PSY Ch 15 5

When scheduling electroconvulsive therapy (ECT), which client should the nurse prioritize? A. A client in bed in a fetal position who is experiencing active suicidal ideations B. A client with an irritable mood and exhibiting angry outbursts C. A client experiencing command hallucinations and delusions of reference D. A client experiencing manic episodes of bipolar disorder

ANS: A A client who is experiencing suicidal ideations is in need of an immediate intervention to prevent self-harm and must be prioritized when the nurse schedules ECT.

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

ANS: C The client has the right to terminate treatment. This nursing reply acknowledges this right but focuses on the client's concerns so that the nurse can provide needed information.

A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to a client's electroconvulsive therapy (ECT) treatment. What is the rationale for administering this medication? A. Robinul decreases anxiety during the ECT procedure. B. Robinul induces an unconscious state to prevent pain during the ECT procedure. C. Robinul prevents severe muscle contractions during the ECT procedure. D. Robinul decreases secretions to prevent aspiration during the ECT procedure.

ANS: D Glycopyrrolate (Robinul) is the standard preoperative medication given prior to ECT treatments to decrease secretions and prevent aspiration.

26. Although death as a result of ECT is rare, the major cause of death with ECT is ____________.

cardiovascular complication Cardiovascular complications such as acute myocardial infarction or cerebrovascular accidents, when they do occur after ECT, are usually in individuals with previously compromised cardiac status. Assessment and management of cardiac disease prior to initiating ECT treatments is vital to reducing morbidity and mortality associated with ECT.

31. The nurse is assessing a client for side effects of electroconvulsive therapy (ECT). Which side effects are common and to be expected? 1) Temporary disorientation 2) Enduring memory loss 3) Residual seizure disorder 4) Cardiovascular complications

1) Temporary disorientation Temporary memory loss and confusion are common side effects of ECT.

33. An initial electroconvulsive therapy (ECT) procedure has been scheduled for a client diagnosed with major depression. After the nurse explains the procedure, the client states, "I'm too scared and can't decide what to do." Which is the appropriate nursing response? 1) "There is no room for concern. You will be all right." 2) "ECT is a safe, effective treatment. There is no degree of risk." 3) "Tell me a little more about your fears." 4) "Let your family make the decision for you."

3) "Tell me a little more about your fears." This therapeutic response explores the client's feelings about fears related to the treatment. The nurse will then be able to provide appropriate information that addresses the client's fears.

36. Which of the following medications would be appropriately administered by an anesthesiologist to a client immediately prior to electroconvulsive therapy (ECT)? Select all that apply. 1) Thiopental sodium (Pentothal) 2) Methohexital sodium (Brevital) 3) Succinylcholine chloride (Anectine) 4) Glycopyrrolate (Robinul) 5) Meperidine (Demerol)

Correct 1: Thiopental sodium (Pentothal) is a short-acting anesthetic that would be appropriate for an anesthesiologist to administer to a client immediately prior to ECT. Correct 2: Methohexital sodium (Brevital) is a short-acting anesthetic that would be appropriate for an anesthesiologist to administer to a client immediately prior to ECT. Correct 3: Succinylcholine chloride (Anectine) is a muscle relaxant that would be appropriate for an anesthesiologist to administer to a client immediately prior to ECT. Feedback 4: Glycopyrrolate (Robinul) is a preoperative medication given to decrease secretions and prevent aspiration. It is administered by the nurse about 30 minutes prior to the procedure. Feedback 5: Meperidine (Demerol) is a narcotic analgesic that would not be given by the anesthesiologist to a client prior to ECT.

24. The client asks the nurse what is involved with electroconvulsive therapy (ECT). What is the appropriate client teaching? Select all that apply. 1) "It creates a seizure in the brain that lasts no more than 5 to 10 seconds." 2) "It involves placing electrodes on your head." 3) "You will need only one treatment." 4) "You will get a muscle relaxant before the treatment." 5) "You may need maintenance treatments on an outpatient basis."

Feedback 1: Explaining that ECT creates a brain seizure may be appropriate teaching, but the seizure duration should be at least 15 to 25 seconds, not 5 to 10 seconds. Correct 2: Appropriate client teaching includes telling the client that electrodes will be placed on the head. Feedback 3: Most clients need not one, but 6 to 12 treatments. Some clients may require as many as 20 treatments. Correct 4: Appropriate client teaching includes telling the client that a muscle relaxant will be administered prior to ECT. Correct 5: Appropriate client teaching includes telling the client that he or she may need maintenance treatments on an outpatient basis.

28. A client is considering electroconvulsive therapy (ECT) and questions the nurse about the side effects of the treatment. What is the nurse's best response? 1) "The most common side effect is weight gain." 2) "The most common side effects are transient memory loss and confusion." 3) "There are no side effects." 4) "The most common side effect is depression."

2) "The most common side effects are transient memory loss and confusion." The memory loss usually encompasses the immediate pre- and post-treatment time frame. Confusion dissipates quickly.

30. A nursing instructor is teaching about nursing interventions during electroconvulsive therapy (ECT). Which student statement indicates the need for further instruction? 1) "I have to ensure that the client's airway is patent and provide suctioning if needed." 2) "I have to observe and record the type and amount of seizure activity." 3) "I have to monitor vital signs and cardiac functioning, and time the seizure." 4) "I have to determine the electrode placement as either bilateral or unilateral."

4) "I have to determine the electrode placement as either bilateral or unilateral." Determining the electrode placement as either bilateral or unilateral is the function of the psychiatrist, not the nurse. This student statement indicates the need for further instruction.

A client scheduled for electroconvulsive therapy (ECT) at 9:00 a.m. is discovered eating breakfast at 8:00 a.m. Based on this observation, which is the most appropriate nursing action? A. The nurse notifies the client's physician of the situation and cancels the ECT. B. The nurse removes the breakfast tray and assists the client to the ECT treatment room. C. The nurse allows the client to finish breakfast and reschedules ECT for 10:00 a.m. D. The nurse increases the client's fluid intake to facilitate the digestive process.

ANS: A A client who is scheduled for ECT treatments is given nothing by mouth (NPO) for a minimum of 6 to 8 hours before treatment.

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 is the most accurate nursing reply? A. "Clients typically receive ECT in their hospital room, daily for 1 month." B. "Clients typically receive 6 to 12 ECT treatments, three times a week in an outpatient setting." C. "Clients typically receive an unlimited number of treatments in the hospital treatment room." D. "Clients typically receive two to three treatments in either an outpatient or inpatient setting."

ANS: B Most clients require an average of 6 to 12 ECT treatments, but some may require up to 20 treatments. 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.

27. A client is about to undergo electroconvulsive therapy (ECT). Which statement most accurately reflects the nurse generalist's role during this procedure? 1) With advanced training, to perform the ECT procedure 2) To administer the general anesthetic during the procedure 3) To administer the ordered preoperative medications 4) To determine the number of ECT treatments

3) To administer the ordered preoperative medications

22. On the morning of a patient's first ECT procedure, the patient states, "I've been thinking about this all night and I've changed my mind; please call my doctor and tell her I don't want ECT treatments." Which of the following is the most appropriate response by the nurse? 1) "Since you have already signed the informed consent document, you will need to go through with the procedure." 2) "Don't worry; ECT treatments are not that bad." 3) "The team has already been assembled; it would be costly to back out now." 4) "I'll contact your doctor and let her know you are reconsidering."

4) "I'll contact your doctor and let her know you are reconsidering." This is an appropriate response by the nurse because it protects the patient's right to refuse medical treatment and demonstrates respect for the patient's expressed concern.

A chronically depressed and suicidal client is admitted to a psychiatric unit. The client is scheduled for electroconvulsive therapy (ECT). During the course of ECT treatments, a nurse should recognize the continued need for which critical intervention? A. Suicide assessment must continue throughout the ECT course of treatment. B. Antidepressant medications are contraindicated throughout the ECT course of treatment. C. Discourage expressions of hopelessness throughout the ECT course of treatment. D. Encourage high-caloric diet throughout the ECT course of treatment.

ANS: A ECT is an intervention for major depression that often includes suicidal ideations as a symptom. Continued suicide assessment is needed because mood improvement due to ECT may cause the client to act on suicidal ideations.

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

ANS: A Immediately after electroconvulsive therapy a nurse should monitor pulse, respirations, and blood pressure every 15 minutes for the first hour, during which time the client should remain in bed.

Immediately after electroconvulsive therapy, in which position should a nurse place the client? A. On his or her side to prevent aspiration B. In semi-Fowler's position to promote oxygenation C. In Trendelenburg's position to promote blood flow to vital organs D. In prone position to prevent airway blockage

ANS: A The nurse should place a client who has received electroconvulsive therapy on his or her side to prevent aspiration. After the treatment, most clients will awaken within 10 to 15 minutes and will be confused and disoriented. Some clients will sleep for 1 to 2 hours. All clients require close observation following treatment.

A nurse should recognize that electroconvulsive therapy (ECT) would potentially improve the symptoms of clients with which of the following Axis I diagnoses? (Select all that apply.) A. Major depressive disorder B. Bipolar disorder: manic phase C. Schizoaffective disorder D. Obsessive-compulsive anxiety disorder E. Body dysmorphic disorder

ANS: A, B, C 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. ECT has also been tried with other disorders, such as obsessive-compulsive disorder (OCD) and anxiety disorders, but little evidence exists to support its efficacy in the treatment of these conditions

During a course of 12 electroconvulsive therapy (ECT) treatments, an anxious client diagnosed with major depression refuses to bathe or attend group therapy. At this time, which of the following nursing diagnoses should be assigned to this client? (Select all that apply.) A. Anxiety R/T post-ECT confusion and memory loss B. Risk for injury R/T post-ECT confusion and memory loss C. Disturbed thought processes R/T post-ECT confusion and memory loss D. Altered sensory perception R/T post-ECT confusion and memory loss E. Social isolation R/T post-ECT confusion and memory loss

ANS: A, B, C, E Because of the post-ECT thought alterations of confusion and memory loss, the client is anxious, accident prone, and has socially isolated self. Altered sensory perception is related to psychotic thoughts of a sensory nature such as hallucinations, and because this client is diagnosed with major depression, not schizophrenia, altered sensory perception would not be anticipated.

Which of the following conditions would place a client at risk for injury during electroconvulsive therapy (ECT) treatments? (Select all that apply.) A. Severe osteoporosis B. Acute and chronic pulmonary disorders C. Hypothyroidism D. Recent cardiovascular accident E. Prostatic hypertrophy

ANS: A, B, D Severe osteoporosis, acute and chronic pulmonary disorders, and a recent history of cardiovascular accident (CVA) can render clients at high risk for injury during electroconvulsive therapy.

A nursing student is observing an electroconvulsive therapy (ECT) treatment. The student notices a blood pressure cuff on the client's lower leg. The student questions the instructor about the cuff placement. Which is the most accurate instructor reply? A. "The cuff has to be placed on the leg because both arms are used for intravenous fluids." B. "The cuff functions to prevent succinylcholine from reaching the foot." C. "The cuff position gives a more accurate blood pressure reading during the treatment." D. "The cuff is placed on the leg so that arms can easily be restrained during seizure."

ANS: B 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 this one limb that is unaffected by the paralytic agent.

A nursing instructor is teaching about electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred? A. "During ECT a state of euphoria is induced." B. "ECT induces a grand mal seizure." C. "During ECT a state of catatonia is induced." D. "ECT induces a petit mal seizure."

ANS: B Electroconvulsive therapy is the induction of a grand mal seizure through the application of electrical current to the brain for the purpose of decreasing depression.

A client is scheduled for an initial treatment of electroconvulsive therapy (ECT). Which information should a nurse include when teaching about the potential side effects of this procedure? A. "You may experience transient tangential thinking." B. "You may experience some memory deficit surrounding the ECT." C. "You may experience avolution for the remainder of the day." D. "You may experience a higher risk for subsequent seizures."

ANS: B The most common side effect of ECT is temporary amnesia following the ECT procedure.

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 determine the feasibility of this treatment option? A. Because the client is extremely suicidal, ECT is an appropriate option. B. Because antidepressant medications have been ineffective, ECT is a good alternative. C. Because informed consent is required for ECT, cognitive deficits preclude this option. D. Because of the client's cognitive deficits, a signed consent is waived.

ANS: C A client who is experiencing cognitive deficits cannot give informed consent that is required prior to ECT treatment. A court proceeding could determine the client's level of competency and, if necessary, appoint a guardian.

A client who is learning about electroconvulsive therapy (ECT) treatment asks a nurse "Isn't this treatment dangerous?" Which is the most appropriate nursing reply? A. "No, this treatment is side-effect free." B. "There can be temporary paralysis but full functioning returns within 3 hours of treatment." C. "There are some risks, but a thorough examination will determine your candidacy for ECT." D. "Transient ischemic attacks (TIA) can occur but are rare."

ANS: C Clients are given medical clearance for ECT. This decreases the risk of injury from the treatment.

A nursing instructor is teaching about the medications given prior to and during electroconvulsive therapy (ECT) treatments. Which student statement indicates that learning has occurred? A. "Atropine (Atro-Pen) is administered to paralyze skeletal muscles during ECT." B. "Succinylcholine chloride (Anectine) decreases secretions to prevent aspiration." C. "Thiopental sodium (Pentothal) is a short-acting anesthesia to render the client unconscious." D. "Glycopyrrolate (Robinul) is given to prevent severe muscle contractions during seizure."

ANS: C In order to render a client unconscious during the ECT procedure, an anesthesiologist administers intravenously, a short-acting anesthetic like thiopental sodium (Pentothal).

A nurse administers pure oxygen to a client during and after electroconvulsive therapy treatment. What is the nurse's rationale for this procedure? A. To prevent increased intracranial pressure resulting from anoxia B. To prevent hypotension, bradycardia, and bradypnea due to electrical stimulation C. To prevent anoxia due to medication-induced paralysis of respiratory muscles D. To prevent blocked airway resulting from seizure activity

ANS: C The nurse administers 100% oxygen during and after electroconvulsive therapy to prevent anoxia due to medication-induced paralysis of respiratory muscles. Electroconvulsive therapy is the induction of a grand mal seizure through the application of electrical current to the brain.

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

ANS: C Vagal stimulation induced by ECT may cause a client to experience bradycardia. Adequate tissue perfusion would be a realistic expectation when normal cardiac output is restored.

34. In the post-treatment period of electroconvulsive therapy (ECT), which is an appropriate nursing intervention? 1) Monitor vital signs every 30 minutes during the first hour. 2) Place client on back to facilitate comfort. 3) Orient client to time and place. 4) Ambulate immediately to promote adequate circulation.

3) Orient client to time and place. Orienting to time and place assists the client with overcoming the temporary confusion and disorientation that often follow ECT.

Which assessment test results should a nurse evaluate and report in the process of clearing a client for electroconvulsive therapy (ECT)? (Select all that apply.) A. Electrocardiogram graphic records B. Pulmonary function study results C. Electroencephalogram analysis D. Complete blood count values E. Urinalysis results

ANS: A, B, D, E A nurse should evaluate electrocardiogram graphic records, pulmonary function study results, complete blood count, and urinalysis results and report any abnormalities to the client's physician. The client must be medically cleared prior to ECT treatment.

35. Which is a projected outcome of electroconvulsive therapy (ECT)? 1) The client's anxiety disorder should improve. 2) The client's mood will be elevated. 3) The client's visual hallucinations will decrease. 4) The client's personality disorder symptoms will improve.

2) The client's mood will be elevated. ECT has been shown to be effective for clients diagnosed with severe depression. The projected outcome of the treatment should be elevated mood.

23. A client is to undergo electroconvulsive therapy (ECT) in the morning. Which nursing intervention is appropriate? 1) Keep the client NPO 24 hours before the procedure. 2) Verify that informed consent has been granted. 3) Ascertain that client has dentures securely in place. 4) Place side rails down for easy access to the restroom.

2) Verify that informed consent has been granted. Informed consent must be obtained prior to ECT.

21. The physician informs the client that succinylcholine chloride (Anectine) will be administered prior to electroconvulsive therapy (ECT). The client asks, "Why must I take this medication?" Which is the appropriate nursing response? 1) "To help settle your stomach before the procedure." 2) "To facilitate prolonged muscular activity during the procedure." 3) "To relax skeletal muscles during ECT." 4) "To control your respirations during ECT."

3) "To relax skeletal muscles during ECT." Succinylcholine chloride is the medication of choice used to relax the skeletal muscles and prevent severe muscle contractions and potential skeletal fractures during the seizure induced by ECT.

29. The nurse is caring for four clients. Which client should not be considered a candidate for electroconvulsive therapy (ECT)? 1) A client experiencing mania 2) A client diagnosed with catatonic schizophrenia 3) A client experiencing intracranial pressure 4) A client diagnosed with major depressive disorder

3) A client experiencing intracranial pressure The only absolute contraindication for ECT is increased intracranial pressure (from brain tumor, recent cardiovascular accident, or other cerebrovascular lesions).

32. A client is scheduled for electroconvulsive therapy (ECT). Prior to the client's ECT, what should the nurse teach the client? 1) "General anesthesia and a muscle relaxant drug will be used during the treatment." 2) "It will take 4 to 5 hours to recover from the procedure." 3) "ECT has been used since the 1930s. There is absolutely no risk involved." 4) "Permanent memory loss is a major side effect."

1) "General anesthesia and a muscle relaxant drug will be used during the treatment." According to the American Psychiatric Association standards, ECT should be given under general anesthesia with the use of a muscle relaxant drug.

25. A client, diagnosed with major depression, is scheduled for electroconvulsive therapy (ECT) in the morning. After awakening, prior to the treatment, the client asks, "Can I please get something to eat?" Which is the appropriate nursing response? 1) "You may have something light, such as crackers." 2) "You'll need to ask the doctor. He'll be in shortly." 3) "Just don't eat anything containing tyramine, such as aged meats and yellow cheeses." 4) "I know you'd like breakfast, but eating before your treatment may lead to complications."

4) "I know you'd like breakfast, but eating before your treatment may lead to complications." Clients are administered general anesthesia during ECT. Clients must be NPO before ECT to prevent nausea, vomiting, and possible aspiration during treatment.