A nurse is assessing a patient diagnosed with major depressive disorder. The patient states, 'I feel worthless, and I don't think things will ever get better.' Which nursing diagnosis is most appropriate for this patient?

Correct Answer: B

Rationale: In this scenario, the most appropriate nursing diagnosis for the patient expressing feelings of worthlessness and hopelessness is option B) Hopelessness. Major depressive disorder often manifests with pervasive feelings of hopelessness, helplessness, and worthlessness. This nursing diagnosis accurately captures the patient's emotional state and is crucial for developing a comprehensive care plan to address the patient's mental health needs. Option A) Powerlessness refers to a lack of control over a situation or environment, which is not the primary concern in this case. The patient's statement reflects a deep sense of hopelessness rather than powerlessness. Option C) Risk for suicide may be a potential concern given the patient's expression of despair, but the immediate focus should be on addressing the underlying feelings of hopelessness before assessing suicide risk. It is important to acknowledge and validate the patient's emotions to establish trust and rapport before delving into risk assessment. Option D) Imbalanced nutrition: Less than body requirements is not the most appropriate nursing diagnosis in this context. While depression can affect appetite and eating habits, the patient's statement primarily reflects emotional distress rather than nutritional concerns. Educationally, understanding how to differentiate between nursing diagnoses is crucial for psychiatric nurses. By accurately identifying the patient's primary issue, nurses can tailor interventions to address the specific needs of individuals experiencing mental health challenges effectively. Effective assessment and diagnosis are fundamental aspects of providing holistic and patient-centered care in psychiatric nursing practice.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Patient will participate in one group activity per day. This outcome is the most appropriate because it is specific, measurable, achievable, and relevant to the nursing diagnosis of impaired social interaction. By setting a goal of participating in one group activity per day, the patient can gradually work on overcoming feelings of shyness and developing social skills. This outcome also allows for progress to be tracked and evaluated effectively. Option A) Patient will express satisfaction with social interactions is not the best choice because it focuses on the patient's feelings of satisfaction rather than tangible behavior change. Option B) Patient will independently seek out social interactions may be too challenging for a patient who is currently struggling with feelings of shyness. Option C) Patient will cooperate with group activities is vague and does not address the patient's need to actively engage in social interactions. From an educational standpoint, it is important to select outcomes that are realistic, measurable, and directly address the underlying nursing diagnosis. By choosing a specific and achievable goal like participating in one group activity per day, nurses can effectively guide patients towards improving their social interactions and overall well-being. Setting clear outcomes also helps in monitoring progress and adjusting interventions as needed to support the patient effectively.

Correct Answer: C

Rationale: In working with a patient diagnosed with bipolar disorder in the depressive phase, the nurse should expect to observe behaviors indicative of depression. Option C, low energy, feelings of sadness, and withdrawal from social activities, is the correct answer. During the depressive phase of bipolar disorder, individuals typically experience symptoms such as persistent sadness, loss of interest in previously enjoyed activities, fatigue, changes in appetite or weight, feelings of worthlessness or guilt, difficulty concentrating, and thoughts of death or suicide. Options A, B, and D describe behaviors more commonly associated with the manic phase of bipolar disorder. During the manic phase, individuals may exhibit hyperactivity, impulsivity, elevated mood, increased energy, rapid speech, racing thoughts, and engage in risky behaviors. In an educational context, understanding the differences between the depressive and manic phases of bipolar disorder is crucial for nurses caring for patients with this condition. Recognizing the specific symptoms associated with each phase is essential for providing appropriate care, support, and interventions tailored to the individual's current needs. Nurses need to be able to differentiate between the two phases to ensure proper management and safety for patients with bipolar disorder.

Correct Answer: B

Rationale: In this scenario, the correct answer is option B) Spending large amounts of money impulsively. The nurse should be most concerned about this behavior because it can have serious consequences for the patient's financial well-being and stability. Impulsive spending during a manic episode is a common symptom of bipolar disorder and can lead to financial ruin, debt, and other negative outcomes. Option A) Excessive talking and rapid speech, while also common in manic episodes, may not pose an immediate risk to the patient or others. It is more of a symptom of the manic phase rather than a behavior with potentially harmful consequences. Option C) Engaging in social activities and making new friends can be positive aspects of a patient's life and may not necessarily be harmful during a manic episode. However, it is important for the nurse to monitor these interactions to ensure they are not exacerbating the manic symptoms or leading to risky behaviors. Option D) Participating in group therapy sessions is actually a positive behavior that can be beneficial for the patient's mental health. While it is important for the nurse to assess the patient's behavior in group therapy to ensure they are not disrupting the session or exhibiting harmful behaviors, it is not typically a cause for immediate concern in the context of a manic episode. Educationally, this question highlights the importance of understanding the manifestations of bipolar disorder, particularly during manic episodes, and the need for nurses to prioritize interventions based on the level of risk posed by specific behaviors. It also underscores the significance of vigilant monitoring and assessment in managing patients with psychiatric disorders.

Correct Answer: D

Rationale: When a specific duration for sessions has been set, the nurse must adhere to the schedule. Leaving the first patient would be equivalent to abandonment and would destroy any trust the patient had in the nurse. Adhering to the contract demonstrates that the nurse can be trusted and that the patient and the sessions are important. The incorrect responses preserve the nurse-patient relationship with the silent patient but may seem abrupt to the interrupting patient, abandon the silent patient, or fail to observe the contract with the silent patient.