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A patient diagnosed with major depressive disorder tells the nurse, 'Bad things that happen are always my fault.' To assist the patient in reframing this overgeneralization, how should the nurse respond?
- A. I really doubt that one person can be blamed for all the bad things that happen.
- B. Let's look at one bad thing that happened to see if another explanation exists.
- C. You are being exceptionally hard on yourself when you say those things.
- D. How does your belief in fate relate to your cultural heritage?
Correct Answer: B
Rationale: By questioning a faulty assumption, the nurse can help the patient look at the premise more objectively and reframe it as a more accurate representation of fact. The incorrect responses are judgmental, irrelevant to an overgeneralization, and cast doubt without requiring the patient to evaluate the statement.
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A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, 'No one cares about me anymore. I'm not worth anything.' Select an appropriate initial outcome.
- A. The patient will verbalize realistic positive characteristics about self by (date).
- B. The patient will consent to take antidepressant medication regularly by (date).
- C. The patient will initiate social interaction with another person daily by (date).
- D. The patient will identify two personal behaviors that alienate others by (date).
Correct Answer: A
Rationale: Low self-esteem is reflected by making consistently negative statements about self and self-worth. Replacing negative cognitions with more realistic appraisals of self is an appropriate intermediate outcome. The incorrect options are not as clearly related to the nursing diagnosis. Outcomes are best when framed positively; identifying two personal behaviors that might alienate others is a negative concept.
A patient diagnosed with major depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. Priority information given to the patient and family should include a directive to do what?
- A. Avoid exposure to bright sunlight.
- B. Report increased suicidal thoughts.
- C. Restrict sodium intake to 1 g daily.
- D. Maintain a tyramine-free diet.
Correct Answer: B
Rationale: Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus, close monitoring is necessary. Avoiding exposure to bright sunlight and restricting sodium intake are unnecessary. Tyramine restriction is associated with monoamine oxidase inhibitor (MAOI) therapy.
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 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.
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.