Deck 16: Depressive Disorders

Question 1

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.

Answer 1

Placing the client on one-to-one observation while continuing to monitor suicidal ideations.

Question 2

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

Answer 2

Hamilton Depression Rating Scale

Question 3

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."

Answer 3

"A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis."

Question 4

A nurse discovers a client's suicide note that details the time,place,and means to commit suicide.What should be the priority nursing action,and why?

A)Administer lorazepam (Ativan)prn,because the client is angry about plan exposure.
B)Establish room restrictions,because the client's threat is an attempt to manipulate the staff.
C)Place client on one-to-one suicide precautions,because specific plans likely lead to attempts.
D)Call an emergency treatment team meeting,because the client's threat must be addressed.

Question 5

A nurse recently admitted a client to an inpatient unit after a suicide attempt.A health-care provider orders amitriptyline (Elavil)for the client.Which intervention,related to this medication,should be initiated to maintain this client's safety upon discharge?

A)Provide a 6-month supply of Elavil to ensure long-term compliance.
B)Provide a 1-week supply of Elavil,with refills contingent on follow-up appointments.
C)Provide pill dispenser as a memory aid.
D)Provide education regarding the avoidance of foods containing tyramine.

Question 6

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

A)The client will not physically harm self.
B)The client will express hope for the future by day three.
C)The client will establish a trusting relationship with the nurse.
D)The client will remain safe during hospital stay.

Question 7

A nurse is planning care for a 13 -year-old 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 (Lexipro)

Question 8

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 9

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 10

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

Question 11

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 12

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 seratonin 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 13

A nurse administers 100% 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 14

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 15

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 16

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 17

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

Question 18

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 19

A client with a history of suicide attempts has been taking fluoxetine (Prozac)for one month.The client suddenly presents with a bright affect,rates mood at 9 out of 10,and is much more communicative.Which action should be the nurse's priority at this time?

A)Give the client off-unit privileges as positive reinforcement.
B)Encourage the client to share mood improvement in group.
C)Increase the level of this client's suicide precautions.
D)Request that the psychiatrist reevaluate the current medication protocol.

Question 20

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 21

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? (Select all that apply.)

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 22

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 23

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 24

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

Question 25

A client is prescribed phenelzine (Nardil).Which of the following statements by the client should indicate to a 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)"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

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? (Select all that apply.)

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.

Question 27

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? (Select all that apply.)

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