Major depressive disorder resulted after a patient's employment was terminated. The patient now says to the nurse, 'I'm not worth the time you spend with me. I am the most useless person in the world.' Which nursing diagnosis applies?

Correct Answer: C

Rationale: The correct nursing diagnosis is C: Situational low self-esteem. This is because the patient's negative self-perception and feelings of worthlessness are directly related to the situational trigger of losing their job. This diagnosis captures the temporary nature of the self-esteem issue. A: Powerlessness does not fully capture the patient's self-esteem issues. B: Defensive coping is not the most appropriate diagnosis as the patient is not exhibiting defensive behaviors. D: Disturbed personal identity is not the best fit as the patient's issue is more focused on self-worth rather than identity confusion or alteration.

Correct Answer: D

Rationale: The correct answer is D because the patient is in the acute phase of major depressive disorder, showing withdrawal and psychomotor retardation. Approach with empathy and understanding is crucial. Bringing up the issue at a community meeting (A) may embarrass the patient. Telling the patient to bathe daily (B) may come off as insensitive. Making observations (C) may not lead to action. Assisting the patient with showering in a firm and neutral manner (D) is the most appropriate as it shows empathy, respect, and provides practical support.

Correct Answer: B

Rationale: The correct answer is B: hypertensive crisis. MAO inhibitors can cause a buildup of tyramine in the body, leading to a sudden increase in blood pressure, potentially resulting in a hypertensive crisis. This is due to the interaction of tyramine with the medication inhibiting MAO. Other choices are incorrect because they do not directly relate to the interaction between MAO inhibitors and tyramine. The risk of hypotensive shock (choice A) is not associated with MAO inhibitors. Cardiac dysrhythmia (choice C) and cardiogenic shock (choice D) are not typically caused by the interaction of MAO inhibitors with certain foods and drugs.

Correct Answer: D

Rationale: The correct answer is D, a residential program. This option is the most appropriate for a patient with antisocial personality disorder and recurring substance abuse issues because it offers a structured and intensive environment for long-term treatment and monitoring. The patient can benefit from 24/7 supervision, therapy, and support to address underlying issues contributing to relapse. In contrast, A (1-week detox) is too short and doesn't address underlying psychological factors. B (outpatient therapy) may not provide enough support and monitoring for this patient. C (12-step program) can be helpful but may not offer the level of structure and supervision needed for someone with antisocial personality disorder. Therefore, D is the best choice for this specific case.

Correct Answer: D

Rationale: The correct answer is D because injecting heroin typically leads to drowsiness, constricted pupils, and slurred speech due to its depressant effects on the central nervous system. Heroin acts as a sedative, causing drowsiness and slowing down brain function. Constricted pupils, known as pinpoint pupils, are a common physical sign of heroin use. Slurred speech may occur due to the drug's impact on coordination and muscle control. Choices A, B, and C are incorrect: A: Anxiety, restlessness, paranoid delusions are more commonly associated with stimulant drugs like cocaine or amphetamines. B: Muscle aching, dilated pupils, tachycardia are more indicative of stimulant drug use rather than heroin. C: Heightened sexuality, insomnia, euphoria are effects more commonly seen with stimulant drugs or hallucinogens, not heroin.