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

Irritability with authority

Being uninterested in school

A change in behaviors over a 2-week period

Feeling insecure at a social gathering

Answer and Explanation

The Correct Answer is C

Depressive disorder in youth presents differently than in adults, often with behavioral and somatic complaints rather than verbalized sadness. Diagnostic criteria emphasize a persistent change in functioning. Irritability, withdrawal, and academic decline may be present, but diagnosis hinges on sustained shifts in mood or behavior. The DSM-5 outlines that symptoms must last at least two weeks and cause significant impairment. Early recognition is critical, as untreated depression in youth increases risk for substance use, academic failure, and suicide.

Rationale for correct answer

3. A sustained behavioral change over a 2-week period meets the DSM-5 threshold for diagnosing depressive disorders in children and adolescents. This duration reflects a persistent alteration in mood, energy, or functioning, distinguishing clinical depression from transient emotional states.

Rationale for incorrect answers

1. Irritability alone is nonspecific and may reflect normal developmental defiance, oppositional behavior, or situational stress. Without duration or associated symptoms, it cannot confirm depression.

2. Uninterest in school may stem from academic challenges, peer conflict, or boredom. While it can be a symptom of depression, it lacks diagnostic specificity without broader behavioral context.

4. Insecurity in social settings is common in adolescence due to developmental changes in self-concept and peer dynamics. It may reflect social anxiety or shyness, not necessarily depression.

Take Home Points

Depression in youth requires a persistent change in mood or behavior lasting at least two weeks.
Irritability is common but not diagnostic without other sustained symptoms.
School disengagement may signal depression but must be evaluated in context.
Social discomfort alone does not indicate depressive disorder; broader patterns must be assessed.

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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.

A. “Yes, he should have stopped smoking. Then he probably wouldn’t have gotten lung cancer.” B. “I can understand how you must feel.” C. “Those feelings are a normal part of the grief response.” D. “Just think about the good times that you had while he was alive.”

Correct Answer is C

Explanation

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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

Correct Answer is C

Explanation

Which client statement is evidence of the etiology of major depressive disorder from a genetic perspective?

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 client admitted with major depressive disorder has a nursing diagnosis of ineffective sleep pattern related to aches and pains. Which is an appropriate short-term outcome for this client?

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?

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

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

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

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?