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A nurse teaching a patient about a tyramine-restricted diet would approve which meal?
- A. Mashed potatoes, ground beef patty, corn, green beans, apple pie
- B. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
- C. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
- D. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls
Correct Answer: A
Rationale: The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine, and fresh ground beef and apple pie should be safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages and hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate.
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A student nurse caring for a patient diagnosed with major depressive disorder reads in the patient's medical record, 'This patient shows vegetative signs of depression.' Which nursing diagnoses most clearly relate to the vegetative signs?
- A. Imbalanced nutrition: less than body requirements
- B. Chronic low self-esteem
- C. Sexual dysfunction
- D. Self-care deficit
- E. Powerlessness
- F. Insomnia
Correct Answer: A,C,D,F
Rationale: Vegetative signs of depression are alterations in the body processes necessary to support life and growth, such as eating, sleeping, elimination, and sexual activity. These diagnoses are more closely related to vegetative signs than to diagnoses associated with feelings about self.
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.
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.
During a psychiatric assessment, the nurse observes a patient's facial expressions that are without emotion. The patient says, 'Life feels so hopeless to me. I've been feeling sad for several months.' How should the nurse document the patient's affect and mood?
- A. Affect depressed; mood flat
- B. Affect flat; mood depressed
- C. Affect labile; mood euphoric
- D. Affect and mood are incongruent
Correct Answer: B
Rationale: Mood is a person's self-reported emotional feeling state. Affect is the emotional feeling state that is outwardly observable by others.
An adult diagnosed with major depressive disorder was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?
- A. Social skills training
- B. Relaxation training classes
- C. Use of complementary therapy
- D. Learning desensitization techniques
Correct Answer: A
Rationale: Social skills training is helpful in treating and preventing the recurrence of depression. Training focuses on assertiveness and coping skills that lead to positive reinforcement from others and the development of a patient's support system. The use of complementary therapy refers to adjunctive therapies such as herbals. Assertiveness would be of greater value than relaxation training because passivity is a concern. Desensitization is used in the treatment of phobias.