A nurse in a mental health facility is caring for a client who has major depressive disorder.
Progress Notes
Week 1
Client is experiencing major depressive disorder following the unexpected death of their partner 6 months ago. Has been unable to proceed through stages of grief. Has been on anti-depressant therapy for 5 months.
Admits to having thoughts of self-harm. Reports increasing anxiety levels. Loss of 15 lb over past months due to anorexia and anxiety. Reports insomnia, sleeping only 4 to 5 hr/night with frequent nightmares. Reports feelings of extreme fatigue.
Plan: Admit for group and individual therapy. Suicide precautions. Will add alprazolam to medication regimen.
Week 2
Client remains depressed, continues to have thoughts of self-harm. Not responding to group or individual therapy. States no improvement in mood or energy level. Admits to less anxiety and increased hours and quality of nightly sleep with addition of alprazolam. Anorexia still present.
Plan: Due to ineffectiveness of antidepressant regimen and psychotherapy, suggest addition of electroconvulsive therapy (ECT).
Medication Administration Record
Bupropion 100 mg PO TID
Escitalopram 20 mg PO daily
Alprazolam 0.25 PO BID PRN anxiety
Which of the following items in the client's medical record indicate that they are a candidate for electroconvulsive therapy (ECT)?
(Select all that apply.)
Energy level
Clinical response to antidepressant therapy
Sleep changes
Appetite
Clinical response to alprazolam therapy
Correct Answer : A,B,D
A. Indication for ECT. The client reports extreme fatigue despite treatment, suggesting a lack of improvement in energy levels with medication and therapy.
B. Indication for ECT. The client has not shown significant improvement in response to antidepressant therapy, as stated in the progress notes.
C. Not an indication since the client reports increased hours and better quality of sleep.
D. Potential indication for ECT. The client has anorexia, which indicates a persistent lack of appetite despite the treatment received.
E. Mixed indication. While alprazolam has helped with anxiety and improved sleep, it hasn't resolved the underlying depressive symptoms or suicidal thoughts. Therefore, it might contribute to considering ECT as an alternative or additional therapy option.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C"]
Explanation
A. Experiencing a life-threatening event such as being trapped can precipitate PTSD.
B. Exposure to an R-rated movie, while potentially distressing, is not typically considered a traumatic event that leads to PTSD.
C. Prolonged exposure to traumatic events like abduction and captivity often leads to PTSD due to the severe and chronic trauma experienced.
D. This is not typically considered a traumatic event leading to PTSD as it's a voluntary, recreational activity that involves perceived safety measures.
Correct Answer is C
Explanation
A. Relaxation strategies involve deliberate and often structured activities aimed at reducing tension and stress, which isn't depicted in the described behavior.
B. Withdrawal behaviors typically involve avoiding social interaction or retreating, which doesn't align with the observed actions.
C. The described behavior, including pacing, clenching fists, and staring at a staff member, indicates potential signs of aggression or agitation.
D. Working through angry feelings might involve communication or expression of emotions, but the described behavior leans more towards agitation and potential aggression.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.