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HESI CASE STUDY: DEPRESSION| GUARANTEE SUCCESS, Exams of Medicine

Texas State UniversityMedicine

HESI CASE STUDY: DEPRESSION| GUARANTEE SUCCESS HESI CASE STUDY: DEPRESSION| GUARANTEE SUCCESS

Typology: Exams

2025/2026

Available from 04/12/2026

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HESI CASE STUDY: DEPRESSION|
GUARANTEE SUCCESS
the nurse completes a physical assessment. when asked what brought her to the
hospital, Bethany replies, "Things just aren't right" and begins to cry. After further
conversation, Bethany describes her mood as very sad now. She rarely goes out or
invites friends to visit. She admits that she feels like strangers are saying bad things
about her. Sometimes she hears a man's voice that is a little bit scary.
1. what is the priority nursing assessment? - Answer-determine how long the client has
been hearing the voice and what it is saying
(determining if voices are being heard and for how long, and what the voice is saying, is
priority. because hearing voices is a subjective experience and not measurable, directly
asking about hallucinations is necessary. the nurse should determine if the voice is
telling the client to do something, like self-harm)
Bethany is assessed by the nurse, a social worker, and the healthcare provider (HCP).
based on their assessments, hospitalization is recommended for psychotic depression.
2. which behavior is inconsistent with depression? - Answer-hearing a man's voice
(auditory hallucinations are inconsistent with depression and are more likely to occur
with psychoses. however, clients may experience a psychotic depression in which there
is evidence of psychosis)
the nurse asks Bethany to sign consent for treatment
3. if the client refuses treatment, which behaviors justify short-term involuntary
treatment? - Answer-- unable to meet basic self-care needs
(involuntary treatment can be initiated if the client is unable to meet basic self-care
needs in such way that he or she is a danger to self)
- states she has a plan to harm herself
(short-term involuntary care may be initiated to protect Bethany if she has a plan to
harm herself. it can also be initiated if she presents an intentional danger to others)
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HESI CASE STUDY: DEPRESSION|

GUARANTEE SUCCESS

the nurse completes a physical assessment. when asked what brought her to the hospital, Bethany replies, "Things just aren't right" and begins to cry. After further conversation, Bethany describes her mood as very sad now. She rarely goes out or invites friends to visit. She admits that she feels like strangers are saying bad things about her. Sometimes she hears a man's voice that is a little bit scary.

  1. what is the priority nursing assessment? - Answer -determine how long the client has been hearing the voice and what it is saying (determining if voices are being heard and for how long, and what the voice is saying, is priority. because hearing voices is a subjective experience and not measurable, directly asking about hallucinations is necessary. the nurse should determine if the voice is telling the client to do something, like self-harm) Bethany is assessed by the nurse, a social worker, and the healthcare provider (HCP). based on their assessments, hospitalization is recommended for psychotic depression.
  2. which behavior is inconsistent with depression? - Answer -hearing a man's voice (auditory hallucinations are inconsistent with depression and are more likely to occur with psychoses. however, clients may experience a psychotic depression in which there is evidence of psychosis) the nurse asks Bethany to sign consent for treatment
  3. if the client refuses treatment, which behaviors justify short-term involuntary treatment? - Answer -- unable to meet basic self-care needs (involuntary treatment can be initiated if the client is unable to meet basic self-care needs in such way that he or she is a danger to self)
  • states she has a plan to harm herself (short-term involuntary care may be initiated to protect Bethany if she has a plan to harm herself. it can also be initiated if she presents an intentional danger to others)

Bethany signs the treatment form and is admitted to the mental health unit. during the first days of hospitalization, she begins antidepressant therapy with fluoxetine (Prozac), 10mg.

  1. in what classification of drugs is the antidepressant fluoxetine (Prozac)? - Answer - selective serotonin reuptake inhibitor (SSRI) (Prozac is an SSRI antidepressant)
  2. what is the major action of SSRI antidepressants? - Answer -increase availability of serotonin (the major actions of SSRIs is to selectively inhibit the reuptake of serotonin and increase the availability of serotonin)
  3. the nurse understands that SSRIs are now more widely prescribed than tricyclics for antidepressant therapy. what is the rationale? - Answer -tricyclics are more lethal in an overdose (SSRIs are more widely prescribed than tricyclics because they have fewer side effects, and tricyclics can be lethal in an overdose because they are cardiotoxic)
  4. when the client receives fluoxetine (Prozac), the nurse must explain the purpose and when to expect therapeutic effectiveness. when should the client begin to feel less depressed? - Answer -generally within 2 to 4 weeks (in general, it takes 2 to 4 weeks for antidepressant effects to begin. however, it depends on the individual, and some clients may feel effects start as soon as 1 week or as late as 6 weeks. it is suggested that depression occurs when a depletion of neurotransmitters in the synapse cause the transmitter receptors to increase. as the antidepressants make more transmitters available, it takes the receptors several weeks to return their numbers back to normal and allow normal synaptic activity)
  5. the nurse should be aware of common side effects of SSRI antidepressants such as Prozac. which side effects commonly occur in clients who are taking SSRI antidepressants? - Answer -gastro-intestinal disturbances
  1. since the client has decreased energy, which intervention is best? - Answer -plan a scheduled rest period (it is best to plan rest periods according to the client's energy level because some clients feel best in the morning and others feel best in the evening)
  2. as the nurse initially communicates with Bethany, which communication technique is important? - Answer -acknowledge the client's courage in seeking help, then offer to sit quietly with the client (offering nonjudgemental acceptance and companionship will help develop trust. acknowledging the step the client took in seeking help may restore the client's sense of control over her situation) Bethany generally declines to participate in the daily, morning community meeting, and she refuses to get out of bed. it takes a great deal of coaxing to get her awakened for meals. she often sits and stares at her tray. according to the nursing process notes, Bethany demonstrates decreased social interaction, she rarely talks, she needs assistance to her room and appears confused. Bethany only slept 30 minutes in the past 24 hours, and the daily graphics indicate that she has slept an average of 2 hours in the past week. she is eating 50% of her meals.
  3. according to this data, what is the priority nursing problem? - Answer -sleep disturbance (considering Maslow's hierarchy, physiologic needs should be addressed first, so this is the priority problem because the client is receiving inadequate sleep. eating 50% of her meals is acceptable, provided that the client is not losing weight)
  4. since Bethany is eating 50% of her meals, which priority nursing intervention should be included on the treatment plan? - Answer -weigh weekly and document (the most objective assessment related to the client's intake is frequent weighing to document any changes in weight that should be monitored more closely) one morning, the nurse takes Bethany's vital signs and notes her blood pressure is 141/108 mmHg. the progress notes indicate this is the third incidence of a high blood pressure
  1. which consideration by the nurse is accurate? - Answer -Bethany's diet, which consists of primarily high sodium foods, could be contributing to her high blood pressure (a high sodium diet can lead to hypertension and fluid retention) the nurse reports the elevated blood pressure to the HCP, and Bethany is prescribed hydrochlorothiazide (Hydro-Chlor) 25mg daily. the nurse collaborates with the dietician about Bethany's meal plan.
  2. which dietary instruction should the nurse provide the client taking Hydro-Chlor? - Answer -decrease sodium and increased potassium (a high-protein, low-fiber diet is not the intervention for hypertension)
  3. the nurse knows that there are other risk factors for high blood pressure. which risk factor does Bethany have? - Answer -African American (african-americans are more likely than caucasians to develop high blood pressure. other risk factors include a sedentary lifestyle and alcohol consumption) one morning, the nurse is doing unit rounds and finds Bethany sitting at the edge of her bed with a sheet around her neck
  4. after removing the sheet, what is the next nursing action? - Answer -stay with Bethany (the nurse should begin constant observation immediately for safety precautions because the client is at risk for self-harm. the other interventions are important, but it is most important for a staff member to remain with the client) the nurse stays with Bethany unit another staff member arrives and safety precautions are initiated. a staff member must keep Bethany within eye sight at all times and document her activity every 15 minutes
  5. when Bethany wants to change clothes and get ready for sleep at night, what should the staff do? - Answer -stay with Bethany while she gets ready (this approach respects Bethany's privacy and also ensures she stays safe)

how she's feeling, Bethany looks down, has a delay - Answer -headache, nausea, and muscle aches may occur after the treatment ( headache, nausea, and muscle aches are common side effects. confusion and disorientation are short-term)

  1. when the nurse prepares Bethany for ECT, what should be expected? - Answer - preparation is similar to a brief surgical procedure (preparation for ECT is similar to a surgical procedure. for example, the client must remain NPO for 6 to 8 hours prior to treatment with the exception of receiving cardiac medications or antihypertensive agents. prostheses should be removed, and the client should void immediately before receiving ECT) before the first treatment, the nurse thoroughly reviews the information with Bethany and again discusses the treatment. The nurse accompanies Bethany to the treatment room and assists her onto a stretcher. an IV line is inserted, and EEG monitoring, which consists of electrodes on the forehead and mastoid, is applied. blood pressure and pulse are also monitored. Bethany must remove her shoes and socks to allow for placement of a blood pressure cuff on an ankle and observation of her extremities during the treatment. an electrical stimulus causes a brief seizure that can be observed in the foot. the seizure generally lasts 30 to 60 seconds.
  2. when Bethany awakens from the treatment, the nurse should be prepared to perform which nursing action? - Answer -take vital signs and assess orientation (the nurse should monitor orientation and vital signs unit they return to an acceptable level for a specified time according to hospital protocol) Bethany receives only five ECT treatments because she refuses the IV insertion for the remaining treatments. when asked if she could tells a difference, she Answer s, "No." after additional months of therapy with multiple antidepressant medications (both SSRIs and tricyclics), the HCP considers treatment with an MAO Inhibitor.
  3. what signs and symptoms should the nurse expect to assess if a client taking an MAO antidepressant ingests foods containing tyramine? - Answer -headache and palpitations

(explosive headache, palpitations, sudden elevation of blood pressure, chest pain, nausea, and vomiting are some of the symptoms of a hypertensive crisis related to tyramine consumption) the nurse plans to give Bethany a list of safe and unsafe foods that contain tyramine. unsafe foods have high tyramine content, and safe foods have little or no tyramine

  1. which food would be considered safe? - Answer -most fruits (most fruits are safe, expect figs, especially if overripe, and bananas in large amounts. some foods with tyramine can be used with caution) after several days of taking an MAO Inhibitor, Bethany refuses to continue taking the medication, and the medication is discontinued.
  2. which specific nursing consideration is most important? - Answer -maintain a low- tyramine or tyramine-free diet for 10 to 14 days (the client should minimize or avoid substances with tyramine for 10 to 14 days after discontinuation of the medication)