A nurse is caring for a client who was involuntarily committed and is scheduled to receive electroconvulsive therapy (ECT). The client refuses the treatment and will not discuss why with the healthcare team. Which of the following actions should the nurse take?

Ask the client's family to encourage the client to receive ECT.

Tell the client they cannot refuse the treatment because they were involuntarily committed.

Document the client's refusal of the treatment in the medical record.

Inform the client that ECT does not require client consent.

Answer and Explanation

The Correct Answer is C

Choice A reason:
Asking the client's family to encourage the client to receive ECT may be a supportive measure, but it should not be the first action taken. The client's autonomy and right to refuse treatment must be respected, even if they are involuntarily committed. Family members can be involved in the discussion, but the client's decision should be paramount.

Choice B reason:
Telling the client they cannot refuse treatment because they were involuntarily committed is incorrect. Involuntary commitment does not automatically override a client's right to refuse treatment. Clients have the right to be informed about their treatment and to refuse it unless specific legal criteria are met.

Choice C reason:
Documenting the client's refusal of the treatment in the medical record is the correct action. It is essential to record the client's decision and the discussion surrounding it. This documentation ensures that the client's rights are respected and provides a legal record of the interaction.

Choice D reason:
Informing the client that ECT does not require client consent is incorrect and unethical. Consent is a fundamental patient right, and all clients, including those involuntarily committed, have the right to be informed about their treatment options and to give or withhold consent unless they are legally deemed incompetent to make such decisions.

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Correct Answer is A

Explanation

Choice A reason:
This statement indicates spiritual distress because it reflects a disruption in the client's spiritual practice due to the scheduling of therapy sessions. Meditation is often a crucial part of an individual's spiritual routine, providing a sense of peace, connection, and well-being. When such practices are interrupted, especially by factors outside one's control, it can lead to feelings of spiritual disconnection and distress.

Choice B reason:
While increased visits from a spiritual advisor could suggest a need for more support, it does not necessarily indicate spiritual distress. It could mean that the client is seeking additional guidance and comfort during illness, which is a common and proactive approach to maintaining spiritual health.

Choice C reason:
Gaining comfort from meditation is a positive statement reflecting that the client is able to find solace and spiritual support through their practice. This does not indicate spiritual distress; rather, it shows effective use of spiritual resources to cope with challenges.

Choice D reason:
Expressing that faith provides hope during difficult times is a sign of spiritual strength and resilience. This statement suggests that the client's spiritual beliefs are a source of support and do not reflect spiritual distress.

A. Implement seizure precautions. B. Monitor for orthostatic hypotension. C. Administer methadone hydrochloride. D. Acidify the client's urine.

Correct Answer is A

Explanation

Choice A reason:
Implementing seizure precautions is a critical intervention for a client with a history of alcohol use disorder who is admitted while intoxicated. Alcohol withdrawal can lead to seizures, which can be life-threatening. Seizure precautions include maintaining a safe environment, having emergency medication and equipment ready, and monitoring the client closely for signs of seizure activity.

Choice B reason:
Monitoring for orthostatic hypotension is important, especially if the client is experiencing withdrawal symptoms, as dehydration and electrolyte imbalances can occur. However, it is not as immediately critical as implementing seizure precautions for a client who is currently intoxicated.

Choice C reason:
Administering methadone hydrochloride is not an appropriate intervention for alcohol intoxication or withdrawal. Methadone is used for opioid use disorder, not alcohol use disorder, and could be harmful if given to a client with alcohol intoxication.

Choice D reason:
Acidifying the client's urine is not a standard intervention for alcohol intoxication or withdrawal. This intervention is more commonly associated with managing certain drug overdoses or poisonings to increase the elimination of the substance.

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A nurse is caring for a client who was involuntarily committed and is scheduled to receive electroconvulsive therapy (ECT). The client refuses the treatment and will not discuss why with the healthcare team. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing the spiritual beliefs of a client. Which of the following client statements indicates spiritual distress?

Correct Answer is A

Explanation

A nurse in an acute care facility is planning care for a client with a history of alcohol use disorder who is admitted while intoxicated. Which of the following interventions should the nurse implement?

Correct Answer is A

Explanation

A nurse is teaching a client who has major depressive disorder about electroconvulsive therapy. Which of the following information should the nurse include?

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