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Ch 14 mh

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wipimebe's version from 2015-10-06 22:10

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. A middle-aged client reveals to the nurse that last week after arriving home from work, after a difficult workweek, she felt fatigued and sad. She stated that she didnÕt eat dinner and went to bed early. She was sad for 2 days until her son called and invited her to dinner. This fluctuation in the clientÕs mood is considered to be which of the following?

 

a. normal fluctuation
b. part of clinical depression
c. predisposition to psychotic depression
d. precursor to manic-depressive illness

 

ANS: A
Feelings of sadness are normal for most individuals at some time. Losses and stresses far less profound than death can make an individual sad, but the feelings are usually fleeting, lasting a few hours to a few days. Even though the client felt fatigue, felt sadness, and did not eat, her mood changed when her son invited her to dinner.

 

PTS: 1 DIF: Analysis REF: Competencies

 

2. Which of the following symptoms must be present during a major depressive episode?

 

a. fatigue or loss of energy
b. loss of interest in previously enjoyable activities
c. sleep disturbance for at least 1 month
d. difficulty making minor day-to-day decisions

 

ANS: B
To qualify for the diagnosis of major depression, the individual must experience at least one major depressive episode. This episode must (1) last at least 2 weeks, (2) represent a change from previous functioning, and (3) cause some impairment in a personÕs social or occupational functioning. During an episode, it is also required that five or more symptoms be present. One of these symptoms must be either depressed mood or loss of interest in previously enjoyable activities.

 

PTS: 1 DIF: Comprehension
REF: What Is Depression?| Major Depressive Disorder

 

3. A major depressive episode must last at least:

 

a. 1 week
b. 2 weeks
c. 1 month
d. 6 months

 

ANS: B
According to the DSM-IV-TR, a major depressive episode must last at least 2 weeks. It must also represent a change from previous functioning and cause some impairment in a personÕs social or occupational functioning.

 

PTS: 1 DIF: Knowledge REF: What Is Depression?| Major Depressive Disorder

 

4. Minor depressive disorder has been:

 

a. proposed for the DSM-IV, but not validated
b. a diagnosis in the DSM-IV since 1982
c. found to have severe symptoms
d. identified in 18% of clinic visits

 

ANS: A
Minor depressive disorder has been proposed for clients who suffer from less severe symptoms of depression that may interfere with their functioning but may not qualify for a diagnosis of major depressive disorder. However, this diagnosis has yet to be validated for formal inclusion in DSM. Minor depression can be brief or associated with fewer than the five symptoms required for a diagnosis of major depressive disorder.

 

PTS: 1 DIF: Knowledge REF: What Is Depression?| Minor Depressive Disorder

 

5. The nurse assesses a client who complains of insomnia, fatigue, and depression every day. ÒIt has been like this since I was a child,Ó said the client. The nurse suspects the client has dysthymic mood disorder, because to be diagnosed with dysthymic mood disorder, a person must experience which of the following symptoms?

 

a. insomnia for several years--more days having problems sleeping than not having problems sleeping
b. the triad of insomnia, fatigue, and depression over several continuous years
c. depressed mood for at least 2 years, more days depressed than not depressed
d. episodes of depression over time with no evidence of suicidal ideation

 

ANS: C
To be diagnosed with a dysthymic mood disorder, a person must experience a depressed mood for at least 2 years. The individual feels depressed nearly all of the time. The depressed mood is experienced most of the day, for more days than not. A person with dysthymic disorder must also have at least two of the following symptoms: appetite disturbance, sleep disturbance, fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.

 

PTS: 1 DIF: Application REF: What Is Depression?| Dysthymic Disorder

 

6. According to the findings of the Whitehall II study in the United Kingdom, persons with abnormalities in small arteries often associated with the development of coronary disease may:

 

a. be protected from depression
b. be mildly depressed
c. commit suicide
d. not respond to antidepressant medications

 

ANS: B
The Whitehall II study in the United Kingdom showed that persons with mild depression had the kinds of abnormalities in small arteries that are often associated with the development of coronary disease and similar cardiovascular disorders. More recent studies continue to document a significant association between depression and cardiac disorders.

 

PTS: 1 DIF: Comprehension
REF: What Is Depression?| Dysthymic Disorder

 

7. A nurse midwife schedules postpartum visits for 2 weeks, 4 weeks, and 6 weeks after the delivery. The nurse midwife would BEST assess for postpartum depression:

 

a. using the Edinburgh Postnatal Depression Scale during each of the three visits
b. through general conversation and observation beginning at 4 weeksÕ postdelivery
c. beginning at 6 weeksÕ postdelivery using the Beck Depression Inventory
d. by interviewing the father of the child during each of the three visits

 

ANS: A
The nurse midwife would best assess for postpartum depression using the Edinburgh Postnatal Depression Scale during each of the three visits. This scale is a commonly used short screening instrument that has been shown to perform well in detecting postpartum depression.

 

PTS: 1 DIF: Application REF: What Is Depression?| Postpartum Depression

 

8. A nurse midwife diagnoses postpartum depression in a new mother. The nurse midwife understands that postpartum depression:

 

a. is not a ÒtrueÓ depression and should self-correct without specific intervention
b. signals inadequate maternal instincts in the mother
c. may result in psychosis or infanticide
d. is a strong indicator of spouse abuse by the father of the child toward the new mother

 

ANS: C
Undetected postpartum depression may lead to serious disturbances in mother-infant bonding, breastfeeding effectiveness, and family functioning. In rare circumstances postpartum depression may result in psychosis, infanticide, or both. Postpartum depression is a true form of depression that requires interventions. It does not indicate inadequate maternal instincts or spousal abuse.

 

PTS: 1 DIF: Application REF: What Is Depression?| Postpartum Depression

 

9. Which of the following examples indicates an abnormal grief reaction?

 

a. keeping busy to distract from the pain of the loss
b. depressive symptoms 1 month after the loss
c. loss of appetite and weight loss
d. grieving with suicidal ideation

 

ANS: D
Grieving with suicidal ideations would indicate an abnormal grief reaction. In abnormal grieving, the individual experiences grief as overwhelming and resorts to maladaptive behaviors. There are four types of abnormal grief reactions: chronic grief, delayed grief, exaggerated grief, and masked grief. Loss of appetite and weight loss, depressive symptoms 1 month after the loss, and the attempt to keep busy are all normal grief reactions to a loss.

 

PTS: 1 DIF: Comprehension
REF: What Is Depression?| Bereavement Versus Depressive Disease

 

10. What are the MOST common initial responses to the sudden death of a loved one?

 

a. despair and protest
b. disorganization and confusion
c. anger and hostility
d. numbness and disbelief

 

ANS: D
The initial response to the sudden death of a loved one is numbness and disbelief. This is the period of shock that lasts from days to a month or more.

 

PTS: 1 DIF: Comprehension
REF: What Is Depression?| Bereavement Versus Depressive Disease| Stage 1: The Period of Shock

 

11. A bereaved person experiences which one of the following during the reality stage of bereavement?

 

a. emotional pain in response to the loss
b. the shock of the event
c. integration of the loss event into life experiences
d. physiologic symptoms

 

ANS: A
Most of the emotional pain in response to the loss occurs during the reality stage. The individual consciously realizes the meaning of the loss to his or her life. Reactions may include anger, guilt, hurt, frustration, or fear.

 

PTS: 1 DIF: Comprehension
REF: What Is Depression?| Bereavement Versus Depressive Disease| Stage 2: The Reality Stage

 

12. During a widows and widowersÕ support group 18 months after the death of her husband, an elderly woman stated, ÒI still miss my husband, but for the first time since my husband died, IÕm going to take a vacation with my church group.Ó This statement suggests that this widow has done which of the following?

 

a. not completed her Ògrief workÓ successfully
b. not completed the initial shock/disbelief stage
c. reached the recovery stage of grief
d. completed the reality stage of bereavement

 

ANS: C
The womanÕs statement indicates that she has reached the recovery stage, the final stage. She is able to integrate the loss into the reality of her life and begin to live again. The individualÕs progress has been facilitated by the caring demonstrated in the widows and widowersÕ support group over the past 18 months since the death of her husband.

 

PTS: 1 DIF: Analysis
REF: What Is Depression?| Bereavement Versus Depressive Disease| Stage 3: The Recovery Stage

 

13. The level of severity of grieving is determined by the:

 

a. individual grieving
b. circumstances provoking the grieving
c. financial status of the grieving person
d. family of the grieving person

 

ANS: A
The level of severity can be determined only by the individual grieving, not the particular circumstances that provoked the grief. A person will respond to the emotions of grief using the same coping strategies that he or she has used to deal with other, powerful emotions in the past.

 

PTS: 1 DIF: Comprehension
REF: What Is Depression?| Bereavement Versus Depressive Disease

 

14. Sigmund FreudÕs psychoanalytic view of depression involved the superego punishing the ego for not living up to the superegoÕs expectations, resulting in which of the following conditions ultimately causing depression?

 

a. overwhelming grief
b. anger turned inward
c. low self-esteem
d. sexual repression

 

ANS: B
According to Sigmund FreudÕs psychoanalytic perspective, depression is a conflict between the ego (the conscious self) and the superego (an inner voice, something like the internalized parent). In depression, the superego punishes the ego for having forbidden wishes or for not living up to the superegoÕs expectations (usually similar to those of oneÕs actual parents). The result of that conflict is guilt, self-hate, and anger turned inward; these processes in turn lead to depression.

 

PTS: 1 DIF: Comprehension
REF: Theories of Depression| Psychoanalysis

 

15. Which of the following ideas are important in BowlbyÕs Object Loss Theory, which was based on the study of World War II orphaned children?

 

a. A strong ego can resist the crisis of maternal loss.
b. Maternal loss early in life may predispose to depression.
c. The mother has little influence on a childÕs ego development.
d. Depression is stimulated only by losses later in life.

 

ANS: B
John BowlbyÕs study of World War II orphaned children concluded that adult mental health required a young child to experience a close and loving relationship with its mother (or an appropriate mother substitute). According to BowlbyÕs observations: (1) traumatic loss early in life may predispose one to depression and (2) subsequent loss or separation in adulthood may serve as a stimulus to depression.

 

PTS: 1 DIF: Comprehension
REF: Theories of Depression| Object Loss Theory

 

16. SeligmanÕs (1974) Theory of Depression is based on the idea that depression is caused by which of the following?

 

a. one or more traumatic events in a personÕs life
b. a loss or separation from loved ones in adulthood
c. an individualÕs belief that no one can make things better
d. separation from or the loss of the mother before age 5

 

ANS: C
According to Seligman, helplessness is defined as the sense that one has no control over life events. He suggested that it is not any situation that causes depression, but rather it is the individualÕs belief that there is nothing either the individual or anyone else can do to make things better. Learned helplessness is caused by a series of reinforcers in oneÕs environment that serve to take control away from the individual.

 

PTS: 1 DIF: Comprehension
REF: Theories of Depression| Learned Helplessness Theory

 

17. According to cognitive theory, the treatment for the depressed client is focused on the clientÕs:

 

a. way of thinking about him- or herself and the world
b. psychobiological and spiritual profile
c. understanding of the origins of feelings
d. sense of control over lifeÕs events

 

ANS: A
According to cognitive theory, the depressed client accepts a view of him- or herself and the world that allows for dysfunctional thoughts, painful emotions, and maladaptive behaviors. The therapist assists the client in learning to see the world differently to come to adopt a healthier and more functional self-image.

 

PTS: 1 DIF: Comprehension
REF: Theories of Depression| Cognitive Theory

 

18. Studies of the brain of depressed subjects suggest that depression is associated with consistent changes in which part of the brain?

 

a. cerebral cortex
b. frontal lobe
c. parietal lobe
d. brain stem

 

ANS: B
Studies of the brain seem to show that depression is associated with consistent changes in the temporal and especially the frontal lobes. Depressed persons do not metabolize glucose well in these areas, but when their depression resolves, the metabolism returns to normal.