Reducing guilty ruminations c. Instilling a sense of hopefulness d. Assisting with self-care activities e. Accommodating psychomotor retardation

ANS: C, D, E

Anergia refers to a lack of energy. Anhedonia refers to the inability to find pleasure or meaning in life; thus, planning should include measures to accommodate psychomotor retardation, assist with activities of daily living, and instill hopefulness. Anergia is lack of energy, not excessive energy. Anhedonia does not necessarily imply the presence of guilty ruminations.

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

REF: Pages 14-7, 16 (Case Study and Nursing Care Plan), 20 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity eBay: testbanks_and_xanax a. Imbalanced nutrition: less than body requirements b. Chronic low self-esteem c. Sexual dysfunction d. Self-care deficit e. Powerlessness f. Insomnia

2. A nurse caring for a patient diagnosed with major depressive disorder reads in the patient’s medical record, “This patient shows vegetative signs of depression.” Which nursing diagnoses most clearly relate to this documentation? (Select all that apply.)

ANS: A, C, D, F

Vegetative signs of depression are alterations in body processes necessary to support life and growth, such as eating, sleeping, elimination, and sexual activity. These diagnoses are more closely related to vegetative signs than diagnoses associated with feelings about self.

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

REF: Pages 14-53(Table 14-2), 58 (Table 14-5)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity a. Offer laxatives if needed. b. Monitor food and fluid intake. c. Provide a quiet sleep environment. d. Eliminate all daily caffeine intake. e. Restrict intake of processed foods.

3. A patient diagnosed with major depressive disorder shows vegetative signs of depression. Which nursing actions should be implemented? (Select all that apply.)

ANS: A, B, C

The correct options promote a normal elimination pattern. Although excessive intake of stimulants such as caffeine may make the patient feel jittery and anxious, small amounts may provide useful stimulation. No indication exists that processed foods should be restricted.

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

REF: Pages 14-21, 23, 27, 53 (Table 14-2), 58 (Table 14-5)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. Vital signs b. Urinary frequency c. Psychomotor retardation d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness

4. A patient being treated with paroxetine 50 mg po daily reports to the clinic nurse, “I took a few extra tablets earlier today and now I feel bad.” Which assessments are most critical? (Select all that apply.)

ANS: A, D, E

The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Serotonin syndrome may progress to a full medical emergency if not treated early. The patient may have urinary retention, but frequency would not be expected.

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

REF: Pages 14-33, 34, 60 (Table 14-6), 71 (Box 14-3)

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