A nurse is assessing a patient with major depressive disorder (MDD). Which assessment tool can the nurse use to measure the severity and impact of depression on the patient’s functioning?

Choice A rationale:

This statement is not accurate for a depressive episode. Excessive involvement in risky activities is more characteristic of a manic episode in bipolar disorder, not a depressive one. Manic episodes are marked by increased energy levels and impulsivity.

Choice B rationale:

An increase in goal-directed activity is not a typical symptom of a depressive episode. Depressive episodes are associated with a decrease in energy, motivation, and interest in previously enjoyed activities, leading to reduced activity levels.

Choice C rationale:

A decreased need for sleep is more commonly associated with manic episodes, where individuals experience a reduced need for sleep due to heightened energy levels. In depressive episodes, sleep disturbances such as insomnia are more prevalent.

Choice D rationale:

Significant weight loss or gain without intentional effort is a possible symptom. Changes in appetite and weight are hallmark features of a depressive episode. Clients may experience a loss of interest in food and subsequently lose weight, or they might engage in "comfort eating," leading to weight gain.

Choice A rationale:

Cognitive abilities, memory, and attention are important cognitive functions to assess in patients with bipolar disorder. However, when addressing aggressive behavior and impulsivity, the focus should be on observing and documenting behavioral aspects rather than cognitive functions. These cognitive functions might be affected, but they are not the primary aspects of interest in this context.

Choice B rationale:

The patient's mood state and affect are indeed important considerations, especially in the context of bipolar disorder. However, the question specifically asks about aggressive behavior and impulsivity. While mood and affect might influence behavior, they are not the same as behavior. Choice D directly addresses the aspects of behavior relevant to the situation.

Choice C rationale:

Physical height and weight are not directly relevant to the assessment of aggressive behavior and impulsivity in a client with bipolar disorder. These measurements are more related to physical health rather than the behavioral or psychosocial aspects of the patient's presentation.

Choice D rationale:

This is the correct choice. Aggressive behavior and impulsivity are behavioral manifestations that can provide important insights into the patient's mental state and psychosocial functioning. Observing and documenting activity level, speech pattern, and self-care behaviors can help understand the extent and nature of these behaviors, which are relevant to the client's bipolar disorder diagnosis.