A nurse is caring for a client who has severe depression and is scheduled to receive electroconvulsive therapy. The nurse should recognize that the client will receive succinylcholine to prevent which of the following adverse effects?
Aspiration
Decreased heart rate
Elevated blood pressure
Muscle distress
The Correct Answer is D
A. Aspiration: Succinylcholine is used during electroconvulsive therapy (ECT) to induce muscle relaxation, but it does not specifically prevent aspiration. Aspiration risk is generally minimized by using an endotracheal tube and appropriate airway management during the procedure, not just succinylcholine.
B. Decreased heart rate: Succinylcholine is not used to manage heart rate. While ECT can cause heart rate fluctuations, other medications, like atropine, are typically used if bradycardia is a concern.
C. Elevated blood pressure: Succinylcholine does not address blood pressure regulation. ECT can cause temporary increases in blood pressure, but succinylcholine is used to relax muscles and does not manage blood pressure.
D. Muscle distress: Succinylcholine is given during ECT to relax muscles and prevent muscle contractions or "muscle distress" during the procedure. Without muscle relaxation, muscle contractions during the procedure could cause injury or severe discomfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "I do not see myself attending community support groups": This indicates resistance to accepting the diagnosis. Participation in community support groups, such as Alcoholics Anonymous, is often an important part of treatment and recovery for alcohol use disorder.
B. "My drinking isn't as bad as everyone says it is.": This statement reflects denial, a common defense mechanism in individuals with alcohol use disorder. It shows a lack of acceptance and an unwillingness to acknowledge the severity of the problem.
C. "My family has a history of alcohol use disorder": This indicates acceptance of the diagnosis as the client is acknowledging the familial connection and potential genetic predisposition to alcohol use disorder. It shows insight into the condition and a willingness to consider its impact.
D. "I was diagnosed because my spouse is upset about my drinking": This statement shifts the responsibility for the diagnosis onto the spouse and does not show acceptance of the disorder. It suggests that the client may not fully accept the diagnosis as their own issue.
Correct Answer is C
Explanation
A. Venlafaxine and frequent yawning/weight loss: Frequent yawning and weight loss are not typical signs of an adverse reaction to venlafaxine. These symptoms can occur with various conditions, but they do not necessarily require withholding the medication.
B. Olanzapine and frequent urination: Frequent urination is not a known side effect of olanzapine. However, the nurse should assess the client for other factors contributing to this symptom. It may not be severe enough to require withholding the medication without further evaluation.
C. Fluoxetine and muscle rigidity/tachycardia: Muscle rigidity and tachycardia could indicate serotonin syndrome, a potentially life-threatening condition. This requires immediate intervention, and the medication should be withheld while notifying the provider for further evaluation and treatment.
D. Nortriptyline and nausea/dry mouth: Nausea and dry mouth are common side effects of tricyclic antidepressants like nortriptyline. These symptoms typically do not require withholding the medication, but the nurse should monitor the client for any worsening or additional adverse effects.
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