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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.
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A nurse worked with a patient diagnosed with major depressive disorder who was severely withdrawn and dependent on others. After 3 weeks, the patient did not improve. The nurse is at risk for what emotional response?
- A. Overinvolvement
- B. Guilt and despair
- C. Disinterest and apathy
- D. Ineffectiveness and frustration
Correct Answer: D
Rationale: Nurses may have expectations for self and patients that are not wholly realistic, especially regarding the patient's progress toward health. Unmet expectations result in feelings of ineffectiveness, anger, or frustration. Guilt and despair might be observed when the nurse experiences feelings about patients because of sympathy. Disinterest and apathy are possible but not the most likely result. The correct response is more global than over-involvement.
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.
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.
A patient diagnosed with major depressive disorder does not interact with others except when addressed and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Select the nurse's most effective approach to communication.
- A. Make observations on neutral topics.
- B. Ask the patient direct questions.
- C. Phrase questions to require 'yes' or 'no' answers.
- D. Frequently reassure the patient to reduce guilt feelings.
Correct Answer: A
Rationale: Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations on the patient for answers. Acceptance and support are shown by the nurse's presence. Direct questions may make the patient feel that the encounter is an interrogation. Open-ended questions are preferable if the patient is able to participate in dialog. Platitudes are never acceptable; they minimize patient feelings and can increase feelings of worthlessness.
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.