A client whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse, “I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way.” What is an appropriate response by the nurse?

“Yes, he should have stopped smoking. Then he probably wouldn’t have gotten lung cancer.”

“I can understand how you must feel.”

“Those feelings are a normal part of the grief response.”

“Just think about the good times that you had while he was alive.”

Answer and Explanation

The Correct Answer is C

Grief response is a multifaceted emotional and psychological process that follows significant loss. It includes stages such as denial, anger, bargaining, depression, and acceptance. In individuals with major depressive disorder, grief may be complicated by persistent sadness, guilt, and hopelessness. Recognizing that anger and guilt are normal reactions within the grieving process helps validate the client’s experience and supports emotional healing.

Rationale for correct answer

3. This response normalizes the client’s emotional experience and provides validation without judgment. It reflects an understanding of the grief process and helps the client feel supported in expressing complex emotions like anger and guilt, which are common in bereavement and do not indicate pathology.

Rationale for incorrect answers

1. This statement reinforces blame, which can intensify guilt and hinder emotional processing. It lacks therapeutic value and may escalate the client’s distress by focusing on preventability rather than acceptance.

2. While empathetic, this response is vague and does not provide the client with insight or reassurance about the normalcy of her feelings. It misses the opportunity to educate and support emotional integration.

4. This response encourages avoidance of current emotions by redirecting focus to positive memories. It may invalidate the client’s present feelings and discourage open expression of grief-related anger and guilt.

Take Home Points

Grief involves a range of emotions including anger, guilt, and sadness, which are normal and should be validated.
Therapeutic communication in grief care must normalize emotional responses and support expression.
Avoid statements that reinforce blame or redirect away from the client’s current emotional state.
Major depressive disorder can complicate grief, requiring sensitive and structured emotional support.

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Correct Answer is A

Explanation

Electroconvulsive therapy (ECT) is a highly effective treatment for severe major depressive disorder, especially when pharmacologic options fail. While ECT can rapidly alleviate symptoms, it is associated with transient memory loss, particularly around the time of treatment. Post-ECT care focuses on educating clients about expected cognitive changes, monitoring recovery, and reinforcing understanding of the procedure’s effects. Most memory deficits resolve over time, but confusion or concern may persist without proper education.

Rationale for correct answer

1. After completing ECT, clients often experience memory loss, especially short-term or retrograde amnesia. If the client lacks understanding of this expected side effect, the most appropriate nursing diagnosis is deficient knowledge. Education helps reduce anxiety and promotes realistic expectations about recovery and cognitive function.

Rationale for incorrect answers

2. Noncompliance implies refusal or failure to follow treatment, which is not applicable post-ECT if the client has completed the full course. The issue is not adherence but understanding of residual effects.

3. Disturbed thought processes suggest cognitive disorganization, hallucinations, or delusions, which are not typical post-ECT. Mild confusion may occur transiently, but it does not meet the criteria for this diagnosis unless severe or persistent.

4. Fear related to the unknown is relevant before ECT, when clients may be anxious about the procedure. After completion, the focus shifts to recovery and education, not anticipatory fear.

Take Home Points

Memory loss is a common and expected side effect of ECT, requiring post-treatment education.
Noncompliance is not applicable once the treatment course is completed.
Thought disturbances are not typical post-ECT unless other psychiatric symptoms persist.
Pre-treatment fear transitions to post-treatment knowledge needs in nursing care planning.

A. Say, “Come with me. I will go with you to group therapy.” B. Make frequent short visits to her room and sit with her. C. Offer to introduce her to the other clients. D. Help her to identify stressors in her life that precipitate crises.

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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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which nursing diagnosis would be most appropriate for the client who has undergone the full course of electroconvulsive therapy (ECT)?

Correct Answer is A

Explanation

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?

Correct Answer is B

Explanation

Which symptom is an example of an affective alteration exhibited by clients diagnosed with severe depression?

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?

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

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

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.

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

Which client is at highest risk for the diagnosis of major depressive disorder?

The nurse is interviewing a client admitted to an in-patient psychiatric unit with major depressive disorder. Which is the primary goal in the assessment phase of the nursing process for this client?