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?

Sit with the client and offer self frequently.

Notify the client of group therapy schedule.

Introduce the client to others on the unit.

Help the client to identify stressors of life that precipitate life crises.

Answer and Explanation

The Correct Answer is A

Major depressive disorder is a mood disorder marked by persistent sadness, anhedonia, and impaired functioning. Clients often exhibit psychomotor retardation, social withdrawal, and diminished verbal engagement, making initial therapeutic connection difficult. Early nursing goals prioritize presence, safety, and nonverbal rapport over verbal processing or group participation.

Rationale for correct answer

1. Establishing a therapeutic relationship with a client in acute depression requires nonverbal presence and emotional availability. Sitting quietly and offering self respects the client's limited energy and avoids pressure to engage. This intervention aligns with early-stage depression care, where trust-building precedes verbal interaction. It also addresses physiological needs by reducing isolation and promoting safety.

Rationale for incorrect answers

2. Group therapy requires motivation and cognitive engagement, which are often impaired in early stages of major depression. Introducing structured activities prematurely may overwhelm the client and hinder rapport.

3. Social introductions demand interpersonal energy and initiative, which are typically absent in clients with severe depression. Forcing socialization may increase anxiety and reinforce withdrawal.

4. Identifying stressors involves introspection, which is not feasible when the client is disengaged and nonverbal. This step is more appropriate after trust and communication have been established.

Take Home Points

Initial nursing interventions for major depressive disorder should prioritize presence and nonverbal support over verbal engagement.
Clients with psychomotor retardation and social withdrawal benefit from quiet companionship before structured therapy.
Group therapy and stressor identification are secondary interventions once rapport and communication are established.
Differentiating depression from conditions like schizophrenia or catatonia requires careful assessment of affect, engagement, and thought content.

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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.

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 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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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

Correct Answer is A

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

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?

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?

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.

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.

Which of the following medications may be administered before electroconvulsive therapy? Select all that apply.

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 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?