Which client is at highest risk for the diagnosis of major depressive disorder?
A 24-year-old married woman
A 64-year-old single woman
A 30-year-old single man
A 70-year-old married man
The Correct Answer is B
Major depressive disorder risk is influenced by age, gender, and marital status. Older adults, especially women, face increased vulnerability due to biological changes, social isolation, and cumulative stressors.
Major depressive disorder is more prevalent in older women, particularly those who are single, widowed, or divorced. Risk increases with age due to declining physical health, reduced social support, and hormonal changes. Women have higher lifetime prevalence and report more severe symptoms.
Rationale for correct answer
2. Older single women are at elevated risk due to age-related vulnerability, lack of spousal support, and higher prevalence of chronic illness. Social isolation and hormonal factors compound the risk for depression.
Rationale for incorrect answers
1. Younger married women have protective factors including spousal support and lower age-related risk. While women are generally at higher risk, marriage and youth reduce susceptibility.
3. Single men have lower prevalence compared to women. Though being single increases risk, men report fewer depressive symptoms and are less likely to seek help, affecting diagnosis rates.
4. Older married men have the lowest risk among the options. Marriage offers emotional support, and men generally have lower depression rates than women, especially in older age groups.
Take Home Points
- Older age and single marital status increase risk for major depressive disorder, especially in women.
- Women have higher lifetime prevalence and more severe symptom profiles than men.
- Social isolation and chronic illness contribute significantly to depression in older adults.
- Marital status is a protective factor, particularly in elderly populations.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is A
Explanation
Electroconvulsive therapy (ECT) induces a controlled seizure to treat severe psychiatric conditions such as major depression, catatonia, and psychosis. The procedure causes transient increases in cerebral blood flow and metabolic demand, which can elevate intracranial pressure. While many medical conditions are considered relative contraindications, increased intracranial pressure (ICP) remains the only absolute contraindication due to the risk of cerebral herniation and irreversible brain damage.
Rationale for correct answer
1. Elevated intracranial pressure is the only absolute contraindication for ECT. The seizure-induced surge in cerebral perfusion and oxygen demand can dangerously exacerbate ICP, risking brainstem compression and herniation. This makes ECT unsafe until ICP is stabilized or resolved.
Rationale for incorrect answers
2. A recent myocardial infarction is a relative contraindication. ECT causes transient sympathetic stimulation, which may strain cardiac function, but with proper monitoring and stabilization, it can be safely administered in select cases.
3. Severe hypertension increases cardiovascular risk during ECT but is not absolute. Pre-treatment antihypertensive management and intra-procedural monitoring allow safe administration in many hypertensive clients.
4. Congestive heart failure poses hemodynamic concerns due to fluid overload and reduced cardiac output. However, it is a relative contraindication, and ECT may still be used with cardiac clearance and close monitoring.
Take Home Points
- Increased intracranial pressure is the only absolute contraindication for ECT due to risk of herniation.
- Cardiac conditions like MI and CHF are relative contraindications requiring individualized risk assessment.
- ECT elevates cerebral blood flow and metabolic demand, making ICP management critical.
- Most medical conditions can be managed to allow safe ECT with proper precautions.
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