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: The MMSE is influenced by education level and may underestimate cognitive abilities in individuals with limited formal education, leading to false positives for impairment.
Choice B reason: The MoCA is a sensitive tool for detecting mild cognitive impairment, but it also relies on literacy and educational background, potentially biasing results in those with low education.
Choice C reason: The SLUMS is specifically designed to account for varying education levels and provides adjusted scoring for individuals without a high school diploma, making it more accurate for initial cognitive assessment in this patient.
Choice D reason: The Mini-Cognition test is brief and useful in certain settings, but it is less comprehensive and may not adequately account for education-related biases, limiting its diagnostic accuracy in this patient.
Correct Answer is C
Explanation
Choice A reason: The St. Louis University Mental Status Exam is a cognitive screening tool designed to assess attention, memory, and executive function. While it evaluates multiple cognitive domains, it does not specifically require patients to draw a clock or recall three items in the same structured manner as other tools.
Choice B reason: The Montreal Cognitive Assessment evaluates multiple cognitive domains, including memory, attention, language, and executive function. It does include some tasks like recalling words, but it does not combine the clock-drawing and three-item recall in the same brief screening format.
Choice C reason: The Mini-Cog is a rapid cognitive screening tool that specifically combines a three-item recall test with a clock-drawing task. This combination allows for quick identification of cognitive impairment, making it especially useful in geriatric populations for detecting early dementia.
Choice D reason: The Geriatric Depression Scale is a screening instrument used to assess depressive symptoms in older adults. It does not include tasks like clock drawing or three-item recall, as its focus is on mood and affect rather than cognitive function.
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