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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.
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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 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.
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 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.
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.