Major Depressive Disorder and Patient Essay

Please complete the following: 1. Select correct answer 2. Provide rationale 3. If you complete all successfully, all points will be awarded. 4. Total points: 34 1pt for correct answer, 1 pt for rationale 1. Select the example of tort. a. The primary nurse does not complete the plan of care for a patient within 24 hours of the patient’s admission. b. An advanced practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized. c. A patient’s admission status is changed from involuntary to voluntary after the patient’s hallucinations subside. d. A nurse gives a PRN dose of an antipsychotic drug to a patient to prevent violent acting out because the unit is short staffed. Rationale: 2. A patient states, â€Å"I’m tired of all these therapy sessions. It’s just too much for me.† Using supportive confrontation, the nurse should reply: a. â€Å"It will get better if you just keep trying.† b. â€Å"You are doing fine. Don’t be so hard on yourself.† c. â€Å"Tell me more about how the therapy sessions are too much.† d. â€Å"I know you find this difficult, but I believe you can get through it.† Rationale: 3. What is the best analysis of this interaction? Patient: I get discouraged when I realize I’ve been struggling with my problems for over a year. Nurse: Yes you have, but many people take even longer to resolve their issues. You shouldn’t be so hard on yourself. a. The nurse has responded ineffectively to the patient’s concerns. b. The patient is expressing lack of willingness to collaborate with the nurse. c. The patient is offering the opportunity for the nurse to revise the plan of care. d. The nurse is using techniques that are consistent with the evaluation step of the nursing process. Rationale: 4. A patient with schizophrenia says to the nurse, â€Å"I feel really close to you. You’re the only true friend I have.† Select the nurse’s most therapeutic response. a. â€Å"We are not friends. Our relationship is a professional one.† b. â€Å"I feel sure there are other friends in your life. Can you name some?† c. â€Å"I am glad you trust me. Trust is important for the work we are doing together.† d. â€Å"Our relationship is professional, but let’s explores ways to strengthen friendships in your life.† Rationale: 5. As a patient and nurse move into the working stage of a therapeutic relationship, the nurse’s most beneficial statement is: a. â€Å"I want to be helpful to you as we explore your problems and the way you express feelings.† b. â€Å"A good long-term goal for someone your age would be to develop better job-related skills.† c. â€Å"Of the problems we have discussed so far, which ones would you most like to work on?† d. â€Å"When someone gives you a compliment, I notice that you become very quiet.† Rationale: 6. Complete this goal statement for a newly admitted patient. â€Å"By the end of the orientation stage of the therapeutic relationship, the patient will demonstrate: a. Greater independence.† b. Increased self-responsibility.† c. Trust and rapport with two staff.† d. Ability to problem-solve one issue.† Rationale: 7. A patient with a history of self-mutilation says to the nurse, â€Å"I want to stop hurting myself.† What is the initial step of the problem-solving process to be taken toward resolution of a patient’s identified problem? a. Deciding on a plan of action b. Determining necessary changes c. Considering alternative behaviors d. Describing the problem or situation Rationale: 8. A patient says, â€Å"I went out drinking only one time last week. At least I’m trying to change.† The nurse responds, â€Å"I appreciate your effort, but you agreed to abstain from alcohol completely.† The nurse is: a. Using cognitive restructuring. b. Preventing manipulation. c. Showing empathy. d. Using flooding. Rationale: 9. A nurse and patient who developed a therapeutic relationship enter the termination phase. An important nursing intervention for this stage is for the nurse to: a. Provide structure and intensive support. b. Inform the patient of the progress made. c. Encourage the patient to describe goals for change. d. Discuss feelings about termination with the patient. Rationale: 10.Which patient behavior would require the most immediate limit setting? a. The patient makes self-deprecating remarks. b. At a goal-setting meeting, the patient interrupts others to express delusions. c. During dinner, a patient manipulates an older adult patient to obtain a second dessert. d. A patient shouts at a roommate, â€Å"You are perverted! You watched me undress.† Rationale: 11.A patient playing pool with another patient throws down the pool cue and begins swearing. The nurse should initially intervene by: a. Asking other patients to leave the room. b. Calling for assistance to restrain the patient. c. Suggesting a time-out in the patient’s room. d. Restating rules of the milieu related to swearing. Rationale: 12.A nurse says, â€Å"What step would you like to take next to resolve this issue?† The patient stands up and shouts, â€Å"You are so controlling! You want me to do everything your way.† What is the likely basis of the patient’s behavior? a. Projection b. Dissociation c. Transference d. Emotional catharsis Rationale: 13.A patient with suicidal ideation is hospitalized. What is the priority intervention? a. Negotiating a no-harm contract. b. Facilitating attendance at groups. c. Administering a psychotropic drug. d. Determining the precipitating situation. Rationale: 14.Following the admission interview, a spouse of a patient asks the nurse, â€Å"Why did you ask my partner all those questions? Some of them had nothing to do with current problems.† The nurse’s best response is, â€Å"Those questions help us understand: a. The patient’s current status.† b. The complete family history.† c. The patient’s past experiences.† d. What the patient prognosis will be?† Rationale: 15.After breakfast, a depressed patient pleads with the nurse, â€Å"Please let me go to my room to lie down for a while.† The nurse should: a. Explain that the patient must attend scheduled activities. b. Bargain with the patient to attend the next activity, then rest. c. Rearrange the patient’s schedule to accommodate the request. d. Explain that the team will be displeased if the schedule is not followed. Rationale: 16.When communicating with a withdrawn, depressed patient who speaks slowly and in monosyllables, the nurse should: a. Be as cheerful as possible. b. Use simple, direct sentences. c. Use silence while assisting the patient. d. Frequently encourage the patient to elaborate. Rationale: 17.Which topics should be included by the nurse preparing psychoeducational groups for patients with major depressive disorder and their families? Select all that apply. 1. Flight of ideas 2. Changes in weight and sleep 3. Feelings of importance or elation 4. Psychomotor retardation or agitation 5. Inability to concentrate or make decisions a.1,2,3 b.2,3,4 c.2,4,5 d. 1,2,3,4,5 Rationale: