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Rheumatoid arthritis is a chronic autoimmune condition affecting joints. While it may complicate positioning during electroconvulsive therapy (ECT), it is not a direct contraindication. With proper precautions and positioning support, clients with rheumatoid arthritis can safely undergo ECT.

Kidney failure is a serious medical condition but does not directly contraindicate ECT. The main considerations would be medication metabolism and electrolyte balance, which can be managed with appropriate monitoring. ECT itself does not directly worsen renal function.

Diabetes mellitus is not a contraindication for ECT. The primary concern is maintaining stable blood glucose levels before and after the procedure. With proper monitoring and adjustment of insulin or oral hypoglycemics, clients with diabetes can safely undergo ECT.

Decreased temperature is not a manifestation of neuroleptic malignant syndrome (NMS). In fact, NMS is characterized by hyperthermia due to severe muscle rigidity and autonomic dysfunction. A low temperature would not align with the pathophysiology of this condition.

Bradycardia is not typical of NMS. Instead, clients often present with tachycardia due to autonomic instability. Bradycardia would suggest another underlying condition rather than NMS.

Hyperthermia is indeed a classic feature of NMS, but in this question, the most defining and diagnostic manifestation is muscle rigidity. Hyperthermia occurs as a consequence of rigidity and autonomic dysfunction, but rigidity is the primary sign that distinguishes NMS from other conditions

Frequently questioning the client about orientation can increase anxiety and agitation, especially in individuals with Alzheimer’s disease. Sundown syndrome already heightens confusion and distress in the evening hours, and repeated questioning may feel overwhelming or frustrating. This approach does not reduce symptoms and can worsen behavioral disturbances.

Offering multiple activities to choose from may overwhelm the client. Individuals with Alzheimer’s disease often struggle with decision-making and processing multiple options. Instead of reducing anxiety, this intervention could increase confusion and agitation, particularly during sundown syndrome episodes.

Providing consistency in the client’s routine is generally beneficial for Alzheimer’s disease management, as it reduces confusion and promotes security. However, in the context of sundown syndrome with acute anxiety, the immediate priority is to reduce environmental stimulation. While routine consistency is important long-term, it does not directly address the acute episode as effectively as a low-stimulation environment.

Discontinuing meditation is not appropriate. Meditation is a relaxation technique that can improve sleep quality by reducing anxiety and promoting calmness. Removing meditation could worsen sleep disturbances rather than improve them.

Taking a 1-hour nap every day may interfere with nighttime sleep. Long daytime naps reduce sleep pressure, making it harder for the client to fall asleep at night. This can perpetuate the cycle of insomnia and daytime sleepiness, worsening the client’s problem.

Exercising late in the day, especially before bedtime, can stimulate the body and increase alertness, making it harder to fall asleep. While exercise is beneficial for depressive disorders, it should be scheduled earlier in the day to promote better sleep hygiene. Exercising close to bedtime is counterproductive for clients with insomnia.

Hypertension is not a primary adverse effect of clozapine. While clozapine can cause cardiovascular changes such as tachycardia or hypotension, hypertension is not a hallmark adverse reaction. Therefore, this option is incorrect.

Hypocalcemia is not associated with clozapine use. Electrolyte disturbances such as hypocalcemia are not part of the drug’s adverse effect profile. Clozapine’s risks are primarily hematologic, cardiovascular, and metabolic, not related to calcium balance.

Bradycardia is not a typical adverse effect of clozapine. Instead, clozapine is more likely to cause tachycardia due to its anticholinergic and adrenergic effects. Bradycardia would not be expected in this context, making this option incorrect.

Encouraging the use of problem-solving skills is appropriate during the working phase of group development, when members are actively engaging in discussions and applying coping strategies. It is not part of the orientation phase, which focuses on establishing trust and ground rules.

Maintaining the group’s focus on identified issues is also part of the working phase. At this stage, the nurse helps guide discussions and ensures that members remain on track with therapeutic goals. This is not the primary task during orientation.

Summarizing the achievement of the group’s goals occurs during the termination phase. This phase involves closure, reflection, and evaluation of progress. It is not appropriate during orientation, which is the initial stage of group formation.

Refusing to eat breakfast due to delusions of food being poisoned is concerning, but it primarily affects nutrition and hydration status. While important to address, it does not pose an immediate risk of harm compared to other findings.

Flat affect is a negative symptom often seen in schizophrenia and depressive disorders. It reflects diminished emotional expression but does not pose an immediate safety risk. This finding is important for treatment planning but is not the priority in acute care.

Paranoid statements such as “Everyone is out to get me” indicate persecutory delusions. These can contribute to mistrust and social withdrawal, but unless they escalate to aggression, they are not the most urgent concern.