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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.
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A patient was started on escitalopram 5 days ago and now says, 'This medicine isn't working.' What is the nurse's best intervention?
- A. Discussing with the health care provider the need to change medications
- B. Reassuring the patient that the medication will be effective soon
- C. Explaining the time lag before antidepressants relieve symptoms
- D. Critically assessing the patient for symptom relief
Correct Answer: C
Rationale: Escitalopram is an SSRI antidepressant. Between 1 and 3 weeks of treatment are usually necessary before a relief of symptoms occurs. This information is important to share with patients.
When counseling patients diagnosed with major depressive disorder, how will an advanced practice nurse likely address the negative thought patterns?
- A. Psychoanalytic therapy
- B. Desensitization therapy
- C. Cognitive behavioral therapy
- D. Alternative and complementary therapies
Correct Answer: C
Rationale: Cognitive behavioral therapy attempts to alter the patient's dysfunctional beliefs by focusing on positive outcomes rather than negative attributions. The patient is also taught the connection between thoughts and resultant feelings. Research shows that cognitive behavioral therapy involves the formation of new connections among nerve cells in the brain and that it is at least as effective as medication. Evidence does not support superior outcomes for the other psychotherapeutic modalities mentioned.
A patient says to the nurse, 'My life does not have any happiness in it anymore. I once enjoyed holidays, but now they're just another day.' How would the nurse document the patient's statement?
- A. Vegetative
- B. Anhedonia
- C. Euphoria
- D. Anergia
Correct Answer: B
Rationale: Anhedonia is a common finding in many types of depression and refers to feelings of a loss of pleasure in formerly pleasurable activities. Vegetative symptoms refer to somatic changes associated with depression. Euphoria refers to an elated mood. Anergia means without energy.
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 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.