Chapter 25: Depression: Management of Depressive Moods and Suicidal Behavior

A client who has been discharged home on citalopram calls the nurse reporting that the medication causes the client to feel too drowsy. The nurse should make which suggestion?

a) Be patient while this early side effect subsides.

b) Take the medication at night.

c) Make an appointment to change to a different medication.

d) Skip a dose if drowsiness is excessive.

b) Take the medication at night.

The mental health nurse appropriately provides education on light therapy to which client?

a) 45-year-old lawyer whose medication therapy needs an additional treatment

b) 58-year-old showing signs of early Alzheimer's disease

c) 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

d) 50-year-old farmer whose major depression has not responded to any treatment modality

c) 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term

Before a client became depressed, the client was an active, involved parent with three children, often attending their school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals that the client feels like an unnecessary burden on the client's family. Which nursing diagnosis is most appropriate?

a) Situational low self-esteem

b) Ineffective activity planning related to depression

c) Ineffective coping related to marital disagreements

d) Anxiety related to side effects of medication

a) Situational low self-esteem

The nurse is planning the inpatient care of a client who has been admitted with major depression. The client's plan of care includes regular exercise, but the client is reluctant to participate due to a lack of energy and motivation. What is the nurse's best action?

a) Teach the client isometric exercises that the client can complete while in bed

b) Collaborate with the client to choose a manageable amount of exercise and acknowledge the client's subsequent effort

c) Arrange for the client to exercise approximately 1 hour after antidepressant administration

d) Describe the benefits of exercise to the client and state that privileges will be lost if the client does not participate

b) Collaborate with the client to choose a manageable amount of exercise and acknowledge the client's subsequent effort

Which statement regarding depression and gender is correct?

a) Depressive disorders are more common in men than women.

b) Depressive disorders affect young men more than older women.

c) Depressive disorders are more common in women than men.

d) Depressive disorders equally affect men and women.

c) Depressive disorders are more common in women than men.

A client with major depression is prescribed paroxetine. The nurse develops an education plan for the client based on the understanding that this drug belongs to which class of drugs?

a) Serotonin norepinephrine reuptake inhibitors

b) Tricyclic antidepressants

c) Monoamine oxidase inhibitors

d) Selective serotonin reuptake inhibitors

d) Selective serotonin reuptake inhibitors

A client's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action?

a) Assess the client's blood pressure

b) Assess the client's jugular venous pressure

c) Call an emergency code

d) Perform a Mini Mental Status Examination (MMSE)

a) Assess the client's blood pressure

A client taking an antidepressant has experienced a 12-pound weight gain in 1 month as a side effect of the medication. Which of the following are nursing interventions to help this patient with this problem? Select all that apply.

a) Recommend daily exercise.

b) Recommend a nutritionally balanced diet.

c) Reassure the patient that the weight gain is not that significant.

d) Advocate with the physician to consider changing the medication.

e) Remind the patient that weight gain is better than feeling depressed.

a) Recommend daily exercise.

b) Recommend a nutritionally balanced diet.

d) Advocate with the physician to consider changing the medication.

A client who is depressed begins to cry and states, "I'm just really sick of feeling this way. Nothing ever seems to go right in my life." Which would be the most appropriate response by the nurse?

a) "Nothing ever goes right?"

b) "Don't cry. Try to look at the positive side of things."

c) "You are feeling really sad right now. It's a hard time."

d) "Hang in there. Your medication will start helping in a few days."

c) "You are feeling really sad right now. It's a hard time."

A client with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation?

a) The client is experiencing catatonia.

b) The level of depression is mild to moderate.

c) Suicidality is of little concern.

d) The client is tolerating the initial drug therapy.

a) The client is experiencing catatonia.

Which signs would a nurse expect in a client diagnosed with serotonin syndrome? Select all that apply.

a) Elevated heart rate

b) Hyporeflexia

c) Agitation

d) Elevated temperature

e) Constipation

a) Elevated heart rate

c) Agitation

d) Elevated temperature

A client was abandoned by the parents at age 3, resulting in the client's perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of what?

a) A reason the client has become lesbian at the age of 23.

b) A feminist viewpoint of depression.

c) A biological explanation for the client's depressive disorder.

d) A psychodynamic interpretation of the client's major depressive disorder.

d) A psychodynamic interpretation of the client's major depressive disorder.

A psychiatric-mental health nurse is conducting a pharmacology review class for a group of nurses. The topic is antidepressant medications. The nurse determines that the review was successful when the group identifies which class of antidepressant as associated with fewer side effects?

a) Selective serotonin reuptake inhibitors (SSRIs)

b) Serotonin norepinephrine reuptake inhibitors (SNRIs)

c) Tricyclic antidepressants (TCAs)

d) Monoamine oxidase inhibitors (MAOIs)

a) Selective serotonin reuptake inhibitors (SSRIs)

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has priority?

a) Risk for suicide related to highly lethal plan

b) Spiritual distress related to conflicting thoughts about suicide and sin

c) Hopelessness related to recent divorce

d) Ineffective coping related to inadequate stress management

a) Risk for suicide related to highly lethal plan

The nurse working on a mental health unit is teaching a nursing student. The student asks the nurse about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response?

a) "Depression is a mood variation to life events."

b) "Feelings of anxiety and sadness as a response to a life event are the most important qualifiers for depression."

c) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

d) "The physician diagnoses depression when a client has feelings of sadness several times a year."

c) "The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

Electroconvulsive therapy would be contraindicated for a client with:

a) hypertension.

b) stroke, 10 years ago.

c) increased intracranial pressure.

d) myocardial infarction, five years ago.

c) increased intracranial pressure.

The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should ...

a) educate the client regarding the symptoms of related physical disorders.

b) assess for depression in the client's family history.

c) prepare the client for diagnostic genetic testing to confirm the diagnosis.

d) encourage the client to seek genetic counseling before considering a pregnancy.

b) assess for depression in the client's family history.

A client has been taking a tricyclic antidepressant (TCA) for several months and is now reporting urinary hesitation. What is the nurse's best action?

a) Ask the primary care provider to prescribe a diuretic

b) Encourage the client to drink low-pH beverages

c) Encourage the client to use a low dose of an over the counter diuretic

d) Encourage the client to increase fluid intake

d) Encourage the client to increase fluid intake

A nursing student is caring for an elderly client who is taking sertraline for depression. The instructor quizzes the student about the medication and its actions. To what classification of drugs should the student assign sertraline?

a) Cyclic antidepressant

b) Monoamine-oxidase inhibitor

c) Selective serotonin reuptake inhibitor

d) Serotonin 2 antagonist

c) Selective serotonin reuptake inhibitor

A client is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also reports having felt unhappy most of the time for "as long as I can remember." Which diagnosis should the nurse anticipate for this client?

a) Mild depressive disorder

b) Rapid cycling disorder

c) Persistent depressive disorder

d) Bipolar disorder

c) Persistent depressive disorder

A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis?

a) The client will reframe negative thoughts in a more positive way.

b) The client will identify factors that contribute to depression.

c) The client will differentiate between reality and fantasy.

d) The client will discuss the cause of the fatigue.

a) The client will reframe negative thoughts in a more positive way.

A psychiatric-mental health nurse is assessing a client who is suspected of experiencing depression. During the interview, the client says, "I just don't care any more. I used to enjoy doing all sorts of things outdoors, but now, I don't. Nothing seems to make me happy." The nurse interprets this statement as:

a) aphasia.

b) anhedonia.

c) affect.

d) labile mood.

b) anhedonia.

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what?

a) Initial insomnia

b) Hypersomnia

c) Terminal insomnia

d) Middle insomnia

d) Middle insomnia

Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension?

a) Take medication with food

b) Increase hydration

c) Eat a nutritionally balanced diet

d) Get daily exercise

b) Increase hydration

When completing a baseline assessment of a client with depression, which diagnostic tests would the nurse anticipate?

a) Abdominal ultrasound

b) Renal function tests

c) Coagulation profile

d) Thyroid function tests

d) Thyroid function tests

Carrie, age 20, was admitted to your unit following a suicide attempt. She is disheveled, disorganized, and dehydrated. The priority for her care during the first 24 hours of her admission is ...

a) assessing Carrie's recent suicide attempt and b) identifying factors that may have contributed to it.

c) assessing Carrie's current suicidal ideation and putting her on suicide precautions.

d) assisting Carrie with her activities of daily living, including a shower and clean clothing.

e) rehydrating Carrie by forcing fluids.

c) assessing Carrie's current suicidal ideation and putting her on suicide precautions.

A 46-year-old client comes to the community mental health center because the client thinks they might be suffering from depression. When assessing this client, which symptom would the nurse identify as being necessary for the diagnosis of major depressive disorder to be made?

a) Euphoria along with poor decision making ability

b) A loss of interest or inability to derive pleasure for previously enjoyed activities

c) Disregard for personal hygiene including cleanliness and appearance

d) A stooped posture and nonverbal signs of a depressed mood

b) A loss of interest or inability to derive pleasure for previously enjoyed activities

A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which is the nurse's priority intervention for this client?

a) Encouraging the client to express feelings of isolation following the recent immigration.

b) Exploring the grief and loss issues concerning the baby's death.

c) Encouraging attendance at group cognitive-behavioral therapy on the unit.

d) Ensuring that the client is not permitted to use anything that would be potentially dangerous.

d) Ensuring that the client is not permitted to use anything that would be potentially dangerous.

A loss of pleasure or interest in a client diagnosed with depression would be documented as what?

a) Hopelessness

b) Anhedonia

c) Flat affect

d) Discouragement

b) Anhedonia

A psychiatric-mental health nurse is conducting a refresher class for a group of psychiatric-mental health nurses returning to the field. After teaching about depressive disorders, the nurse determines a need for additional teaching when the class identifies which physical or psychological symptom as being associated with depression?

a) Catatonia

b) Insomnia

c) Worthlessness

d) Fatigue

a) Catatonia

A psychiatric-mental health nurse is working at a community mental health center that serves a large pediatric population. When assessing children for depression, which information would be most important for the nurse to keep in mind?

a) Anxiety symptoms are more commonly noted in children who are depressed.

b) The risk of suicide is low in children and adolescents.

c) Children commonly experience the same symptoms of depression as adults.

d) The mood observed in children with depression is more often sad than irritable.

a) Anxiety symptoms are more commonly noted in children who are depressed.

Which outcome would be appropriate to determine an early favorable response to antidepressant medication?

a) The client will establish a balance of rest, sleep, and activity.

b) The client will demonstrate assertive communication skills.

c) The client will make plans to attend one community social activity a week.

d) The client will describe signs and symptoms of major depression.

a) The client will establish a balance of rest, sleep, and activity.

A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client's feelings of sadness and hopelessness, the nurse would expect to assess what?

a) Increased focus

b) Psychomotor retardation

c) Increased energy level

d) Decreased complaints of pain

b) Psychomotor retardation

Which term is used to describe decreased attention to and enjoyment from previously pleasurable activities?

a) Rumination

b) Psychomotor retardation

c) Flight of ideas

d) Anhedonia

d) Anhedonia

A depressed older adult client is being treated with a tricyclic antidepressant (TCA). For which clinical manifestations should the nurse monitor the client?

a) Photosensitivity and skin rashes

b) Diarrhea and electrolyte imbalance

c) Pseudoparkinsonism and tardive dyskinesia

d) Orthostatic hypotension and urinary retention

d) Orthostatic hypotension and urinary retention

The nurse is working with a client who has been diagnosed with depression. When performing a strength assessment with the client, what is the nurse's best statement or question?

a) "Do you consider yourself to be a strong person overall?"

b) "It's important that you remember that you're an exceptionally strong and capable person."

c) "How have you dealt with feelings like this in the past?"

d) "What can the care team do to help you become a stronger person?"

c) "How have you dealt with feelings like this in the past?"

A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition?

a) Light therapy

b) Antidepressant therapy

c) Electroconvulsive therapy

d) Psychotherapy

a) Light therapy

Which disorder is characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode?

a) Seasonal affective disorder

b) Hypomania

c) Cyclothymic disorder

d) Dysthymic disorder

d) Dysthymic disorder

A client has just been diagnosed with a major depressive disorder following recent problems with the client's mood, work performance, and sleep quality. When planning this client's care, the nurse should anticipate what interventions? Select all that apply.

a) Administration of a monoamine oxidase inhibitor (MAOI)

b) Repetitive transcranial magnetic stimulation (rTMS)

c) Cognitive therapy

d) Phototherapy

e) Administration of a selective serotonin reuptake inhibitor (SSRI)

c) Cognitive therapy

e) Administration of a selective serotonin reuptake inhibitor (SSRI)

Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what?

a) Moderate depression

b) Anaclitic depression

c) A mood disorder due to a general medical condition

d) Postpartum psychosis

a) Moderate depression

A client who was receiving a monoamine oxidase inhibitor (MAOI) is to be switched to a selective serotonin reuptake inhibitor (SSRI). The nurse would expect to begin administering the SSRI how many days after the MAOI is discontinued?

a) 7 days

b) 21 days

c) 14 days

d) 28 days

c) 14 days

The nurse is providing teaching to a client with depression. Which statement by the client would indicate that the education has been effective?

a) "When I reduce the stress in my life, the depression will go away."

b) "I didn't realize so many factors could cause depression."

c) "All old people get depressed. It's a natural part of aging."

d) "I'll begin to feel better in about 3 or 4 days."

b) "I didn't realize so many factors could cause depression."

A client with major depression and a suicide attempt is admitted to the inpatient facility. The client is started on antidepressant therapy. The next day, the client demonstrates significantly higher energy and says, "I'll feel much better." The nurse would interpret this behavior as suggesting what?

a) An act to cover up the client's true feelings

b) A typical response to the medication

c) Possible decision to complete a suicide attempt

d) Effectiveness of the drug therapy

c) Possible decision to complete a suicide attempt

An elderly client is admitted to the hospital with fatigue and weight loss of 20 pounds in 1 month. Upon further assessment, the client is diagnosed with depression. What other thing should the nurse assess this client for based on the weight loss?

a) Suicide

b) Decreased energy

c) Dehydration

d) Sleep disturbance

c) Dehydration

A client with a history of self-harm reports lethargy, loss of appetite and insomnia to the nurse. The client states that she relies heavily on sleep medications that her primary care provider prescribed. What is the nurse's priority assessment question?

a) "Have you ever had to take sleeping pills at any other point in your life?"

b) "How do you feel about having to take medication to help you sleep?"

c) "How many of the sleeping pills do you have at home right now?"

d) "Are their any strategies you've tried so that you wouldn't need sleeping pills?"

c) "How many of the sleeping pills do you have at home right now?"

A patient with severe depression is being treated with medications and is told to increase activity and to exercise at least 4 times a week. Which of the following domains would these nursing interventions address?

a) Spiritual

b) Psychological

c) Biologic

d) Social

c) Biologic

A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what?

a) Demonstrated examples of unwise decisions

b) A significant decrease in appetite

c) Self-report of being sad after a break up

d) Claims by family, friends, or coworkers that the client is depressed

b) A significant decrease in appetite

Which type of antidepressants are rarely fatal in overdose?

a) Tricyclics

b) Atypical

c) MAOIs

d) SSRIs

d) SSRIs

When assessing a child with major depression, which informaton would the nurse need to keep in mind? Select all that apply.

a) Children more often have anxiety symptoms

b) The risk for suicide is less in children than adults.

c) Children have more interaction with their peers than adults do.

d) Somatic complaints are rarely noted.

e) Mood may be more irritable than sad.

a) Children more often have anxiety symptoms

The risk for suicide is less in children than adults.

e) Mood may be more irritable than sad.

A parent of four small children lost a spouse in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since the spouse's death, the client's mood has been somber; until now, the client has refused treatment. What is this client at high risk for?

a) Schizophrenia

b) Dysthymic disorder

c) Bipolar disorder

d) Suicide

d) Suicide

The nurse reviews the medication list for a client who is newly prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which client statement indicates a need to assess the client for serotonin syndrome?

a) "I started taking diet pills to assist with weight loss."

b) "I stopped drinking red wine when I started taking my new prescription."

c) "I stopped taking St. John's wort 4 weeks ago."

d) "I used to enjoy taking ecstasy, but I know it isn't safe with my new medication."

a) "I started taking diet pills to assist with weight loss."

A client is prescribed a selective serotonin reuptake inhibitor (SSRI) as treatment for depression. Which would the nurse most likely administer?

a) Maprotiline

b) Venlafaxine

c) Escitalopram

d) Phenelzine

c) Escitalopram

A client who otherwise is healthy is admitted for depression and reports feeling "all alone" following a recent divorce. The client admits to drinking at least 12 beers every day. The client has which risk factors for the depression? Select all that apply.

a) Family history of depression

b) Medical comorbodity

c) Life and environmental stressors

d) Lack of coping abilities

e) Current substance use or abuse

c) Life and environmental stressors

d) Lack of coping abilities

e) Current substance use or abuse

A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment findings would support this suspicion? Select all that apply.

a) Agitation

b) Confusion

c) Hallucinations

d) Orthostatic hypotension

e) Headache

a) Agitation

b) Confusion

c) Hallucinations

A client has experienced a first episode of major depression and has received medication and treatment, which has led to a complete remission of the symptoms. The client asks the nurse, "How much longer will I need to take the medication?" Which response by the nurse would be most appropriate?

a) "You'll need to continue the medication for about 6 to 12 months to see how things go."

b) "It's probably best to continue the medication for another month, gradually decreasing the dosage over that time."

c) "The medication has eliminated your symptoms so you'll need to keep taking it for the rest of your life."

d) "Since you have no more symptoms, you can stop taking the medications tomorrow."

a) "You'll need to continue the medication for about 6 to 12 months to see how things go."

After teaching a group of nursing students about major depression, the instructor determines that the education was successful when the group identifies which information is accurate?

a) Depression is correlated with low intellectual ability

b) Onset of depression is common in adolescence

c) Onset of depression is most common in middle-aged persons

d) Depression is twice as common in women than in men

d) Depression is twice as common in women than in men

A nurse is providing care to a client with recurrent major depression. The nurse would most likely expect a combination of medications and which treatment to be used to achieve maximum effectiveness?

a) Deep brain stimulation

b) Vagal nerve stimulation

c) ECT

d) Psychotherapy

d) Psychotherapy

Which of the following is a cognitive intervention for clients diagnosed with depression?

a) Problem solving

b) Activity scheduling

c) Thought stopping

d) Social skills training

c) Thought stopping

A nurse is preparing a presentation for a local community group about antidepressant therapy and suicidality. When describing those who would be at increased risk for suicide, which group would the nurse include?

a) Individuals over age 65 years

b) Adolescents

c) Middle-aged males

d) Females over age 35

b) Adolescents

Which of the following would a nurse be least likely to include when instituting behavioral therapy for a client with depression?

a) Thought stopping

b) Activity scheduling

c) Problem solving

d) Social skills training

a) Thought stopping

A client has been diagnosed with depression and states that the client is reluctant to receive treatment, stating that the client "would prefer to just wait this out." What is the nurse's most appropriate action?

a) Document a nursing diagnosis of ineffective denial and choose interventions accordingly

b) Explain to the client that untreated depression often becomes increasingly severe and frequent over time

c) Document a nursing diagnosis of noncompliance and educate the client about the benefits of treatment

d) Assess the client's knowledge of depression and describe the risks of suicide

b) Explain to the client that untreated depression often becomes increasingly severe and frequent over time

Which is a true statement regarding depressive disorders?

a) The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated.

b) They are more prevalent in men than women.

c) Depression in older adults is easier to diagnose.

d) It is the fourth leading cause of years lost because of disability.

a) The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated.

A nurse is preparing a presentation about suicide for a local community group. What would the nurse most likely include?

a) Suffocation is a common means of suicide among children.

b) Hispanic individuals have the highest rates of suicide.

c) Women typically use firearms in their attempts.

d) Men often use pills to commit suicide.

a) Suffocation is a common means of suicide among children.

A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the client will have to demonstrate specific symptoms. What are some of these symptoms? Select all that apply.

a) obsessive desire to exercise

b) disruption in sleep

c) excessive guilt

d) disruption in concentration

e) disruption in appetite

b) disruption in sleep

c) excessive guilt

d) disruption in concentration

e) disruption in appetite