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The admission note indicates a patient diagnosed with major depressive disorder has displayed symptomology of both anergia and anhedonia. For which measures should the nurse plan?
- A. Channeling excessive energy
- B. Reducing guilty ruminations
- C. Instilling a sense of hopefulness
- D. Assisting with self-care activities
- E. Accommodating psychomotor retardation
Correct Answer: C,D,E
Rationale: Anhedonia refers to the inability to find pleasure or meaning in life; thus, planning should include measures to accommodate psychomotor retardation, assist with activities of daily living, and instill hopefulness. Anergia is the lack of energy, not excessive energy. Anhedonia does not necessarily imply the presence of guilty ruminations.
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A patient diagnosed with major depressive disorder shows vegetative signs of depression. Which nursing actions should be implemented?
- A. Offer laxatives, if needed.
- B. Monitor food and fluid intake.
- C. Provide a quiet sleep environment.
- D. Eliminate all daily caffeine intake.
- E. Restrict the intake of processed foods.
Correct Answer: A,B,C
Rationale: The correct options promote a normal elimination pattern. Although excessive intake of stimulants such as caffeine may make the patient feel jittery and anxious, small amounts may provide useful stimulation. No indication exists that processed foods should be restricted.
A nurse worked with a patient diagnosed with major depressive disorder who was severely withdrawn and dependent on others.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 nurse provided medication education for a patient who is prescribed phenelzine for depression. Which patient behavior indicates effective learning?
- A. Monitors sodium intake and weight daily.
- B. Wears support stockings and elevates the legs when sitting.
- C. Consults the pharmacist when selecting over-the-counter medications.
- D. Can identify foods with high selenium content, which should be avoided.
Correct Answer: C
Rationale: Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.
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.
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.