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Ch 14 part 4

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wipimebe's version from 2015-10-06 22:15

Section

52. Which of the following principles should be kept in mind when the nurse evaluates the clientÕs progress in managing depression?

 

a. Grieving resulting from significant loss should be over within 2 months.
b. To be considered successful, all of the identified outcomes should show progress.
c. The clientÕs view of the changes since the beginning of therapy is not objective.
d. Significant energy and a conscious effort are required by the client to maintain perspective.

 

ANS: D
When evaluating, the nurse needs to keep in mind and to remind the client that managing depression often requires significant energy and a conscious effort on the clientÕs part to balance emotions and maintain perspective. It is also important to remember that depression, resulting from a significant loss, such as loss of a loved one, may take many weeks or months to overcome and that the client will need sensitive nursing care to adapt to the new situations and roles that accompany such a loss.

 

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

 

53. In a research examining the impact of insurance coverage and copayment costs for antidepressant medications for older adults, the researchers reported that which of the following was associated with a significant drop in frequency of antidepressant initiation?

 

a. full coverage
b. copayments
c. income-based deductible
d. age-based deductible

 

ANS: B
The research examining the impact of insurance and copayment costs for antidepressant medications for older adults found that copayment was associated with a significant drop in frequency of antidepressant initiation. Many elderly people are on fixed income and therefore may be unable to pay for medications.

 

PTS: 1 DIF: Comprehension
REF: Nursing Literature on Depression: Findings and Reports

 

54. Aerobic exercise training has been shown to have what effect on depressive symptoms?

 

a. It reduces depressive symptoms.
b. It increases fatigue and anergia.
c. It reduces calmness and muscle relaxation.
d. It increases irritability and anxiety.

 

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: Comprehension REF: Reports

 

55. Qualitative research by Ugarriza (2002) looked at how elderly women experience and view depression. The symptoms that the informants in this study emphasized MOST were:

 

a. feelings of guilt and worthlessness
b. fatigue and weakness
c. weight loss and anorexia
d. suicidal ideation and lack of a sense of future

 

ANS: B
In the study by Ugarriza (2002), the researcher found that informants emphasized the experience of feelings of fatigue and weakness as major components of depression, in contrast to DSM-IV, which emphasized feelings of guilt, worthlessness, weight loss, and suicidal ideation.

 

PTS: 1 DIF: Comprehension
REF: Nursing Literature on Depression: Findings and Reports

 

56. As a nurse working with a depressed client, which of the following interventions would MOST likely contribute to a lessening of the depression?

 

a. pointing out behaviors the client needs to improve
b. helping the client identify dysfunctional behaviors in his or her family
c. helping the client identify personal strengths
d. pointing out the rules and consequences for the unit

 

ANS: C
The nurse helping the client identify personal strengths would contribute to lessening of the clientÕs depression. This would help the client develop a more positive view of self and reduce feelings of inadequacy and isolation.

 

PTS: 1 DIF: Application REF: Nursing Care| Planning/Interventions

 

57. As a nurse evaluating your clientÕs progress in managing depression, you would first do which of the following?

 

a. Check with the night shift regarding sleep patterns and changes in patterns since admission.
b. Ask the provider if the client has made progress in lessening depressive symptoms.
c. Check with the family, and ask what they think about the clientÕs progress.
d. Ask the client to give his or her view of changes that have come about since therapy began.

 

ANS: D
In evaluating a clientÕs progress in managing depression, the nurse should first ask the client to give his or her view of changes that have come about since therapy began. Specific indicators such as stronger sleep patterns, return of appetite, renewed or increasing sense of control and self-worth, and renewed interest in previous or new activities are all good signs of progress. Speaking with family members and other health care providers will not provide an adequate perspective since the client is the only person who can determine if the feelings of depression have reduced.

 

PTS: 1 DIF: Analysis REF: Nursing Care| Evaluation

 

58. A nurse assesses a client with depression who reports fatigue, sadness, insomnia, powerlessness, and social isolation. The nurse knows that the BEST practice is to focus on which symptom?

 

a. fatigue so that the client can experience enough energy to work on other symptoms
b. sadness in order to reduce or eliminate the need for suicide precautions
c. the symptom that the client identifies as the most urgent need
d. all of the identified symptoms simultaneously in a coordinated manner

 

ANS: C
The nurse knows that the best practice is to focus on the symptoms that the client identifies as the most urgent. This approach would indicate to the client that the nurse cares about the clientÕs feelings and perception of the problem. By focusing on the symptoms that the client feels are most urgent, the nurse can build a trusting relationship with the client.

 

PTS: 1 DIF: Application REF: Nursing Care| Assessment

 

59. Using a concept map to graphically depict the symptoms and issues present helps the nurse to:

 

a. quantify the symptoms and issues to justify the highest remuneration schedule
b. identify the primary focal issues that relate to or are the basis for most of the others
c. conserve time and paper by drawing it all out on one page instead of dictating a long history
d. codify the client record so that personal, intimate issues are not readily apparent to others

 

ANS: B
Using a concept map to graphically depict the symptoms and issues present helps the nurse identify the primary focal issues that relate to or are the basis for most of the others. As the focal issues emerge, they become the priorities for the nurseÕs attention and form the basis for development of the nursing care plan.

 

PTS: 1 DIF: Application REF: Exemplar for Practice| Concept Map: Depression

 

60. What two therapies from Nursing Interventions Classification (NIC) are used during every interaction with clients?

 

a. active listening and presence
b. coping enhancement and emotional support
c. assertiveness training and cognitive restructuring
d. teaching of prescribed medications and body image enhancement

 

ANS: A
During every intervention with a client, the nurse uses active listening and presence. Both concepts are based on the premise of building and strengthening the nurse-client relationship. By listening and hearing the experience of clients, the nurse will be able to assess their responses to the emotions they are experiencing. By being present, the nurse offers him- or herself as a source of support for the client. Both active listening and presence are a means of portraying honest interest in the clients.

 

PTS: 1 DIF: Application
REF: Nursing Interventions and Therapies from the NIC Useful to Consider When Working with Depressed Clients

 

61. A variety of hormones have been implicated in the causation of postpartum depression, including:

 

a. growth hormone
b. estrogen
c. testosterone
d. aldosterone

 

ANS: B
Many suggestions have been made about causes of postpartum depression, most focusing on changes in hormonal levels following delivery. A variety of hormones have been implicated in the causation of postpartum depression, such as estrogen. Other hormones implicated include: progesterone, thyroxine, melatonin, cortisol, and prolactin.

 

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

 

62. Personal risk factors that have been consistently shown to play a role in predicting postpartum depression include:

 

a. strong mother-infant bonding
b. low level of social support
c. premature delivery
d. neonatal complications

 

ANS: B
The most important personal factor for postpartum depression is low level of social support. Giving birth requires a revision of the current role. A support system can assist the new mother in making the role transition required. The support system can also provide assistance with normal responsibilities and at times provide the new mother with a period of respite.

 

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