1. A patient became severely depressed when the last of the family's six children
moved out of the home 4 months ago. The patient repeatedly says, "No
... [Show More] one cares
about me. I'm not worth anything." Which response by the nurse would be the
most helpful?
"I'll sit with you for 10 minutes now and 10 minutes after lunch to help you
feel that I care about you."
Spending time with the patient at intervals throughout the day shows acceptance
by the nurse and will help the patient establish a relationship with the nurse. The
therapeutic technique is "offering self." Setting definite times for the therapeutic
contacts and keeping the appointments show predictability on the part of the
nurse, an element that fosters trust building.
2. A patient became depressed after the last of the family's six children moved
out of the home 4 months ago. Select the best initial outcome for the nursing
diagnosis Situational low self-esteem related to feelings of abandonment. The
patient will:
verbalize realistic positive characteristics about self by (date).
Low self-esteem is reflected by making consistently negative statements about self
and self-worth. Replacing negative cognitions with more realistic appraisals of self
is an appropriate intermediate outcome.
3. A patient diagnosed with major depression says, "No one cares about me
anymore. I'm not worth anything." Today the patient is wearing a new shirt and has
neat, clean hair. Which remark by the nurse supports building a positive selfesteem
for this patient?
"You're wearing a new shirt."
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 making an observation avoid negative
interpretations.
4. An adult diagnosed with major depression was treated with medication and
cognitive behavioral therapy. The patient now recognizes how passivity contributed
to the depression. Which intervention should the nurse suggest?
Social skills training
Social skill 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 development of a patient's support system.
5. Priority interventions for a patient diagnosed with major depression and
feelings of worthlessness should include:
careful unobtrusive observation around the clock
Approximately two-thirds of people with depression contemplate suicide. Patients
with depression who exhibit feelings of worthlessness are at higher risk. Regular
planned observations of the patient diagnosed with depression may prevent a
suicide attempt on the unit.
6. When counseling patients diagnosed with major depression, an advanced
practice nurse will address the negative thought patterns by using:
cognitive behavioral therapy
Cognitive behavioral therapy attempts to alter the patient's dysfunctional beliefs
by focusing on positive outcomes rather than negative attributions. The patient is
also taught the connection between thoughts and resultant feelings. Research
shows that cognitive behavioral therapy involves the formation of new connections
between nerve cells in the brain and that it is at least as effective as medication.
7. A patient says to the nurse, "My life doesn't have any happiness in it anymore.
I once enjoyed holidays, but now they're just another day." The nurse documents
this report as an example of:
anhedonia
Anhedonia is a common finding in many types of depression. It refers to feelings of
a loss of pleasure in formerly pleasurable activities.
8. A patient diagnosed with major depression began taking a tricyclic
antidepressant 1 week ago. Today the patient says, "I don't think I can keep taking
these pills. They make me so dizzy, especially when I stand up." The nurse will:
teach the patient strategies to manage postural hypotension
Drowsiness, dizziness, and postural hypotension usually subside after the first few
weeks of therapy with tricyclic antidepressants. Postural hypotension can be
managed by teaching the patient to stay well hydrated and rise slowly. Knowing
this information may convince the patient to continue the medication.
9. A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg
qhs. Which assessment finding would prompt the nurse to collaborate with the
health care provider regarding potentially hazardous side effects of this drug?
Urinary retention
All the side effects mentioned are the result of the anticholinergic effects of the
drug. Only urinary retention and severe constipation warrant immediate medical
attention.
10. A patient diagnosed with major depression tells the nurse, "Bad things that
happen are always my fault." Which response by the nurse will best assist the
patient to reframe this overgeneralization?
"Let's look at one bad thing that happened to see if another explanation
exists."
assumption, the nurse can help the patient look at the premise more objectively
and reframe it as a more accurate representation of fact. [Show Less]