Psychiatric Nursing Exam 2 (testbank)
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1. A patient became severely depressed when the last of six children moved
out of the home 4 months ago. The patient repeatedly says, No one cares about
me. Im not worth anything. Which response by the nurse would be the most
helpful?
a. Things will look brighter soon. Everyone feels down once in a while.
b. The staff here cares about you and wants to try to help you get better.
c. It is difficult for others to care about you when you repeatedly say negative
things about yourself.
d. Ill sit with you for 10 minutes now and return for 10 minutes at lunchtime
and again at 2:30 this afternoon.: d
2. A patient became depressed after the last of six children moved out of the
home 4 months ago. The patient has been self-neglectful, slept poorly, lost
weight, and repeatedly says, No one cares about me anymore. Im not worth
anything. Select an appropriate initial outcome for the nursing diagnosis:
Situational low self-esteem, related to feelings of abandonment. The patient
will:
a. verbalize realistic positive characteristics about self by (date)
b. consent to take antidepressant medication regularly by (date)
c. initiate social interaction with another person daily by (date)
d. identify two personal behaviors that alienate others by (date).: a
3. A nurse wants to reinforce positive self-esteem for a patient diagnosed with
major depressive disorder. Today, the patient is wearing a new shirt and has
neat, clean hair. Which remark is most appropriate?
a. You look nice this morning.
b. You are wearing a new shirt.
c. I like the shirt youre wearing.
d. You must be feeling better today.: b
4. An adult diagnosed with major depressive disorder was treated with med-
ication and cognitive behavioral therapy. The patient now recognizes how
passivity contributed to the depression. Which intervention should the nurse
suggest?
a. Social skills training
b. Relaxation training classes
c. Use of complementary therapy
d. Learning desensitization techniques: a
5. A priority nursing intervention for a patient diagnosed with major depres-
sive disorder is:
a. distracting the patient from self-absorption.
b. carefully and inconspicuously observing the patient around the clock.
, Psychiatric Nursing Exam 2 (testbank)
Study online at https://quizlet.com/_919vcf
c. allowing the patient to spend long periods alone in self-reflection.
d. offering opportunities for the patient to assume a leadership role in the
therapeutic milieu.: b
6. When counseling patients diagnosed with major depressive disorder, an
advanced practice nurse will address the negative thought patterns by using:
a. psychoanalytic therapy.
b. desensitization therapy.
c. cognitive behavioral therapy.
d. alternative and complementary therapies.: c
7. A patient says to the nurse, My life does not have any happiness in it
anymore. I once enjoyed holidays, but now theyre just another day. How would
the nurse document the complaint?
a. Vegetative symptom
b. Anhedonia
c. Euphoria
d. Anergia: b
8. A patient diagnosed with major depressive disorder is taking a tricyclic
antidepressant. The patient says, I dont think I can keep taking these pills.
They make me so dizzy, especially when I stand up. The nurse should:
a. explain how to manage postural hypotension, and educate the patient that
side effects go away after several weeks.
b. tell the patient that the side effects are a minor inconvenience compared
with the feelings of depression.
c. withhold the drug, force oral fluids, and notify the health care provider to
examine the patient.
d. teach the patient how to use pursed-lip breathing.: a
9. A patient diagnosed with major depressive disorder is receiving imipramine
(Tofranil) 200 mg every night at bedtime. Which assessment finding would
prompt the nurse to collaborate with the health care provider regarding po-
tentially hazardous side effects of this drug?
a. Dry mouth
b. Blurred vision
c. Nasal congestion
d. Urinary retention: d
10. A patient diagnosed with major depressive disorder tells the nurse, Bad
things that happen are always my fault. To assist the patient in reframing this
overgeneralization, the nurse should respond:
a. I really doubt that one person can be blamed for all the bad things that
happen.
, Psychiatric Nursing Exam 2 (testbank)
Study online at https://quizlet.com/_919vcf
b. Lets look at one bad thing that happened to see if another explanation
exists.
c. You are being exceptionally hard on yourself when you say those things.
d. How does your belief in fate relate to your cultural heritage?: b
11. A nurse worked with a patient diagnosed with major depressive disorder
who was severely withdrawn and dependent on others. After 3 weeks, the
patient did not improve. The nurse is at risk for feelings of:
a. overinvolvement.
b. guilt and despair.
c. interest and pleasure.
d. ineffectiveness and frustration.: d
12. A patient diagnosed with major depressive disorder begins selective sero-
tonin reuptake inhibitor (SSRI) antidepressant therapy. Priority information
given to the patient and family should include a directive to:
a. avoid exposure to bright sunlight.
b. report increased suicidal thoughts.
c. restrict sodium intake to 1 g daily.
d. maintain a tyramine-free diet.: b
13. A nurse teaching a patient about a tyramine-restricted diet would approve
which meal?
a. Mashed potatoes, ground beef patty, corn, green beans, apple pie
b. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
c. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast
rolls: a
14. What is the focus of priority nursing interventions for the period immedi-
ately after electroconvulsive therapy treatment?
a. Supporting physiologic stability
b. Reducing disorientation and confusion
c. Monitoring pupillary responses
d. Assisting the patient to identify and test negative thoughts: a
15. A nurse provided medication education for a patient who takes phenelzine
(Nardil) for depression. Which behavior indicates effective learning? The pa-
tient:
a. monitors sodium intake and weight daily.
b. wears support stockings and elevates the legs when sitting.
c. consults the pharmacist when selecting over-the-counter medications.
d. can identify foods with high selenium content, which should be avoided.: c
, Psychiatric Nursing Exam 2 (testbank)
Study online at https://quizlet.com/_919vcf
16. A patients employment is terminated and major depressive disorder re-
sults. The patient says to the nurse, Im not worth the time you spend with me.
Im the most useless person in the world. Which nursing diagnosis applies?a.
Powerlessness
b. Defensive coping
c. Situational low self-esteem
d. Disturbed personal identity: c
17. A patient diagnosed with major depressive disorder does not interact with
others except when addressed and then only in monosyllables. The nurse
wants to show nonjudgmental acceptance and support for the patient. Select
the nurses most effective approach to communication.
a. Make observations.
b. Ask the patient direct questions.
c. Phrase questions to require yes or no answers.
d. Frequently reassure the patient to reduce guilt feelings.: a
18. A patient being treated for major depressive disorder has taken 300 mg
amitriptyline (Elavil) daily for a year. The patient calls the case manager at
the clinic and says, I stopped taking my antidepressant 2 days ago. Now I
am having cold sweats, nausea, a rapid heartbeat, and nightmares. The nurse
should advise the patient:
a. Go to the nearest emergency department immediately.
b. Do not to be alarmed. Take two aspirin and drink plenty of fluids.
c. Take one dose of the antidepressant. Come to the clinic to see the health
care provider.
d. Resume taking the antidepressant for 2 more weeks, and then discontinue
it again.: c
19. Which documentation indicates the treatment plan of a patient diagnosed
with major depressive disorder was effective?
a. Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing
grandchild.
b. Slept 10 hours uninterrupted. Attended craft group; stated project was a
failure, just like me.
c. Slept 5 hours with brief interruptions. Personal hygiene adequate with
assistance. Weight loss of 1 pound.
d. Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies.
States, I feel tired all the time.: a
20. A woman gave birth to a healthy newborn 1 month ago. The patient now
reports she cannot cope and is unable to sleep or eat. She says, I feel like a
failure. This baby is the root of my problems. The priority nursing diagnosis is:
Study online at https://quizlet.com/_919vcf
1. A patient became severely depressed when the last of six children moved
out of the home 4 months ago. The patient repeatedly says, No one cares about
me. Im not worth anything. Which response by the nurse would be the most
helpful?
a. Things will look brighter soon. Everyone feels down once in a while.
b. The staff here cares about you and wants to try to help you get better.
c. It is difficult for others to care about you when you repeatedly say negative
things about yourself.
d. Ill sit with you for 10 minutes now and return for 10 minutes at lunchtime
and again at 2:30 this afternoon.: d
2. A patient became depressed after the last of six children moved out of the
home 4 months ago. The patient has been self-neglectful, slept poorly, lost
weight, and repeatedly says, No one cares about me anymore. Im not worth
anything. Select an appropriate initial outcome for the nursing diagnosis:
Situational low self-esteem, related to feelings of abandonment. The patient
will:
a. verbalize realistic positive characteristics about self by (date)
b. consent to take antidepressant medication regularly by (date)
c. initiate social interaction with another person daily by (date)
d. identify two personal behaviors that alienate others by (date).: a
3. A nurse wants to reinforce positive self-esteem for a patient diagnosed with
major depressive disorder. Today, the patient is wearing a new shirt and has
neat, clean hair. Which remark is most appropriate?
a. You look nice this morning.
b. You are wearing a new shirt.
c. I like the shirt youre wearing.
d. You must be feeling better today.: b
4. An adult diagnosed with major depressive disorder was treated with med-
ication and cognitive behavioral therapy. The patient now recognizes how
passivity contributed to the depression. Which intervention should the nurse
suggest?
a. Social skills training
b. Relaxation training classes
c. Use of complementary therapy
d. Learning desensitization techniques: a
5. A priority nursing intervention for a patient diagnosed with major depres-
sive disorder is:
a. distracting the patient from self-absorption.
b. carefully and inconspicuously observing the patient around the clock.
, Psychiatric Nursing Exam 2 (testbank)
Study online at https://quizlet.com/_919vcf
c. allowing the patient to spend long periods alone in self-reflection.
d. offering opportunities for the patient to assume a leadership role in the
therapeutic milieu.: b
6. When counseling patients diagnosed with major depressive disorder, an
advanced practice nurse will address the negative thought patterns by using:
a. psychoanalytic therapy.
b. desensitization therapy.
c. cognitive behavioral therapy.
d. alternative and complementary therapies.: c
7. A patient says to the nurse, My life does not have any happiness in it
anymore. I once enjoyed holidays, but now theyre just another day. How would
the nurse document the complaint?
a. Vegetative symptom
b. Anhedonia
c. Euphoria
d. Anergia: b
8. A patient diagnosed with major depressive disorder is taking a tricyclic
antidepressant. The patient says, I dont think I can keep taking these pills.
They make me so dizzy, especially when I stand up. The nurse should:
a. explain how to manage postural hypotension, and educate the patient that
side effects go away after several weeks.
b. tell the patient that the side effects are a minor inconvenience compared
with the feelings of depression.
c. withhold the drug, force oral fluids, and notify the health care provider to
examine the patient.
d. teach the patient how to use pursed-lip breathing.: a
9. A patient diagnosed with major depressive disorder is receiving imipramine
(Tofranil) 200 mg every night at bedtime. Which assessment finding would
prompt the nurse to collaborate with the health care provider regarding po-
tentially hazardous side effects of this drug?
a. Dry mouth
b. Blurred vision
c. Nasal congestion
d. Urinary retention: d
10. A patient diagnosed with major depressive disorder tells the nurse, Bad
things that happen are always my fault. To assist the patient in reframing this
overgeneralization, the nurse should respond:
a. I really doubt that one person can be blamed for all the bad things that
happen.
, Psychiatric Nursing Exam 2 (testbank)
Study online at https://quizlet.com/_919vcf
b. Lets look at one bad thing that happened to see if another explanation
exists.
c. You are being exceptionally hard on yourself when you say those things.
d. How does your belief in fate relate to your cultural heritage?: b
11. A nurse worked with a patient diagnosed with major depressive disorder
who was severely withdrawn and dependent on others. After 3 weeks, the
patient did not improve. The nurse is at risk for feelings of:
a. overinvolvement.
b. guilt and despair.
c. interest and pleasure.
d. ineffectiveness and frustration.: d
12. A patient diagnosed with major depressive disorder begins selective sero-
tonin reuptake inhibitor (SSRI) antidepressant therapy. Priority information
given to the patient and family should include a directive to:
a. avoid exposure to bright sunlight.
b. report increased suicidal thoughts.
c. restrict sodium intake to 1 g daily.
d. maintain a tyramine-free diet.: b
13. A nurse teaching a patient about a tyramine-restricted diet would approve
which meal?
a. Mashed potatoes, ground beef patty, corn, green beans, apple pie
b. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
c. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast
rolls: a
14. What is the focus of priority nursing interventions for the period immedi-
ately after electroconvulsive therapy treatment?
a. Supporting physiologic stability
b. Reducing disorientation and confusion
c. Monitoring pupillary responses
d. Assisting the patient to identify and test negative thoughts: a
15. A nurse provided medication education for a patient who takes phenelzine
(Nardil) for depression. Which behavior indicates effective learning? The pa-
tient:
a. monitors sodium intake and weight daily.
b. wears support stockings and elevates the legs when sitting.
c. consults the pharmacist when selecting over-the-counter medications.
d. can identify foods with high selenium content, which should be avoided.: c
, Psychiatric Nursing Exam 2 (testbank)
Study online at https://quizlet.com/_919vcf
16. A patients employment is terminated and major depressive disorder re-
sults. The patient says to the nurse, Im not worth the time you spend with me.
Im the most useless person in the world. Which nursing diagnosis applies?a.
Powerlessness
b. Defensive coping
c. Situational low self-esteem
d. Disturbed personal identity: c
17. A patient diagnosed with major depressive disorder does not interact with
others except when addressed and then only in monosyllables. The nurse
wants to show nonjudgmental acceptance and support for the patient. Select
the nurses most effective approach to communication.
a. Make observations.
b. Ask the patient direct questions.
c. Phrase questions to require yes or no answers.
d. Frequently reassure the patient to reduce guilt feelings.: a
18. A patient being treated for major depressive disorder has taken 300 mg
amitriptyline (Elavil) daily for a year. The patient calls the case manager at
the clinic and says, I stopped taking my antidepressant 2 days ago. Now I
am having cold sweats, nausea, a rapid heartbeat, and nightmares. The nurse
should advise the patient:
a. Go to the nearest emergency department immediately.
b. Do not to be alarmed. Take two aspirin and drink plenty of fluids.
c. Take one dose of the antidepressant. Come to the clinic to see the health
care provider.
d. Resume taking the antidepressant for 2 more weeks, and then discontinue
it again.: c
19. Which documentation indicates the treatment plan of a patient diagnosed
with major depressive disorder was effective?
a. Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing
grandchild.
b. Slept 10 hours uninterrupted. Attended craft group; stated project was a
failure, just like me.
c. Slept 5 hours with brief interruptions. Personal hygiene adequate with
assistance. Weight loss of 1 pound.
d. Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies.
States, I feel tired all the time.: a
20. A woman gave birth to a healthy newborn 1 month ago. The patient now
reports she cannot cope and is unable to sleep or eat. She says, I feel like a
failure. This baby is the root of my problems. The priority nursing diagnosis is:
