Exam 2: Module 4-7 Q Flashcards
when teaching about the tricyclic group of antidepressant medications, which information should the nurse include?
o Strong or aged cheese should not be eaten while taking this group of medications.
o The full therapeutic potential of tricyclics may not be reached for 4 weeks.
o Long-term use may result in physical dependence.
o Tricyclics should not be given with anti-anxiety agents.
the full therapeutic potential of tricyclics may not be reached for 4 weeks
a patient needs to be advised that it may take several weeks or tricyclic medications to reach their full therapeutic effect and for relief of symptoms to be noted
a patient has been diagnosed with major depression.
the psychiatrist prescribes paroxetine (paxil)
which of the following medication information should the nurse include in discharge teaching?
o Do not eat chocolate while taking this medication.
o The medication may cause priapism (prolonged erection).
o The medication should not be discontinued abruptly.
o The medication may cause photosensitivity
The medication should not be discontinued abruptly.
Antidepressants, such as paroxetine, must be tapered and not stopped abruptly.
All classifications of antidepressants have varying potentials to cause discontinuation syndromes. Abrupt withdrawal from SSRIs, such as paroxetine, may result in dizziness, lethargy, headache, and nausea.
A hospitalized client is started on phenelzine for the treatment of depression.
The nurse should instruct the client that which food is acceptable to consume while taking this medication?
o A Yogurt
o B Sausage
o C Beer
o D Crackers
Crackers
Phenelzine is a MAOI.
The client should avoid ingesting foods that are high in tyramine.
Ingestion of these foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt; aged cheeses; smoked and processed meats; red wines; beer; fruits such as avocados, papaya, raisins or figs.
A suicidal client says to a nurse, “There’s nothing to live for anymore.”
Which is the most appropriate nursing reply?
o A “Why don’t you consider doing volunteer work in a homeless shelter?”
o B “Let’s discuss the negative aspects of your life.”
o C “Things will look better in the morning.”
o D “It sounds like you are feeling pretty hopeless.”
“It sounds like you are feeling pretty hopeless.”
This statement verbalizes the client’s implied feelings and allows him or her to validate and explore them. This statement also shows empathy toward the client and may help them open up and discuss their feelings.
Which sign/symptom is most important when assessing the client diagnosed with Major Depressive Disorder?
o A The client does not find pleasure in life.
o B The client is unable to concentrate.
o C The client does not have any energy.
o D The client is unable to stay asleep.
The client does not find pleasure in life.
The most significant sign of major depressive disorder is a loss of pleasure in life. The others are symptoms but not the most important.
The nurse is reviewing orders given for a patient with depression.
Which order should the nurse question?
o A Cognitive behavioral therapy (CBT) in combination with bupropion
o B Electroconvulsive therapy (ECT) for recurrent depression
o C A low starting dose of citalopram
o D Low dose sertraline in combination with isocarboxazid
Low dose sertraline in combination with isocarboxazid.
This is a drug-to-drug interaction (SSRI with MAOI) which can cause Serotonin Syndrome. The other responses are all effective treatments for depression.
A client with a history of three suicide attempts has been taking paroxetine for 1 month. The client suddenly presents with a bright affect, is much more communicative, and rates mood at 9/10.
Which action should be the nurse’s priority at this time?
o A Give the client off-unit privileges as positive reinforcement.
o B Encourage the client to share mood improvement in group.
o C Request that the psychiatrist reevaluate the current medication protocol.
o D Increase frequency of client observation.
Increase frequency of client observation.
The nurse should monitor the client more frequently or implement one-to-one observation. A sudden increase in mood rating and change in affect may indicate the client is at serious risk for suicide. Serious suicide risk may occur early during treatment with antidepressants.
A nurse is completing a nursing history for a client who has major depressive disorder. Which of the following client statements indicates a cognitive distortion in the client’s thinking?
o A. “I never say the right thing to other people.”
o B. “I have been having trouble getting to sleep at night.”
o C. “I’ve been feeling really sad for about a month.”
o D. “I will miss my family while I’m in the hospital.”
“I never say the right thing to other people.”
Cognitive distortions are negative thoughts that indicate distorted thinking about oneself or the environment. This statement is an example of an automatic all-or-nothing generalization which is negative and unrealistic. Cognitive therapy can assist the client in understanding distortions and, over time, changing thoughts to be more positive and realistic.
A nurse in an acute care mental health facility is caring for a newly admitted client who has major depressive disorder (MDD). The client tells the nurse, “My life is meaningless! I’m going to kill myself tonight.”
Which of the following actions should the nurse identify as the priority?
o A. Search the client’s belongings for objects that could cause harm.
B. Place the client on suicide precautions.
C. Obtain details about the client’s suicide plan.
D. Ask the client to sign a suicide prevention contract.
Obtain details about the client’s suicide plan.
The first action the nurse should take when using the nursing process is to assess the client’s suicide plan fully by asking about details of the client’s plan, lethality of the planned method, and the client’s access to it.
A nurse is providing teaching to a client who has major depressive disorder and a new prescription for citalopram.
Which of the following statements by the client demonstrates an understanding of the teaching?
o A. “I will avoid eating cheese or smoked meats while taking this medication.”
o B. “I will need to take this medication for at least 4 months after my symptoms go away.”
o C. “I can expect to feel better after taking this medication for 3 or 4 days.”
o D. “This medication will decrease my nervousness and anxiety.”
Give the client step-by-step instructions when performing ADLs.
The client who has severe depression often has slowed thinking and lacks energy to perform ADLs. At the same time, daily routines of washing and dressing are important for the client’s well-being. The nurse can assist the client by giving one direction at a time and staying with the client while activities are performed.
A nurse has arranged to meet with a newly admitted client who has major depressive disorder. When the nurse arrives for the meeting, the client tells the nurse, “I’m just not up to talking today.”
Which of the following responses should the nurse make?
o A. “I think you should try to talk to me, even if it’s just for a few minutes.”
B. “I’ll just sit here with you for a few minutes, and you don’t need to feel pressure to talk.”
C. “Don’t worry, I’m sure you’re doing much better than you were when you were admitted.”
D. “Why do you feel you aren’t up to talking today?”
“I’ll just sit here with you for a few minutes, and you don’t need to feel pressure to talk.”
Depression can slow a client’s thought processes and also can slow speech. The nurse is planning to use silence as a therapeutic technique to demonstrate caring and begin development
Which criteria would eliminate a diagnosis of MDD?
o Client maxing out credit cards and promiscuous sexual behavior
o Client sleeping more
o Client who does not find joy in usual hobbies
client maxing out credit cards and promiscuous sexual behavior
A nurse in a long term facility is caring for a client who has major neurocognitive disorder and attempts to wander out of the building. The client states, “I have to get home”.
Which of the following statements should the nurse make?
o A You have forgotten that this is your home.
o B You cannot go outside without a staff member
o C Why would you want to leave? Aren’t you happy with your care?
o D I am your nurse. Let’s walk together to your room and talk about what’s going on
I am your nurse.
Let’s walk together to your room and talk about what’s going on. It is appropriate to introduce yourself with each new interaction and to promote reality in a calm, reassuring manner.
A home health nurse is making a visit to a client who has Alzheimer’s disease to assess the home for safety.
Which of the following suggestions should the nurse make to decrease the client’s risk for injury? SATA or Select all that apply
o A Install extra locks at the top of exit doors.
o B Place rugs over electrical cords
o C Put cleaning supplies on a shelf
o D Place the client’s mattress on a low bed frame or the floor
o E Install light fixtures above stairs
A, D, E
Install extra locks at the top of exit doors
Place the client’s mattress on a low bed frame or the floor Install light fixtures above stairs
A nurse is making a home visit to a client who is in the late stages of AD. The client’s partner, who is the primary caregiver, wishes to discuss concerns about the client’s nutrition and the stress of providing care.
Which of the following actions should the nurse take?
o A Verify that a current power of attorney is on file
o B Instruct the client’s partner to offer finger foods to increase oral intake
o C Provide information on resources for respite care (short term relief for primary caregivers; can provide assistance at home, facility, or day care center)
o D Schedule the client for placement of an enteral feeding tube
Provide information on resources for respite care (short term relief for primary caregivers; can provide assistance at home, facility, or day care center)
A nurse is performing an admission assessment for a client who has delirium related to an acute urinary tract infection.
Which of the following findings should the nurse expect? SATA.
o A Gradual memory loss
o B Family report of personality changes
o C Hallucinations
o D Unaltered level of consciousness
E Restlessness
B, C, E
family report of personality changes
hallucinations
restlessness
A nurse is caring for a client who is experiencing a crisis.
Which of the following medications might the provider prescribe? (Select all that apply.)
o A Lithium carbonate (mood stabilizer)
o B Paroxetine (antidepressant)
o C Risperidone (antipsychotic)
o D Haloperidol (antipsychotic)
o E Lorazepam (anxiolytic)
B -Paroxetine (antidepressant)
E- Lorazepam (anxiolytic)
SSRI antidepressants (paroxetine) may be prescribed to decrease the anxiety and depression of a client who is experiencing a crisis. Benzodiazepines (lorazepam) may be prescribed to decrease the anxiety of a client who is experiencing a crisis.
A nurse is developing a plan of care for a suicidal client.
Which documented intervention should the nurse implement first?
o A Observe the client.
o B Provide a hazard-free environment.
o C Assess suicide risk.
o D Communicate therapeutically
o C Assess suicide risk.
Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions. Suicide risk assessment should always be the first step taken when working with depressed or suicidal patients. All the other interventions can be done after risk is assessed.
