A mental health nurse is planning care for a group of clients.
Which of the following clients should the nurse identify as having a contraindication for applying restraints?

Choice A rationale:

It is not accurate to state that the provider is required to notify the client's family of their admission. While providers may often choose to involve family members in the care of a client with MDD, this is not a mandatory requirement for voluntary admission.

Disclosing a client's admission without their consent could breach confidentiality and potentially damage trust between the client and healthcare team.

It's essential to respect the client's privacy and autonomy, and to obtain their permission before sharing any information with family members.

Choice C rationale:

It is incorrect to state that a client gives up their right to refuse psychotropic medications upon voluntary admission. Informed consent remains a crucial principle even in an acute mental health setting.

Clients have the right to decline medications or other treatments, even if healthcare providers believe those interventions would be beneficial.

It's important to engage in a collaborative discussion with the client, provide education about treatment options, and respect their decisions.

Choice D rationale:

It is misleading to suggest that a client cannot leave the facility until the provider completes a discharge summary and authorizes discharge.

While providers play a significant role in discharge planning, clients ultimately have the right to request discharge from voluntary admission, even if the provider does not fully agree with the decision.

Providers may need to initiate involuntary commitment procedures if a client poses a serious risk to themselves or others, but this is a separate process with specific legal requirements.

Choice B is the most accurate statement because it emphasizes the importance of informed consent throughout the treatment process. Even in a voluntary admission, clients retain their right to make decisions about their care and to be fully informed about the risks and benefits of any proposed treatments.

Choice A rationale:

The client’s reported behavior of using laxatives and inducing vomiting after eating can lead to a condition known as hypomagnesemia. Hypomagnesemia is a condition characterized by low levels of magnesium in the blood. This condition can be caused by poor intake, excessive loss, or movement of magnesium from the blood into less accessible locations. The use of laxatives can lead to excessive loss of magnesium through increased bowel movements. Similarly, self-induced vomiting can also result in a loss of magnesium. Therefore, the client’s behavior puts them at risk for developing hypomagnesemia.

Choice B rationale:

Renal failure, also known as kidney failure, occurs when the kidneys lose their ability to filter waste products from the blood. While the use of laxatives and self-induced vomiting can lead to dehydration, which can strain the kidneys, these behaviors are not directly associated with renal failure. Therefore, while it’s possible for the client to develop kidney problems, it’s less likely compared to hypomagnesemia.

Choice C rationale:

Heart failure occurs when the heart muscle doesn’t pump blood as well as it should. This condition can cause symptoms like shortness of breath, swelling, fatigue, and other symptoms. While severe electrolyte imbalances, such as those that might result from the use of laxatives and self-induced vomiting, can affect heart function, they would typically result in arrhythmias (irregular heartbeats) rather than heart failure. Therefore, it’s less likely for the client to develop heart failure based on the behaviors described.

Choice D rationale:

Hyperthyroidism is a condition where the thyroid gland produces and releases too much thyroid hormone. This condition can cause symptoms like rapid heartbeat, weight loss, and anxiety. The client’s behaviors of using laxatives and inducing vomiting after eating do not directly influence the production of thyroid hormones. Therefore, it’s less likely for the client to develop hyperthyroidism based on the behaviors described.