Nokea
An adult diagnosed with major depressive disorder was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?
- A. Social skills training
- B. Relaxation training classes
- C. Use of complementary therapy
- D. Learning desensitization techniques
Correct Answer: A
Rationale: Social skills training is helpful in treating and preventing the recurrence of depression. Training focuses on assertiveness and coping skills that lead to positive reinforcement from others and the development of a patient's support system. The use of complementary therapy refers to adjunctive therapies such as herbals. Assertiveness would be of greater value than relaxation training because passivity is a concern. Desensitization is used in the treatment of phobias.
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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.
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 diagnosed with major depressive disorder repeatedly tells staff members, 'I have cancer. It's my punishment for being a bad person.' Diagnostic tests reveal no cancer. Select the priority nursing diagnosis.
- A. Powerlessness
- B. Risk for suicide
- C. Stress overload
- D. Spiritual distress
Correct Answer: B
Rationale: A patient with depression who feels so worthless as to believe cancer is deserved is at risk for suicide. Safety concerns take priority over the other diagnoses listed.
Which documentation indicates the treatment plan of a patient diagnosed with major depressive disorder was effective?
- A. Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild.
- B. Slept 10 hours uninterrupted. Attended craft group; stated 'project was a failure, just like me.'
- C. Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound.
- D. Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, 'I feel tired all the time.'
Correct Answer: A
Rationale: Sleeping 6 hours, participating in a group activity, and anticipating an event are all positive happenings. All the other options show at least one negative finding.
What is a priority nursing intervention for a patient diagnosed with major depressive disorder?
- A. Distracting the patient from self-absorption
- B. Carefully and inconspicuously observing the patient around the clock
- C. Allowing the patient to spend long periods alone in self-reflection
- D. Offering opportunities for the patient to assume a leadership role in the therapeutic milieu
Correct Answer: B
Rationale: Approximately two-thirds of people with depression contemplate suicide. Patients with depression who exhibit feelings of worthlessness are at higher risk. Regularly planned observations of the patient with depression may prevent a suicide attempt on the unit.