A 27-year-old woman with major depressive disorder (MDD) was recently admitted voluntarily to an inpatient psychiatric hospital. Upon discharge, she is referred to a psychiatric-mental health nurse practitioner for follow-up. The client says she has tried several medications for MDD, but so far none has worked. The PMHNP recommends electroconvulsive therapy (ECT) as a treatment, explaining that the practice is safe and highly effective for treatment-resistant depression. The client declines, explaining she has heard too many negative things about ECT. Which of the following is the most appropriate response by the PMHNP?
"If you don't agree to treatment with ECT, you will have to be hospitalized against your will."
"Trust me, this is for your own good."
"I want you to feel comfortable with any treatment we agree upon. Let's put ECT on the back burner for now and explore other options."
"Do you really want to keep trying more and more medications? ECT works for most people. Just try it. What can it hurt?"
The Correct Answer is C
Choice A reason: Threatening hospitalization violates patient autonomy and informed consent principles. Coercion is unethical and legally problematic.
Choice B reason: Telling the patient to “trust me” dismisses her autonomy and does not allow her to make an informed decision. This approach undermines patient-centered care.
Choice C reason: Respecting the patient’s autonomy while offering guidance exemplifies ethical practice. By acknowledging her concerns and exploring alternatives, the PMHNP fosters a collaborative therapeutic relationship and supports informed decision-making.
Choice D reason: Pressuring the patient to accept ECT disregards her autonomy and can erode trust. This approach is coercive and not consistent with patient-centered ethical standards.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Patient safety is the overarching goal, but the description focuses specifically on cultural and organizational strategies to achieve safety rather than safety as a general outcome.
Choice B reason: Zero harm is a principle aiming for no errors, but it does not address the cultural and reporting elements described.
Choice C reason: Just Culture emphasizes accountability while promoting an open, non-punitive reporting environment, encouraging learning from errors without blame, aligning precisely with the hospital’s stated approach.
Choice D reason: A sociotechnical system considers the interaction of social and technical components but does not specifically encapsulate the ethical and cultural approach to reporting and accountability described here.
Correct Answer is D
Explanation
Choice A reason: This question addresses self-perception or body image rather than mood disturbances.
Choice B reason: This question pertains to health anxiety or obsessive worry, not mood.
Choice C reason: This question targets anxiety and control over worry, not mood specifically.
Choice D reason: Asking about periods of high energy, reduced need for sleep, and elevated mood screens for mood disorders such as mania or hypomania, making it the most relevant to the mood domain in the psychiatric ROS.
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