Author Question: A patient's employment is terminated and major depression results. The patient says to the nurse, ... (Read 31 times)

joblessjake · **on:** Jul 19, 2018

A patient's employment is terminated and major depression results. The patient says to the nurse, I'm not worth the time you spend with me. I'm 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

Question 2

A nurse provided medication education for a patient who takes phenelzine (Nardil) for depression. Which behavior indicates effective learning? The patient:

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.

mathjasmine · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

ANS: C
The patient's statements express feelings of worthlessness and most clearly relate to the nursing diagnosis of Situational low self-esteem. Insufficient information exists to lead to other diagnoses.

Answer to Question 2

ANS: C
Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.