NCLEX Depression Practice Questions with Answers

Preparing for the NCLEX requires a deep understanding of mental health, specifically how to manage patients with major depressive disorder. NCLEX Depression questions often focus on patient safety, therapeutic communication, and pharmacological interventions like SSRIs or MAOIs. Nurses must be able to identify the risk of self-harm while providing a supportive environment that encourages social interaction and self-care. This guide provides the essential knowledge and practice needed to master this critical portion of the psychiatric-mental health nursing exam.

Concept Explanation

Depression is a mood disorder characterized by persistent feelings of sadness, loss of interest (anhedonia), and physical symptoms that interfere with daily functioning. In the context of the NCLEX, depression is viewed through the lens of safety and the nursing process. The primary concern is always the risk of suicide, particularly when a patient begins to feel better and gains the energy to carry out a plan. Nurses must also be familiar with the DSM-5 criteria for Major Depressive Disorder, which include sleep disturbances, appetite changes, and feelings of worthlessness.

Interventions for depression range from milieu therapy to complex medication management. When studying, it is helpful to compare these concepts with other body systems, such as how neurological changes affect mood, which you can explore in our Hard NCLEX Neurology Practice Questions. Key nursing responsibilities include:

• Safety Assessment: Performing frequent suicide risk assessments and implementing 1:1 observation if necessary.
• Pharmacology: Monitoring for side effects of Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclic Antidepressants (TCAs), and Monoamine Oxidase Inhibitors (MAOIs), including the dreaded hypertensive crisis.
• Therapeutic Communication: Using silence and open-ended questions to allow the patient to express feelings without feeling pressured.
• Physical Needs: Assisting with hygiene, nutrition, and sleep hygiene as the patient may lack the motivation for basic self-care.

Understanding the interplay between physical health and mental health is vital. For instance, endocrine imbalances can often mimic depressive symptoms, a topic covered in our Medium NCLEX Endocrine Practice Questions. By mastering these connections, you can approach NCLEX Depression questions with clinical confidence.

Solved Examples

1. Scenario: A patient with major depression says, "I don't see the point in anything anymore. Everyone would be better off without me." What is the nurse's priority action?
   Solution:
   1. Identify the statement as a potential suicidal ideation.
   2. Ask a direct, clarifying question: "Are you thinking about hurting or killing yourself?"
   3. Assess for a specific plan and the lethality of the method.
   4. The priority is always safety and direct assessment of self-harm.
2. Scenario: A patient is prescribed Phenelzine (an MAOI). The nurse provides dietary teaching. Which food choice by the patient indicates an understanding of the teaching?
   Solution:
   1. Recognize that MAOIs require a low-tyramine diet to prevent hypertensive crisis.
   2. Exclude high-tyramine foods: aged cheeses, cured meats, red wine, and overripe bananas.
   3. Select a safe option: Fresh grilled chicken with steamed broccoli.
   4. Confirm the patient knows to avoid fermented or aged products.
3. Scenario: A severely depressed patient has not bathed in three days and stays in bed all day. How should the nurse approach hygiene?
   Solution:
   1. Understand that the patient has low energy and low self-esteem.
   2. Avoid asking "Do you want to bathe?" (which allows a "No" response).
   3. Use a firm, kind, and directive approach: "I have your towels ready. I will help you to the shower now."
   4. Provide step-by-step assistance to reduce the cognitive load on the patient.

Practice Questions

1. A nurse is caring for a client who was admitted with major depressive disorder and started on Fluoxetine 20 mg daily. Which assessment finding is the most significant priority to report to the provider within the first two weeks of treatment?

2. A client diagnosed with depression is sitting alone in the dayroom staring out the window. Which nursing intervention is most appropriate for this client?

3. A client is scheduled for Electroconvulsive Therapy (ECT). Which pre-procedure action is mandatory for the nurse to complete?

4. A nurse is teaching a client about Amitriptyline. Which common side effect should the nurse include in the teaching? (Select all that apply)

5. The nurse is assessing a client with depression who has been taking Selegiline. The client reports a severe headache, nausea, and a stiff neck. What is the nurse's first action?

6. A nurse is evaluating a client's risk for suicide. Which factor is considered the highest risk for a completed suicide attempt?

7. A client with depression states, "I am a failure at everything I do. I couldn't even keep my job." Which response by the nurse uses cognitive-behavioral techniques?

8. A nurse is planning care for a client with psychomotor retardation. Which intervention should be included in the plan of care?

9. A client with depression is being discharged. Which statement by the family indicates a need for further teaching regarding the client's recovery?

10. During a group therapy session, a depressed client remains silent and downcast. How should the nurse leader facilitate the client's participation?

Answers & Explanations

1. Answer: Increased energy or sudden improvement in mood.
   Explanation: When patients start antidepressants, their energy often improves before their mood does. This gives them the physical ability to carry out a suicide plan they previously lacked the energy to execute. This is a high-risk period that requires close monitoring.
2. Answer: Sitting quietly with the client for a brief period.
   Explanation: For a severely depressed client, "offering self" by sitting in silence conveys worth and support without making demands on the client’s limited energy or communication abilities.
3. Answer: Ensuring informed consent is signed and the client has been NPO.
   Explanation: ECT requires general anesthesia and a muscle relaxant. Therefore, the nurse must ensure the client has been NPO to prevent aspiration and that legal informed consent is obtained. You can find more on procedural safety in our Hard NCLEX Patient Safety Practice Questions.
4. Answer: Dry mouth, blurred vision, urinary retention, and constipation.
   Explanation: Amitriptyline is a Tricyclic Antidepressant (TCA) with significant anticholinergic side effects. Patients should be taught to increase fluid intake and use sugarless gum for dry mouth.
5. Answer: Check the client's blood pressure.
   Explanation: Selegiline is an MAOI. Headache, nausea, and neck stiffness are signs of a hypertensive crisis, often caused by ingesting tyramine. Assessment of blood pressure is the immediate priority.
6. Answer: A previous suicide attempt.
   Explanation: Statistically, the single best predictor of a completed suicide is a history of previous attempts. Other factors include access to lethal means and a specific plan.
7. Answer: "Can you tell me about a time when you were successful at a task?"
   Explanation: Cognitive-behavioral therapy (CBT) focuses on identifying and challenging negative thought patterns. By asking for a counter-example, the nurse helps the client reframe the "all-or-nothing" thinking of being a "failure."
8. Answer: Allowing extra time for the client to complete activities of daily living (ADLs).
   Explanation: Psychomotor retardation involves a slowing of physical and mental processes. The nurse must provide a structured schedule but allow the client plenty of time to avoid frustration and pressure.
9. Answer: "We will know he is better when he stops taking his medication."
   Explanation: Depression is often a chronic condition requiring long-term medication adherence. Stopping medication abruptly can lead to relapse or withdrawal symptoms. Education should emphasize that medication is not a "quick fix."
10. Answer: Addressing the client directly with a simple, non-threatening observation.
    Explanation: Statements like "I notice you are very quiet today" acknowledge the client's presence without forcing them to speak or perform, which can reduce social anxiety in a group setting.

Quick Quiz

Frequently Asked Questions

What is the priority nursing diagnosis for a patient with severe depression?

The priority nursing diagnosis is Risk for Suicide or Risk for Self-Directed Violence. Ensuring the patient's physical safety takes precedence over all other psychological or physiological needs during the acute phase of depression.

Why is there an increased risk of suicide after starting antidepressants?

Antidepressants often improve a patient's physical energy and motivation before they improve the patient's mood. This "window" provides the energy necessary to act on suicidal thoughts that the patient previously felt too lethargic to carry out.

What are the symptoms of Serotonin Syndrome?

Serotonin Syndrome is a life-threatening condition characterized by mental status changes (agitation, confusion), autonomic hyperactivity (fever, tachycardia, diaphoresis), and neuromuscular abnormalities (tremors, hyperreflexia). It often occurs when multiple serotonergic drugs are combined.

What is the role of the nurse during Electroconvulsive Therapy (ECT)?

The nurse is responsible for maintaining the airway, monitoring vital signs, and ensuring safety during the post-ictal phase when the patient may be confused or agitated. The nurse also provides education to alleviate the patient's anxiety about the procedure.

How can a nurse distinguish between grief and major depression?

Grief is typically associated with a specific loss and occurs in waves, where the individual can still experience moments of pleasure. Major depression is more persistent, often involves feelings of worthlessness or self-loathing, and is not always tied to a clear external trigger.

What is psychomotor agitation in depression?

Psychomotor agitation refers to excessive motor activity associated with a feeling of inner tension, such as pacing, wringing hands, or the inability to sit still. It is the opposite of psychomotor retardation and can be a sign of severe distress in depressed patients.

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