PrepU- Ch. 18 Somatic Therapies
When a client who is considering electroconvulsive therapy (ECT) asks the nurse how this treatment will improve his depression, the most appropriate response is ... a) "Although the exact way the therapy works isn't completely understood, the results have been very encouraging among clients with symptoms similar to yours." b) "It seems to affect the reuptake of serotonin and dopamine but with greater efficiency than tricyclic antidepressants or reuptake inhibitors." c) "Stimulation of the frontal lobe of the brain appears to bring about the minimization or either elimination of depression." d) "The seizure activity seems to stimulate the hypothalamus and pituitary encouraging the release of hormones that have antidepressant affects."
"Although the exact way the therapy works isn't completely understood, the results have been very encouraging among clients with symptoms similar to yours." Explanation: ;;;;; When a client who is considering electroconvulsive therapy (ECT) asks the nurse how this treatment will improve his depression, the most appropriate response is the following: "Although the exact way the therapy works isn't completely understood, the results have been very encouraging among clients with symptoms similar to yours."
A client with depression has been admitted to have a medical workup preliminary to electroconvulsive therapy (ECT) treatments. During pretreatment education with the family, the client's daughter asks, "Isn't this treatment dangerous?" The most appropriate nursing response would be: a) "There are some side effects to the treatment, but they are not life-threatening." b) "Although there are some risks, your mother will have a thorough examination in advance to ensure that she is a good candidate for the treatment." c) "Risks are involved, but with depression as serious as your mother's, the benefits outweigh the risks because she will recover quicker with ECT." d) "This treatment is absolutely safe."
"Although there are some risks, your mother will have a thorough examination in advance to ensure that she is a good candidate for the treatment." Explanation: Supportive and informative teaching requires a description of the risk and the measures of it through the assessment and examination process. Explaining that the treatment is absolutely safe would be false. Suggesting that there are side effects that are not life-threatening is vague and not reassuring to the family. Explaining that the client will recover quicker gives a false sense of hope.
A client with depression has been admitted to have a medical workup preliminary to electroconvulsive therapy (ECT) treatments. During pretreatment education with the family, the client's daughter asks, "Isn't this treatment dangerous?" The most appropriate nursing response would be: a) "Risks are involved, but with depression as serious as your mother's, the benefits outweigh the risks because she will recover quicker with ECT." b) "This treatment is absolutely safe." c) "Although there are some risks, your mother will have a thorough examination in advance to ensure that she is a good candidate for the treatment." d) "There are some side effects to the treatment, but they are not life-threatening."
"Although there are some risks, your mother will have a thorough examination in advance to ensure that she is a good candidate for the treatment." Explanation: Supportive and informative teaching requires a description of the risk and the measures of it through the assessment and examination process. Explaining that the treatment is absolutely safe would be false. Suggesting that there are side effects that are not life-threatening is vague and not reassuring to the family. Explaining that the client will recover quicker gives a false sense of hope.
A client with a diagnosis of depression has not seen her mood and affect improve with the use of antidepressants, and the worsening of her symptoms has prompted her physician to order ECT. Which of the nurse's following teaching points about the procedure is most accurate? a) "The permanent memory loss associated with ECT is a small price to pay for curing your depression." b) "You will probably not be able to use antidepressant medications for several months after the treatment, but they will likely be unnecessary." c) "Even though the exact way that ECT helps depression isn't known, the therapy has been shown to be safe and effective." d) "Most people who are depressed experience a permanent improvement in their mood after their first treatment."
"Even though the exact way that ECT helps depression isn't known, the therapy has been shown to be safe and effective." Explanation: The exact therapeutic mechanisms of ECT are unclear, but the therapy itself has been proven safe and effective. Repeat treatments are the norm, and any resulting memory loss is not permanent. ECT does not contraindicate the use of antidepressants
A client with a diagnosis of depression has not seen her mood and affect improve with the use of antidepressants, and the worsening of her symptoms has prompted her physician to order ECT. Which of the nurse's following teaching points about the procedure is most accurate? a) "Even though the exact way that ECT helps depression isn't known, the therapy has been shown to be safe and effective." b) "The permanent memory loss associated with ECT is a small price to pay for curing your depression." c) "You will probably not be able to use antidepressant medications for several months after the treatment, but they will likely be unnecessary." d) "Most people who are depressed experience a permanent improvement in their mood after their first treatment."
"Even though the exact way that ECT helps depression isn't known, the therapy has been shown to be safe and effective." Explanation: The exact therapeutic mechanisms of ECT are unclear, but the therapy itself has been proven safe and effective. Repeat treatments are the norm, and any resulting memory loss is not permanent. ECT does not contraindicate the use of antidepressants.
You are working with a 56-year-old female who is a candidate for ECT. The client states, "I would think about doing this ECT, but I heard that I won't remember anything after I wake up, and that scares me very much." The most therapeutic nursing response to the client's statement is what? a) "I understand your concern. You may experience some short-term memory loss right after the procedure, but it is not a long-term effect." b) "I hear what you are saying. What is it that makes you so afraid of losing your memory?" c) "Don't worry; you will be just fine after ECT. Lots of people are afraid of losing their memory, but it's not really a problem." d) "Who told you that? It's not really much of an issue with ECT. Sometimes people do lose some of their memory, but it is not a long-term problem."
"I understand your concern. You may experience some short-term memory loss right after the procedure, but it is not a long-term effect." Explanation: The correct answer provides empathy for the client's concerns, followed by client teaching about the effects of ECT. Memory loss after ECT is usually short term, with a return to normal function in a few days or weeks.
A client with depression has been admitted for a medical workup preliminary to electroconvulsive therapy (ECT) treatments. While teaching the client and family about what to expect immediately after the ECT, which of the following nursing statements would be appropriate? a) "The client will be heavily sedated after the treatment and may sleep for several hours." b) "The client will have almost immediate positive results from the treatment and will feel much improved after the first ECT." c) "The client will likely experience some confusion and disorientation after the treatment." d) "The client may experience muscle soreness and tenderness after the treatment."
"The client will likely experience some confusion and disorientation after the treatment." Explanation: Clients typically experience some confusion and disorientation after treatment; this generally resolves quickly. Clients are not heavily sedated after treatment. Muscle soreness is rare. Clients do not have immediate benefits after treatment; the typical course is six to ten treatments.
When teaching a client who is to undergo ECT, the client asks, "How long will the seizure last?" The nurse's best response includes which of the following? a) "No seizures are associated with this type of treatment." b) "You will be unconscious, so it will not matter." c) "The convulsion will last approximately 1 minute." d) "Don't worry about it; everything will be ok."
"The convulsion will last approximately 1 minute." Explanation: Clients experience a convulsion that lasts approximately 1 minute. A seizure is associated with ECT. Telling the client not to worry does not answer the client's question. The client's question is very important and does matter.
A client who has been admitted to the hospital after a suicide attempt has been diagnosed with major depression and the client's care team has recommended ECT. Which of the following teaching points should the nurse include in client education before the procedure? a) "I'll teach you some techniques to help you remain calm and focused during the procedure." b) "You'll be required to fast from solid food for 24 hours before your ECT procedure." c) "You might feel a bit confused or disoriented after your treatment, but this will pass." d) "After their ECT, most clients say that the pain they experienced was very manageable."
"You might feel a bit confused or disoriented after your treatment, but this will pass." Explanation: The confusion and disorientation that may accompany the immediate recovery period after ECT are temporary and resolve spontaneously. The client is unconscious during the procedure and is NPO for 8 hours prior. ECT is painless.
A client receiving light therapy for seasonal affective disorder (SAD) questions when her symptoms will be alleviated. The nurse would be correct in telling the client that relief of symptoms generally occurs in which timeframe after beginning light therapy? a) 4 days b) 10 days c) 1 week d) 2 weeks
4 days Explanation: Relief of symptoms generally occurs within 4 days of beginning treatment.
The psychiatric nurse recognizes that the client most likely to be prescribed electroconvulsive therapy (ECT) is a) A 10-year-old who has been experiencing visual hallucinations for the last 2 months b) A 19-year-old who has been severely depressed since the death of a parent and has not shown improvement with initial treatment c) A 35-year-old diagnosed with schizophrenia who has a history of suicide attempts d) A 32-year-old who is acutely depressed since experiencing an unplanned pregnancy and a severely fracture leg
A 35-year-old diagnosed with schizophrenia who has a history of suicide attempts Explanation: ECT is used to treat the clinical symptoms of schizophrenia as well as for individuals who are at high risk for suicide. Thus, the psychiatric nurse recognizes that the client most likely to be prescribed ECT is a 35-year-old diagnosed with schizophrenia who has a history of suicide attempts.
Which of the following clients most likely faces the highest risk of experiencing adverse effects of ECT? a) A man who has diagnoses of depression and poorly controlled hypertension and who experienced a myocardial infarction 3 months ago b) A morbidly obese woman whose depression has been treated with a sustained serotonin reuptake inhibitor (SSRI) for the past several months c) A man who has schizophrenia, who is an intravenous user of heroin and cocaine, and who smokes marijuana on a daily basis d) A woman who has been admitted to the hospital after a suicide attempt and who has type I diabetes mellitus
A man who has diagnoses of depression and poorly controlled hypertension and who experienced a myocardial infarction 3 months ago Explanation: Hypertension and recent MI are both associated with an increased risk of adverse effects during ECT. Diabetes, antidepressant therapy, and drug use are not noted to appreciably increase the risk of adverse effects.
Which of the following would not be considered an indication for psychosurgery? a) Minimal alteration in psychosocial functioning b) Acute psychiatric illness c) Psychiatric illness that responds to conventional therapy d) Chronic psychiatric illness
Acute psychiatric illness Explanation: Currently, only people with chronic, severe, and disabling psychiatric illness that is completely refractory to all conventional therapy are considered for surgery.
During anesthesia for ECT, some clients receive which type of medication to prevent aspiration of secretions? a) Diuretic b) Anticholinergic c) Cholinergic d) Antihypertensive
Anticholinergic Explanation: Some clients receiving ECT may receive anticholinergic medication to dry secretions that might interfere with respiration
The nurse is preparing to give Robinul to a patient undergoing electroconvulsive therapy (ECT). The nurse understands that this drug is in which of the following medication classifications? a) Anticholinergic b) Antispasmodic c) Selective serotonin reuptake inhibitor (SSRI) d) Cholinergic
Anticholinergic Explanation: Robinul is an atropine-like drug used to dry up secretions and prevent aspiration during ECT. It is classified as an anticholinergic drug.
The nurse is preparing to give Robinul to a patient undergoing electroconvulsive therapy (ECT). The nurse understands that this drug is in which of the following medication classifications? a) Anticholinergic b) Cholinergic c) Antispasmodic d) Selective serotonin reuptake inhibitor (SSRI)
Anticholinergic Explanation: Robinul is an atropine-like drug used to dry up secretions and prevent aspiration during ECT. It is classified as an anticholinergic drug.
After today's ECT treatment, a client has emerged from anesthesia agitated, confused, and incoherent. Which of the following interventions should the nurse anticipate? a) Placing the client in seclusion until the client's behavior normalizes b) Application of physical restraints and sublingual lorazepam (Ativan) administration c) Close monitoring and administration of an intravenous benzodiazepine d) Administration of an anesthetic and a repeat ECT treatment
Close monitoring and administration of an intravenous benzodiazepine Explanation: Postictal agitation may require intravenous diazepam (Valium) to stabilize the symptoms. Seclusion would be unsafe, and restraints would be a measure of last resort. The ECT treatment would not be repeated
A client has a long-standing diagnosis with a dystonic disorder that has been minimally responsive to pharmacological treatment. Which of the following alternative somatic therapies may be clinically appropriate? a) Transcranial magnetic stimulation (TMS) b) Vagus nerve stimulation (VNS) c) Deep brain stimulation (DBS) d) Magnetic seizure therapy (MST)
Deep brain stimulation (DBS) Explanation: DBS is a minimally invasive yet significant form of neurosurgery in which a surgically implanted neurostimulator in the brain helps control Parkinson's disease, essential tremor, and dystonic disorders.
The vagal nerve stimulator has shown effectiveness for seizures, but has also been known effective in which of the following mental health disorders? a) Schizoaffective disorder b) Depression c) Mania d) Bipolar
Depression Explanation: VNS seems to help clients with treatment-refractory depression
A client is emerging from anesthesia following ECT. The client is agitated and incoherent. The nurse may expect to administer which medication to stabilize these symptoms? a) Robinul b) Brevital c) Diazepam d) Caffeine
Diazepam Explanation: When postictal agitation occurs, the client may require intravenous diazepam (Valium). During the ECT procedure, the client is given a quick-acting anesthetic, such as Brevital, after being placed on a padded mat or table. An atropine-like drug, Robinul, is given to dry up body secretions and prevent aspiration. Caffeine would be an inappropriate drug to give this patient for these symptoms.
A client is emerging from anesthesia following ECT. The client is agitated and incoherent. The nurse may expect to administer which medication to stabilize these symptoms? a) Robinul b) Caffeine c) Diazepam d) Brevital
Diazepam Explanation: When postictal agitation occurs, the client may require intravenous diazepam (Valium). During the ECT procedure, the client is given a quick-acting anesthetic, such as Brevital, after being placed on a padded mat or table. An atropine-like drug, Robinul, is given to dry up body secretions and prevent aspiration. Caffeine would be an inappropriate drug to give this patient for these symptoms.
Which of the following is the most effective treatment available for refractory major depression? a) Psychosurgery b) Phototherapy c) Electroconvulsive therapy (ECT) d) Deep brain stimulation
Electroconvulsive therapy (ECT) Explanation: ECT is the most effective treatment available for refractory major depression (i.e., depression that recurs and does not respond to other modalities).
The effective minimization of the clinical symptoms of depression as a result of electroconvulsive therapy (ECT) has been proven to be a result of a) Client age and length of time the depression have been affecting the client's quality of life b) Seizures that last less than 25 seconds and minimal EEG activity during the actual seizure c) Electrode placement and the form and dosage of the electrical stimulus d) Presence of preexisting chronic mental and physical conditions
Electrode placement and the form and dosage of the electrical stimulus Explanation: Research has proven that electrode location and the form and dosage of the electrical stimulus contribute to the clinical efficacy and cognitive effects of seizures.
A client has been diagnosed with seasonal affective disorder (SAD). Symptoms of SAD typically occur in which season? a) Fall b) Early spring c) Summer d) Late winter
Fall Explanation: Typically, symptoms of SAD begin in the fall or early winter and resolve in the spring.
Which of the following conditions is associated with an increased risk of complications during ECT? a) Tuberculosis b) Aortic aneurysm c) Hypertension d) Recent fracture
Hypertension Explanation: Hypertension is a condition associated with increased risk during ECT. Special considerations are given to clients with aortic aneurysm, tuberculosis, and recent fractures.
When providing care during electroconvulsive therapy (ECT), the psychiatric nurse documents the length and duration of the tonic-clonic seizure activity most noticeable in the muscles of the client's a) Abdomen b) Clavicles c) Jaw and face d) Upper arms
Jaw and face Explanation: During treatment, the nurse observes that tonic-clonic seizure activity is usually strongest in the muscles of the client's jaw and face. The seizure activity is not well-observed in the clavicles, upper arms, or abdomen.
Which of the following client factors would override the need to obtain informed consent from the client before administering ECT? a) A documented history of violence b) Presence of delusions c) Legal incapacitation d) Noncompliance with previous medication regimen
Legal incapacitation Explanation: The only time that informed consent for ECT would not be required from a client is if the client has been declared legally incapacitated by a court.
Which of the following client factors would override the need to obtain informed consent from the client before administering ECT? a) Noncompliance with previous medication regimen b) A documented history of violence c) Legal incapacitation d) Presence of delusions
Legal incapacitation Explanation: The only time that informed consent for ECT would not be required from a client is if the client has been declared legally incapacitated by a court.
The magnetic impulses used during transcranial magnetic stimulation are similar to those of which diagnostic procedure? a) Electroencephalography (EEG) b) Positron emission tomography (PET) c) Computerized tomography (CT) d) Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI) Explanation: The magnetic impulses are roughly the strength of the magnetic scanner used in MRI but are considerably more focused. They pass easily through the skull, just as the MRI scanner fields do.
Clients with seasonal affective disorder have symptoms similar to which of the following mental health disorders? a) Major depression b) Anxiety c) Schizophrenia d) Bipolar disorder
Major depression Explanation: Clients with SAD have symptoms similar to depression, which tend to disappear once the days become longer in the springtime.
Which of the following indications is the primary use for ECT? a) Substance abuse with mood disorder b) Major depression with psychotic features c) Noncompliance with treatment regimen d) Personality disorder
Major depression with psychotic features Explanation: ECT is indicated for treating major depression with psychotic features. ECT is not used in substance abuse or personality disorders; it would not be appropriate to treat with ECT for the sole reason that the client does not comply with treatment.
A client with refractory major depression is undergoing ECT using bilateral electrodes. The nurse should monitor the client for which of the following adverse effects related to this type of placement? a) Anemia b) Memory loss c) Urinary incontinence d) Hypotension
Memory loss Explanation: Bilateral (both temples) placement of electrodes has happened in the past and sometimes is used now; however, such placement leads to increased adverse effects, such as memory loss. Hypotension, anemia, and urinary incontinence are not generally adverse effects of ECT.
A client with refractory major depression is undergoing ECT using bilateral electrodes. The nurse should monitor the client for which of the following adverse effects related to this type of placement? a) Anemia b) Memory loss c) Urinary incontinence d) Hypotension
Memory loss Explanation: Bilateral (both temples) placement of electrodes has happened in the past and sometimes is used now; however, such placement leads to increased adverse effects, such as memory loss. Hypotension, anemia, and urinary incontinence are not generally adverse effects of ECT.
Prior to ECT, the client will undergo brief general anesthesia to prevent which of the following? a) Pain b) Memory loss c) Muscle contractions d) Vomiting
Muscle contractions Explanation: Prior to the procedure, clients undergo general anesthesia with succinylcholine to prevent severe muscle contractions that might result in muscle or bone injuries.
Succinylcholine (Anectine), a medication used in electroconvulsive therapy (ECT), has which of the following actions? a) Antihypertensive b) Antipsychotic c) Muscle relaxant d) Diuretic
Muscle relaxant Explanation: Succinylcholine is the muscle relaxant of choice during ECT. This drug does not have the classification of diuretic, antihypertensive, or antipsychotic.
Succinylcholine (Anectine), a medication used in electroconvulsive therapy (ECT), has which of the following actions? a) Antipsychotic b) Antihypertensive c) Diuretic d) Muscle relaxant
Muscle relaxant Explanation: Succinylcholine is the muscle relaxant of choice during ECT. This drug does not have the classification of diuretic, antihypertensive, or antipsychotic.
A client is undergoing ECT. The nurse would be correct to inform the client of which aspect prior to the ECT? a) There will be mild to moderate pain. b) The client will be awake during the procedure. c) NPO will be employed 8 hours prior to the procedure. d) The procedure is done with a full bladder.
NPO will be employed 8 hours prior to the procedure. Explanation: Prior to the ECT procedure, the client is NPO for 8 hours. The client will empty his bladder just before or after vital signs are taken prior to the ECT. The client will not be harmed or feel any pain. The client will be asleep during the procedure.
Clients who will be undergoing phototherapy for seasonal affective disorder (SAD) should consult with what medical specialty prior to the start of treatment? a) Neurologist b) Ophthalmologist c) Pulmonologist d) Gastroenterologist
Ophthalmologist Explanation: Clients should be instructed to consult an ophthalmologist prior to commencing treatment and not to look directly into the light. Ophthalmic damage was reported from the use of earlier, less sophisticated phototherapy boxes, but newer boxes screen out harmful rays that may damage the eyes.
When responsible for the recovery care of a client receiving electroconvulsive therapy (ECT), the psychiatric nurse provides care until the client is ... a) Communicating verbally and nonverbally b) Awake and moving all extremities c) Capable of spontaneous respirations d) Oriented to person, place, and time
Oriented to person, place, and time Explanation: According to ECT guidelines, interventions are provided as needed until the client is awake, alert, and oriented to person, place, and time. The other options provided do not signal termination of treatment care.
Deep brain stimulation (DBS) is utilized in which disease for relief of tremors? a) Alzheimer's disease b) Seasonal affective disorder c) Depression d) Parkinson's disease
Parkinson's disease Explanation: Deep brain stimulation is used in end-stage Parkinson's disease for relief of distressing tremors
The most common therapy for seasonal affective disorder includes which of the following? a) ECT b) Phototherapy c) Psychosurgery d) Deep brain stimulation
Phototherapy Explanation: The most common treatment for SAD is phototherapy. It is generally accepted that SAD develops in predisposed people as a result of insufficient exposure to sunlight.
The action of vagus nerve stimulation (VNS) is on which of the following nerves? a) Trigeminal b) Facial c) Phrenic d) Optic
Phrenic Explanation: The action of VNS is on the phrenic nerve, which feeds back to the brain's limbic system. The VNS does not affect the optic, trigeminal, or facial nerves
In seasonal affective disorder, levels of melatonin and serotonin depend on the exposure of which gland to sunlight? a) Sebaceous b) Thyroid c) Pituitary d) Pineal
Pineal Explanation: Levels of melatonin and serotonin depend on the exposure of the pineal gland to sunlight.
A client is scheduled to undergo bilateral electroconvulsive therapy (ECT) tomorrow. The nurse should plan for which of the following activities? a) Encourage caffeine intake the day before treatment to support seizure activity. b) Encourage fluids 6 to 8 hours before the treatment. c) Provide frequent, supportive reorientation after the treatment. d) Encourage the family to accompany the client to the treatment.
Provide frequent, supportive reorientation after the treatment. Explanation: Common side effects of bilateral ECT treatments are confusion, disorientation, and short-term memory loss. The nurse should plan frequent, brief, and succinct reorientation statements.
Approximately 100,000 U.S. citizens receive electroconvulsive therapy (ECT) annually. ECT is the most effective treatment for which mental health disorder? a) Refractory major depression b) Schizophrenia c) Anxiety disorder d) Mania
Refractory major depression Explanation: ECT is the most effective treatment available for refractory major depression.
Approximately 100,000 U.S. citizens receive electroconvulsive therapy (ECT) annually. ECT is the most effective treatment for which mental health disorder? a) Mania b) Refractory major depression c) Anxiety disorder d) Schizophrenia
Refractory major depression Explanation: ECT is the most effective treatment available for refractory major depression.
The most important nursing intervention during post-op recovery from ECT is what? a) Monitoring the client's vital signs every hour for 4 hours b) Encouraging early ambulation c) Reorienting the client to time and place d) Placing the client in Trendelenburg's position
Reorienting the client to time and place Explanation: The most common adverse side effects of ECT are confusion and temporary memory loss. Continuous orientation to time and place is important as the client is waking up from ECT. Vital signs should be monitored for 15 minutes, and the client should be placed in a side-lying position to reduce the risk of aspiration. The client should remain on bed rest until he or she is fully alert and oriented.
Mrs. Taylor's psychiatrist has explained the potential benefits of ECT in the treatment of her depression. Which of the following nursing diagnoses is most likely to apply to a client who is scheduled to soon begin ECT? a) Risk for ineffective protection b) Risk for impaired physical mobility c) Risk for anxiety d) Risk for decisional conflict
Risk for anxiety Explanation: The prospect of beginning a regimen of ECT is likely to cause anxiety in a client. This likely supersedes the risks of decisional conflict, impaired mobility, or ineffective protection.
Mrs. Taylor's psychiatrist has explained the potential benefits of ECT in the treatment of her depression. Which of the following nursing diagnoses is most likely to apply to a client who is scheduled to soon begin ECT? a) Risk for impaired physical mobility b) Risk for decisional conflict c) Risk for anxiety d) Risk for ineffective protection
Risk for anxiety Explanation: The prospect of beginning a regimen of ECT is likely to cause anxiety in a client. This likely supersedes the risks of decisional conflict, impaired mobility, or ineffective protection.
Phototherapy is used as a treatment of which of the following mood disorders? a) Seasonal affective disorder (SAD) b) Mania c) Schizoaffective disorder d) Major depression
Seasonal affective disorder (SAD) Explanation: Phototherapy (light therapy) was introduced during the 1980s as a treatment for seasonal affective disorder, a mood disorder with a seasonal pattern. Phototherapy has not been shown effective in major depression, mania, or schizoaffective disorder
Most of the literature regarding ECT posits that which of the following neurotransmitters increases after the procedure? a) Norepinephrine b) Dopamine c) Epinephrine d) Serotonin
Serotonin Explanation: One theory is that ECT alters neurotransmitter receptors and thereby the chemistry of the brain. Most often, the literature posits that serotonergic levels increase after ECT. Dopamine, epinephrine, and norepinephrine are not implicated in the use of ECT.
Prior to undergoing ECT, brief general anesthesia is given to prevent which of the following? a) Memory loss b) Dry secretions c) Emesis d) Severe muscle contractions
Severe muscle contractions Explanation: Prior to the ECT procedure, clients undergo brief general anesthesia with succinylcholine to prevent severe muscle contractions that might result in muscle or bone injuries.
A generally accepted theory states that seasonal affective disorder results from insufficient amounts of which of the following? a) Calcium b) Iron c) Vitamin C d) Sunlight
Sunlight Explanation: Although competing theories of the etiology of SAD exist, it is generally accepted that SAD develops in predisposed people as a result of insufficient exposure to sunlight. SAD is not caused by insufficient iron, calcium, or vitamin C.
When teaching a client diagnosed with seasonal affective disorder (SAD), the nurse should include which of the following in the teaching plan? a) Use heavy drapes rather than translucent curtains or shades b) Jog before sunup c) Take brief walks outside around noon without sunglasses d) Sleep and work in a west-facing room
Take brief walks outside around noon without sunglasses Explanation: The nurse must teach the client with SAD and his or her family to take brief walks outside around noon without sunglasses. He or she must be taught to sleep and work in an east-facing room, use translucent curtains or shades rather than heavy drapes, and jog before sundown.
ECT involves placing an electrode on which area and inducing a grand mal seizure? a) Temporal region b) Frontal region c) Cerebellar region d) Occipital region
Temporal region Explanation: ECT itself involves placing an electrode on the temple and inducing a grand mal seizure. Bilateral (both temples) placement of electrodes has happened in the past and sometimes is used now; however, such placement leads to increased adverse effects, such as memory loss
In providing post-op care for the client who has just undergone ECT, which of the following findings would indicate that ECT has been effective and the client is displaying normal sequelae of this procedure? a) The client is highly agitated and trying to get out of the bed. b) The client has a seizure in the recovery room. c) The client's heart rate is 120 and a slight arrhythmia is detected. d) The client cannot remember to which inpatient unit he or she is returning.
The client cannot remember to which inpatient unit he or she is returning. Explanation: Short-term memory loss is a common side effect of the ECT procedure. Arrhythmias, tachycardia, seizures, and agitation are not expected following ECT; they should be thoroughly assessed.
A client is undergoing implantation of a vagal nerve stimulator for refractory partial-onset seizures. Preoperative teaching for this client should include which of the following? a) Local anesthesia will be used during the procedure b) The procedure will be done under general anesthesia c) Hospitalization will be required for several days d) There are relatively no side effects from the procedure
The procedure will be done under general anesthesia Explanation: The implantation of the VNS is done under general anesthesia on an outpatient basis. Side effects include coughing, hoarseness, voice changes, dyspnea, and irritation at the site of the implant.
Deep brain stimulation (DBS) is used in end-stage Parkinson's disease for relief of which of the following symptoms? a) Bradykinesia b) Rigidity c) Tremor d) Mask-like face
Tremor Explanation: DBS is used in end-stage Parkinson's disease for relief of distressing tremors. Rigidity, bradykinesia, and a mask-like face are symptoms of Parkinson's disease, but are not the targets of DBS.
As part of the pretreatment information, the nurse should explain that the client will be asked to fast for which timeframe prior to electroconvulsive therapy (ECT)? a) 6 hours b) after midnight c) 2 hours d) 4 hours
after midnight Explanation: Clients are generally asked to fast after midnight the day of the procedure
As part of the pretreatment information, the nurse should explain that the client will be asked to fast for which timeframe prior to electroconvulsive therapy (ECT)? a) 4 hours b) 2 hours c) after midnight d) 6 hours
after midnight Explanation: Clients are generally asked to fast after midnight the day of the procedure.
Which of the following procedures have been found safest and most effective concerning psychosurgery? Select all that apply. a) Limbic leucotomy b) Anterior cingulotomy c) Subcaudate tractomy d) Anterior capsulotomy e) Thymectomy
• Anterior cingulotomy • Subcaudate tractomy • Limbic leucotomy • Anterior capsulotomy Explanation: Four procedures are most commonly employed and regarded as the safest and most effective: anterior cingulotomy, subcaudate tractomy, limbic leucotomy, and anterior capsulotomy. All are performed bilaterally, and all involve creating lesions of limbic or paralimbic structures and interruptions of their connections with deeper brain structures.
Somatic therapies are biologically based and generally include which of the following? Select all that apply. a) Chinese medicine b) Psychopharmacotherapeutics c) Bodily-oriented modalities d) Energy medicine e) Holism
• Bodily-oriented modalities • Psychopharmacotherapeutics Explanation: Somatic therapies are biologically based therapies and generally include psychopharmacotherapeutics and nonpharmacologic, bodily-oriented modalities. Holism, energy medicine, and Chinese medicine are known as integrative therapies.
Choice Multiple question - Select all answer choices that apply. In clients who have not responded to more traditional treatment modalities, electroconvulsive therapy (ECT) has been proven to be effective in managing the symptomology of depression as well as (Select all that apply.) a) Intractable mania b) Grief reaction c) Somatic disorders d) Obsessive-compulsive disorder (OCD) e) Acute schizophrenia
• Intractable mania • Acute schizophrenia • Obsessive-compulsive disorder (OCD) Explanation: In clients who have not responded to more traditional treatment modalities, electroconvulsive therapy (ECT) has been proven to be effective in managing the symptomology of depression as well as OCD, acute schizophrenia, and intractable mania.
Besides refractory major depression, electroconvulsive therapy (ECT) is indicated for which of the following mental health disorders? Select all that apply. a) Schizoaffective disorder b) Schizophrenia c) Anorexia nervosa d) Alcoholism e) Mania
• Schizophrenia • Mania • Schizoaffective disorder Explanation: Approximately 85% of clients receiving ECT have major depression as the indication for use, with the remainder having schizoaffective disorder, mania, schizophrenia, and occasionally Parkinson's disease. Anorexia nervosa and alcoholism are not indications for ECT.
There are physical conditions that present an increased safety risk to a client receiving electroconvulsive therapy (ECT). These conditions include (Select all that apply.) a) Tuberculosis b) Osteoporosis c) Retinal detachment d) Diabetes e) Asthma
• Tuberculosis • Retinal detachment • Osteoporosis • Asthma Explanation: There are physical conditions that present an increased safety risk to a client receiving electroconvulsive therapy (ECT). These conditions include tuberculosis, retinal detachment, osteoporosis, and asthma.
Immediately following the implantation of a vagus nerve stimulator (VNS), the client may develop which of the following manifestations, which tend to decrease over time? a) Voice alteration b) Neck discomfort c) Shortness of breath d) Coughing e) Muscle spasms
• Voice alteration • Neck discomfort • Shortness of breath • Coughing Explanation: The client may develop voice alteration, shortness of breath, neck discomfort, and coughing after the vagus nerve stimulator is implanted, but these adverse effects tend to decrease with time.
