According to Melinda Walker, RN, from Johns Hopkins Hospital, which nursing intervention is most appropriate for a patient immediately after undergoing Electroconvulsive Therapy (ECT) for Major Depressive Disorder (MDD)?

Choice A reason: The most therapeutic approach is to acknowledge the client’s distress and validate their concerns while gently redirecting focus toward coping strategies. This balances empathy with promoting adaptive behaviors. It avoids dismissing the client’s experience and supports long-term management of somatic symptom disorder.

Choice B reason: Encouraging the client to minimize attention to symptoms may appear dismissive and can increase anxiety or mistrust. Clients with somatic symptom disorder often feel invalidated, so this approach is not therapeutic.

Choice C reason: Immediate psychiatric evaluation is not warranted unless there is evidence of acute psychiatric crisis, such as suicidal ideation. In this case, the client’s symptoms are consistent with somatic symptom disorder and can be managed with therapeutic communication and coping strategies.

Choice D reason: Reassuring the client that nothing is physically wrong invalidates their experience and may worsen anxiety. It is not therapeutic and does not promote trust or coping.

Choice A reason: A basketball game is highly stimulating, competitive, and physically demanding. For a manic client, this can escalate hyperactivity, impulsivity, and risk-taking behaviors. It increases the likelihood of injury and agitation, making it inappropriate.

Choice B reason: Group discussions about elections involve complex, stimulating, and potentially controversial topics. A manic client may become argumentative, intrusive, or unable to regulate speech and thought processes. This option risks worsening disorganized thinking and agitation.

Choice C reason: Watching a video in a group setting provides some structure but still involves stimulation that may overwhelm a manic client. They may struggle to sit still, interrupt others, or become restless. While calmer than sports or debates, it does not provide the therapeutic outlet of controlled physical activity.

Choice D reason: Walking with the nurse in the courtyard is calm, structured, and noncompetitive. It provides physical activity without overstimulation, allows therapeutic interaction, and supports safety. This option is most appropriate for managing boredom while minimizing risk during mania.