Question 1

A priority nursing intervention for a patient diagnosed with major depressive disorder is:

Accepted Answer

A)   distracting the patient from self-absorption.
B)   carefully and inconspicuously observing the patient around the clock.
C)   allowing the patient to spend long periods alone in self-reflection.
D)   offering opportunities for the patient to assume a leadership role in the therapeutic milieu. B

Question 2

What is the focus of priority nursing care for the period immediately after a patient has an electroconvulsive therapy (ECT) treatment?

Accepted Answer

A)   Supporting physiologic stability
B)   Reducing disorientation and confusion
C)   Monitoring pupillary responses
D)   Assisting the patient to plan for the future A

Question 3

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

Accepted Answer

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." A

Question 4

A patient diagnosed with major depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. Priority information given to the patient and family should include a directive to:

Accepted Answer

A)   avoid exposure to bright sunlight.
B)   report increased suicidal thoughts.
C)   restrict sodium intake to 1 g daily.
D)   maintain a tyramine-free diet.

Question 5

A patient became severely depressed when the last of 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?

Accepted Answer

A)   "Things will look brighter soon. Everyone feels down once in a while."
B)   "The staff here cares about you and wants to try to help you get better."
C)   "It is difficult for others to care about you when you repeatedly say negative things about yourself."
D)   "I'll sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this afternoon."

Question 6

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.)

Accepted Answer

A)   Channeling excessive energy
B)   Reducing guilty ruminations
C)   Instilling a sense of hopefulness
D)   Assisting with self-care activities
E)   Accommodating psychomotor retardation

Question 7

A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, "No one cares about me anymore. I'm not worth anything." Select an appropriate initial outcome. The patient will:

Accepted Answer

A)   verbalize realistic positive characteristics about self by (date) .
B)   consent to take 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) .

Question 8

A nurse teaching a patient about a tyramine-restricted diet would approve which meal?

Accepted Answer

A)   Mashed potatoes, ground beef patty, corn, green beans, apple pie
B)   Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
C)   Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
D)   Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

Question 9

A woman gave birth to a healthy newborn 1 month ago. The patient now reports she cannot cope and is unable to sleep or eat. She says, "I feel like a failure. This baby is the root of my problems." The priority nursing diagnosis is:

Accepted Answer

A)   insomnia.
B)   ineffective coping.
C)   situational low self-esteem.
D)   risk for other-directed violence.

Question 10

A disheveled patient with severe depression and psychomotor retardation has not bathed for several days. The nurse should:

Accepted Answer

A)   avoid forcing the issue.
B)   bring up the issue at the community meeting.
C)   calmly tell the patient, "You must bathe daily."
D)   firmly and neutrally assist the patient with showering.

Question 11

During a psychiatric assessment, the nurse observes a patient's facial expressions that are without emotion. The patient says, "Life feels so hopeless to me. I've been feeling sad for several months." How should the nurse document the patient's affect and mood?

Accepted Answer

A)   Affect depressed; mood flat
B)   Affect flat; mood depressed
C)   Affect labile; mood euphoric
D)   Affect and mood are incongruent

Question 12

A patient diagnosed with major depressive disorder is taking a tricyclic antidepressant. 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 should:

Accepted Answer

A)   explain how to manage postural hypotension, and educate the patient that side effects go away after several weeks.
B)   tell the patient that the side effects are a minor inconvenience compared with the feelings of depression.
C)   withhold the drug, force oral fluids, and notify the health care provider to examine the patient.
D)   teach the patient how to use pursed-lip breathing.

Question 13

When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will address the negative thought patterns by using:

Accepted Answer

A)   psychoanalytic therapy.
B)   desensitization therapy.
C)   cognitive behavioral therapy.
D)   alternative and complementary therapies.

Question 14

A patient diagnosed with major depressive disorder is receiving imipramine (Tofranil) 200 mg every night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?

Accepted Answer

A)   Dry mouth
B)   Blurred vision
C)   Nasal congestion
D)   Urinary retention

Question 15

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. Select the nurse's most effective approach to communication.

Accepted Answer

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.

Question 16

A patient was started on escitalopram (Lexapro) 5 days ago and now says, "This medicine isn't working." The nurse's best intervention would be to:

Accepted Answer

A)   discuss with the health care provider the need to change medications.
B)   reassure the patient that the medication will be effective soon.
C)   explain the time lag before antidepressants relieve symptoms.
D)   critically assess the patient for symptom relief.

Question 17

A patient diagnosed with major depressive disorder will begin electroconvulsive therapy tomorrow. Which interventions are routinely implemented before the treatment? (Select all that apply.)

Accepted Answer

A)   Administer pretreatment medication 30 to 45 minutes before treatment.
B)   Withhold food and fluids for a minimum of 6 hours before treatment.
C)   Remove dentures, glasses, contact lenses, and hearing aids.
D)   Restrain the patient in bed with padded limb restraints.
E)   Assist the patient to prepare an advance directive.

Question 18

A patient's employment is terminated and major depressive disorder develops shortly afterward. The patient says to the nurse, "I'm not worth the time you spend with me. I'm the most useless person in the world." Which nursing diagnosis applies?

Accepted Answer

A)   Powerlessness
B)   Defensive coping
C)   Situational low self-esteem
D)   Disturbed personal identity

Question 19

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

Accepted Answer

A)   Powerlessness
B)   Risk for suicide
C)   Stress overload
D)   Spiritual distress

Question 20

A patient diagnosed with major depressive disorder was hospitalized for 8 days. Treatment included six electroconvulsive therapy sessions and aggressive dose adjustments of antidepressant medications. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling.

Accepted Answer

A)   Temporary memory impairments and confusion can be associated with electroconvulsive therapy.
B)   Antidepressant medications alter catecholamine levels, which impair decision-making abilities.
C)   Antidepressant medications may cause confusion related to a limitation of tyramine in the diet.
D)   The patient needs time to reorient him or herself to a pressured work schedule.

Exam 15: Mood Disorders: Depression