Ch. 25 Depressive Disorders Review questions NCLEX

Ch. 25 Depressive Disorders Review questions NCLEX 1. Margaret, age 68, is a widow of 6 months. Since her husband dies, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with major depressive disorder. The PRIORITY nursing diagnosis for Margaret would be: A. Imbalanced nutrition: less than body requirements B. Complicated grieving C. Risk for suicide D social isolation: c Rationale This client is indicating thoughts of suicide. Safety should always be considered the priority with the other diagnoses being addressed after the initial threat has passed. 2. The physician orders sertraline (Zoloft) 50 mg PO bid for Margaret, a 68 year old women with major depressive disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? A. Cheer up, Margaret. You have so much to be happy about. B. Sometimes it take a few weeks for the medicine to bring about an improve- ment in symptoms. C. I'll report that to the physician, Margaret. Maybe he will order something different. D. Try not to dwell on your symptoms. Why don't you join the others down in the dayroom?: B Rationale To answer this question it is important to understand the action of Zoloft and the amount of time it takes to be in the body before it becomes effective. It can take up to a few weeks before there is an improvement in symptoms. 3. The goal of cognitive therapy with depressed clients is to: A. Identify and change dysfunctional patterns of thinking. B. Resolve the symptoms and initiate or restore adaptive family functioning. C. Alter the neurotransmitters that are creating the depressed mood. D. Provide feedback from peers who are having similar experiences.: A Rationale Cognitive therapy focuses on identifying and changing dysfunctional patterns of thinking. Resolving symptoms and initiating or restoring adaptive family functioning is the goal of Family Therapy. Altering the neurotransmitters that are creating the depressed mood is the goal with psychopharmacology. Providing feedback from peers who are having similar experiences happens with Self-Help Groups. 4. Education for the client who is taking MAOI's should include which of the following? A. Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity. B. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks. C. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at the end of treatment. D. Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification.: D Rationale Tyramine can cause episodes of hypertensive crisis. Foods that contain tyramine include:aged cheeses, raisins, fava beans, red wines, smoked and processed meats, chicken of beef liver, soy sauce, meat tenderizer, chocolate. There is a lot of medication interactions that occur with MAOI's so it is important to consult your physician before taking any OTC meds. 5. In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? (Select ALL that apply) A. Don't eat chocolate while taking this medication. B. Keep taking this medication, even if you don't feel it is helping. It some- times take a while to take effect. C. Don't take this medication with the migraine drugs "triptans". D. Go to the lab each week to have your blood drawn for therapeutic levels of this drug. E. This drug causes a high degree of sedation, so take it just before bedtime.- : B, C Rationale A - chocolate is not something you would want your client to eat while taking an MAOI B - Antidepressants can take a few weeks before affects are felt. C - serotonin syndrome may occur with concomitant use of SSRI fluoxetine and "triptans" D - E - SSRI's can cause insomnia so it is important to take the dose early in the day. 6. A client has just been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? (Select ALL that apply) A. Slumped posture B. Delusional thinking C. Feelings of despair D. Feels best early in the morning and worse as the day progresses E. Anorexia: A, B, C, E Rationale Behavioral symptoms of severe depression include slumped posture, walking slow- ly, virtually nonexistent communication, delusional thinking, no personal hygiene. Affective symptoms of depression include: feelings of total despair, hopelessness, and worthlessness, flat unchanging affect, sadness, and inability to feel pleasure. Physiological symptoms of severe depression include: constipation, urinary reten- tion, anorexia, weight loss, difficulty falling asleep and awakening very early in the morning. D is incorrect because -- people with severe depression feel worse early in the morning and somewhat better as the day progresses. * Individuals with Moderate depression experience feeling better early in the morning and worse as the day progresses. 7. A client with depressi