A client admitted with major depressive disorder has a nursing diagnosis of ineffective sleep pattern related to aches and pains. Which is an appropriate short-term outcome for this client?
The client will express feeling rested on awakening.
The client will rate pain level at or below a 4/10.
The client will sleep 6 to 8 hours at night by day 5.
The client will maintain a steady sleep pattern while hospitalized.
The Correct Answer is C
Sleep disturbance in depression is a core symptom, often presenting as insomnia or hypersomnia. In clients with major depressive disorder, sleep disruption is frequently exacerbated by somatic pain, which interferes with sleep initiation and maintenance. The goal of nursing care is to restore restorative sleep patterns through behavioral, pharmacologic, and environmental interventions. Sleep quality directly influences mood regulation, cognitive function, and pain perception. Short-term goals must be measurable, time-bound, and focused on functional improvement.
Rationale for correct answer
3. A goal of sleeping 6 to 8 hours by day 5 is measurable and time-specific, aligning with short-term outcome criteria. It reflects a realistic target for sleep restoration in clients with depression and pain, allowing evaluation of nursing interventions and adjustment of care plans.
Rationale for incorrect answers
1. Rested is a subjective term and lacks measurable criteria. While feeling rested is desirable, it cannot be objectively evaluated or tracked over time, making it unsuitable for short-term outcome documentation.
2. Pain rating addresses the physical symptom but not the sleep pattern directly. Although pain management is essential, this outcome does not reflect improvement in sleep behavior, which is the focus of the nursing diagnosis.
4. Steady sleep pattern is vague and lacks a defined timeframe or quantifiable metric. Without specifying duration or quality, it cannot be reliably assessed or used to guide care.
Take Home Points
- Sleep goals in depression should be specific, measurable, and time-bound to evaluate progress.
- Pain management supports sleep but must be linked to sleep outcomes for relevance.
- Subjective feelings like “rested” are not reliable indicators for nursing outcomes.
- Vague terms like “steady” lack the precision needed for short-term goal setting.
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Related Questions
Correct Answer is D
Explanation
Cognitive behavioral therapy (CBT) is a structured, evidence-based psychotherapeutic approach that targets maladaptive thoughts, emotional distress, and behavioral patterns. It is especially effective in treating depression, including during pregnancy, where pharmacologic options may be limited due to fetal safety concerns. CBT helps clients identify and reframe negative thought processes, develop coping strategies, and improve mood through behavioral activation and cognitive restructuring.
Rationale for correct answer
4. CBT is the most widely recommended nonpharmacologic treatment for depression in pregnancy. It is safe, effective, and adaptable to individual needs. CBT addresses distorted thinking and promotes behavioral engagement, making it ideal for clients who are reluctant to use medications during gestation.
Rationale for incorrect answers
1. Client-centered therapy emphasizes unconditional positive regard and empathy but lacks the structured cognitive and behavioral techniques necessary for targeted depression treatment. It may support emotional expression but is less effective in modifying depressive thought patterns.
2. Gestalt therapy focuses on awareness and present-moment experience, often using experiential techniques. It is not first-line for depression and lacks the empirical support and structured framework that CBT provides, especially in perinatal populations.
3. Therapeutic touch therapy is based on energy field manipulation and lacks robust scientific validation. It is not considered an evidence-based intervention for depression and should not be recommended as a primary treatment modality.
Take Home Points
- CBT is the most effective and evidence-based nonpharmacologic therapy for depression during pregnancy.
- It targets cognitive distortions and promotes behavioral activation, improving mood and functioning.
- Other therapies may offer emotional support but lack the structured approach and empirical backing of CBT.
- Safety and efficacy are critical when selecting treatments for pregnant clients with mood disorders.
Correct Answer is C
Explanation
Hopefulness in depression reflects a shift from passive despair to active engagement with future possibilities. Major depressive disorder impairs motivation, cognition, and affect, often leading to hopelessness and withdrawal. A sign of improvement is when the client begins to express future-oriented thinking, problem-solving, or plans that imply belief in change. Statements that show initiative, intention, or desire to resolve issues signal emerging hope and therapeutic progress.
Rationale for correct answer
3. Future planning is evident in the client’s intent to address workplace conflict. This shows restored motivation and belief in personal agency, aligning directly with the outcome of verbalizing hope.
Rationale for incorrect answers
1. Despair is still present. Avoiding suicide due to guilt or concern for others does not reflect internal hope or future engagement.
2. Activity participation is positive but nonspecific. It reflects behavioral activation, not necessarily hope about the future or resolution of internal distress.
4. Gratitude is interpersonal and reflective, not future-oriented. It does not indicate the client’s outlook or plans beyond the present moment.
Take Home Points
- Hope in depression is marked by future-oriented statements and problem-solving intentions.
- Behavioral activation alone does not confirm hope unless tied to future goals.
- Avoidance of suicide due to guilt or external pressure is not equivalent to internal hope.
- Therapeutic progress includes both emotional recovery and cognitive re-engagement with life plans.
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