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 health care team. Which of the following actions should the nurse take?

Tell the client he cannot refuse the treatment because he was involuntarily committed.

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

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

A.   Coercing the client into treatment violates the client's autonomy and rights. Involuntary commitment does not mean the client loses the right to refuse treatment.
B.   Involving the client's family without their consent or participation in decision-making may not be appropriate and could breach confidentiality.
C.   Documenting the client's refusal of treatment ensures that the decision is appropriately recorded in the medical record and facilitates communication among the healthcare team members. It also protects the client's autonomy and legal rights.
D.   Informing the client that ECT does not require consent is incorrect. While laws regarding involuntary treatment vary by jurisdiction, clients generally have the right to refuse treatment, even if they are involuntarily committed.

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Correct Answer is A

Explanation

A. This response directly addresses the potential for self-harm, which is a critical concern when a client expresses hopelessness. It is an open-ended question that invites the client to discuss their feelings and provides the nurse with information to assess the client's safety.
B. Asking the client a why question may not be alright and this may make them to be guarded.
C. This response may come off as dismissive and lacks empathy towards the client's feelings.
D. Suggesting medication without further assessment is premature and may not address the root cause of the client's statement.

A. Provide written information about the client's treatment plan. B. Encourage countertransference when developing the nurse-client relationship. C. Monitor the client for splitting behaviors. D. Isolate the client from social or group interactions.

Correct Answer is A

Explanation

A. Providing written information about the treatment plan promotes transparency and helps to establish trust with the client, which is important in the care of individuals with paranoid personality disorder.
B. Encouraging countertransference can blur professional boundaries and may exacerbate distrust or suspicion in clients with paranoid personality disorder.

C. Monitoring for splitting behaviors is important in personality disorders but does not directly address the client's needs or promote therapeutic engagement.
D. Isolating the client from social or group interactions can exacerbate feelings of paranoia and may not be therapeutic or appropriate.

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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 health care team. Which of the following actions should the nurse take?

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