Nokea
A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder. Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate?
- A. You look nice this morning.
- B. You are wearing a new shirt.
- C. I like the shirt you're wearing.
- D. You must be feeling better today.
Correct Answer: B
Rationale: Patients with depression usually see the negative side of things. The meaning of compliments may be altered to 'I didn't look nice yesterday' or 'They didn't like my other shirt.' Neutral comments such as an observation avoid negative interpretations. Saying 'You look nice' or 'I like your shirt' gives approval (nontherapeutic techniques). Saying 'You must be feeling better today' is an assumption, which is nontherapeutic.
You may also like to solve these questions
What is a priority nursing intervention for a patient diagnosed with major depressive disorder?
- A. Distracting the patient from self-absorption
- B. Carefully and inconspicuously observing the patient around the clock
- C. Allowing the patient to spend long periods alone in self-reflection
- D. Offering opportunities for the patient to assume a leadership role in the therapeutic milieu
Correct Answer: B
Rationale: Approximately two-thirds of people with depression contemplate suicide. Patients with depression who exhibit feelings of worthlessness are at higher risk. Regularly planned observations of the patient with depression may prevent a suicide attempt on the unit.
A patient being treated with paroxetine 50 mg/day orally for major depressive disorder reports to the clinic nurse, 'I took a few extra tablets earlier in the day and now I feel bad.' Which aspects of the nursing assessment are most critical?
- A. Vital signs
- B. Urinary frequency
- C. Increased suicidal ideation
- D. Presence of abdominal pain and diarrhea
- E. Hyperactivity or feelings of restlessness
Correct Answer: A,D,E
Rationale: The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. Although assessing for suicidal ideation is never inappropriate, in this situation physiological symptoms should be the initial focus. The patient may have urinary retention, but frequency would not be expected.
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's employment is terminated, and major depressive disorder develops shortly afterward. The patient says to the nurse, 'I'm not worth the time you spend with me. I'm the most useless person in the world.' Which nursing diagnosis applies?
- A. Powerlessness
- B. Defensive coping
- C. Situational low self-esteem
- D. Disturbed personal identity
Correct Answer: C
Rationale: The patient's statements express feelings of worthlessness and most clearly relate to the nursing diagnosis of situational low self-esteem. Insufficient information exists to justify the other diagnoses.
A woman gave birth to a healthy newborn 1 month ago. The patient now reports she cannot cope and is unable to sleep or eat. She says, 'I feel like a failure. This baby is the root of my problems.' What is the priority nursing diagnosis?
- A. Insomnia
- B. Ineffective coping
- C. Situational low self-esteem
- D. Risk for other-directed violence
Correct Answer: D
Rationale: When a new mother develops depression with a postpartum onset, ruminations or delusional thoughts about the infant often occur. The risk for harming the infant is increased; thus, it becomes the priority diagnosis. The other diagnoses are relevant but are of lower priority.