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
Explanation
A. Availability of means and lethality of method is a priority as it directly influences the risk and immediacy of a potential suicide attempt. Access to lethal methods increases the risk of a fatal outcome.
B. The patient's insight into the suicidal motivation is valuable, but it may not indicate immediate risk or specific details about the plan.
C. Quality and availability of social support are important for long-term prevention but may not provide immediate information about the plan or risk.
D. Patient's financial and educational status might be factors contributing to stress but may not directly reflect the immediate risk of suicide.
Correct Answer is C
Explanation
A. While assessing the impact of a suicide attempt on others is important, the immediate focus following a successful suicide attempt in a mental health unit is to ensure the safety of all clients.
B. Restricting group therapy for 72 hours might impede the therapeutic process and does not directly address the safety of clients after a suicide attempt.
C. Following a suicide attempt, it's standard practice to heighten monitoring and implement suicide precautions for all clients to ensure their safety.
D. While assessing the situation is important, immediate intervention to prevent further harm to other clients is a priority following a suicide attempt. The psychological assessment might occur but would not be the primary intervention in this immediate crisis situation.
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