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Chapter 27: Mood Diorders: Depression Multiple Choice Identify the choice that best completes the statement or answers the question

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Chapter 27: Mood Diorders: Depression

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1) A client is diagnosed with dysthymic disorder. Which should a nurse classify as an affective symptom of this disorder?

A.	Social isolation with a focus on self
B.	Low energy level
C.	Difficulty concentrating
D.	Gloomy and pessimistic outlook on life

____ 2. A client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this disorder?

A.	Altered communication R/T feelings of worthlessness AEB anhedonia
B.	Social isolation R/T poor self-esteem AEB secluding self in room
C.	Altered thought processes R/T hopelessness AEB persecutory delusions
D.	Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

____ 3. A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis?

A.	The client is disheveled and malodorous.
B.	The client refuses to interact with others.
C.	The client is unable to feel any pleasure.
D.	The client has maxed-out charge cards and exhibits promiscuous behaviors.

____ 4. A nurse reviews the laboratory data of a client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis?

A.	Thyroid-stimulating hormone (TSH) level of 6.2 U/mL
B.	Potassium (K⁺) level of 4.2 mEq/L
C.	Sodium (Na⁺) level of 140 mEq/L
D.	Calcium (Ca²⁺) level of 9.5 mg/dL

____ 5. A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client’s depressive symptoms?

A.	According to psychoanalytic theory, depression is a result of anger turned inward.
B.	According to object-loss theory, depression is a result of abandonment.
C.	According to learning theory, depression is a result of repeated failures.
D.	According to cognitive theory, depression is a result of negative perceptions.

____ 6. What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder?

A.	The attention during the assessment is beneficial in decreasing social isolation.
B.	Depression can generate somatic symptoms that can mask actual physical disorders.
C.	Physical health complications are likely to arise from antidepressant therapy.
D.	Depressed clients avoid addressing physical health and ignore medical problems.

____ 7. A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents?

A.	Paroxetine (Paxil)
B.	Sertraline (Zoloft)
C.	Citalopram (Celexa)
D.	Fluoxetine (Prozac)

____ 8. A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam?

A.	To rule out bipolar disorder
B.	To rule out schizophrenia
C.	To rule out senile dementia
D.	To rule out a personality disorder

____ 9. A confused client has recently been prescribed sertraline (Zoloft). The client’s spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect and what could be its possible cause?

A.	Neuroleptic malignant syndrome caused by ingestion of two different seratonin reuptake inhibitors (SSRIs)
B.	Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI)
C.	Serotonin syndrome caused by ingestion of an SSRI and an MAOI
D.	Serotonin syndrome caused by ingestion of two different SSRIs

____ 10. A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, “I heard about something called a monoamine oxidase inhibitor (MAOI). Can’t my doctor add that to my medications?” Which is an appropriate nursing reply?

A.	“This combination of drugs can lead to delirium tremens.”
B.	“A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis.”
C.	“That’s a good idea. There have been good results with the combination of these two drugs.”
D.	“The only disadvantage would be the exorbitant cost of the MAOI.”

____ 11. A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid?

A.	Pepperoni pizza and red wine
B.	Bagels with cream cheese and tea
C.	Apple pie and coffee
D.	Potato chips and diet cola

____ 12. A client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching?

A.	“I cannot drink any alcohol with this medication.”
B.	“It is going to take 2 to 3 weeks in order for me to begin to feel better.”
C.	“This drug causes physical dependence and I need to strictly follow doctor’s orders.”
D.	“I can’t take this medication with food. It needs to be taken on an empty stomach.”

____ 13. A client is admitted to the psychiatric unit with a diagnosis of major depression. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this client’s plan of care?

A.	A simple, structured daily schedule with limited choices of activities
B.	A daily schedule filled with activities to promote socialization
C.	A flexible schedule that allows the client opportunities for decision making
D.	A schedule that includes mandatory activities to decrease social isolation

____ 14. An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu?

A.	“We’ll go to the day room when you are ready for group.”
B.	“I’ll walk with you to the day room. Group is about to start.”
C.	“It must be difficult for you to attend group when you feel so bad.”
D.	“Let me tell you about the benefits of attending this group.”

____ 15. Sertraline (Zoloft) has been prescribed for a client complaining of poor appetite, fatigue, and anhedonia. Which consideration should the nurse recognize as influencing this prescriptive choice?

A.	Zoloft is less expensive for the client.
B.	Zoloft is extremely sedating and will help with sleep disturbances.
C.	Zoloft has less adverse side effects than other antidepressants.
D.	Zoloft begins to improve depressive symptoms quickly.

____ 16. What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)?

A.	The client’s understanding of the need for regular blood work
B.	The client’s mood and affect score, using the facility’s mood scale
C.	The client’s cognitive ability to understand information about the medication
D.	The client’s access to a support network willing to participate in treatment

____ 17. A client diagnosed with seasonal affective disorder (SAD) states, “I’ve been feeling ‘down’ for 3 months. Will I ever feel like myself again?” Which reply by the nurse will best assess this client’s symptoms.

A.	“Have you been diagnosed with any physical disorder within the last 3 months?”
B.	“Have you experienced any traumatic events that triggered this mood change?”
C.	“People who have seasonal mood changes often feel better when spring comes.”
D.	“Help me understand what you mean when you say, ‘feeling down’?”

____ 18. A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, “I’m feeling a lot better so you can stop watching me. I have taken up too much of your time already.” Which is the best nursing reply?

A.	“I really appreciate your concern but I have been ordered to continue to watch you.”
B.	“Because we are concerned about your safety, we will continue to observe you.”
C.	“I am glad you are feeling better. The treatment team will consider your request.”
D.	“I will forward you request to your psychiatrist because it is his decision.”

____ 19. A newly admitted client is diagnosed with major depressive disorder with suicidal ideations. Which would be the priority nursing intervention for this client?

A.	Teach about the effective of suicide on family dynamics.
B.	Carefully and unobtrusively observe based on assessed data, at varied intervals around the clock.
C.	Encourage the client to spend a portion of each day interacting within the milieu.
D.	Set realistic achievable goals to increase self esteem.

____ 20. The nurse is providing counseling to clients diagnosed with major depressive disorder. The nurse chooses to assess and attempt to modify the negative thought patterns of these clients. The nurse is functioning under which theoretical framework?

A.	Psychoanalytic theory
B.	Interpersonal theory
C.	Cognitive theory
D.	Behavioral theory

____ 21. Which client statement expresses a typical underlying feeling of clients diagnosed with major depressive disorder?

A.	“It’s just a matter of time and I will be well.”
B.	“If I ignore these feelings, they will go away.”
C.	“I can fight these feelings and overcome this disorder.”
D.	“I deserve to feel this way.”

____ 22. A 75-year-old client diagnosed with a long history of depression is currently on doxepin (Sinequan) 100 mg daily. The client takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority?

A.	Risk for ineffective thermoregulation R/T anhidrosis
B.	Risk for constipation R/T excessive fluid loss
C.	Risk for injury R/T orthostatic hypotension
D.	Risk for infection R/T suppressed white blood cell count

____ 23. A client is admitted with a diagnosis of depression NOS (not otherwise specified). Which client statement would describe a somatic symptom that can occur with this diagnosis?

A.	“I am extremely sad, but I don’t know why.”
B.	“Sometimes I just don’t want to eat because I ache all over.”
C.	“I feel like I can’t ever make the right decision.”
D.	“I can’t seem to leave the house without someone with me.”

____ 24. A client diagnosed with major depressive disorder was raised in an excessively religiously based household. Which nursing intervention would be most appropriate to address this client’s underlying problem?

A.	Encourage the client to bring into awareness underlying sources of guilt.
B.	Teach the client that religious beliefs should be put into perspective throughout the life span.
C.	Confront the client with the irrational nature of the belief system.
D.	Assist the client to modify his or her belief system in order to improve coping skills.

____ 25. A nurse is caring for four clients taking various medications including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication?

A.	Tofranil
B.	Senequan
C.	Geodon
D.	Parnate

____ 26. A client admitted to the psychiatric unit following a suicide attempt is diagnosed with major depressive disorder. Which behavioral symptoms should the nurse expect to assess?

A.	Anxiety and unconscious anger
B.	Lack of attention to grooming and hygiene
C.	Guilt and indecisiveness
D.	Expressions of poor self-esteem

____ 27. A newly admitted client diagnosed with major depressive disorder states, “I have never considered suicide.” Later the client confides to the nurse about plans to end it all by medication overdose. What is the most helpful nursing reply?

A.	“I’m glad you shared this. There is nothing to worry about. We will handle it together.”
B.	“Bringing this up is a very positive action on your part.”
C.	“We need to talk about the things you have to live for.”
D.	“I think you should consider all your options prior to taking this action.”

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 28. A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit? (Select all that apply.)

A.	Sad mood on most days
B.	Mood rating of 2/10 for the past 6 months
C.	Labile mood
D.	Sad mood for the past 3 years after spouse’s death
E.	Pressured speech when communicating

____ 29. An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.)

A.	Gender differences in social opportunities that occur with age
B.	Drastic temperature and barometric pressure changes
C.	Increased levels of melatonin
D.	Variations in serotonergic functioning
E.	Inaccessibility of resources for dealing with life stressors

____ 30. A client is prescribed phenelzine (Nardil). Which of the following client statements should indicate to a nurse that discharge teaching about this medication has been successful? (Select all that apply.)

A.	“I’ll have to let my surgeon know about this medication before I have my cholecystectomy.”
B.	“Guess I will have to give up my glass of red wine with dinner.”
C.	“I’ll have to be very careful about reading food and medication labels.”
D.	“I’m going to miss my caffeinated coffee in the morning.”
E.	“I’ll be sure not to stop this medication abruptly.”

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