A 45-year-old patient with severe major depressive disorder has been non-responsive to several antidepressant medications over the past year. The patient has been experiencing significant weight loss, insomnia, and suicidal ideation. The psychiatrist is considering electroconvulsive therapy (ECT) as a treatment option. What is the most appropriate reason for choosing ECT in this case?

ECT is typically the first-line treatment for all patients with depression.

ECT is preferred due to its ability to permanently cure depression.

ECT is used primarily for managing anxiety disorders.

ECT is effective for patients with treatment-resistant depression.

Answer and Explanation

The Correct Answer is D

Choice A reason: ECT is not the first-line treatment for depression. Antidepressant medications and psychotherapy are typically tried first.

Choice B reason: ECT is not a permanent cure for depression. It is highly effective but relapse can occur, requiring maintenance therapy.

Choice C reason: ECT is not primarily used for anxiety disorders. It is reserved for severe depression, catatonia, or treatment-resistant cases.

Choice D reason: ECT is particularly effective for patients with treatment-resistant depression, especially when symptoms are severe and life-threatening, such as suicidal ideation and significant weight loss. This makes it the most appropriate reason for choosing ECT in this case.

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Correct Answer is D

Explanation

Choice A reason: Administering PRN medications may help with hallucinations, but this is not the immediate priority when the client is confused and disorganized. Safety and reassurance must come first before pharmacological interventions.

Choice B reason: Distraction techniques can be useful in managing hallucinations or agitation, but they do not address the immediate need for safety and reassurance when the client is confused.

Choice C reason: Group activities may overwhelm a confused client and increase distress. Forcing participation is not therapeutic and does not prioritize safety.

Choice D reason: Providing reassurance and ensuring safety is the priority intervention. Confusion and disorganized thinking increase the risk of harm to self or others. Establishing a calm environment, offering comfort, and maintaining safety are foundational nursing responsibilities in acute psychiatric care.

A. Ask the client, “Can you tell me exactly what the voices are telling you to do?” B. Remind the client that the voices are not real and encourage distraction techniques. C. Escort the client to a quiet room and encourage deep breathing. D. Notify the provider of the hallucination and request a medication adjustment.

Correct Answer is A

Explanation

Choice A reason: The priority is to assess the content of the hallucinations to determine the level of risk. If the voices are commanding self-harm or violence, immediate safety interventions are required. This makes assessment the first and most critical step.

Choice B reason: Reminding the client that the voices are not real may be therapeutic later, but it does not address the immediate safety concern. Without knowing the content of the hallucinations, the nurse cannot determine risk.

Choice C reason: Escorting the client to a quiet room and encouraging relaxation may help reduce anxiety but does not address the potential danger of command hallucinations. Safety assessment must come first.

Choice D reason: Notifying the provider and requesting medication adjustment is appropriate after assessing the hallucination content. Immediate risk must be evaluated before treatment changes are considered.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has been diagnosed with schizophrenia and appears confused and has distortions in their thinking and speech patterns. Which of the following is the priority nursing intervention for this client?

Correct Answer is D

Explanation

A nurse is assessing a client with schizophrenia who is hearing voices. The client states, “They keep telling me to do something bad to myself.” Which of the following actions should the nurse take first?

Correct Answer is A

Explanation

A nurse is reviewing discharge instructions with a client who has bipolar disorder and is taking lithium. Which of the following manifestations should the nurse include as an indication of mild toxicity?

A nurse is assessing for the presence of extrapyramidal side effects (EPS) in a client who is taking chlorpromazine. Which of the following findings should the nurse recognize as EPS? (Select all that apply.)

A nurse is caring for a client who is receiving haloperidol for acute psychosis. During morning rounds, the client is observed to have a stiff neck, an arched back, and eyes fixed upward. Which of the following actions should the nurse take first?

The psychiatric ED triage nurse evaluates four clients. Based on the severity and urgency of suicidality, which client should be prioritized for immediate intervention?

A nurse is caring for a client diagnosed with somatic symptom disorder who reports chest pain. Laboratory results and ECG are within normal limits, and the client has no cardiac history. Which of the following nursing actions is most appropriate at this time?

A nurse is evaluating the effectiveness of interventions for a client with schizophrenia who is experiencing negative symptoms. Which of the following client statements indicates that the interventions have been effective?

A nurse on a mental health unit is caring for a client Exhibits The nurse is planning care for the client. Which of the following actions should the nurse plan to take? (Select all that apply.)

A nurse is reviewing the medical record of a client who has schizophrenia and is receiving olanzapine. Which of the following findings should the nurse identify as an adverse effect of olanzapine?