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Ch 14 part 3

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wipimebe's version from 2015-10-06 22:14

Section

36. Medications a client must avoid when taking monoamine oxidase inhibitors, such as isocarboxazid (Marplan), include which of the following?

 

a. acetaminophen
b. ibuprofen
c. guaifenesin
d. meperidine

 

ANS: D
Clients taking monoamine oxidase inhibitors should avoid meperidine (Demerol). Other medications to avoid include tricyclic antidepressants, Prozac, amphetamines, and amphetamine-like medications including all sympathomimetics.

 

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

 

37. The nurse finds on assessing a client with depression that she is taking St. JohnÕs wort (hypericum). The nurse knows that while this biological extract has some advantages over commonly prescribed drugs for depression, it also has disadvantages such as:

 

a. nonstandard preparation, so the amount of hypericum may vary among manufacturers
b. much more expensive cost of preparation than other commonly prescribed drugs
c. blood testing required every week for dyscrasias
d. purchase amounts limited to a 2-week supply

 

ANS: A
St. JohnÕs wort (hypericum), which is an over-the-counter medication for depression, may have a nonstandard preparation and the amount of hypericum may vary among manufacturers. Other disadvantages of St. JohnÕs wort include that it may be less effective than prescription drug therapy or cognitive therapy. In addition, drug interactions can occur and may be significant.

 

PTS: 1 DIF: Application REF: Treatment| Medications| Effect of Medications

 

38. If the client can tolerate the side effects of antidepressants, a relief of depressive symptoms occurs in what percentage of clients?

 

a. 30% to 40%
b. 50% to 60%
c. 60% to 70%
d. 70% to 80%

 

ANS: C
In general, if clients can tolerate medication side effects, a response occurs in 60% to 70% of both inpatients and outpatients. Most studies show a placebo improvement in depression of about 18% to 30%.

 

PTS: 1 DIF: Comprehension
REF: Treatment| Medications| Effect of Medications

 

39. Studies show that, in addition to their antidepressant effects, antidepressant medications are among the MOST effective:

 

a. antipsychotic agents
b. sedative-hypnotic agents
c. antimanic agents
d. antianxiety agents

 

ANS: D
Studies have shown that in addition to their antidepressant effects, antidepressant medications are among the most effective anti-anxiety agents. Paxil has been found to be useful in treating generalized anxiety disorders and social phobias. In addition, some of the new SSRIs have been found to be useful in treating generalized anxiety disorder, social phobias, and panic disorder.

 

PTS: 1 DIF: Comprehension REF: Treatment| Medications

 

40. There is some evidence that venlafaxine and duloxetine may be more effective than the SSRIs in the management of depression, especially when associated with:

 

a. physical pain
b. insomnia
c. psychosis
d. mania

 

ANS: A
Venlafaxine and duloxetine may be more effective than the SSRIs in the management of depression, especially when associated with physical pain. Venlafaxine, an agent that has an effect on both serotonin and norepinephrine brain pathways, is similar in side effects to SSRIs; however, it may elevate blood pressure in some persons.

 

PTS: 1 DIF: Comprehension
REF: Treatment| Medications| Miscellaneous Antidepressants

 

41. Depression has been shown to be a significant risk factor for:

 

a. chronic obstructive pulmonary disease
b. myocardial infarction
c. cholecystitis
d. sleep apnea

 

ANS: B
Depression has been shown to be a significant risk factor for myocardial infarction. It remains unclear exactly how depression influences the heart. Nursing research suggests that women who suffered a heart attack report that in the weeks before their attack, they had felt unusually fatigued, were anxious, and had difficulty sleeping. Whether these depressive-like symptoms were the cause of their heart attacks or came about as a result of some metabolic or inflammatory process that itself led to the attack will require further study.

 

PTS: 1 DIF: Comprehension
REF: Treatment| Medications| Effect of Medications

 

42. Using Jean WatsonÕs Theory of Human Caring to establish client goals, the nurseÕs respect and caring for the client in the spirit of mutuality should result in which of the following?

 

a. a lifting of depressive symptoms
b. compliance with the treatment regimen
c. a sense of belonging and being liked
d. increased involvement in social activities

 

ANS: C
A caring approach could serve to provide the client with a sense of belonging as well as a sense that he is Òlikable.Ó The nurse would strive to understand the world from the clientÕs perspective and be willing to listen to the clientÕs subjective experiences. Through a positive nurse-client relationship, the nurse could aid the client in experiencing a positive view of self and a positive sense of future hope.

 

PTS: 1 DIF: Application REF: Nursing Care| Caring Theories

 

43. The nurse makes a home visit to an elderly man who was referred for depression. She finds him thin and unkempt, and diagnoses him with self-care deficit. According to Dorothea OremÕs Self-Care Deficit Theory of Nursing, encouraging the client to meet his own needs increases the clientÕs:

 

a. self-care agency
b. nursing agency
c. self-care deficit
d. independent agency

 

ANS: A
According to OremÕs Self-Care Deficit Theory of Nursing, encouraging the client to meet his own needs increases the clientÕs sense of self-care agency. The concept of nursing agency refers to nursing activities required to compensate for the clientÕs inability to meet his own self-care requirements.

 

PTS: 1 DIF: Application REF: Nursing Care| Self-Care Deficit Theory

 

44. You are the nurse working with a client who has been diagnosed with major depression. When this client demonstrates that she is able to care for her own basic physical and personal needs, you will move to which of the following roles?

 

a. nurse agency
b. self-care agency
c. supportive-educative role
d. terminative-referring role

 

ANS: C
When the client begins to be able to care for her basic physical and personal needs, the nurse will move to a supportive-educative role. This type of role focuses on enhancing the clientÕs ability both to carry on effectively without nursing support and to rise above the feelings of depression that brought on the initial deficit in self-care.

 

PTS: 1 DIF: Application REF: Nursing Care| Self-Care Deficit Theory

 

45. Which of the following questions by the nurse in a general medical setting would be BEST to elicit information to assess for depression?

 

a. ÒYou look sad. Is something wrong?Ó
b. ÒAre you depressed about this illness?Ó
c. ÒHow are you feeling today?Ó
d. ÒTell me how things have been going lately.Ó

 

ANS: D
The best question to elicit information to assess for depression would be, ÒTell me how things have been going lately.Ó Using an open-ended question is best for eliciting feelings.

 

PTS: 1 DIF: Analysis
REF: Nursing Care| Application of the Nursing Process| Assessment

 

46. Research has shown that Korean Americans are likely to demonstrate symptoms of depression in which of the following forms?

 

a. disturbed sleep
b. social isolation
c. hopelessness
d. difficulty concentrating

 

ANS: A
Research has shown that depression in Korean Americans is most likely to demonstrated as a sleep disturbance.

 

PTS: 1 DIF: Comprehension
REF: Nursing Care| Application of the Nursing Process| Assessment

 

47. A depressed client is questioning the meaning of life and her own existence after her divorce. She stopped attending church, as she didnÕt feel like going there alone anymore. Which of the following diagnoses does the nurse identify as MOST appropriate for this clientÕs state?

 

a. Hopelessness
b. Powerlessness
c. Spiritual Distress
d. Social Isolation

 

ANS: C
Because the client was questioning the meaning of life and her own existence, the clientÕs state would be an example of spiritual distress. Spiritual Distress is used as a nursing diagnosis when there is a disruption in the personÕs life principles such that he or she questions the meaning of life and his or her own existence. The person also experiences a lack of a sense of future and of being.

 

PTS: 1 DIF: Analysis
REF: Nursing Care| Application of the Nursing Process| Nursing Diagnosis

 

48. The nurse interviewing a client on admission suspects this client may be depressed. The nurse knows that there are self-rating scales that the client can complete to assist in the detection of depression. Two of the MOST common self-rating scales the nurse might ask the client to complete are the:

 

a. Stanford and the WISC
b. Beck and the Zung
c. Miller and the GRE
d. Rorschach and the MMPI

 

ANS: B
The two most common self-rating scales used with clients who may be depressed are the Beck Depression Inventory and the Zung Self-Rating Depression Scale. The Beck Depression Inventory is a 21-item scale used with individuals ages 13 and older. It measures the severity of depression. The Zung Self-Rating Depression Scale is a 20-item scale that measures four common characteristics of depression.

 

PTS: 1 DIF: Application
REF: Nursing Care| Application of the Nursing Process| Assessment

 

49. The nurse is working with a client who has been admitted to the hospital with a psychotic depression. Which of the following nursing diagnoses is the MOST important for this client at this time?

 

a. Social Isolation
b. Powerlessness
c. Risk for Injury
d. Self-Care Deficit

 

ANS: C
Because the client has been admitted for depression, the most important diagnosis would be Risk for Injury. Individuals who are depressed pose a possible safety risk to themselves. Some may experience feelings of hopelessness and see suicide as the only option. While issues of social isolation, powerlessness, and self-care deficit are a concern for the depressed client, safety is always the priority. The nurse must protect the client against self-harm.

 

PTS: 1 DIF: Analysis
REF: Nursing Care| Application of the Nursing Process| Nursing Diagnosis

 

50. The police informed a woman that her husband was in an auto accident on the way home from work. Family members took her to the emergency room where she found out that her husband was killed. Which of the following ÒhelpersÓ may be contributing to this womanÕs grief?

 

a. the nurse who remains with her in the emergency room
b. the friends who help her with funeral arrangements
c. the sister who listens to her talk about the events of the day
d. the emergency room physician who prescribed Valium for her

 

ANS: D
The emergency room physician who prescribed Valium for the client contributed to the womanÕs grief. A person will respond to the emotion of grief using the same coping strategies that she has used to deal with other, powerful emotions in the past. One learns how to grieve by learning how to understand and accept emotions, how to feel emotions, and how to use supportive persons to talk about feelings. The nurse, friend, and sister were all helpers because they allowed the woman to talk. The physician on the other hand only medicated the client.

 

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

 

51. Which of the following interventions used to treat depression has been supported by research findings?

 

a. exercise
b. support groups
c. music therapy
d. psychocatharsis

 

ANS: A
To study the effects of an aerobic exercise training program on the feelings of depression in an HIV-positive population, researchers used a randomized controlled trial of a supervised, 12-week aerobic training program. At the end of the 12-week exercise intervention, the experimental group showed reductions in depressive symptoms.

 

PTS: 1 DIF: Application REF: Reports