HESI - Psych. Electroconvulsive Therapy
The patient's son accompanies the patient to the unit for an outpatient ECT in the morning. The son asks when his father will be able to eat and drink after the procedure. Which comment best indicates the nurse's experience with ECT recovery? A. "Your dad will probably feel like eating and drinking around lunchtime." B. "As soon as your dad is able to talk and swallow after his treatment this morning, he will be offered breakfast fluids and foods." C. "Your dad will need to continue nothing-by-mouth status for the rest of today." D. "Your dad can eat as soon as he says he is hungry or thirsty."
B. "As soon as your dad is able to talk and swallow after his treatment this morning, he will be offered breakfast fluids and foods." Rationale: As soon as a patient can talk and swallow, he or she may typically eat and drink without the risk of choking. The nurse cannot predict a specific time (e.g., lunchtime) when the patient will be able talk and swallow. Forcing the patient to remain NPO the entire day is overly protective and causes discomfort.
After a first ECT treatment, the patient becomes agitated and begins striking out. A new nurse comments that ECT obviously did not work for this patient because she became so agitated. Which is the best response from an experienced nurse? A. "You're right; the ECT treatment made her worse. I am sure they will discontinue treatments." B. "The agitation she exhibited is very dangerous, so treatments will be discontinued." C. "The patient exhibited postictal agitation, which is no reason to discontinue treatments." D. "Patients with a history of agitation become worse with ECT; therefore, patients should be screened for aggression."
C. "The patient exhibited postictal agitation, which is no reason to discontinue treatments." Rationale: After treatment, the patient may exhibit postictal agitation requiring medical intervention and additional medications before future treatments. Postictal agitation does not indicate that the treatment has not been effective and does not preclude further treatments. Screening for aggression is unrelated to the results of ECT.
The patient is brought to the procedural area and premedicated for ECT treatment. The nurse notices that there is no signed the consent form for the treatment. Which action should the nurse take? A. Get the patient to sign the consent immediately so the procedure can take place. B. Have the patient sign the consent after the procedure so treatment is not delayed. C. Have the practitioner sign off on the consent form because the patient has been medicated. D. Advise the practitioner that there is no signed consent so the treatment will have to be postponed.
D. Advise the practitioner that there is no signed consent so the treatment will have to be postponed. Rationale: A signed consent form is required before ECT can be administered. Having the patient sign the form after he or she has been premedicated is inappropriate. Having the patient sign the form after treatment is also inappropriate. The practitioner is not authorized to sign the consent for the patient.
A patient who is scheduled for ECT appears anxious and ambivalent and expresses concern to the nurse regarding fears of not remembering her family after the treatment. Which is the best response the nurse can give? A. "You may experience some temporary short-term memory loss and gaps in memory for events occurring around the time of treatment." B. "ECT does cause memory loss, but it helps people recover from depression." C. "You have already agreed to the treatment, and it is scheduled, so you cannot change your mind at this late stage." D. "You will have to ask your practitioner about the adverse effects of the ECT and the risk of memory loss."
A. "You may experience some temporary short-term memory loss and gaps in memory for events occurring around the time of treatment." Rationale: Patients may experience short-term memory loss or gaps in memory for events occurring at the time of treatment; however, most short-term memory loss is temporary. The memory loss does not help people recover from depression, nor does everyone experience memory loss. A patient can always refuse treatment even if he or she has signed consent. Referring all questions to the practitioner is inappropriate; the nurse should answer patient and family questions whenever possible.
An older adult patient diagnosed with major depressive disorder is admitted to the psychiatric unit for ECT treatment. During admission, the nurse assesses the patient's physical health history and current physical status. Why does the nurse also assess the patient's ability to perform ADLs? A. Nurses need to know the patient's baseline ability to perform self-care before starting ECT treatments. B. ECT patients experience memory loss of all voluntary activities. C. Ability to perform ADLs can determine the amount of confusion the patient experiences after a treatment. D. Providing all care for the patient, including all the patient's ADLs, is important.
A. Nurses need to know the patient's baseline ability to perform self-care before starting ECT treatments. Rationale: Knowing the baseline allows posttreatment assessment of the patient's ability to perform ADLs. It also aids in assessing the patient's posttreatment level of confusion. ECT patients experience various levels of short-term memory loss, but not for all voluntary activities. Posttreatment confusion cannot be predicted by a patient's ability to perform ADLs before treatment. Patients should be encouraged to be as independent as possible in performing their ADLs.
A patient and family asks which medical conditions would prevent the patient from having ECT. Which is the best response? A. "Any serious medical illness, including all types of cancer would be considered contraindications to ECT." B. "ECT has no absolute contraindications; however, unstable cardiac conditions and increased intracranial pressure may present risks." C. "No risks exist; therefore, a medical history is not necessary when scheduling a patient for ECT." D. "You need to ask your practitioner because it is up to him or her to determine if there are any risks or concerns related to ECT."
B. "ECT has no absolute contraindications; however, unstable cardiac conditions and increased intracranial pressure may present risks." Rationale: Although ECT has no absolute contraindications, patients with unstable cardiac conditions or increased intracranial pressure may have a higher risk of complications. Clearly, some risk exists, and a full medical history is essential when planning ECT. Referring all questions to the practitioner is inappropriate; the nurse should answer patient and family questions whenever possible.
A pregnant patient presents to the emergency room complaining of feeling depressed and sometimes suicidal. She refuses to take any medication for fear it will hurt the baby. What should the nurse tell the patient? A. "Medication is the only treatment you can consider for depression when you are pregnant." B. "ECT treatment can be considered to treat depression and suicidal ideation during pregnancy." C. "You will have to wait until after the baby is born before you can begin treatment for your depression." D. "You will need to be hospitalized because that is the only way to keep you safe during your pregnancy."
B. "ECT treatment can be considered to treat depression and suicidal ideation during pregnancy." Rationale: A pregnant patient experiencing depression should be advised of all the options available for treating depression. ECT is a safe and effective option. Pregnant women can be successfully treated during pregnancy. Not every pregnant patient experiencing depression or suicidal thoughts needs to be hospitalized.
The patient planning to have ECT on an outpatient basis asks the nurse if he will be able to drive himself home after the treatment. Which is the best response? A. "After the treatment, your mental status and ability will return to normal, so there is no reason that you cannot drive yourself home." B. "You will probably have to stay in the hospital overnight, but the next day you will be able to drive yourself home." C. "You must arrange for someone to pick you up after treatment because you cannot drive on the day of treatment." D. "You will have to ask your practitioner if you will have any restrictions on your activity."
C. "You must arrange for someone to pick you up after treatment because you cannot drive on the day of treatment." Rationale: Although most patients return to their pretreatment cognitive status within an hour, the recommendation is that the patient should not drive or engage in business transactions or decisions on the day of treatment. Outpatients typically do not stay in the hospital overnight after treatment. Although the practitioner may specify additional restrictions, referring all questions to the practitioner is inappropriate; the nurse should answer patient and family questions whenever possible.
A patient has just completed an ECT treatment. What is the nurse's most important intervention? A. Observe the patient for disorientation. B. Ask the patient to state his or her name. C. Monitor the patient's respiratory status. D. Document the length of seizure activity.
C. Monitor the patient's respiratory status. Rationale: In a patient who has just completed an ECT treatment, the priority assessment is respiratory status. Any patient who is coming out of general anesthesia should be monitored until clearly breathing without assistance. Observing the patient for disorientation, asking the patient to state his or her name, and documenting the length of seizure activity are secondary to monitoring respiratory status.
After the first ECT treatment, the patient reports a sore jaw and a taste of blood in the mouth. On examining the oral cavity, the nurse notes what appears to be a small cut on the left side of the tongue. Why does the nurse suspect that the patient bit the tongue during the ECT treatment? A. Most patients bite their tongue during every ECT treatment. B. Tongue paddles and bite blocks are no longer used during ECT treatment. C. The patient's new dentures are too large for the mouth, thus causing the patient to bite the tongue during the seizure. D. Tongue biting is an adverse reaction that may occur during the seizure.
D. Tongue biting is an adverse reaction that may occur during the seizure. Rationale: Seizures, induced (e.g., an ECT seizure) or otherwise, may result in the patient biting the tongue. A preventive measure is to place a bite block or mouth guard in the patient's mouth. The anesthesia provider performs this preventive measure before the psychiatrist administers the treatment. Tongue paddles are not used during ECT treatments, but bite blocks are used. Dentures are removed before ECT treatments. Tongue biting is not a usual occurrence during ECT treatments.
