Author Question: A nurse is caring for a client with major depression. The client tells the nurse that she just isn't ... (Read 46 times)

RYAN BANYAN · **on:** Jul 19, 2018

A nurse is caring for a client with major depression. The client tells the nurse that she just isn't sure that life is worth living. The nurse documents which nursing diagnosis as the priority?

A) Self-esteem, Low, related to depressive episode
B) Hopelessness related to symptoms of depression
C) Anxiety related to lack of energy for self-care activities
D) Thought Processes, Disturbed, related to memory loss and depression

Question 2

A nurse is caring for a client in the outpatient setting who has been diagnosed with a depressive disorder. Before the client is given a prescription for a tricyclic antidepressant, assessment for which of the following would be most important?

A) Suicide
B) Hypersomnia
C) Cardiac dysrhythmias
D) Erectile dysfunction

kingfahad97 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

Ans: B
The priority nursing diagnosis is Hopelessness related to symptoms of depression. There is no evidence to suggest low self-esteem, anxiety, or disturbed thought processes.

Answer to Question 2

Ans: A
Tricyclic antidepressants (TCAs) should not be prescribed for clients at risk for suicide because lethal doses are only three to five times the therapeutic dose, and more than 1 g of a TCA is often toxic and may be fatal. Death may result from cardiac dysrhythmias, hypotension, or uncontrollable seizures. Hypersomnia may be a symptom of depression for which a client is receiving medication therapy. Assessment of cardiac dysrhythmias or erectile dysfunction would not be as important as the client's risk for suicide.