A client has just been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply.
Slumped posture
Delusional thinking
Feelings of despair
Feels best early in the morning and worse as the day progresses
Anorexia
Correct Answer : A,C,E
Major depressive disorder is a mood disorder characterized by persistent sadness, loss of interest, and neurovegetative changes. It affects emotional, cognitive, and physical functioning. Common behavioral signs include psychomotor retardation, poor posture, social withdrawal, and appetite disturbances. Clients often experience despair, hopelessness, and slowed movements. Somatic symptoms such as anorexia and fatigue are frequent, while psychotic features like delusions are less common unless the depression is severe.
Rationale for correct answers
1. A slumped posture reflects psychomotor retardation, a hallmark of major depression. It indicates diminished energy, slowed movement, and emotional withdrawal, often seen in severely depressed clients.
3. Feelings of despair are central to the emotional experience of depression. They manifest as hopelessness, helplessness, and a sense of futility, contributing to suicidal ideation and impaired functioning.
5. Anorexia is a common neurovegetative symptom in depression. It results from reduced appetite and interest in food, often leading to weight loss and nutritional deficiencies.
Rationale for incorrect answers
2. Delusional thinking is associated with psychosis, not typical major depressive disorder. It may occur in severe cases with psychotic features, but is not a standard behavioral manifestation.
4. Clients with depression often feel worse in the morning due to diurnal variation. Improvement later in the day is more typical, making this statement inconsistent with common depressive patterns.
Take Home Points
- Major depressive disorder commonly presents with psychomotor retardation, hopelessness, and appetite changes.
- Delusions are not typical unless depression is severe with psychotic features.
- Diurnal variation in depression often causes worse symptoms in the morning.
- Behavioral assessment should focus on posture, affect, and neurovegetative signs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Severe depression is a mood disorder characterized by persistent sadness, loss of interest, and impaired functioning. It affects emotional expression, cognition, and physical behavior. Affective symptoms reflect changes in mood and emotional tone. These include anhedonia, apathy, hopelessness, and feelings of worthlessness. Neurobiologically, dysregulation of serotonin, norepinephrine, and dopamine pathways contributes to affective flattening and emotional blunting. These symptoms are central to diagnosis and often precede cognitive or somatic manifestations.
Rationale for correct answer
1. Apathy reflects a diminished emotional responsiveness and lack of motivation, which are hallmark affective symptoms in major depressive disorder. It indicates a blunting of emotional tone and loss of interest in previously valued activities, consistent with affective flattening.
Rationale for incorrect answers
2. Delusion is a psychotic symptom, not affective. Somatic delusions involve false beliefs about bodily functions or health and are categorized under thought content disturbances, not mood alterations.
3. Insomnia is a physiological symptom. Difficulty falling asleep is a vegetative sign of depression, linked to circadian rhythm disruption and hyperarousal, but it does not reflect affective tone.
4. Isolation is behavioral. Social withdrawal results from decreased energy and motivation but is considered a behavioral response to affective and cognitive symptoms, not an affective symptom itself.
Take Home Points
- Affective symptoms in depression include apathy, anhedonia, and hopelessness, reflecting emotional blunting.
- Somatic delusions are psychotic features and not part of affective symptomatology.
- Sleep disturbances are vegetative signs and reflect physiological dysregulation in depression.
- Social isolation is a behavioral consequence, not a direct affective alteration.
Correct Answer is B
Explanation
Depression with psychomotor retardation often presents as withdrawal, slowed movements, and diminished verbal engagement. Clients may appear disengaged or nonresponsive, but this reflects internal suffering rather than defiance. Establishing a therapeutic alliance requires consistent presence, emotional attunement, and non-demanding interaction. Early interventions should prioritize trust-building over verbal or social engagement, especially when the client is isolating.
Rationale for correct answer
2. Making short, frequent visits and sitting quietly communicates presence without pressure. This approach respects the client’s current emotional state and initiates connection through nonverbal support. It lays the foundation for trust and future engagement by showing reliability and empathy without demanding interaction.
Rationale for incorrect answers
1. Inviting the client to group therapy prematurely may feel overwhelming and intrusive. It assumes readiness for social interaction, which contradicts her current withdrawn behavior and may increase anxiety or resistance.
3. Introducing her to other clients is premature and socially demanding. It bypasses the essential first step of building a one-on-one therapeutic relationship and may reinforce feelings of isolation if she declines.
4. Exploring stressors requires verbal engagement and insight, which the client is not currently demonstrating. This intervention is more appropriate once rapport is established and the client is emotionally ready to reflect.
Take Home Points
- Psychomotor retardation in depression requires gentle, nonverbal therapeutic engagement.
- Trust-building precedes verbal or social interventions in severely withdrawn clients.
- Avoid overwhelming clients with premature group or social activities.
- Consistent, quiet presence is a powerful tool in initiating therapeutic relationships.
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