Chapter11:DepressiveDisordersMy NursingTestBanks

Chapter 11: Depressive Disorders

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. You are admitting a new patient who is depressed. Your initial contact should do what?

A. Address why he is depressed

B. Keep communication open

C. Lift his spirits

D. Establish trust

2. In caring for a patient with major depression, the nurse knows that the patient needs:

A. Frequent changes in activities.

B. Introduction to multiple new staff members.

C. Behavior modification that restructures feelings.

D. Well-defined, structured interactions at the beginning of treatment.

3. Patients with major depression commonly display signs of:

A. Energy.

B. Repetitive, compulsive behaviors.

C. Worthlessness.

D. Visual hallucinations.

4. When your patient says I am depressed, what is the best response?

A. We all feel that way now and then.

B. Why do you feel that way?

C. Everything will be OK once you snap out of it.

D. Tell me more about what is going on with you.

5. Your patient takes tranylcypromine for depression. Which of the following is most likely to indicate dietary restrictions have not been followed?

A. Hypertensive crisis

B. Syncope

C. Muscle spasms

D. Increased depression

6. Your depressed patient who is taking a tricyclic antidepressant is advised of possible anticholinergic side effects. Which of the following is NOT an anticholinergic side effect?

A. Blurred vision

B. Difficulty starting urine stream

C. Dry mouth

D. Muscle rigidity

7. Helen, a 47-year-old client with a long history of severe depression, has not responded to antidepressant medications or psychotherapy. The nurse caring for the patient knows that the treatment of choice for depression unresponsive to conventional treatment would be:

A. Lithium.

B. Electroconvulsive therapy (ECT).

C. Light therapy.

D. Neurolinguistic programming.

8. Your depressed patient is just started on duloxetine (Cymbalta). Which statement by the spouse tells you that family teaching has been effective?

A. I cant wait for him to be back to his old self in the next day or so.

B. I realize we cant expect big changes right away.

C. I have to take him for weekly blood tests to monitor the drug dosage.

D. I will make sure he doesnt eat any aged cheese for the next 2 months until th

9. Biological theories of depressive disorders include all of the following except:

A. Chemical imbalances are responsible.

B. The patient experiences maladaptive thought processes.

C. There are genetic tendencies that run in families.

D. Hormonal factors make women more susceptible than men.

10. Light therapy has been shown to be effective in treating patients with:

A. Bipolar disorder.

B. Dysthymia.

C. Major depression with seasonal pattern.

D. Schizophrenia.

11. You are doing patient teaching for Margaret, who has been prescribed amitriptyline (Elavil) for treatment of depression. Which of the following statements suggests that Margaret needs further instruction?

A. I know I might not start feeling better for a few weeks, but Ill keep taking th the doctor prescribed.

B. Ill keep some hard candies in my purse in case my mouth gets dry from the

C. Once I start feeling better, Im looking forward to cutting down on this medic

D. Im worried I may gain some weight, but thats a small price to pay for feeling

12. What is the main difference between major depression and dysthymic depression?

A. Dysthymia is a short-term depression and major depression lasts for years.

B. Dysthymia is a chronic, low-level depression that lasts for years, while majo severe.

C. Dysthymia is more likely to be caused by psychological factors and major d by neurological dysfunction.

D. Dysthymia is normally treated with psychotherapy only, while major depres antidepressants and psychotherapy.

13. Your depressed patient is starting a new medication called phenelzine (Nardil). Which teaching would be most important to emphasize?

A. Educate the patient to take this medication ongoing, even as symptoms impr

B. Instruct the patient and family about the many food-drug interactions.

C. Instruct the patient about interventions to relieve dry mouth.

D. Inform the patient that this medication takes 4 to 6 weeks to take full effect.

14. Which of the following antidepressants is a tricyclic?

A. Bupropion (Wellbutrin)

B. Sertraline (Zoloft)

C. Nortripyline (Pamelor)

D. Venlafaxine (Effexor)

15. Which statement is most true about depression?

A. It is more common in women than men.

B. It is rare to have more than one episode of major depression in ones lifetime

C. Young children do not suffer from depression.

D. As one ages, there is reduced risk of depression.

16. A newly admitted client has been diagnosed with major depressive disorder. Which nursing diagnosis takes priority?

A. Impaired social interaction

B. Self-esteem deficit

C. Hopelessness

D. Self-care deficit

17. The nurse knows that the two factors that often differentiate major depression from dysthymia depression are:

A. Amounts of mania and sadness.

B. Presence or absence of anger and guilt.

C. Severity and duration of symptoms.

D. Patients gender and age.

18. You are caring for an older adult who is recently widowed. She says, No one cares if I die. Everyone I ever loved is dead. What is the best response?

A. I am sure that you still have people who care about you.

B. You sound like you are feeling all alone.

C. Boy, that is depressing.

D. I dont believe that.

19. Your patient with major depression tells you he suffers from urinary retention. Which medication would be most likely to cause this?

A. Amitriptyline

B. Duloxetine

C. Carbamazepine

D. Ritalin

20. Which activity would be best for a depressed patient?

A. A puzzle

B. Drawing

C. Crossword puzzles

D. Television

21. Which of the following meal choices indicates the patient understands the diet restrictions when taking an MAOI?

A. Pepperoni pizza and beer

B. Roast chicken, baked potato, and beer

C. Fried fish, rice, and cola

D. Pickled herring, eggs, and coffee

22. Your patient with major depression sits in her room for hours staring out the window. Which of the following would be the most appropriate intervention?

A. Sit with the patient and gently offer your availability to help.

B. Keep encouraging the patient to go to exercise class.

C. Offer the class once and then let the patient decide.

D. Sit with the patient and ask her to list reasons for her depression.

23. Which of the following drugs is a tricyclic antidepressant?

A. Bupropion (Wellbutrin)

B. Amitriptyline (Elavil)

C. Fluoxetine (Prozac)

D. Citalopram (Celexa)

24. Some medications such as tricyclics cause blurred vision. What is the cause of this effect?

A. Hyperglycemia

B. Anticholinergic effect

C. Hypoxia

D. Hypertension

25. Your patient has been taking a SSRI antidepressant for 6 weeks. On arrival at the clinic, which observation would indicate a positive outcome from the medication?

A. Patient reports sleeping 12 hours a night.

B. Patient reports sleeping 3 hours a night.

C. Patient reports a weight loss of 10 pounds.

D. Patient arrives neatly dressed.

26. Which response best describes how dysthymic disorder is different from major depression?

A. More severe depression with psychotic features

B. Chronic low level depression

C. Mild depression with episodes of hypomania

D. Depression with more anxiety symptoms

27. Which of the following would be the most effective intervention for a depressed patient?

A. Establish one small goal to accomplish today.

B. Help the patient develop a goal to complete in the next month.

C. Encourage the patient to talk about recent failures in his or her life.

D. Let the patient guide what is the next best action.

28. Which of the following is an important intervention for a patient taking nortriptyline?

A. Make sure that CBC is ordered to monitor blood counts.

B. Monitor for anticholinergic side effects.

C. Ensure that the patients diet is gluten free.

D. Push fluids to prevent dehydration.

29. A patient admitted to the mental unit has shown a deficit in providing self-care and has a medical diagnosis of major depression. The nursing diagnosis for this would be:

A. Knowledge deficit related to personal choices.

B. Self-care deficit related to impaired ability to provide personal hygiene.

C. Risk for violence related to poor hygiene.

D. Impaired social interaction related to poor hygiene.

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

30. Annie has been diagnosed as having dysthymic depression. The nurse knows that symptoms of this disorder include: (Select all that apply)

A. A depressed mood that lasts for most of each day over a 2-year period

B. Low self-esteem

C. Hallucinations

D. Difficulty in making decisions

E. Periods of euphoria

F. Sleep pattern disturbances

31. Which of the following nursing interventions apply to all depressed patients? (Select all that apply)

A. Show patience

B. Monitor lithium levels

C. Monitor for suicidal ideation

D. Communicate effectively

E. Provide meaningful activities

F. Include alternative therapies in the treatment plan

Chapter 11: Depressive Disorders

Answer Section

Multiple Choice

1. ANS: D

Responses A and C are not helpful in just meeting the patient. Though response B is important, it begins with trust.

PTS: 1

REF: Chapter 11: Depressive Disorders; Table 11-2, Nursing Care Plan for Depressed Patient; page 187

KEY: Integrated Processes: Caring | Content Area: Mental Health: Therapeutic communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

2. ANS: D

The depressed patient may become overwhelmed if too much is offered too soon. Structured, goal-directed activities are less stressful.

PTS: 1

REF: Chapter 11: Depressive Disorders; Table 11-3, Nursing Care Plan for Depressed Patient; page 188

KEY: Integrated Processes: Caring | Content Area: Mental Health:

Therapeutic communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

3. ANS: C

Feelings of worthlessness are part of the common symptoms of sadness and low self-worth seen in major depression.

PTS: 1 REF: Chapter 11: Depressive Disorders; Major Depressive Disorders; page 182

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Mood disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

4. ANS: D

This response gives the patient an opening to share feelings without being pressured to come up with reasons for these feelings. Responses A and C are not helpful for someone with depression because they minimize what the patient is experiencing.

PTS: 1 REF: Chapter 11: Depressive Disorders; General Nursing Interventions; page 186-187

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Therapeutic communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

5. ANS: A

This medication is a MAOI (monoamine oxidase inhibitor). Eating foods with this enzyme can trigger a hypertensive crisis.

PTS: 1 REF: Chapter 11: Depressive Disorders; Table 11-2, Antidepressants; page 187

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Pharmacology | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration as well as expected actions/outcomes as well as adverse effects/contraindications/side effects/interactions

6. ANS: D

Muscle rigidity is not an anticholinergic side effect.

PTS: 1 REF: Chapter 11: Depressive Disorders; Table 11-2, Antidepressants; page 187

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Pharmacology | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration as well as adverse effects/contraindications/side effects/interactions

7. ANS: B

Though antidepressants are the treatment of choice for depression, electroconvulsive therapy is sometimes needed in cases of severe depression unresponsive to antidepressants. Lithium is generally not useful in depression. Light therapy and neurolinguistic programming may be adjuvants, not primary treatment in severe depression.

PTS: 1

REF: Chapter 11: Depressive Disorders; Treatment of Depressive Disorders; page 185

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Mood disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

8. ANS: B

This response tells you the spouse understands that antidepressants can take some time before seeing improvements. Response A tells you the spouse incorrectly thinks the drug will work immediately. There are no blood tests or food restrictions with this drug.

PTS: 1 REF: Chapter 11: Depressive Disorders; Pharmacology Corner; page 286

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Mood disorders and Adult health: Pharmacology | Cognitive Level: Application | Client Need: Health Promotion and Maintenance: Principles of Teaching/Learning: Psychosocial Integrity: Mental health concepts

9. ANS: B

Responses A, C, and D are all contributing biological factors to depression.

PTS: 1 REF: Chapter 11: Depressive Disorders; Etiology of Depressive disorders; page 185

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Mood disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

10. ANS: C

Exposure to light has been shown to lift mood in this disorder.

PTS: 1 REF: Chapter 11: Depressive Disorders; Alternative Treatment; pages 185-186

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Mood disorder | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

11. ANS: C

Antidepressants need to be taken consistently, including when the patient starts feeling better. Tricyclic antidepressants like amitriptyline can cause dry mouth.

PTS: 1 REF: Chapter 11: Depressive Disorders; Pharmacology Corner; page 186

KEY: Integrated Processes: Nursing Process: Analysis: Teaching/Learning |

Content Area: Mental Health: Pharmacology | Cognitive Level: Application |

Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration and Health Promotion and Maintenance: Principles of Teaching/Learning

12. ANS: B

Dysthymia is depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. The level of depression is less than in major depression. Major depression is more severe and affects all areas of ones life.

PTS: 1 REF: Chapter 11: Depressive Disorders; Dysthymic Disorder; page 183

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Mood disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

13. ANS: B

Though all the responses are correct, response B is most important. Nardil is a MAOI (monoamine oxidase inhibitor) with a potentially life-threatening side effect of hypertensive crisis in the presence of certain aged and/or processed foods.

PTS: 1 REF: Chapter 11: Depressive Disorders; Table 11-2, Antidepressants; page 187

KEY: Integrated Processes: Teaching/Learning | Content Area: Mental Health: Pharmacology | Cognitive Level: Comprehension | Client Need:

Physiological Integrity: Pharmacological and parenteral therapies: Medication administration and adverse effects/contraindications/side effects/interactions: Health Promotion and Maintenance: Principles of Teaching/Learning

14. ANS: C

The other medications are examples of SSRIs and SSNIs.

PTS: 1 REF: Chapter 11: Depressive Disorders; Table 11-2, Antidepressants; page 187

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Pharmacology | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration and adverse effects/contraindications/side effects/interactions

15. ANS: A

Nearly twice as many women as men are affected by depression. Men are more likely to mask depression in other ways, such as substance abuse. The elderly and children are also at risk for depression.

PTS: 1

REF: Chapter 11: Depressive Disorders; Box 11-1, General Information

About Depressive Disorders; page 182

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Mood disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

16. ANS: C

While all of these diagnoses are important, the presence of hopelessness may be a sign of suicidal ideation and would take priority.

PTS: 1 REF: Chapter 11: Depressive Disorders; General Nursing Interventions; page 186-187

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Mood disorders | Cognitive Level: Analysis | Client Need: Psychosocial Integrity

17. ANS: C

Major depression and dysthymia are differentiated by severity and duration. The other responses are not factors.

PTS: 1

REF: Chapter 11: Depressive Disorders; Major Depressive Disorder; page 182; Dysthymic Disorder; page 183

KEY: Integrated Processes: Nursing Process: Application | Content Area: Mental Health: Mood disorders | Cognitive Level: Comprehension | Client

Need: Psychosocial Integrity: Mental health concepts

18. ANS: B

By translating words into feelings you are helping her focus on why she is feeling low. Responses A and D disavow her reality, and response C expresses the nurses sense of being overwhelmed.

PTS: 1 REF: Chapter 11: Depressive Disorders; General Nursing Interventions; page 186

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Grief: Mood disorders | Cognitive Level: Application | Client

Need: Psychosocial Integrity: Therapeutic communication

19. ANS: A

Amitriptyline is a tricyclic antidepressant and is known to cause anticholinergic effects such as urinary retention.

PTS: 1 REF: Chapter 11: Depressive Disorders; Table 11-2, Antidepressants; page 187

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Pharmacology | Cognitive Level: Comprehension | Client

Need: Physiological Integrity: Pharmacological and parenteral therapies: Adverse effects/contraindications/side effects/interactions

20. ANS: B

This response has no right or wrong answer and doesnt tax memory or concentration, which would occur in responses A and C. Television is passive and the patient can withdraw into his or her own world.

PTS: 1 REF: Chapter 11: Depressive Disorders; General Nursing Interventions; page 187

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Mood disorders: Therapeutic nursing process | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

21. ANS: C

The other responses contain dangerous foods, including pepperoni, beer, and pickled herring.

PTS: 1 REF: Chapter 11: Depressive Disorders; Pharmacology Corner; page 186

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Adverse effects/contraindications/side effects/interactions

22. ANS: A

This approach is the best one to establish trust without making too many demands on someone who has little energy to deal with demands. It is also important not to leave the patient alone too much, as that will send a message of not caring for her.

PTS: 1

REF: Chapter 11: Depressive Disorders; Table 11-3, Care Plan for the Depressed Patient; page 188

KEY: Integrated Processes: Nursing Process: Implementation | Content Area:

Mental Health: Mood disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

23. ANS: B

The other choices are other categories of antidepressants.

PTS: 1 REF: Chapter 11: Depressive Disorders; Table 11-2, Antidepressants; page 187

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Pharmacology | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration

24. ANS: B

Anticholinergic effect can create blurred vision, urinary retention, and dry mouth caused by the blockage of acetylcholine.

PTS: 1 REF: Chapter 11: Depressive Disorders; Table 11-2, Antidepressants; page 187

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Pharmacology | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Adverse effects/contraindications/side effects/interactions

25. ANS: D

Attention to personal appearance is an important indicator of improved mood. The other responses are not indicative of improvements in depression. Abnormal sleep patterns indicate continued depression. Weight loss can occur with some antidepressants but would not be used as a measure of positive outcome for depression.

PTS: 1 REF: Chapter 11: Depressive Disorders; Pharmacology Corner; page 186

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Pharmacology | Cognitive Level: Application | Client Need:

Physiological Integrity: Pharmacological and parenteral therapies: Medication administration

26. ANS: B

The symptoms are less severe than major depressive disorder but have gone on for long periods.

PTS: 1 REF: Chapter 11: Depressive Disorders; Dysthymic Disorder; page 183

KEY: Integrated Processes: Nursing Process: Analysis | Content Area:

Mental Health: Mood disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

27. ANS: A

Small, achievable goals are the hallmark of helping a depressed person. One goal today is more concrete and achievable than one to be completed in a month. Talking about failures emphasizes negativity. The depressed patient may have no energy to identify the next best action.

PTS: 1 REF: Chapter 11: Depressive Disorders; General Nursing Interventions; page 186

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Mood disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

28. ANS: B

Anticholinergic effects from tricyclic antidepressants are a common initial side effect.

PTS: 1 REF: Chapter 11: Depressive Disorders; Table 11-2, Antidepressants; page 187

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Adverse effects/contraindications/side effects/interactions

29. ANS: B

Patient has the ability to provide own self-care, but cognitive ability to select the appropriate choice can be impaired by the depression.

PTS: 1

REF: Chapter 11: Depressive Disorders; General Nursing Interventions; Table 11-3 Nursing Care Plan for the Depressed Patient; page 188

KEY: Integrated Processes: Nursing Process: Planning Nursing Diagnosis | Content Area: Mental Health: Depression | Cognitive Level: Analysis | Client Need: Psychosocial Integrity: Mental Health Concepts

MULTIPLE RESPONSE

30. ANS: A, B, D, F

Dysthymic disorder includes symptoms of low level depression over a long period of time. It does not include hallucinations or periods of euphoria.

PTS: 1 REF: Chapter 11: Depressive Disorders; Dysthymic Disorder; page 183

KEY: Integrated Processes: Nursing Process: Analysis

31. ANS: A, D, E

Basic supportive interventions focus on communication and promoting selfesteem. All depressed patients do not need to be monitored for suicidal ideation. Lithium is usually not a medication for depression. Alternate therapies may not be appropriate for some patients.

PTS: 1 REF: Chapter 11: Depressive Disorders; General Nursing Interventions; page 186-187

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Mood disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic environment and communication