Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis
Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis
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Chapter 18: Mood Disorders: Depression
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
MULTIPLE CHOICE
1) A client, age 56 years, became severely depressed when the last of her six children moved out of the home 4 months ago. Since then she has neglected to care for herself, lost weight, and repeatedly states “No one cares about me anymore.” Before the onset of symptoms she had been a meticulous housekeeper, was neatly groomed, and often participated in community activities. She was noncompliant with tricyclic antidepressant therapy, so admission to the mental health unit was sought. After her admission, the client repeatedly tells nursing staff “No one cares about me. I’m not worth anything.” A helpful response by the nurse would be
| A. | “I care about you, and I want to try to help you get better.” |
| B. | “Things will look brighter soon. Everyone feels down once in a while.” |
| C. | “It is difficult for others to care about you when you say the same negative things over and over.” |
| D. | “I’ll sit with you for 10 minutes, I’ll return for 10 minutes at lunchtime, and again at 2:30 this afternoon.” |
ANS: D
Spending time with the client at intervals throughout the day shows acceptance by the nurse and will help the client establish a relationship with the nurse. Setting definite times for the therapeutic contacts and keeping the appointments shows predictability on the part of the nurse, an element that fosters trust building. Option A is difficult for a profoundly depressed person to believe. Option B provides trite reassurance. Option C is counterproductive. The client is essentially unable to say positive things at this point.
DIF: Cognitive Level: Application REF: Text Page: 339, Text Page: 400
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
2) A client, age 56 years, became severely depressed when the last of her six children moved out of the home 4 months ago. Since then she has neglected to care for herself, sleeps poorly, lost weight, and repeatedly states “No one cares about me anymore. I’m not worth anything.” After hospitalization the nursing diagnosis of situational low self-esteem related to feelings of abandonment has been established. An appropriate intermediate outcome would be “Client will
| A. | verbalize realistic positive things about self by (date).” |
| B. | agree to take antidepressant medication regularly by (date).” |
| C. | initiate social interaction with another person daily by (date).” |
| D. | identify two personal behaviors that might push others away by (date).” |
ANS: A
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. Option B should be a short-term outcome. Options C and D are not as clearly related to the nursing diagnosis.
DIF: Cognitive Level: Analysis REF: Text Page: 338
TOP: Nursing Process: Planning (Outcome Identification)
MSC: NCLEX: Psychosocial Integrity
3) A client, age 56 years, became severely depressed when the last of her six children moved out of the home 4 months ago. Since then she has neglected to care for herself, sleeps poorly, lost weight, and repeatedly states “No one cares about me anymore. I’m not worth anything.” After hospitalization the nursing diagnosis of situational low self-esteem related to feelings of abandonment was identified. The nurse wishes to reinforce the client’s self-esteem by acknowledging the improvement in her personal appearance. She’s wearing a new dress and has combed her hair. The most appropriate remark would be
| A. | “You look nice this morning.” |
| B. | “I like the dress you’re wearing.” |
| C. | “What brought about this glamorous transformation?” |
| D. | “You’re wearing a new dress.” |
ANS: D
Depressed clients 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 dress.” Neutral comments such as an observation avoid negative interpretations.
DIF: Cognitive Level: Application REF: Text Page: 340
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
4) A client, age 56 years, became severely depressed when the last of her six children moved out of the home 4 months ago. Since then she has neglected to care for herself, sleeps poorly, lost weight, and repeatedly states “No one cares about me anymore. I’m not worth anything.” An inappropriate intervention to include in the client’s care plan is
| A. | observe and record sleep pattern nightly. |
| B. | weigh weekly and observe eating patterns. |
| C. | monitor bowel movements daily and evaluate need for laxatives. |
| D. | provide activities that involve concentration and fine motor skills. |
ANS: D
The activities that should be provided for a severely depressed client call for minimal concentration and involve gross motor skills rather than fine motor skills. The other interventions related to physiological integrity are appropriate.
DIF: Cognitive Level: Application REF: Text Page: 339
TOP: Nursing Process: Planning MSC: NCLEX: Physiologic Integrity
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