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 C
Explanation
A. Providing medications against a patient's will generally requires a legal process or evaluation of capacity rather than a blanket statement of administration.
B. Clients who are involuntarily admitted might not have the right to refuse treatment initially based on the nature of the admission.
C. Involuntary admissions often allow for extended hospitalization based on the judgment of the treatment team.
D. Laws regarding restraints are generally consistent regardless of the mode of admission, focusing on safety and necessity rather than the mode of admission.
Correct Answer is ["C","D"]
Explanation
A. Discussing the client's suicide plan might inadvertently trigger or worsen suicidal thoughts and is not recommended.
B. Restricting visitors might hinder the client's social support system, which is essential in managing depression.
C. Reinforcing statements regarding a will to live and realistic plans for the future promotes hope and positive thinking.
D. Encouraging the client to discuss thoughts and feelings about wanting to die allows for expression and processing of emotions.
E. Limiting time allowed to play video games might be part of a broader plan, but it's not directly addressing depression and might not be as impactful as other interventions.
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