Ch 19 Electroconvulsive Therapy

9. A client scheduled for ECT at 9:00 a.m. is discovered eating breakfast at 8:00 a.m. Based on this observation, which action would the nurse take? 1. Notify the client's physician of the situation and cancel the ECT. 2. Remove the breakfast tray and assist the client to the ECT procedure room. 3. Allow the client to finish breakfast and reschedule ECT for 10:00 a.m. 4. Increase the client's fluid intake to facilitate the digestive process.

1. This is correct. A client who is scheduled for an ECT treatment is given nothing by mouth for a minimum of 6 to 8 hours before treatment.

2. In which position would the nurse place the client immediately after electroconvulsive therapy (ECT)? 1. On his or her side to prevent aspiration 2. In semi-Fowler's position to promote oxygenation 3. In Trendelenburg's position to promote blood flow to vital organs 4. In prone position to prevent airway blockage

1. This is correct. After the ECT procedure, the client should be positioned on his or her side to prevent aspiration.

17. The nurse recognizes that electroconvulsive therapy (ECT) would potentially improve the symptoms of clients with which of the following diagnoses? Select all that apply. 1. Major depressive disorder 2. Bipolar I disorder: acute mania 3. Schizoaffective disorder 4. Obsessive-compulsive disorder (OCD) 5. Body dysmorphic disorder

1. This is correct. ECT has been shown to be effective in the treatment of severe depression. 2. This is correct. ECT has been shown to be effective in the treatment of acute mania, particularly if it is accompanied by catatonic or affective (depression or mania) symptomatology. 3. This is correct. ECT has been shown to be effective in the treatment of severe depression, acute mania, and acute schizophrenia, particularly if it is accompanied by catatonic or affective (depression or mania) symptomatology.

4. For which client would the nurse question the use of electroconvulsive therapy (ECT)? 1. A client with schizophrenia and hypertension 2. A client with mania and seasonal allergies 3. A client with obsessive-compulsive disorder (OCD) and a history of cancer 4. A client with major depressive disorder (MDD) who feels sad

1. This is correct. ECT is contraindicated in clients with untreated hypertension or heart disease.

18. Which assessment results would the nurse evaluate and report to prepare a client for electroconvulsive therapy (ECT)? Select all that apply. 1. Electrocardiographic records 2. Pulmonary function study results 3. Electroencephalogram analysis 4. Complete blood count values 5. Urinalysis results

1. This is correct. Electrocardiographs should be obtained prior to ECT. 2. This is correct. Pulmonary function study results should be available prior to scheduling a client for ECT. 4. This is correct. A complete blood count should be performed prior to scheduling a client for ECT. 5. This is correct. Results of a urinalysis should be reviewed prior to scheduling the client for ECT.

6. Immediately after an initial electroconvulsive (ECT) procedure, a client states, "I'm not hungry and just want to stay in bed and sleep." Based on this information, which nursing intervention is appropriate? 1. Allow the client to remain in bed. 2. Encourage the client to join the milieu to promote socialization. 3. Obtain a physician's order for parenteral nutrition. 4. Involve the client in physical activities to stimulate circulation.

1. This is correct. Immediately after ECT, the nurse should monitor pulse, respirations, and blood pressure every 15 minutes for the first hour, during which time the client should remain in bed.

20. Which conditions place a client at risk for injury during electroconvulsive therapy (ECT)? Select all that apply. 1. Severe osteoporosis 2. Acute and chronic pulmonary disorders 3. Hypothyroidism 4. Recent cardiovascular accident 5. Prostatic hypertrophy

1. This is correct. Severe osteoporosis places a client at risk for injury during ECT. 2. This is correct. Acute and chronic pulmonary disorders place a client at risk for injury during ECT. 4. This is correct. Cardiovascular conditions that place a client at high risk for injury during ECT include myocardial infarction or cerebrovascular accident within the preceding 3 to 6 months, aortic or cerebral aneurysm, severe underlying hypertension, and congestive heart failure. Clients with cardiovascular problems are at risk because of the body's response to the seizure itself.

19. During a course of 12 electroconvulsive therapy (ECT) procedures, an anxious client diagnosed with major depressive disorder (MDD) refuses to bathe or attend group therapy. The client reports some memory problems and says he has trouble figuring out what time of day it is. Which of the following nursing diagnoses should be assigned to this client? Select all that apply. 1. Anxiety R/T post-ECT confusion and memory loss 2. Risk for injury R/T post-ECT confusion and memory loss 3. Risk for activity intolerance R/T post-ECT confusion and memory loss 4. Altered sensory perception R/T post-ECT confusion and memory loss 5. Social isolation R/T post-ECT confusion and memory loss

1. This is correct. The most common side effects of ECT leading to client anxiety are temporary memory loss and confusion. 2. This is correct. The client is at risk for injury due to anxiety related to post-ECT side effects of confusion and memory loss. 3. This is correct. The client is at risk for activity intolerance due to post-ECT side effects of confusion and memory loss. 5. This is correct. Social isolation characterized by not attending group therapy is related to post-ECT side effects of confusion and memory loss.

15. When scheduling electroconvulsive (ECT), which client would the nurse prioritize? 1. A client in bed in a fetal position who is experiencing active suicidal ideations 2. A client with an irritable mood who is exhibiting angry outbursts 3. A client experiencing command hallucinations and delusions of reference 4. A client experiencing manic episodes of bipolar disorder

1. This is correct. The nurse should prioritize the client experiencing suicidal ideation. Severely suicidal clients require urgent treatment to prevent self-harm

12. Which response by the instructor is accurate regarding blood pressure cuff placement on the client's lower leg during an electroconvulsive therapy (ECT) procedure? 1. "The cuff has to be placed on the leg because both arms are used for IV fluids." 2. "The cuff functions to prevent succinylcholine from reaching the foot." 3. "The cuff position gives a more-accurate blood pressure reading during the treatment." 4. "The cuff is placed on the leg so that arms can easily be restrained during seizure."

2. This is correct. A blood pressure cuff is placed on the lower leg and inflated above systolic pressure before injection of succinylcholine. This is to ensure that seizure activity can be observed and timed in the one limb that is unaffected by the paralytic agent.

3. Which student statement indicates that learning has occurred regarding electroconvulsive therapy (ECT)? 1. "During ECT, a state of euphoria is induced." 2. "ECT induces a grand mal seizure." 3. "During ECT, a state of catatonia is induced." 4. "ECT induces a petit mal seizure."

2. This is correct. ECT is the induction of a grand mal seizure through the application of electrical current to the brain to decrease depression.

13. A client states, "My doctor has told me I am a candidate for electroconvulsive therapy (ECT). Where will the treatment take place, and how much time would this entail?" Which nursing reply is best? 1. "Clients typically receive ECT in their hospital room daily for 1 month." 2. "Clients typically undergo 6 to 12 ECT procedures three times a week in an outpatient setting." 3. "Clients typically receive an unlimited number of treatment, in the hospital procedure room." 4. "Clients typically receive two to three treatment, in either an outpatient or inpatient setting."

2. This is correct. Most clients require an average of 6 to 12 ECT treatments, but some may require up to 20. Treatments are usually administered every other day, three times per week. Treatments are performed on either an inpatient or outpatient basis, depending on the need for client monitoring

14. Which information will the nurse include when teaching a client about the potential side effects of electroconvulsive (ECT)? 1. "You may experience transient tangential thinking." 2. "You may experience some memory deficit surrounding the ECT." 3. "You may experience avolition for the remainder of the day." 4. "You may experience a higher risk for subsequent seizures."

2. This is correct. The most common side effect of ECT is temporary amnesia following the ECT procedure.

16. A client with cognitive deficits is extremely suicidal. The client has not responded to antidepressants, and the treatment team is considering electroconvulsive therapy (ECT). What client information would impact the feasibility of this treatment option? 1. Because the client is extremely suicidal, ECT is an appropriate option. 2. Because antidepressant medications have been ineffective, ECT is a good alternative. 3. Because informed consent is required for ECT, cognitive deficits could preclude this option. 4. Because of the client's cognitive deficits, a signed consent form is waived.

3. This is correct. A client experiencing cognitive deficits cannot give informed consent, which is required prior to ECT. A court proceeding would determine the client's level of competency, and a judge would appoint a guardian if necessary.

10. A client who is learning about electroconvulsive therapy (ECT) asks a nurse, "Isn't this treatment dangerous?" Which reply by the nurse is appropriate? 1. "ECT is not dangerous because there are no side effects. 2. "There can be temporary paralysis, but full functioning returns within 3 hours of treatment." 3. "You will have a thorough examination beforehand to ensure you can safely undergo ECT." 4. "Transient ischemic attacks can occur but are rare."

3. This is correct. A complete physical examination must be conducted by the appropriate medical professional prior to the initiation of ECT. Studies indicate that the mortality rate from ECT is about 0.002% per treatment and 0.01% for each client (Sadock et al., 2015).

11. A client experienced bradycardia during electroconvulsive therapy (ECT). A nurse assigns a nursing diagnosis of decreased cardiac output related to (R/T) vagal stimulation occurring during ECT. Which outcome would the nurse expect the client to achieve? 1. The client will verbalize an understanding of the need for moving slowly after treatment. 2. The client will maintain an oxygen saturation level of 88% 1 hour after treatment. 3. The client will continue adequate tissue perfusion 1 hour after treatment. 4. The client will verbalize an understanding of common side effects of ECT.

3. This is correct. Adequate tissue perfusion is a priority outcome. Reestablishment of a normal heart rate within 1 hour reflects adequate circulation and tissue perfusion

5. After undergoing two of nine electroconvulsive (ECT) procedures, a client states, "I can't even remember eating breakfast, so I want to stop the ECT." Which reply by the nurse is appropriate? 1. "After you begin the course of treatments, you must complete all of them." 2. "You'll need to talk with your doctor about what you're thinking." 3. "It is within your right to discontinue the treatments, but let's talk about your concerns." 4. "Memory loss is a rare side effect of the treatment. I don't think it should be a concern."

3. This is correct. ECT is voluntary, and client consent may be withdrawn at any time. This reply acknowledges this right and focuses on the client's concerns so the nurse can address them.

8. Which statement by the student indicates a need for further teaching regarding client preparation for electroconvulsive therapy (ECT)? 1. "I will ensure my client has voided before the procedure." 2. "My client's spouse is holding his wedding band while he is having ECT." 3. "I told my client it is okay for him to wear his contact lenses during the procedure so he does not lose them." 4. "My client has removed her dentures and placed them in a denture cup with her name on it.

3. This is correct. Teaching was ineffective because the student told the client they could wear their contact lenses during the procedure. The client must remove eyeglasses and contact lenses for ECT.

1. A nurse administers pure oxygen to a client during and after electroconvulsive therapy (ECT). Which statement describes the rationale for this procedure? 1. To prevent increased intracranial pressure resulting from anoxia 2. To prevent hypotension, bradycardia, and bradypnea due to electrical stimulation 3. To prevent anoxia due to medication-induced paralysis of respiratory muscles 4. To prevent blocked airway resulting from seizure activity

3. This is correct. The nurse administers 100% oxygen during and after ECT to prevent anoxia due to medication-induced paralysis of respiratory muscles.

7. A nurse administers ordered preoperative glycopyrrolate 30 minutes prior to a client's electroconvulsive (ECT) procedure. Which statement describes the rationale for administering this medication? 1. Glycopyrrolate decreases anxiety during the ECT procedure. 2. Glycopyrrolate induces an unconscious state to prevent pain during the ECT procedure. 3. Glycopyrrolate prevents severe muscle contractions during the ECT procedure. 4. Glycopyrrolate decreases secretions to prevent aspiration during the ECT procedure.

4. This is correct. Glycopyrrolate is given to decrease secretions and counteract the effects of vagal stimulation (bradycardia) induced by ECT.