A client is admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder. Which of the following data would the nurse expect to assess? Select all that apply.

Loss of interest in almost all activities and anhedonia

A change of more than 5% of body weight in 1 month

Fluctuation between increased energy and loss of energy

Psychomotor retardation or agitation

Insomnia or hypersomnia

Answer and Explanation

Correct Answer : A,B,D,E

Major depressive disorder is a psychiatric illness marked by persistent low mood or loss of interest, accompanied by somatic, cognitive, and behavioral symptoms that impair daily functioning and last at least two weeks.

Major depressive disorder presents with diminished interest in activities, significant weight changes, sleep disturbances, and psychomotor changes. Symptoms must be present nearly daily and cause functional impairment. Appetite and sleep may increase or decrease.

Rationale for correct answers

1. Loss of interest and anhedonia are core symptoms of depression. They reflect a diminished ability to experience pleasure and are required for diagnosis when present nearly daily for two weeks.

2. A weight change of more than 5% in one month indicates appetite dysregulation, a vegetative symptom of depression. It may manifest as weight loss or gain, independent of intentional dieting.

4. Psychomotor retardation or agitation is a behavioral marker of depression. These changes must be observable by others and reflect slowed movements or restlessness, not just subjective feelings.

5. Insomnia or hypersomnia are common neurovegetative symptoms. Sleep disturbances occur nearly daily and may alternate between difficulty sleeping and excessive sleep, contributing to fatigue and impaired functioning.

Rationale for incorrect answer

3. Fluctuating energy levels suggest bipolarity, not unipolar depression. Increased energy is more consistent with manic or hypomanic episodes, which are excluded in major depressive disorder diagnosis.

Take Home Points

Major depressive disorder requires five or more symptoms, including either depressed mood or anhedonia, lasting at least two weeks.
Psychomotor changes and sleep disturbances are observable and diagnostically significant.
Appetite and weight changes must be unintentional and clinically relevant.
Fluctuating energy levels may indicate bipolar spectrum disorders and should prompt differential evaluation.

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Correct Answer is D

Explanation

Persistent depressive disorder (formerly dysthymia) is a chronic mood disturbance characterized by a depressed mood lasting at least two years in adults. Symptoms are less severe than major depressive disorder but more enduring. Individuals often experience low energy, poor concentration, and feelings of hopelessness. The condition may coexist with major depressive episodes, known as double depression. Diagnosis requires a depressed mood most of the day, more days than not, for at least two years, along with two or more additional symptoms such as appetite changes, sleep disturbances, or low self-esteem. Duration, severity, and functional impact distinguish it from major depressive disorder.

Rationale for correct answer

4. The defining criterion for persistent depressive disorder is a depressed mood lasting at least two years in adults. This chronicity differentiates it from major depressive disorder, which requires a minimum of two weeks of symptoms. The two-year duration is essential for diagnosis and reflects the enduring nature of the disorder.

Rationale for incorrect answers

1. The risk of suicide is generally higher in major depressive disorder due to the severity of symptoms, including suicidal ideation and psychomotor retardation. Dysthymia carries a risk, but it is typically lower unless compounded by a major depressive episode.

2. Psychotic features such as delusions or hallucinations are associated with severe major depressive episodes, not dysthymia. Persistent depressive disorder does not include psychotic symptoms in its diagnostic criteria.

3. While guilt may be present in both disorders, excessive guilt is more characteristic of major depressive disorder. In dysthymia, symptoms are milder and chronic, and guilt is not a defining feature.

Take Home Points

Persistent depressive disorder requires a minimum of two years of depressed mood and associated symptoms.
Major depressive disorder is more severe and episodic, often with psychotic features and higher suicide risk.
Dysthymia may coexist with major depressive episodes, forming a condition known as double depression.
Differentiating based on duration and symptom severity is critical for accurate diagnosis and treatment planning.

A. Empathize with the client about fears regarding ECT. B. Monitor for any cardiac alterations to avoid possible negative outcomes. C. Discuss with the client and family expected short-term memory loss. D. Inform the client that injury related to induced seizure commonly occurs.

Correct Answer is C

Explanation

Electroconvulsive therapy (ECT) is a neuromodulation treatment used for severe, treatment-resistant major depressive disorder. It involves brief electrical stimulation of the brain under anesthesia to induce a controlled seizure. The most common adverse effect is short-term memory loss, which may persist for weeks. ECT is contraindicated in patients with recent myocardial infarction or unstable cardiac conditions due to transient increases in intracranial pressure and cardiovascular strain. Despite its risks, ECT remains one of the most effective interventions for severe depression, especially with psychotic features or suicidality.

Rationale for correct answer

3. Memory loss is the most frequent and expected side effect of ECT. Clients and families must be informed of transient anterograde and retrograde memory deficits.

Rationale for incorrect answers

1. Empathy is important but not a priority teaching point. Therapeutic communication supports trust but does not address physiological or procedural risks.

2. Cardiac monitoring is essential during ECT, especially for clients with known heart disease, but it is not the primary teaching focus unless cardiac risk is present.

4. Injury from induced seizure is rare due to muscle relaxants and anesthesia. Modern ECT protocols minimize physical harm, making this teaching point less relevant.

Take Home Points

ECT is indicated for severe, treatment-resistant depression, especially with suicidality or psychotic features.
Short-term memory loss is the most common adverse effect and must be discussed with clients and families.
Cardiac risks exist but are rare in healthy individuals; pre-procedure screening mitigates complications.
ECT is safe when administered under anesthesia with muscle relaxants, reducing seizure-related injury.

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A client is admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder. Which of the following data would the nurse expect to assess? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which statement describes a major difference between a client diagnosed with major depressive disorder and a client diagnosed with dysthymic disorder?

Correct Answer is D

Explanation

A client diagnosed with major depressive disorder is being considered for electroconvulsive therapy (ECT). Which client teaching should the nurse prioritize?

Correct Answer is C

Explanation

A depressed client states that her daughter uses amphetamines, then asks the nurse, “What will happen when my daughter can’t get them and goes into withdrawal from them?” Which response by the nurse would be helpful information for the client?

Which client statement is evidence of the etiology of major depressive disorder from a genetic perspective?

A newly admitted depressed client isolates herself in her room and just sits and stares into space. How best might the nurse begin an initial therapeutic relationship with this client?

A client diagnosed with major depressive disorder has an outcome that states, “The client will verbalize a measure of hope about the future by day 3.” Which client statement indicates this outcome was successful?

Which is the key to understanding if a child or adolescent is experiencing an underlying depressive disorder?

A client recently diagnosed with depression tells a nurse that she is 2 months pregnant and is reluctant to take an antidepressant medication. The client asks what other treatment options are available. Which type of therapy should a nurse recommend as an alternate treatment for depression?

A nursing student is studying major depressive disorder. Which student statement indicates that learning has occurred?

A newly admitted client diagnosed with major depressive disorder isolates self in room and stares out the window. Which nursing intervention would be the most appropriate to implement initially, when establishing a nurse-client relationship?