Deck 16: Depressive Disorders

Question 1

A nurse is working with a client who has just been prescribed buproprion (Wellbutrin). Which statement by the client indicates that further education is necessary?

A) "I will begin using sunblock when outdoors."
B) "If I miss a dose, I will just take two pills the next day to catch up."
C) "I will only discontinue the medication under the guidance of my physician."
D) "I will use caution when driving and using dangerous machinery."

Answer 1

"If I miss a dose, I will just take two pills the next day to catch up."

Question 2

A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis?

A) Thyroid-stimulating hormone (TSH) level of 25 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

Answer 2

Thyroid-stimulating hormone (TSH) level of 25 U/mL

Question 3

Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client?

A) On his or her side, to prevent aspiration
B) In high Fowler's position, to prevent increased intracranial pressure
C) In Trendelenburg's position, to promote blood flow to vital organs
D) In prone position, to prevent airway blockage

Answer 3

On his or her side, to prevent aspiration

Question 4

A client diagnosed with major depressive episode hears voices commanding self-harm. Which should be the nurse's priority intervention at this time?

A) Obtaining an order for locked seclusion until client is no longer suicidal
B) Conducting 15-minute checks to ensure safety
C) Placing the client on one-to-one observation while continuing to monitor suicidal ideations
D) Encouraging client to express feelings related to suicide

Question 5

A nurse assesses a client suspected of having the diagnosis of major depressive episode. Which client symptom would rule out this diagnosis?

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

Question 6

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

A) "This combination of drugs can lead to delirium tremens."
B) "A combination of an MAOI and Luvox 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 7

A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms?

A) According to psychoanalytic theory, depression is a result of negative perceptions.
B) According to object-loss theory, depression is a result of overprotection.
C) According to learning theory, depression is a result of repeated failures.
D) According to cognitive theory, depression is a result of anger turned inward.

Question 8

A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this 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 9

When planning care for a depressed client, which correctly written outcome should be a nurse's first priority?

A) The client will promise not to physically harm self.
B) The client will discuss feelings with staff and family by day three.
C) The client will establish a trusting relationship with the nurse.
D) The client will remain safe during hospital stay.

Question 10

A nurse is planning care for a 13-year-old client who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents?

A) Paroxetine (Paxil)
B) Sertraline (Zoloft)
C) Citalopram (Celexa)
D) Escitalopram (Lexapro)

Question 11

A client who has been newly diagnosed with depression is beginning tricyclic antidepressant therapy. The nurse has just completed teaching with this client. Which statement by the client indicates the need for further education?

A) "I will continue to take this medication even if the symptoms have not subsided."
B) "I may experience drowsiness or dizziness while taking this medication."
C) "I do not need to quit smoking."
D) "I will stop drinking alcohol now that I am taking this medication."

Question 12

A number of assessment rating scales are available for measuring severity of depressive symptoms. Which scale would a nurse practitioner use to assess a depressed client?

A) Zung Depression Scale
B) Hamilton Depression Rating Scale
C) Beck Depression Inventory
D) AIMS Depression Rating Scale

Question 13

A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects a depressive disorder. What is the rationale for performing a mini-mental status exam?

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

Question 14

The severity of depressive symptoms in the postpartum period varies from a feeling of the "blues," to moderate depression, to psychotic depression or melancholia. Which disorder is correctly matched with its presenting symptoms?

A) Maternity blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions)
B) Postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby)
C) Postpartum melancholia (overprotection of infant, expresses concern about inability to care for baby, mysophobia)
D) Postpartum depressive psychosis (transient depressed mood, agitation, abnormal fear of child abduction, suicidal ideations)

Question 15

The nurse educator is lecturing a group of nursing students on depression in adolescents. Which statement indicates that teaching has been effective?

A) "Adolescents are not likely to suffer from depression."
B) "Depressed adolescents always seek immediate treatment."
C) "Many symptoms are attributed to normal adjustments of adolescents."
D) "Suicide is not common among depressed adolescents."

Question 16

What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive episode?

A) The attention during the assessment is beneficial in decreasing social isolation.
B) Depression can generate somatic symptoms that can mask actual physical disorders.
C) Physical health complications are likely to arise from antidepressant therapy.
D) Depressed clients avoid addressing physical health and ignore medical problems.

Question 17

A client, who is taking transdermal selegiline (Emsam) for depressive symptoms, states, "My physician told me there was no need to worry about dietary restrictions." Which would be the most appropriate nursing response?

A) "Because your dose of Emsam is 6 mg in 24 hours, dietary restrictions are not recommended."
B) "You must have misunderstood. An MAOI like Emsam always has dietary restrictions."
C) "Only oral MAOIs require dietary restrictions."
D) "All transdermal MAOIs do not require dietary modifications."

Question 18

A nurse administers 100 percent oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure?

A) To prevent increased intracranial pressure resulting from anoxia
B) To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation
C) To prevent anoxia resulting from medication-induced paralysis of respiratory muscles
D) To prevent blocked airway, resulting from seizure activity

Question 19

A staff nurse is counseling a depressed client. The nurse determines that the client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives?

A) "It's all my fault for trusting him."
B) "I don't play games. I never win."
C) "She never visits, because she thinks I don't care."
D) "I don't have a green thumb. Any old fool can grow a rose."

Question 20

An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why?

A) Neuroleptic malignant syndrome; caused by ingestion of two different serotonin reuptake inhibitors (SSRIs)
B) Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI)
C) Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI
D) Serotonin syndrome; possibly caused by ingestion of two different SSRIs

Question 21

After 6 months of taking imipramine (Tofranil) for depressive symptoms, a client complains that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem?

A) "Are you consuming foods high in tyramine?"
B) "How many packs of cigarettes do you smoke daily?"
C) "Do you drink any alcohol?"
D) "Are you taking St. John's wort?"

Question 22

Order the depressive disorders and their predominant affective symptoms according to level of severity.
________ Dysthymic disorder (pessimistic outlook, low self-esteem)
________ Grief (feelings of anger, anxiety, guilt, helplessness)
________ Major depressive episode (despair, worthlessness, flat affect, apathy, anhedonia)
________ Transient depression (sadness, dejection, feeling downhearted, having "the blues")

Question 23

___________________________ is a pervasive and sustained emotion that may have a major influence on a person's perception of the world.

Question 24

A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit?

A) Sad mood on most days
B) Mood rating of 2 out of 10 for the past 6 months
C) Labile mood
D) Sad mood for the past 3 years after spouse's death
E) Pressured speech when communicating

Question 25

A client is prescribed phenelzine (Nardil). Which of the following statements by the client should indicate to a nurse that the discharge teaching about this medication has been successful?

A) "I'll have to let my surgeon know about this medication before I have my cholecystectomy."
B) "I 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."

Question 26

An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms?

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

Question 27

A nursing instructor is teaching about the new DSM-5 diagnostic category of disruptive mood dysregulation disorder (DMDD). Which of the following information should the instructor include?

A) Symptoms include verbal rages or physical aggression toward people or property.
B) Temper outbursts must be present in at least two settings (at home, at school, or with peers).
C) DMDD is characterized by severe recurrent temper outbursts.
D) The temper outbursts are manifested only behaviorally.
E) Symptoms of DMDD must be present for 18 or more months to meet diagnostic criteria.
Other