Question 1

A depressed patient does not converse except when addressed,and then only in monosyllables.Which response by the nurse is likely to be most helpful?

Accepted Answer

A)  "Can you tell me how you're feeling today?" 
B)  "What would you like to talk about?" 
C)  "It would be helpful if you talked more." 
D)  "It seems rather cold in here today."

Question 2

A middle-aged patient who has been treated for depression with SSRIs and cognitive-behavioral therapy has identified that passivity probably contributed to her depression.Which treatment modality would be best for the nurse to suggest?

Accepted Answer

A)  Social skills training 
B)  Assertive communication training 
C)  Relaxation training classes 
D)  Exercise therapy group

Question 3

A recently divorced man with severe depression exhibits poor sleep and impaired concentration,leading him to function poorly at work.Inattention to hygiene and irritability with others aggravate problems at work.Co-workers do not recognize that he is depressed and instead assume his behavioral changes are due to drug abuse.One day he is fired.Work had been his one remaining source of self-worth.The man presents at the emergency room seeking medication to help him sleep.Which of the following responses would be most important for the triage nurse to take at this time?

Accepted Answer

A)  "Have you considered seeking treatment for the depression itself?" 
B)  "Tell me what you have already been trying to help improve your sleep." 
C)  "We usually don't prescribe sleep medications in the emergency room." 
D)  "You said you are depressed;have you thought about harming yourself?"

Question 4

A woman became severely depressed when the last of her six children moved out of the home 4 months ago.Since then she has neglected to care for herself,sleeps poorly,lost weight,and repeatedly states,"No one cares about me anymore.I'm worthless." After hospitalization,the nursing diagnosis of situational low self-esteem related to feelings of abandonment was identified.The nurse wishes to reinforce the patient's self-esteem by acknowledging the improvement in her personal appearance.She's wearing a new dress and has combed her hair.The most appropriate remark would be:

Accepted Answer

A)  "You look very nice this morning,Mrs.J." 
B)  "I like the dress you're wearing,it's very pretty." 
C)  "What brought about this glamorous transformation?" 
D)  "You've combed your hair and are wearing a new dress."

Question 5

A patient being treated for depression has been taking 300 mg amitriptyline (Elavil)daily for nearly a year.She calls her case manager at the mental health clinic,stating she stopped taking her antidepressant 2 days ago and has developed something like the "flu," with cold sweats,nausea,a rapid heartbeat,terrible nightmares when she sleeps,but no other symptoms.How should the nurse respond?

Accepted Answer

A)  Advise her to go to the nearest emergency department for an evaluation. 
B)  Tell her to take two aspirin,drink plenty of fluids,and call her family doctor. 
C)  Explain it may be withdrawal;tell her to take one Elavil and contact her doctor. 
D)  Direct her to take the medicine every other day for 2 weeks,then stop.

Question 6

During assessment,the nurse is most likely to find the attitude of the depressed patient toward his illness to be:

Accepted Answer

A)  "It's just a matter of time and I'll be well." 
B)  "I think the medicine will help in time." 
C)  "I can fight this,I don't have to be depressed." 
D)  "It's the way I am,I deserve to be this way."

Question 7

A depressed patient who is taking a tricyclic antidepressant tells the nurse,"I don't think I can keep taking these pills.They make me very dizzy,especially when I stand up." The best nursing response is:

Accepted Answer

A)  "That is annoying,but it is something most patients are able to learn to live with as time goes on.You'll get used to the medicine's side effects." 
B)  "The medicine can slow the body's adjustment of blood pressure when changing position;drinking more fluids and changing position slowly can help." 
C)  "Compared to the problems caused by the depression,it seems like a relatively small annoyance to have to put up with." 
D)  "All medicines have side effects,and this one is relatively mild.It could be that your depression is causing you to think negatively about the medicine."

Question 8

A student nurse working with a depressed patient finds herself becoming angry with the patient when he responds slowly or not at all to her efforts to improve his mood.Which explanation most likely explains her emotional response?

Accepted Answer

A)  The majority of depressed persons respond only partially to treatment interventions. 
B)  This depressed patient is responding more slowly than most,leading to frustration. 
C)  Depressed patients are often resistant to treatment and a source of frustration to staff. 
D)  Staff can have unrealistic expectations,believing depressed people should "cheer up."

Question 9

A patient being treated for major depression is the CEO of her own business.She has shown significant improvement and is about to be discharged after completing a course of 15 electroconvulsive therapy sessions.She will continue on SSRI medications.The patient has been counseled not to make a major business decision for a month.The rationale for this is that:

Accepted Answer

A)  SSRIs may cause confusion in susceptible persons. 
B)  ECT often causes temporary memory impairment. 
C)  Lingering depression makes the patient incompetent. 
D)  The patient needs months to readjust to work pressures.

Question 10

A severely depressed patient with psychomotor retardation has begun activities therapy.His schedule is: 9 AM,ceramics;10 AM,exercise group;11 AM to noon,open;noon,lunch.The nurse creating the patient's schedule should opt to fill the hour block from 11 AM to noon with:

Accepted Answer

A)  group therapy. 
B)  a rest period. 
C)  reminiscence group. 
D)  individual counseling.

Question 11

A man with severe depression is admitted to the partial hospitalization program for mood disorders after exhibiting unintentional weight loss and refusal to go to work.He does not bathe or shave,sleeps poorly,and repeatedly states: "I'm useless,I'm no good to anyone." Which intervention would be best to include in the patient's initial care plan?

Accepted Answer

A)  Involve patient in activities akin to those at his work to restore comfort. 
B)  Reinforce his interest in resuming work attendance when it returns. 
C)  Provide patient with nutrient-dense finger foods and weigh daily. 
D)  Provide activities that involve concentration and fine motor skills.

Question 12

An elderly patient complains bitterly and repetitively about numerous somatic concerns,but he has been examined thoroughly by several different health care providers,and physical examinations suggest that he is in good health.The nurse should suspect that the patient's somatic complaints most likely are:

Accepted Answer

A)  indications of a hidden physical illness. 
B)  a maladaptive way of coping with stress. 
C)  indications that he is feeling depressed. 
D)  typical responses to the aches of growing older.

Question 13

A student in the Mood Disorders Clinic states that everything he does is wrong and that nothing he tries ever works.Although he has never failed an exam,he believes he will fail the next one.Based on evidence-based research,which of the following interventions would best address a presentation of this type?

Accepted Answer

A)  Psychoanalytic therapy 
B)  Desensitization therapy 
C)  Cognitive-behavioral therapy 
D)  Alternative and complementary therapies

Question 14

A disheveled,severely depressed patient with psychomotor retardation has not showered for several days.The nurse should:

Accepted Answer

A)  provide rewards when the patient showers and withhold them when he doesn't. 
B)  assist him into the shower,provide soap,and direct him to wash his face first. 
C)  motivate the patient by noting that his body odor is beginning to offend his peers. 
D)  discuss hygiene at the community meeting,without mentioning specific patients.

Question 15

A patient taking a monoamine oxidase inhibitor reports that he forgot he wasn't supposed to take over-the-counter drugs without prior approval and took some medication for his cold 6 hours ago.His wife,a nurse's aide,checked and reports that his blood pressure is 128/84,slightly above his usual blood pressure.He has not noticed any other changes or symptoms.Which of the following responses by the nurse would be most appropriate? Select all that apply.

Accepted Answer

A)  "A single dose of the cold medicine will probably be OK,so you can relax." 
B)  "To be safe,have someone drive you to the emergency room to be checked." 
C)  "If you develop a headache,fever,stiff neck,nausea,or vomiting,go to the ER." 
D)  "Check your blood pressure each hour,and go to the ER if it goes over 140/100." 
E)  "Drink more fluid to reduce the medication concentration and you should be OK."

Question 16

Planned interventions for a newly admitted severely depressed patient should include:

Accepted Answer

A)  allowing the patient to be alone if he or she prefers. 
B)  encouraging the patient to sleep to regain energy. 
C)  careful,unobtrusive observation around the clock. 
D)  chances to enact a leadership role in the therapeutic milieu.

Exam 13: Depressive Disorders