A nurse at an outpatient mental health facility is monitoring effective use of stress management techniques for a client who is attending stress management group therapy. Which of the following statements made by the client indicates effective use of cognitive reframing?

Rationale:

A. Decreased heart rate: Propranolol is a non-selective beta-blocker that reduces heart rate by blocking beta-1 receptors in the heart. Bradycardia is a common and expected adverse effect, and clients should be taught to monitor their pulse regularly and report significant drops.

B. Sudden weight loss: Sudden weight loss is not a typical adverse effect of propranolol. If it occurs, it may indicate an underlying condition or adverse reaction unrelated to the pharmacologic action of beta-blockers and should be evaluated separately.

C. Increased urinary output: Propranolol does not act on the kidneys to promote diuresis. While beta-blockers may be used in combination with diuretics, increased urine output is not a direct effect of this medication and is not expected.

D. White patches on the tongue: White patches on the tongue suggest oral candidiasis, which is more commonly associated with inhaled corticosteroids, not beta-blockers like propranolol. This symptom is unrelated to the medication’s mechanism of action.

Rationale:

A. Tonic-clonic seizures: Tonic-clonic activity is induced during the ECT procedure itself but typically resolves within seconds. It is not expected to persist 15 minutes post-procedure, as seizure activity is carefully controlled and monitored during the treatment.

B. Sleep apnea: While general anesthesia used during ECT can cause brief respiratory depression, sleep apnea is not a typical or expected consequence of the procedure. Continuous monitoring ensures airway patency during and immediately after treatment.

C. Paresthesias: Numbness or tingling sensations (paresthesias) are not common side effects of ECT. The procedure affects brain activity and cognition rather than peripheral nerves, making this symptom unlikely post-treatment.

D. Disorientation: Temporary confusion or disorientation is a common and expected side effect shortly after ECT. It typically resolves within 30 to 60 minutes as the effects of anesthesia wear off, and it is routinely monitored during recovery.