Medium NCLEX Depression Practice Questions

Concept Explanation

Depression in the context of NCLEX preparation refers to Major Depressive Disorder (MDD), a mood disorder characterized by persistent feelings of sadness, loss of interest (anhedonia), and physical symptoms that interfere with daily life for at least two weeks. Nurses must recognize that depression is not just a psychological state but a clinical condition involving neurotransmitter imbalances, particularly serotonin, norepinephrine, and dopamine. Effective nursing care involves prioritizing safety—specifically assessing for suicidal ideation—managing pharmacological interventions like SSRIs and SNRIs, and utilizing therapeutic communication to build rapport with patients who may be withdrawn or non-verbal. Understanding the diagnostic criteria from the DSM-5 is essential for identifying symptoms such as psychomotor retardation, sleep disturbances, and feelings of worthlessness.

Solved Examples

1. Example 1: Prioritizing Patient Safety
   A client with severe depression is admitted to the psychiatric unit. Which nursing intervention is the highest priority?
   Solution:
   1. Assess the client for a specific suicide plan and the lethality of the method.
   2. Safety is always the primary concern in mental health nursing.
   3. The nurse should use direct language: "Are you thinking of hurting yourself?"
   4. Continuous observation may be necessary if the risk is high.
2. Example 2: Pharmacological Education
   A patient is prescribed Phenelzine, a Monoamine Oxidase Inhibitor (MAOI). What dietary education is critical?
   Solution:
   1. The nurse must instruct the patient to avoid foods high in tyramine, such as aged cheeses, cured meats, and red wine.
   2. Tyramine interaction with MAOIs can lead to a hypertensive crisis.
   3. Symptoms of this crisis include severe headache, palpitations, and stiff neck.
3. Example 3: Therapeutic Communication
   A client sits in the corner of the dayroom and does not respond to the nurse's greeting. How should the nurse proceed?
   Solution:
   1. The nurse should sit quietly with the client for a brief period.
   2. This technique, known as "offering self," conveys value to the client without placing the burden of conversation on them.
   3. Short, frequent visits are more effective than one long, demanding interaction for a severely depressed patient.

Practice Questions

1. A nurse is caring for a client with Major Depressive Disorder who has started taking Fluoxetine. The nurse should monitor for which life-threatening condition associated with this medication class?
2. Which statement by a client recently diagnosed with depression indicates a need for further teaching regarding their Selective Serotonin Reuptake Inhibitor (SSRI) prescription?
3. A client with depression is being prepared for Electroconvulsive Therapy (ECT). What is the nurse's priority action immediately following the procedure?

4. A nurse is assessing a client with depression. Which finding would most likely indicate the client is experiencing psychomotor retardation?
5. A client who has been severely depressed and suicidal for several weeks suddenly appears cheerful and energetic. What is the nurse's most appropriate interpretation of this behavior?
6. A nurse is planning care for a client with depression who has poor nutritional intake. Which intervention is most appropriate?
7. A client is prescribed Amitriptyline, a Tricyclic Antidepressant (TCA). Which side effect should the nurse instruct the client to report immediately?
8. The nurse is conducting a suicide risk assessment. Which factor represents the highest risk for a completed suicide?
9. A client with depression states, "I’m a failure at everything I do. My family would be better off without me." Which response by the nurse is therapeutic?
10. A nurse is educating a client about Light Therapy for Seasonal Affective Disorder (SAD). Which instruction is correct?

Answers & Explanations

1. Serotonin Syndrome: Fluoxetine is an SSRI. Serotonin syndrome is a potentially fatal reaction characterized by mental status changes, autonomic hyperactivity (tachycardia, hyperthermia), and neuromuscular abnormalities (tremors, rigidity).
2. "I will stop the medication as soon as I feel my mood has improved.": This indicates a need for teaching because antidepressants must be tapered slowly to avoid withdrawal symptoms and should be continued for 6-12 months after remission to prevent relapse. Many students find using an AI-powered retrieval tool helpful for memorizing these medication timelines.
3. Maintaining a patent airway: Following ECT, the client is under general anesthesia and has received muscle relaxants. The priority is the ABCs (Airway, Breathing, Circulation) until the client is fully awake and stable.
4. Slowed speech and body movements: Psychomotor retardation is a visible slowing of physical reactions, speech, and movement. It is a hallmark symptom of MDD, often contrasted with psychomotor agitation seen in anxiety disorders.
5. The client may have finalized a suicide plan and feels relief: A sudden, unexplained improvement in mood in a suicidal client is a major red flag. It often suggests the person has decided to end their life and feels a sense of peace or has the energy to carry out the plan.
6. Offer small, high-calorie, high-protein snacks throughout the day: Depressed clients often lack the energy to eat large meals. Frequent, nutrient-dense snacks are more manageable and help prevent weight loss.
7. Urinary retention: TCAs have strong anticholinergic effects. While dry mouth is common, urinary retention is a serious complication that requires immediate intervention.
8. Access to a firearm and a history of previous attempts: According to the CDC, previous attempts and access to lethal means are the strongest predictors of completed suicide.
9. "You feel like you are failing and that your family would be better off?": This is a restating technique. It validates the client's feelings and encourages them to elaborate without being judgmental or offering false reassurance.
10. "Sit in front of the light box for 30 minutes shortly after waking up.": Light therapy is most effective when used in the morning to reset the circadian rhythm. Clients should not look directly at the light but stay within the prescribed distance.

Quick Quiz

Frequently Asked Questions

What is the difference between grief and Major Depressive Disorder?

Grief usually occurs in waves and is related to a specific loss, with the individual still able to experience moments of pleasure. Major Depressive Disorder is a persistent, pervasive low mood that includes feelings of worthlessness and a lack of self-esteem not typically found in uncomplicated grief.

Why are SSRIs preferred over TCAs for depression?

SSRIs are preferred because they have a much lower side-effect profile and a higher safety index. Unlike TCAs, which can be cardiotoxic in overdose, SSRIs are significantly less lethal if a patient attempts to self-harm using their medication.

What is the "Black Box Warning" on antidepressants?

The FDA requires a black box warning on all antidepressants stating that they may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults. Nurses must monitor these populations closely during the first few weeks of therapy.

How does a nurse assess for anhedonia?

A nurse assesses for anhedonia by asking the client if they still find pleasure in activities they used to enjoy, such as hobbies or spending time with family. A negative response indicates a loss of interest, which is a core symptom of depression.

Can depression manifest with physical symptoms?

Yes, many patients experience somatic symptoms such as chronic headaches, digestive issues, and vague aches and pains that do not respond to typical treatments. These physical complaints are often the primary reason a patient seeks medical care before being diagnosed with depression.

What is the role of St. John's Wort in depression treatment?

St. John's Wort is an herbal supplement sometimes used for mild depression, but it is not FDA-approved for MDD. It is dangerous when combined with prescription antidepressants because it significantly increases the risk of Serotonin Syndrome.

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