Which nursing diagnosis supports the psychoanalytic theory of development of major depressive disorder?

Social isolation related to self-directed anger

Low self-esteem related to learned helplessness

Risk for suicide related to neurochemical imbalances

Imbalanced nutrition less than body requirements related to weakness

Answer and Explanation

The Correct Answer is A

Psychoanalytic theory posits that unresolved unconscious conflicts, often rooted in early childhood experiences, contribute to the development of major depressive disorder. According to this model, depression may result from internalized anger turned inward, typically stemming from loss, abandonment, or unmet emotional needs. The theory emphasizes the role of self-directed aggression, guilt, and repressed emotions in shaping depressive symptoms.

Rationale for correct answer

1. This diagnosis reflects the psychoanalytic concept of self-directed anger, where the client isolates due to unconscious hostility turned inward. Freud’s model suggests that unresolved grief or loss leads to internalized rage, manifesting as withdrawal and depressive symptoms. This aligns directly with psychoanalytic etiology.

Rationale for incorrect answers

2. Learned helplessness is a cognitive-behavioral construct, not psychoanalytic. It describes a belief system formed through repeated failures, leading to passivity and low self-worth, but does not involve unconscious conflict or repressed anger.

3. Neurochemical imbalances are central to the biological model of depression, focusing on serotonin, norepinephrine, and dopamine dysregulation. This explanation is physiological, not psychodynamic, and does not involve unconscious processes.

4. Nutritional deficits relate to somatic symptoms of depression and are addressed in physical care planning. They do not reflect the psychological or unconscious mechanisms emphasized in psychoanalytic theory.

Take Home Points

Psychoanalytic theory attributes depression to unconscious conflicts and internalized anger.
Self-directed aggression and isolation are key manifestations of psychodynamic depression.
Learned helplessness and neurochemical imbalance reflect cognitive and biological models, respectively.
Somatic symptoms like poor nutrition are consequences, not etiologic indicators, of depression.

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Correct Answer is A

Explanation

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.

A. Glycopyrrolate (Robinul) B. Thiopental sodium (Pentothal) C. Succinylcholine chloride (Anectine) D. Lorazepam (Ativan) E. Divalproex sodium (Depakote)

Correct Answer is ["A","B","C"]

Explanation

Electroconvulsive therapy (ECT) is a procedure that induces a controlled seizure to treat severe psychiatric conditions. Prior to ECT, specific medications are administered to reduce cardiac complications, facilitate anesthesia, and prevent muscle injury. These agents are chosen to optimize safety and seizure quality without interfering with the therapeutic mechanism.

Rationale for correct answers

1. Glycopyrrolate is an anticholinergic used pre-ECT to reduce salivary secretions and prevent bradycardia during the procedure. Its peripheral action minimizes central side effects, making it ideal for ECT preparation.

2. Thiopental sodium is a barbiturate anesthetic that induces rapid unconsciousness before ECT. It has a short duration of action and minimal impact on seizure threshold, making it suitable for brief procedures.

3. Succinylcholine is a neuromuscular blocker administered to prevent musculoskeletal injury during the seizure. It produces short-term paralysis, reducing the risk of fractures or dislocations during convulsions.

Rationale for incorrect answers

4. Lorazepam is a benzodiazepine that raises the seizure threshold and may blunt the therapeutic seizure. Its sedative properties interfere with ECT efficacy, making it contraindicated before the procedure.

5. Divalproex sodium is an anticonvulsant that suppresses seizure activity. Administering it before ECT would counteract the intended seizure induction, reducing treatment effectiveness.

Take Home Points

Pre-ECT medications include anticholinergics, anesthetics, and muscle relaxants to optimize safety and seizure quality.
Benzodiazepines and anticonvulsants are avoided as they interfere with seizure induction.
Glycopyrrolate prevents bradycardia and excessive secretions during ECT.
Succinylcholine minimizes physical injury by inducing short-term paralysis during the seizure.

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Which nursing diagnosis supports the psychoanalytic theory of development of major depressive disorder?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

Correct Answer is A

Explanation

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

Correct Answer is ["A","B","C"]

Explanation

Which nursing diagnosis supports the psychoanalytic theory of development of major depressive disorder?

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

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 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?

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

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?

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

Which of the following conditions is considered to be the only absolute contraindication for ECT?