Nokea
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.
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A nurse worked with a patient diagnosed with major depressive disorder who was severely withdrawn and dependent on others.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 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 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 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.
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.