Nokea
A nurse provided medication education for a patient who is prescribed phenelzine for depression. Which patient behavior indicates effective learning?
- A. Monitors sodium intake and weight daily.
- B. Wears support stockings and elevates the legs when sitting.
- C. Consults the pharmacist when selecting over-the-counter medications.
- D. Can identify foods with high selenium content, which should be avoided.
Correct Answer: C
Rationale: Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.
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A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, 'No one cares about me anymore. I'm not worth anything.' Select an appropriate initial outcome.
- A. The patient will verbalize realistic positive characteristics about self by (date).
- B. The patient will consent to take antidepressant medication regularly by (date).
- C. The patient will initiate social interaction with another person daily by (date).
- D. The patient will identify two personal behaviors that alienate others by (date).
Correct Answer: A
Rationale: Low self-esteem is reflected by making consistently negative statements about self and self-worth. Replacing negative cognitions with more realistic appraisals of self is an appropriate intermediate outcome. The incorrect options are not as clearly related to the nursing diagnosis. Outcomes are best when framed positively; identifying two personal behaviors that might alienate others is a negative concept.
What is the focus of priority nursing care for the period immediately after a patient has an electroconvulsive therapy (ECT) treatment?
- A. Supporting physiological stability
- B. Reducing disorientation and confusion
- C. Monitoring pupillary responses
- D. Assisting the patient to plan for the future
Correct Answer: A
Rationale: During the immediate post-treatment period, the patient is recovering from general anesthesia, hence the need to establish and support physiological stability. Monitoring pupillary responses is not a priority. Reducing disorientation and confusion is an acceptable intervention but not the priority. Assisting the patient to plan for the future is inappropriate in the immediate post-treatment period because the patient may be confused.
A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate?
- A. Arms crossed
- B. Staring at the nurse
- C. Smiling inappropriately
- D. Eyes casted downward
Correct Answer: D
Rationale: Nonverbal communication is usually considered more powerful than verbal communication. Downward-casted eyes suggest feelings of worthlessness or hopelessness.
A patient diagnosed with major depressive disorder is receiving imipramine 200 mg every night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?
- A. Dry mouth
- B. Blurred vision
- C. Nasal congestion
- D. Urinary retention
Correct Answer: D
Rationale: All the side effects mentioned are the result of the anticholinergic effects of the drug. Only urinary retention and severe constipation warrant immediate medical attention. Dry mouth, blurred vision, and nasal congestion may be less troublesome as therapy continues.
A patient diagnosed with major depressive disorder is taking a tricyclic antidepressant. The patient says, 'I don't think I can keep taking these pills. They make me so dizzy, especially when I stand up.' The nurse should implement what intervention?
- A. Explain how to manage postural hypotension and educate the patient that side effects go away after several weeks.
- B. Tell the patient that the side effects are a minor inconvenience compared with the feelings of depression.
- C. Withhold the drug, force oral fluids, and notify the health care provider to examine the patient.
- D. Teach the patient how to use pursed-lip breathing.
Correct Answer: A
Rationale: Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with tricyclic antidepressants. Postural hypotension can be managed by teaching the patient to stay well hydrated and rise slowly. Knowing these facts may be enough to convince the patient to remain medication compliant. The minor inconvenience of side effects as compared with feelings of depression is a convincing reason to remain on the medication. Withholding the drug, forcing oral fluids, and having the health care provider examine the patient are unnecessary steps. Independent nursing action is appropriate. Pursed-lip breathing is irrelevant.