Psych CH29

A nurse is discussing ECT (electroconvulsive therapy) treatments with a patient with chronic depression and the patient's parents. Which is the first therapeutic comment appropriate for this situation? a. "What do you know about ECT treatment?" b. "ECT treatment is used very successfully in treating your disorder." c. "The risks most often associated with ECT treatment are both minor and rare." d. "Do you have any questions about ECT treatment that I can answer for you now?"

ANS: A Educating the patient and family about ECT is a crucial nursing intervention. During the initial meeting, the nurse performs an assessment to determine the understanding of ECT by the patient and family. The nurse best accomplishes this by asking a direct assessment question that focuses on ECT knowledge. Beginning patient education with a needs-assessment question assists the nurse in organizing an effective teaching-learning plan. DIF: Cognitive Level: Analysis REF: Text Pages: 594-595 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

Which therapeutic nursing intervention would a nurse initiate just before ECT (electroconvulsive therapy) treatment? a. Providing the patient the opportunity to void in order to prevent incontinence b. Insertion of a straight urinary catheter to ensure the patient has an empty bladder c. Administration of diazepam (Valium) to minimize the presence of muscle spasms d. Administration of thiopental sodium (Pentothal) to help induce muscle relaxation

ANS: A Immediately before the patient receives ECT treatment, the nurse instructs the patient to void. This prevents incontinence during the treatment, minimizes the potential for bladder distention, and prevents damage during the procedure. Catheterization is not necessary since fluids have been restricted. Pre-procedure medications will be administered once the client has been transported to the procedure area. DIF: Cognitive Level: Analysis REF: Text Pages: 597-598 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

During the ECT (electroconvulsive therapy) stimulus, the nurse supports the patient's chin firmly against the bite-block positioned between the upper and lower teeth. The rationale for this intervention is to prevent: a. involuntary biting of the lips. b. tooth damage or gum laceration. c. involuntary swallowing of the tongue. d. development of TMJD (temporomandibular joint disorder).

ANS: B Although most muscles become completely relaxed during ECT, the nurse uses a bite-block between the upper and lower teeth in the patient's mouth to prevent the patient's jaw muscles, which are stimulated directly by ECT, from causing the teeth to clench. This prevents tooth damage and tongue or gum laceration during the stimulus. DIF: Cognitive Level: Comprehension REF: Text Page: 598 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient tells a nurse, "I've been having excellent results with phototherapy, but as soon as I stop, my mood gets worse." The nurse responds: a. "That is a strange reaction, but we know so little about light therapy that you may need to increase the dose." b. "That is one of the drawbacks with light therapy; depression may come back rapidly once the therapy is stopped." c. "I cannot account for your response to phototherapy. It is idiosyncratic, and you may need to take medication for your depression." d. "I think your response to phototherapy is unusual, but your health care provider will be best able to advise you regarding what to do next."

ANS: B Although most patients experience some degree of relief in 3 to 5 days, they experience relapse equally quickly when treatment is stopped. There is knowledge regarding how light therapy works and how it affects the body. The remaining options lack reference to what is known about the therapy. DIF: Cognitive Level: Application REF: Text Page: 601 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

Which patient has the greatest potential for symptom improvement after ECT (electroconvulsive therapy) treatment? a. A patient who has a dual diagnosis of cocaine and alcohol abuse b. A patient who appears stuporous and is diagnosed with major depression c. A patient diagnosed with depression who exhibits a sociopathic personality disorder d. A patient diagnosed with chronic schizophrenia who is exhibiting signs of dementia

ANS: B ECT is effective for target behaviors such as catatonia (stupor), and hyperemotionality, severe psychosis with acute onset. ECT is used as treatment for major depression in some patients. The effects ECT has on the human brain appear to have no effect on the other conditions mentioned in the options. DIF: Cognitive Level: Analysis REF: Text Pages: 595-596 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A patient shares with a nurse, "Since I moved from Florida to New York, I get depressed right before the winter holidays and it lasts for weeks. Is there anything I can do besides taking pills?" The most therapeutic nursing response is: a. "Consider phototherapy since it's likely you are experiencing seasonal affective disorder (SAD)." b. "I'm not clear about what you are saying. Please tell me more about what you are experiencing." c. "If you have a biochemically based depression, you will need antidepressant medication if you want to see improvement." d. "If you want dramatic results, ECT (electroconvulsive therapy) works the fastest and can usually be done on an outpatient basis."

ANS: B Phototherapy has been demonstrated to help patients affected by SAD. However, the question provides no information about whether the patient has been diagnosed with depression and little data about the clinical manifestations except that the patient speaks of having a depressed mood during the winter. Although much of this data fits SAD, it can fit other entities as well. The most therapeutic nursing intervention is the one that attempts to gather more baseline data from the patient rather than one that involves premature intervention. DIF: Cognitive Level: Analysis REF: Text Page: 601 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

Which statement should be included during the educational preparation of a patient who will undergo ECT (electroconvulsive therapy) in 1 week? a. "The induced seizure will last approximately 2 minutes and will be very mild." b. "We encourage a family member to stay with the patient during the treatment." c. "I'd be happy to arrange for you to speak with a patient who has experienced ECT." d. "There may be a small amount of permanent memory loss, but it is usually related to the time of the seizure itself."

ANS: C It is helpful to have the patient speak with another individual who has undergone ECT to alleviate anxiety. The motor seizure induced as part of the ECT treatment should last about 20 seconds but should not exceed 2 minutes to prevent a postictal state. Family members should be encouraged to come with the patient for at least the first few treatments but are not generally present during the actual treatment. Memory loss is temporary in most cases, and if it occurs it is usually related to the entire treatment. DIF: Cognitive Level: Application REF: Text Pages: 596-597 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

An ancillary staff member new to the night shift states, "I love working, but lately I'm so depressed for no apparent reason. What should I do?" Which nursing response would be most therapeutic? a. "I'm sure it is just temporary. If you just visit a tanning salon, the depression will be relieved more quickly." b. "As your friend I cannot advise you. You need to see a psychiatrist. Remember, the longer you wait, the worse depression becomes." c. "It may be that you aren't getting enough sunlight working the night shift. I'd suggest you discuss the possibility of phototherapy with your health care provider." d. "This seems temporary and will most likely disappear when you get used to this work schedule. In the meanwhile, get one of those special lights for your home."

ANS: C Sixty to ninety percent of patients with such a history appear to respond well to phototherapy (light therapy). The correct option appropriately suggests professional treatment while focusing on the possible cause of the depression. DIF: Cognitive Level: Analysis REF: Text Pages: 600-601 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

Which intervention would have the most therapeutic value for a patient who has just awakened after an ECT (electroconvulsive therapy) treatment and appears disoriented? a. The nurse brings a family member into the recovery room to stay and talk with the patient until the patient is fully awake. b. The nurse touches the patient's hand and in a calming voice assures the patient, "Everything is fine; the treatment is over." c. The nurse tells the patient that the treatment is over and shares, "You'll be a little confused but for only a very short time." d. The nurse addresses the patient by name and states, "I'm your nurse here at the hospital. Your treatment is over and you're doing fine."

ANS: D The most therapeutic nursing communication is the one in which the nurse does the following: greets the patient by the name he or she prefers; identifies the nurse and his or her purpose; orients the patient to the surroundings; reassures the patient of his or her status; and provides anticipatory guidance. DIF: Cognitive Level: Application REF: Text Page: 599 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A patient has been enrolled in a clinical trial of repetitive transcranial magnetic stimulation (rTMS). A nurse should ensure that which item is available in the treatment area? a. A blood pressure cuff b. A reflex hammer c. Suction d. Earplugs

ANS: D The potential for tinnitus or even transient hearing loss caused by the high-frequency noise produced by the treatment apparatus has prompted the routine use of earplugs for both patient and investigator, thus minimizing the occurrence of this adverse effect. DIF: Cognitive Level: Application REF: Text Pages: 601-602 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient scheduled for an early-morning electroconvulsive therapy (ECT) treatment asks a nurse, "Am I going to be able to eat breakfast before I go for ECT?" Which response by the nurse is most appropriate? a. "No, but you can have your breakfast when you get back to the unit." b. "You can have a light, liquid breakfast along with your medications." c. "You may only have enough liquids before the procedure to swallow your allergy medications." d. "Yes, but you need to get up early so you can fast for 2 to 4 hours before your ECT treatment begins."

ANS: A Patients who receive ECT treatment on an outpatient basis are asked to stay NPO for 6 to 8 hours before treatment to prevent aspiration from general anesthesia. If the patient is taking cardiac, antihypertensive, or H2 blocker medications, he or she may do so with a small sip of water several hours before the procedure. Food and liquids can be offered as soon as the patient is awake and can swallow effectively. DIF: Cognitive Level: Application REF: Text Pages: 594-595 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient scheduled for an initial ECT (electroconvulsive therapy) treatment asks a nurse, "Isn't the electrical current dangerous?" Which response would be the most therapeutic? a. "The amount of electricity is very small and used for only a few seconds." b. "The chance of you being shocked is minimal; you won't feel anything." c. "There's a small chance of something going wrong; the risk is about the same as with minor surgery." d. "You're worried about being electrocuted, aren't you? Don't worry; there is no chance of that happening."

ANS: A Patients who undergo ECT treatment often worry about the possibility of electrocution. However, it is best if the patient identifies fears by the facilitative communication technique of the nurse. The most therapeutic technique is that which provides information using a matter-of-fact communication style and a sense of authority that is reassuring but not overbearing. Trivialization is disrespectful, and using the word electrocution can often create anxiety rather than alleviate it. It is important for the patient to identify concerns rather than for the nurse to identify them; talking to a supportive nurse will alleviate a patient's anxiety. DIF: Cognitive Level: Analysis REF: Text Pages: 596-597 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A patient with a history of depression who has a pacemaker tells a nurse, "I want to receive transcranial magnetic stimulation (TMS) to help with my depression. Do you think that's possible?" Which is the nurse's best response? a. "I really can't assess whether or not you are a likely candidate for the treatment, but I'll share your interest with your health care provider." b. "Of course. Individuals who were willing to volunteer for groundbreaking treatments are so courageous." c. "TMS may be effective for depression, and it is safe for patients with an implanted pacemaker like you." d. "This treatment is far too experimental for a patient with your complex health problems."

ANS: A TMS, a noninvasive procedure that changes magnetic fields in the brain, has been found to be effective in the treatment of depression. However, patients with pacemakers, screws, plates, shrapnel, and other implants that might create a low-resistance current path are not considered for TMS. The comment regarding courage is not relevant to this situation. DIF: Cognitive Level: Application REF: Text Pages: 601-602 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A nurse is planning a unit education with staff about vagus nerve stimulation (VNS) in the field of psychiatry. The nurse would conclude that patients with which type of disorder would be most likely to benefit from this therapy, given current evidence? a. Depression b. Anxiety disorders c. Sleep disorders d. Addiction disorders

ANS: A The most compelling use of VNS in psychiatry is in the treatment of affective disorders, particularly depression. Because the vagus nerve has many functions, it should be studied in the future for other conditions, such as anxiety disorders, obesity, chronic pain syndromes, addictions, and sleep disorders. DIF: Cognitive Level: Comprehension REF: Text Page: 603 TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment: Management of Care

The spouse of a patient who is scheduled for ECT (electroconvulsive therapy) asks, "Isn't this a risky treatment? I know pills haven't worked, but this seems barbaric to me." Which response to the question is of greatest therapeutic communication value? a. "Although no treatment is perfect, research has proven that this therapy has the same risk as minor surgery and actually presents a lower risk than medication." b. "The psychiatrist would not order a treatment that would place your spouse in any real danger. I've seen many patients respond well to this treatment." c. "That's an understandable concern. However, you've been misled by outdated information that stigmatizes ECT treatment." d. "You appear to be very concerned about consenting to the treatment. I'd suggest you discuss this with your spouse's health care provider."

ANS: A The patient's spouse is expressing a common concern based on fear about what a loved one may experience. It is important for the nurse to be sensitive to the patient's concerns and encourage the expression of those concerns. The correct option is based on research findings. Notice that the nurse uses an analogy to make the point of safety to the patient. DIF: Cognitive Level: Application REF: Text Page: 600 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A patient diagnosed with major depression tells a nurse, "My cousin talked about sleep deprivation therapy as a treatment for depression. Can you tell me about it?" Which response by the nurse is most therapeutic? a. "Your cousin is right; sleep deprivation is a successful, scientifically based emerging therapy. I can suggest several health care providers who work with the therapy." b. "That therapy modality is not widely used at this time. It appears that the effects are not permanent, and there needs to be more scientific research done to prove its value." c. "Sleep deprivation therapy appears useful only when a patient is taking a monoamine oxidase inhibitor (MAOI) type of antidepressant in conjunction with the therapy." d. "Yes, the literature shows that this is a very promising therapy for a majority of patients with depression, and many clinical research studies are now under way to investigate this further."

ANS: B Although up to 60% of depressed patients respond to sleep deprivation therapy immediately, many become depressed again when they resume sleeping even as little as 2 hours per night. Few randomized trials have been conducted in this area, so it is not widely used in clinical practice. DIF: Cognitive Level: Application REF: Text Pages: 600-601 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A nurse is assisting in the preprocedure care of a patient scheduled for ECT (electroconvulsive therapy). Which nursing action must be taken immediately before the procedure? a. The electrode sites are shaved and cleaned with a soap and water. b. A blood pressure cuff and the oxygen saturation probe are applied. c. A 12-lead electrocardiogram (ECG) is run and the strip placed in the chart. d. The patient signs an informed consent form allowing for the treatment.

ANS: B The nurse applies equipment necessary for patient monitoring, including blood pressure cuff and oxygen saturation probe. Mild soap is used to cleanse the areas designated for electrode placement, but shaving the areas and shampooing the hair are not required. Results of a 12-lead ECG, which should be performed well before the patient gets to the treatment area, should have been reviewed to determine risks associated with anesthesia. The consent form should be signed earlier, and there is no need to sign another consent form at this time. DIF: Cognitive Level: Analysis REF: Text Page: 598 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient with recurring depression who experiences anhedonia, early-morning awakening, and sadness asks a nurse, "Do you think this sleep deprivation therapy would work for me?" Which response reflects the best attempt to answer the patient's question? a. "It's a legitimate therapy that works for some people. What do you know about it?" b. "Up to 60% of patients improve after sleep deprivation, but the depression tends to return soon after sleeping." c. "You can't go without sleep forever. What didn't you like about the treatment you received the last time?" d. "Sleep deprivation therapy may or may not help, but you've responded well in the past to antidepressant drug therapy."

ANS: B The patient has asked a legitimate question that reflects some reluctance about using a certain treatment. The correct option answers the patient's question in a direct, factual manner that provides accurate information. DIF: Cognitive Level: Analysis REF: Text Page: 597 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

What equipment should be available to the staff caring for a patient after receiving an ECT (electroconvulsive therapy) treatment? a. Spirometer b. Suctioning equipment c. Tympanic thermometer d. Padded wrist and ankle restraints

ANS: B The posttreatment recovery room for ECT should contain oxygen and suctioning equipment, an emergency cart, a pulse oximeter, and vital-sign monitoring equipment. A tympanic thermometer, spirometer, and padded restraints are not necessary equipment related to ECT treatment. DIF: Cognitive Level: Comprehension REF: Text Page: 599 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A nurse should plan to implement which action as part of the routine morning care for a hospitalized patient who has just returned from having ECT (electroconvulsive therapy) therapy? a. Have a walker available for use if the patient is unsteady on their feet. b. Measure and record all vital signs, including orientation, once per shift. c. Check the gag reflex before administering medications and offering breakfast. d. Wake the patient up every 30 minutes to assess and document neurological status.

ANS: C The nurse should check the gag reflex before offering medications and breakfast so that the patient does not aspirate because of the effects of general anesthesia. The nurse should use side rails and assist the patient to walk if unsteadiness is present. Vital signs should be measured every 15 minutes initially and then less often, but once per shift is insufficient after this procedure. Neurological status should be assessed every 30 minutes while the patient is awake, but the patient should not be awakened. It is thought that sleep helps return the patient to baseline more quickly. DIF: Cognitive Level: Application REF: Text Page: 599 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

Which data would a nurse document as being an adverse event after ECT (electroconvulsive therapy) treatment? a. Systolic pressure 30 points above baseline at 30 minutes posttreatment b. Complaints of muscle weakness continuing for 2 hours posttreatment c. Disorientation to time and place lasting 45 minutes posttreatment d. Complaints of nausea continuing for 4 hours posttreatment

ANS: D Adverse events associated with ECT treatment include prolonged periods of confusion or disorientation, recurrent nausea or headaches, and elevated blood pressure that do not remit after several hours following ECT treatment. DIF: Cognitive Level: Application REF: Text Page: 596 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient who has received three ECT (electroconvulsive therapy) treatments with no ill effects displays confusion and memory loss after the fourth treatment. Which nursing intervention would be most therapeutic based on a nurse's knowledge of ECT effects? a. Administer a benzodiazepine by IM injection immediately. b. Call the health care provider and report this sudden alteration immediately. c. Inform the family that the short-term memory loss may be permanent. d. Orient the patient periodically, emphasizing that the memory loss is temporary.

ANS: D Memory loss for recent events and confusion are common immediately after ECT treatment. They may persist for several weeks and then remit. The patient requires ongoing orientation for reassurance and safety. DIF: Cognitive Level: Application REF: Text Page: 599 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A nurse reviewing the medical records of inpatients on the psychiatric unit would conclude that which patient may gain the most benefit from transcranial magnetic stimulation (TMS)? a. A patient with anorexia nervosa b. A patient with a personality disorder c. A patient with generalized anxiety disorder d. A patient with a chronic severe mood disorder

ANS: D TMS has been studied for a number of indications, but the indication for this therapy most frequently cited in psychiatry has been mood disorders. A few small studies have suggested this treatment also may be helpful for those with obsessive-compulsive disorder and posttraumatic stress disorder. DIF: Cognitive Level: Comprehension REF: Text Pages: 601-602 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

Which finding indicates to a nurse that a patient experienced a brief generalized seizure while receiving bilateral ECT (electroconvulsive therapy) treatment? a. A motor seizure lasting 200 seconds b. A motor seizure lasting 150 seconds c. Motoric movement in both feet and an unchanged EEG d. Motoric movement in the cuffed foot and electroencephalogram (EEG) changes

ANS: D The electrical stimulus causes an observable, brief generalized seizure for 30 to 60 seconds in the cuffed foot and characteristic EEG changes. If the seizure lasts longer than 120 seconds (2 minutes), it is terminated with diazepam (Valium) or thiopental sodium (Pentothal). DIF: Cognitive Level: Comprehension REF: Text Page: 598 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential