A client has just been admitted to the Post Anesthesia Care Unit after electroconvulsive therapy (ECT). Which intervention will the nurse perform first?

Orient the client and offer reassurance

Encourage the client to drink some fluids

Orient the client and monitor vital signs

Assist the client from the stretcher to a wheelchair

Answer and Explanation

The Correct Answer is C

C. After ECT, the client may be disoriented, confused, or drowsy due to the effects of anesthesia and the procedure itself. Orienting the client to their surroundings and situation helps promote their safety and comfort. Monitoring vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation, is crucial to assess the client's immediate post-procedural status and detect any complications.
A. Offering reassurance can help alleviate any anxiety or confusion the client may experience. However, while this intervention is important, it may not be the first priority immediately upon admission to the Post Anesthesia Care Unit (PACU).
B. Hydration is important after any medical procedure, including ECT. However, immediately after ECT, the client may still be recovering from anesthesia and may not be fully alert or able to safely drink fluids.
D. Assisting the client with mobility is important but it may not be the first intervention performed in the PACU after ECT. The priority immediately upon admission to the PACU is to ensure the client's safety.

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Correct Answer is C

Explanation

C. This statement demonstrates an understanding of the availability of support groups specifically for family members affected by alcohol use disorder and reflects the spouse's willingness to seek support independently of the client's readiness for treatment.
A. Effective teaching would convey that support groups are available not only for individuals struggling with alcohol use disorder but also for their family members who may need support in coping with the impact of the disorder on their lives.
B. Alcoholics Anonymous (AA) meeting are primarily for individuals with alcohol use disorder.
D. Effective teaching would emphasize the importance of the family seeking support for themselves independently of the client's readiness to seek treatment.

A. "The police will want to interview you." B. "I will call your spouse." C. "We'll have to take photographs of those wounds." D. "You are safe now."

Correct Answer is D

Explanation

D. This statement prioritizes the client's immediate emotional needs by providing reassurance, validation, and a sense of safety in a traumatic situation. It acknowledges the client's distress and communicates empathy and support, which are essential for building trust and rapport and facilitating the client's emotional healing process.
A. The client may feel overwhelmed by the prospect of speaking to the police at that moment, and it may not be the most therapeutic statement to prioritize.
B. Contacting the client's spouse may provide emotional support and assistance, but it may not be the priority therapeutic statement in this situation.
C. The client may already be feeling vulnerable and exposed, and discussing the need for photographs may exacerbate feelings of distress or discomfort.

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A client has just been admitted to the Post Anesthesia Care Unit after electroconvulsive therapy (ECT). Which intervention will the nurse perform first?

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Correct Answer is C

Explanation

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Correct Answer is D

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