A client with a history of major depressive disorder with psychotic features was rescued before jumping off a dam. The client is pacing, picking at the arms, and repeatedly mumbling, "I have to die. You cannot stop me." When the health care provider recommends electroconvulsive therapy (ECT) as the initial treatment, the client’s spouse says to the nurse, "I can’t allow such a cruel treatment. Why can’t they just give my spouse medication?" Which is the best response by the nurse?
"Your spouse could die by not receiving this treatment."
"ECT is safe and your spouse will not feel anything."
"It could take up to 3 weeks for medication to become effective."
"Your spouse is very ill and ECT might be the best treatment at this time. What are your concerns about ECT?"
The Correct Answer is D
Choice A reason: While it is true that untreated suicidal depression can be fatal, this response is confrontational and increases fear without addressing the spouse’s concern.
Choice B reason: Assuring the spouse that the client will not feel anything oversimplifies ECT. Though anesthesia prevents pain, this statement dismisses the spouse’s fears and does not encourage discussion.
Choice C reason: While medications do take weeks to be effective, simply giving this fact does not address the emotional concerns and fears about ECT being “cruel.”
Choice D reason: This response acknowledges the seriousness of the illness, explains why ECT may be necessary, and opens dialogue by inviting the spouse to share concerns. It is therapeutic, informative, and supportive, making it the best choice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Focusing only on medications neglects the interpersonal development central to Peplau’s model. The orientation phase emphasizes relationship building, not task-centered care.
Choice B reason: Allowing expression without structure or guidance does not fulfill the orientation phase, which requires the nurse to actively build trust and clarify roles.
Choice C reason: Excessive distance prevents rapport, which is essential in the orientation phase where the foundation for a therapeutic relationship must be established.
Choice D reason: Establishing trust, being consistent, and clarifying client expectations define the orientation phase of Peplau’s theory. This phase sets the groundwork for collaboration and progress in treatment.
Correct Answer is A
Explanation
Choice A reason: Consistent rules and firm boundaries are essential when working with individuals who display antisocial traits. Structure minimizes opportunities for manipulation and helps maintain safety and fairness on the unit.
Choice B reason: Offering sympathy and reassurance may reinforce manipulative behavior and undermine professional boundaries. It does not address the core issue of rule violation and lack of accountability.
Choice C reason: Allowing too much flexibility may increase opportunities for the client to exploit staff and disregard rules. This approach is counterproductive when dealing with manipulative behaviors.
Choice D reason: Developing a close, personal rapport risks blurring professional boundaries. Clients with these traits may exploit such relationships to gain privileges, which can disrupt treatment and unit structure.
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