24. A disheveled patient in the acute phase of major depressive disorder is withdrawn, has psychomotor retardation, and has not showered for several days. The nurse will a. bring up the issue at the community meeting.b. calmly tell the patient, “You must bathe daily.”c. make observations about the patient’s poor personal hygiene.d. firmly and neutrally assist the patient with showering.ANS: D When patients are unable to perform self-care activities, staff must assist them rather than ignore the issue. Better grooming increases self-esteem. The patient needs assistance, not simply making an observation. Calmly telling the patient to bathe daily and bringing up the issue at a community meeting are punitive.PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 14-53 (Table 14-2), 58 (Table 14-5) | Page 14-16 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance25. A patient diagnosed with major depressive disorder began taking escitalopram 5 days ago. The patient now says, “This medicine isn’t working.” The nurse’s best intervention would be to NURSINGTB.COMVARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK
NURSINGTB.COMEscitalopram is an SSRI antidepressant. One to three weeks of treatment is usually necessary before symptom relief occurs. This information is important to share with patients.PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 14-32, 60 (Table 14-6) | Page 14-72 (Box 14-4) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity26. A patient is experiencing psychomotor agitation associated with major depressive disorder. Which observation would the nurse associate with this symptom? The patient Psychomotor agitation may be evidenced by constant pacing and wringing of hands. Slowed movements and responses are aspects of psychomotor retardation. Complaints of the unusual skin sensations may represent a delusion or hallucination. Asking the nurse to repeat instructions indicates difficulty with concentration.PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 14-8, 16 (Case Study and Nursing Care Plan), 21 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
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