Deck 25: Depressive Disorders

Question 1

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?

A)Depression is a result of anger turned inward.
B)Depression is a result of abandonment.
C)Depression is a result of repeated failures.
D)Depression is a result of negative thinking.

Answer 1

Depression is a result of repeated failures.

Question 2

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?

A)A simple,structured daily schedule with limited choices of activities
B)A daily schedule filled with activities to promote socialization
C)A flexible schedule that allows the client opportunities for decision-making
D)A schedule that includes mandatory activities to decrease social isolation

Answer 2

A simple,structured daily schedule with limited choices of activities

Question 3

A client who is diagnosed with MDD asks the nurse what causes depression.Which is the nurse's most accurate response?

A)"Depression is caused by a deficiency in neurotransmitters,including serotonin and norepinephrine."
B)"The exact cause of depressive disorders is unknown.A number of things,including genetic,biochemical,and environmental influences,likely play a role."
C)"Depression is a learned state of helplessness caused by ineffective parenting."
D)"Depression is caused by intrapersonal conflict between the id and the ego."

Answer 3

"The exact cause of depressive disorders is unknown.A number of things,including genetic,biochemical,and environmental influences,likely play a role."

Question 4

A psychiatrist prescribes an MAOI for a client.Which foods should the nurse teach the client to avoid?

A)Pepperoni pizza and red wine
B)Bagels with cream cheese and tea
C)Apple pie and coffee
D)Potato chips and diet cola

Question 5

A client is diagnosed with Persistent Depressive Disorder (PDD)(dysthymia).Which should the nurse classify as an affective symptom of this disorder?

A)Social isolation with a focus on self
B)Low energy level
C)Difficulty concentrating
D)Gloomy and pessimistic outlook on life

Question 6

The nurse is implementing a one-on-one suicide observation level with a client diagnosed 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?

A)"I really appreciate your concern but I have been ordered to continue to watch you."
B)"Because we are concerned about your safety,we will continue to observe you."
C)"I am glad you are feeling better.The treatment team will consider your request."
D)"I will forward you request to your psychiatrist because it is his decision."

Question 7

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?

A)"We'll go to the day room when you are ready for group."
B)"I'll walk with you to the day room.Group is about to start."
C)"It must be difficult for you to attend group when you feel so bad."
D)"Let me tell you about the benefits of attending this group."

Question 8

The nurse reviews the laboratory data of a 29-year-old client suspected of having MDD.Which laboratory value would potentially rule out this diagnosis?

A)Thyroid-stimulating hormone (TSH)level of 6.2 U/mL
B)Potassium (K⁺)level of 4.2 mEq/L
C)Sodium (Na⁺)level of 140 mEq/L
D)Calcium (Ca²⁺)level of 9.5 mg/dL

Question 9

What is the priority reason for the nurse to perform a full physical health assessment on a client admitted with a diagnosis of MDD?

A)The attention during the assessment is beneficial in decreasing social isolation
B)Depression is a symptom of several medical conditions
C)Physical health complications are likely to arise from antidepressant therapy
D)Depressed clients avoid addressing physical health and ignore medical problems

Question 10

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?

A)"Have you been diagnosed with any physical disorder within the last 3 months?"
B)"Have you ever felt this way before?
C)"People who have mood changes often feel better when spring comes."
D)"Help me understand what you mean when you say,'feeling down'?"

Question 11

A confused client has recently been prescribed sertraline (Zoloft).The client's spouse is taking paroxetine (Paxil).The client presents with restlessness,tachycardia,diaphoresis,and tremors.Which complication does the nurse suspect,and what could be its possible cause?

A)Neuroleptic malignant syndrome caused by ingestion of two different SSRIs
B)Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI)
C)Disturbances in serotonin caused by ingestion of an SSRI and an MAOI
D)Disturbances in serotonin caused by ingestion of two different SSRIs

Question 12

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?

A)To rule out bipolar disorder
B)To rule out schizophrenia
C)To rule out neurocognitive disorder (NCD)
D)To rule out a personality disorder

Question 13

Which client statement expresses typical underlying feelings of clients diagnosed with MDD?

A)"It's just a matter of time and I will be well."
B)"If I ignore these feelings,they will go away."
C)"I can fight these feelings and overcome this disorder."
D)"Nothing will help me feel better."

Question 14

A client who has been taking fluvoxamine (Luvox)without significant improvement asks the nurse,"I heard about something called MAOI.Can't my doctor add that to my medications?" Which is the most appropriate nursing reply?

A)"This combination of drugs can lead to delirium tremens."
B)"A combination of an MAOI and fluvoxamine can lead to a life-threatening hypertensive crisis."
C)"That's a good idea.There have been good results with the combination of these two drugs."
D)"The only disadvantage would be the exorbitant cost of the MAOI."

Question 15

The nurse assesses a client suspected of having MDD.Which client symptom would eliminate this diagnosis?

A)The client is disheveled and malodorous.
B)The client refuses to interact with others.
C)The client is unable to feel any pleasure.
D)The client has maxed-out charge cards and exhibits promiscuous behaviors.

Question 16

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?

A)Altered communication R/T feelings of worthlessness AEB anhedonia
B)Social isolation R/T poor self-esteem AEB secluding self in room
C)Altered thought processes R/T hopelessness AEB persecutory delusions
D)Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

Question 17

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?

A)Psychoanalytic theory
B)Interpersonal theory
C)Cognitive theory
D)Behavioral theory

Question 18

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?

A)Paroxetine (Paxil)
B)Sertraline (Zoloft)
C)Citalopram (Celexa)
D)Fluoxetine (Prozac)

Question 19

A newly admitted client is diagnosed with MDD with suicidal ideations.Which is the priority nursing intervention for this client?

A)Teach about the effect of suicide on family dynamics.
B)Carefully and unobtrusively observe on the basis of assessed data at varied intervals around the clock.
C)Encourage the client to spend a portion of each day interacting within the milieu.
D)Set realistic achievable goals to increase self-esteem.

Question 20

Which client information does the nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)?

A)The client's understanding of the need for regular bloodwork
B)The client's mood and affect score,according to the facility's mood scale
C)The client's cognitive ability to understand information about the medication
D)The client's access to a support network willing to participate in treatment

Question 21

A client admitted to the psychiatric unit following a suicide attempt is diagnosed with MDD.Which behavioral symptoms should the nurse expect to assess?

A)Anxiety and unconscious anger
B)Lack of attention to grooming and hygiene
C)Guilt and indecisiveness
D)Low self-esteem

Question 22

The nurse is caring for four clients taking various medications,including imipramine (Tofranil),doxepine (Sinequan),ziprasidone (Geodon),and tranylcypromine (Parnate).The nurse orders a special diet for the client receiving which medication?

A)Imipramine (Tofranil)
B)Doxepine (Sinequan)
C)Ziprasidone (Geodon)
D)Tranylcypromine (Parnate)

Question 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 his illness?

A)Encourage the client to bring into awareness underlying sources of guilt.
B)Teach the client that religious beliefs should be put into perspective throughout the life span.
C)Confront the client with the irrational nature of the belief system.
D)Assist the client to modify his or her belief system to improve coping skills.

Question 24

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.

A)"I'll have to let my surgeon know about this medication before I have my cholecystectomy."
B)"Guess I will have to give up my glass of red wine with dinner."
C)"I'll have to be very careful about reading food and medication labels."
D)"I'm going to miss my caffeinated coffee in the morning."
E)"I'll be sure not to stop this medication abruptly."
F) "None of above"

Question 25

The 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?

A)3 to 5 years
B)6 to 8 years
C)9 to 12 years
D)11 to 14 years

Question 26

A client is admitted with a diagnosis of PDD.Which client statement describes a symptom consistent with this diagnosis?

A)"I am sad most of the time and I've felt this way for the last several years."
B)"I find myself preoccupied with death."
C)"Sometimes I hear voices telling me to kill myself."
D)"I'm afraid to leave the house."

Question 27

The nurse understands psychotic postpartum depression is characterized by which symptoms? Select all that apply.

A)Agitation
B)Fear the infant will be harmed
C)Loss of libido
D)Guilt
E)Sleep disturbances

Question 28

Electroconvulsive therapy (ECT)is considered the treatment of choice for which client?

A)39-year-old man experiencing recurrent suicidal ideation
B)23-year-old woman experiencing postpartum depression
C)41-year-old woman describing a suicide plan
D)67-year-old man explaining a recent suicide attempt

Question 29

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?

A)Risk for ineffective thermoregulation R/T anhidrosis
B)Risk for constipation R/T excessive fluid loss
C)Risk for injury R/T orthostatic hypotension
D)Risk for infection R/T suppressed white blood cell count

Question 30

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?

A)"There is nothing to worry about.We will handle it together."
B)"Bringing this up is a very positive action on your part."
C)"We need to talk about the things you have to live for."
D)"I think you should consider all of your options prior to taking this action."

Question 31

A 20-year-old female has a diagnosis of Premenstrual Dysphoric Disorder.Which of the following should the nurse identify as consistent with this diagnosis? Select all that apply.

A)Symptoms are causing significant interference with work,school,and social relationships.
B)Patient-rated mood is 2/10 for the past 6 months.
C)Mood swings occur the week before onset of menses.
D)Patient reports subjective difficulty concentrating.
E)Patient manifests pressured speech when communicating.

Question 32

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.

A)"Are you thinking about hurting yourself or someone else?"
B)"Can you tell me your feelings about dying?"
C)"Where do you keep your gun?"
D)"Have you told your psychiatrist you feel like dying?"
E)"Have you thought about how you would hurt yourself?"

Question 33

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.

A)Gender differences in social opportunities that occur with age
B)Drastic temperature and barometric pressure changes
C)Increased levels of melatonin
D)Variations in serotonergic functioning
E)Inaccessibility of resources for dealing with life stressors

Question 34

Which is associated with premenstrual dysphoric disorder?

A)Norepinephrine
B)Serotonin
C)Progesterone
D)Acetylcholine