Nokea
A patient became severely depressed when the last of six children moved out of the home 4 months ago. The patient repeatedly says, 'No one cares about me. I'm not worth anything.' Which response by the nurse would be the most helpful?
- A. Things will look brighter soon. Everyone feels down once in a while.
- B. The staff here cares about you and wants to try to help you get better.
- C. It is difficult for others to care about you when you repeatedly say negative things about yourself.
- D. I'll sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this afternoon.
Correct Answer: D
Rationale: Spending time with the patient at intervals throughout the day shows acceptance by the nurse and helps the patient establish a relationship with the nurse. The therapeutic technique is called offering self. Setting definite times for the therapeutic contacts and keeping the appointments show predictability on the part of the nurse, an element that fosters the building of trust. The incorrect responses would be difficult for a person with profound depression to believe, provide trite reassurance, and are counterproductive. The patient is unable to say positive things at this point.
You may also like to solve these questions
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.
A patient being treated for major depressive disorder has taken 300 mg amitriptyline daily for a year. The patient calls the case manager at the clinic and says, 'I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares.' How should the nurse advise the patient?
- A. Go to the nearest emergency department immediately.
- B. Do not to be alarmed. Take two aspirin and drink plenty of fluids.
- C. Take one dose of the antidepressant, and then come to the clinic to see the health care provider.
- D. Resume taking the antidepressant for 2 more weeks, and then discontinue it again.
Correct Answer: C
Rationale: The patient has symptoms associated with abrupt withdrawal of the tricyclic antidepressant. Taking a dose of the drug will ameliorate the symptoms. Seeing the health care provider will allow the patient to discuss the advisability of going off the medication and to be given a gradual withdrawal schedule if discontinuation is the decision. This situation is not a medical emergency, although it calls for medical advice. Resuming taking the antidepressant for 2 more weeks and then discontinuing again would produce the same symptoms the patient is experiencing.
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.
A patient diagnosed with major depressive disorder will begin electroconvulsive therapy tomorrow. Which interventions are routinely implemented before the treatment?
- A. Administer pretreatment medication 30 to 45 minutes before treatment.
- B. Withhold food and fluids for a minimum of 6 hours before treatment.
- C. Remove dentures, glasses, contact lenses, and hearing aids.
- D. Restrain the patient in bed with padded limb restraints.
- E. Assist the patient to prepare an advance directive.
Correct Answer: A,B,C
Rationale: The correct interventions reflect routine electroconvulsive therapy preparation, which is similar to preoperative preparation: sedation and anticholinergic medication before anesthesia, maintaining nothing-by-mouth status to prevent aspiration during and after treatment, airway maintenance, and general safety by removing prosthetic devices. Restraint is not part of the pretreatment protocol. An advance directive is prepared independent of this treatment.
A nurse instructs a patient taking a drug that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of what risk?
- A. Hypotensive shock
- B. Hypertensive crisis
- C. Cardiac dysrhythmia
- D. Cardiogenic shock
Correct Answer: B
Rationale: Patients taking MAOIs must be on a tyramine-free diet to prevent hypertensive crisis. In the presence of MAOIs, tyramine is not destroyed by the liver and, in high levels, produces intense vasoconstriction, resulting in elevated blood pressure.