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Ch 14 part 2

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wipimebe's version from 2015-10-06 22:12

Section

19. Interferon and certain related ÒcytokinesÓ are frequently produced by the body in response to some cancers and chronic inflammatory illnesses. These substances may be responsible at least in part for:

 

a. a false sense of well-being that hampers the individualÕs initial awareness of the disease
b. an endogenous ÒantidepressantÓ defense mounted by the body in response to the disease
c. the surge in energy and elevated mood that heralds the successful defeat of the disease
d. the depression that often accompanies malignancies and chronic illnesses

 

ANS: D
Researchers have recently recognized that interferon and certain related ÒcytokinesÓ are frequently produced by the body in response to some cancers and chronic inflammatory illnesses(such as rheumatoid arthritis). These substances appear to have a direct effect on the brain and may be responsible, at least in part, for depression that often accompanies malignancies and chronic illnesses.

 

PTS: 1 DIF: Comprehension
REF: Theories of Depression| Physical/Biological Models

 

20. A client is started on interferon treatment for multiple sclerosis. In response to the client asking about side effects and how the interferon will make him feel, the nurse responds:

 

a. ÒYou might begin to feel unusually energetic and upbeat.Ó
b. ÒDepression has been found to be one of the major side effects of interferon treatment.Ó
c. ÒYou shouldnÕt notice any change in your moods at all, unless you are allergic to it.Ó
d. ÒInterferon has a natural antidepressant effect on the brain.Ó

 

ANS: B
When a client is started on interferon treatment for multiple sclerosis and begins to ask the nurse about side effects and how the medication will make him feel, the nurse would inform the client that depression is one of the major side effects of this medication. Depression has been linked to changes in brain concentrations of serotonin.

 

PTS: 1 DIF: Application
REF: Theories of Depression| Physical/Biological Models

 

21. Recent research by Kessler et al. (2003) suggests that the current status of treatment for depression is that:

 

a. for those persons with depression who do receive treatment, 90% are judged effective
b. over 75% of all persons with depression receive treatment at some point
c. almost all persons found to be depressed are diagnosed within 3 months of onset
d. less than 25% of persons with depression receive treatment that is judged adequate

 

ANS: D
Data suggest that barely half of persons with depression receive treatment. In addition, less than half of those treated (less than 25% of the total) receive treatment that is judged adequate based on number and timing of follow-up visits.

 

PTS: 1 DIF: Comprehension REF: Treatment

 

22. In comparison to the 1980s, clients with depression in the 2000s are:

 

a. more likely to be diagnosed
b. more likely to have not responded to earlier prophylactic treatment
c. less likely to be offered treatment
d. being diagnosed and treated at the same rate

 

ANS: A
Currently clients with depression are more likely to be diagnosed with depression and offered treatment than in the 1980s. Significant progress has been made in managing depression, but much more remains to be done. Current treatments include psychotherapy, somatic or physical therapies, and medications.

 

PTS: 1 DIF: Comprehension REF: Treatment

 

23. Marital therapy is relevant in the treatment of depression, because marital distress is common and research studies suggest that marital discord:

 

a. causes most cases of depression
b. makes depressive episodes last longer
c. often precedes relapses of depression
d. can actually bring a person out of depression

 

ANS: C
Marital therapy is relevant to the treatment of depression because marital distress is common and often includes at least one depressed spouse. Studies suggest that relapses of depression are often preceded by marital discord. Behavioral marital therapy focuses on enhancing behaviors that are supportive of healthy marital relationships.

 

PTS: 1 DIF: Comprehension REF: Treatment| Psychotherapy

 

24. Psychotherapy as a treatment for depression has been found to be:

 

a. less effective than placebo
b. less beneficial than medication
c. consistently beneficial
d. of very little help

 

ANS: C
Psychotherapy as a treatment for depression has been found to be consistently beneficial. This form of treatment refers to any of over 250 types of treatments involving verbal techniques designed to help individuals surmount psychological stresses, including depression. Psychotherapy based on psychoanalytic interventions emphasize helping clients gain insight into the causes of their depression.

 

PTS: 1 DIF: Comprehension REF: Treatment| Psychotherapy

 

25. Although electroconvulsive therapy (ECT) has been shown to be highly effective, its use is reserved for treating depression for which of the following types of clients?

 

a. clients who are suicidal or homicidal
b. clients who are aggressive or acting out and depressed
c. clients with physical problems resulting in depression
d. clients who are severely depressed and do not respond to medication trials

 

ANS: D
Electroconvulsive therapy (ECT) is highly effective in helping clients who are severely depressed and do not respond to medications trials. Many studies on ECT and depression produce response rates as high as 90%, in comparison to medications (tricyclic antidepressants and MAO inhibitors).

 

PTS: 1 DIF: Application
REF: Treatment| Physical Therapies| Electroconvulsive Therapy

 

26. When working with clients who have recently received ECT, the nurse must keep in mind that the client may be suffering from which of the following side effects of the treatment?

 

a. temporary memory loss
b. bruising and pain
c. unstable blood pressure
d. ringing in the ears

 

ANS: A
The nurse must keep in mind that clients who have recently received ECT may suffer from temporary memory loss. In general, memory deficits are limited are mild.

 

PTS: 1 DIF: Application
REF: Treatment| Physical Therapies| Electroconvulsive Therapy

 

27. When light therapy is used to treat seasonal affective disorder (SAD), a response should occur within:

 

a. 2 weeks
b. 4 weeks
c. 3 months
d. 1 year

 

ANS: A
When used for SAD, light therapy relieves symptoms in about 75% of persons. Response should occur within 2 weeks, and neither safety nor efficacy has be established for treatment lasting longer than this. Researchers have evaluated the use of light therapy in a small population of women with nonseasonal depression and reported improvements, indicating that light therapy may have use in treating depression outside of SAD.

 

PTS: 1 DIF: Comprehension
REF: Treatment| Physical Therapies| Light Therapy

 

28. New experimental treatments of depression include:

 

a. ablation of brain tissue that is emitting abnormal electrical signals
b. isolation and sensory deprivation during sleep
c. stimulating the brain using powerful localized magnetic fields
d. sustained whole-brain overstimulation from simultaneous multimedia sources

 

ANS: C
New experimental treatments of depression include stimulating the brain using powerful localized magnetic fields. The technique involves placement of a small magnetic coil over specific areas of the brain. This treatment is known as repetitive transcranial magnetic stimulation (rTMS).

 

PTS: 1 DIF: Knowledge
REF: Treatment| Physical Therapies| Brain Stimulation

 

29. Repetitive transcranial magnetic stimulation (rTMS) has shown some effectiveness in the treatment of depression, particularly if scheduled:

 

a. once (it cannot be repeated without causing irreversible brain damage)
b. repeatedly over time
c. three times each week for 4 consecutive weeks
d. multiple times a day on a prn basis

 

ANS: B
If repetitive transcranial magnetic stimulation (rTMS) treatments are repeated over time, improvement in mood may result, at least in some individuals. Whether each improvement is lasting and whether it can be obtained less expensively with other psychiatric treatments remains to be seen.

 

PTS: 1 DIF: Knowledge
REF: Treatment| Physical Therapies| Brain Stimulation

 

30. Tricyclic antidepressants given to persons with depression:

 

a. work by reducing available dopamine
b. take a month or more to become effective
c. are usually given in eight small, divided doses
d. may cause weight loss in many clients

 

ANS: B
Full response to tricyclic antidepressants usually requires 4 to 6 weeks. Blood testing to determine plasma levels of antidepressant drugs is often used for amitriptyline (Elavil), imipramine (Tofranil), desipramine (Norpramin), and nortriptyline (Pamelor).

 

PTS: 1 DIF: Comprehension
REF: Treatment| Medications| Tricyclic and Related Antidepressants

 

31. The nurse working with depressed clients taking tricyclic antidepressants must keep in mind which of the following in planning and implementing care?

 

a. Blood dyscrasias are extremely common, and blood work must be monitored carefully.
b. Severe food and drug interactions are common, so special dietary instructions must be given.
c. Hypertensive crisis can occur anytime when a client is taking tricyclics.
d. These medications are dangerous in overdose, and clients must be monitored for suicidal ideation.

 

ANS: D
When planning and implementing care for a client taking tricyclic antidepressants, the nurse must keep in mind that these medications are dangerous in overdose, and clients must be monitored for suicidal ideations. As the medication helps improve the clientÕs mood, there is an increase energy level, which could be used to commit suicide.

 

PTS: 1 DIF: Analysis
REF: Treatment| Medications| Selective Serotonin Reuptake Inhibitors

 

32. The MOST common side effects of selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Paxil have been identified as which of the following?

 

a. increased salivation and constipation
b. orthostatic hypertension
c. agitation, insomnia, weight loss
d. hypertensive crisis

 

ANS: C
The SSRI side effects may include agitation, restlessness, insomnia, weight loss, headache, nausea, and diarrhea. Sexual dysfunction may also occur, especially in men.

 

PTS: 1 DIF: Comprehension
REF: Treatment| Medications| Selective Serotonin Reuptake Inhibitors

 

33. The increase in the current use of SSRIs compared to tricyclic antidepressants occurred because SSRIs:

 

a. have less troublesome side effects
b. target rare types of depression
c. are less expensive
d. cause fewer problems with libido

 

ANS: A
The SSRIs have achieved their current popularity because their side effects are less troublesome than those of the tricyclic antidepressants. The SSRIs lack the anticholinergic and orthostatic side effects of tricyclic antidepressants.

 

PTS: 1 DIF: Comprehension
REF: Treatment| Medications| Selective Serotonin Reuptake Inhibitors

 

34. Which of the following foods should be considered safe to eat for a client taking monoamine oxidase inhibitors?

 

a. smoked fish
b. a ripe avocado
c. fava beans
d. cottage cheese

 

ANS: D
A client taking monoamine oxidase inhibitors should consider cottage cheese as a safe food. Foods to be avoided are those containing tyramine such as smoked fish, ripe avocados, and fava beans.

 

PTS: 1 DIF: Analysis
REF: Foods and Medications That Must Be Avoided by Clients Taking MAO Inhibitors

 

35. The wife of a client who is taking tranylcypromine (Parnate) calls the clinic nurse. Which of the following reports by the wife should be considered in need of the MOST urgent attention?

 

a. a fever of 99.8 degrees Fahrenheit
b. blood pressure of 170/100
c. diarrhea
d. insomnia

 

ANS: B
The most important information reported by the wife would be that the clientÕs blood pressure is 170/100. Parnate is an MAO inhibitor. Clients taking MAO inhibitors who consume substances containing tyramine typically experience a dangerous rise in blood pressure. This may result