A nurse in a mental health facility is caring for a client who has major depressive disorder.

Progress Notes

Week 1

Client is experiencing major depressive disorder following the unexpected death of their partner 6 months ago. Has been unable to proceed through stages of grief. Has been on anti-depressant therapy for 5 months.

Admits to having thoughts of self-harm. Reports increasing anxiety levels. Loss of 15 lb over past months due to anorexia and anxiety. Reports insomnia, sleeping only 4 to 5 hr/night with frequent nightmares. Reports feelings of extreme fatigue.

Plan: Admit for group and individual therapy. Suicide precautions. Will add alprazolam to medication regimen.

Week 2

Client remains depressed, continues to have thoughts of self-harm. Not responding to group or individual therapy. States no improvement in mood or energy level. Admits to less anxiety and increased hours and quality of nightly sleep with addition of alprazolam. Anorexia still present.

Plan: Due to ineffectiveness of antidepressant regimen and psychotherapy, suggest addition of electroconvulsive therapy (ECT).

Medication Administration Record

Bupropion 100 mg PO TID

Escitalopram 20 mg PO daily

Alprazolam 0.25 PO BID PRN anxiety

Which of the following items in the client's medical record indicate that they are a candidate for electroconvulsive therapy (ECT)?

(Select all that apply.)

Energy level

Clinical response to antidepressant therapy

Sleep changes

Appetite

Clinical response to alprazolam therapy

Answer and Explanation

Correct Answer : A,B,D

A.   Indication for ECT. The client reports extreme fatigue despite treatment, suggesting a lack of improvement in energy levels with medication and therapy.
B.   Indication for ECT. The client has not shown significant improvement in response to antidepressant therapy, as stated in the progress notes.
C.   Not an indication since the client reports increased hours and better quality of sleep.
D.   Potential indication for ECT. The client has anorexia, which indicates a persistent lack of appetite despite the treatment received.
E.   Mixed indication. While alprazolam has helped with anxiety and improved sleep, it hasn't resolved the underlying depressive symptoms or suicidal thoughts. Therefore, it might contribute to considering ECT as an alternative or additional therapy option.

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Correct Answer is D

Explanation

A. Extrapyramidal symptoms are more commonly associated with antipsychotic medications rather than SSRIs.
B. SSRIs might have varying effects on motor activity, but this is not a primary outcome for their use.
C. While SSRIs may indirectly contribute to cognitive improvements, the primary expected outcome revolves around mood changes rather than thought processes.
D. SSRIs are primarily used to treat mood disorders like depression and anxiety, and the main goal of their use is to improve mood and emotional symptoms. Therefore, the expected outcome criteria often relate to mood improvement.

A. "Let's talk about something else because this subject is upsetting you." B. "I can see that you feel sad about this situation." C. "Crying is a way of expressing the hurt you're experiencing." D. "The loss of your parent is very painful for you."

Correct Answer is ["B","C","D"]

Explanation

A. This response invalidates the patient's feelings and avoids addressing the emotion, hindering communication.
B. Acknowledging the patient's emotion validates their feelings and encourages further discussion.
C. Validates the patient's emotional expression and offers understanding.
D. Acknowledges the depth of the patient's pain and encourages expression without judgment.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse caring for a patient prescribed a selective serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to what outcome?

Correct Answer is D

Explanation

A patient cries as the nurse explores the patient's relationship with a deceased parent. The patient says, "I shouldn't be crying like this. It happened a long time ago." Which responses by the nurse will facilitate communication? (Select all that apply.)

Correct Answer is ["B","C","D"]

Explanation

A nurse is performing an admission assessment for a client who is receiving treatment following a situational crisis. Which of the following assessments by the nurse is the highest priority?

What is the primary difference between somatic system disorders and dissociative disorders?

A charge nurse is conducting a staff education in-service about depressive disorders. Which of the following should the nurse identify as a risk factor for depression?

A nurse is caring for a client who was involved in heavy combat and observed war casualties. The nurse should suspect that the client is suffering from posttraumatic stress disorder (PTSD) if the client makes which of the following statements?

A nurse is caring for a client following a suicide attempt. The client has a history ofdepression, substance abuse, and anorexia nervosa. Which of the following actions is the nurse's priority?

Which experiences are most likely to precipitate posttraumatic stress disorder (PTSD)? (Select all that apply.)

Which statement provides the best rationale for why a nurse should closely monitor a severely depressed patient during antidepressant medication therapy?

A patient states, "I'm starting cognitive behavioral therapy. What can I expect from the sessions? Which responses by the nurse are appropriate? (Select all that apply.)