A nurse is caring for a client who has major depressive disorder. After discussing the treatment with his partner, the client verbally agrees to electroconvulsive therapy (ECT) but will not sign the consent form. Which of the following actions should the nurse take?

Request that the client's partner sign the consent form.

Inform the client about the risks of refusing ECT.

Cancel the scheduled ECT procedure.

Proceed with preparation for ECT based on implied consent.

Answer and Explanation

The Correct Answer is C

A. Request that the client's partner sign the consent form:
While involving the client's partner might offer emotional support and facilitate communication, legal and ethical guidelines typically require the informed consent of the individual undergoing the procedure. Having a partner sign the form without the client's explicit consent would not adhere to these standards.

B. Inform the client about the risks of refusing ECT:
Educating the client about the potential risks and benefits of ECT, as well as discussing alternative treatments, is a crucial step in the informed consent process. However, merely informing the client does not replace the need for the client to provide explicit, written consent for the procedure to be performed legally and ethically.

C. Cancel the scheduled ECT procedure:
This is the correct action. Without the client's signed consent, the procedure cannot proceed. Canceling the ECT procedure respects the client's autonomy and adheres to legal and ethical standards surrounding informed consent. The healthcare team should continue to engage with the client, addressing any concerns and questions, to obtain their informed and voluntary consent before rescheduling the procedure if the client chooses to proceed.

D. Proceed with preparation for ECT based on implied consent:
Implied consent is not sufficient for significant medical procedures such as ECT. Implied consent implies agreement based on actions or behavior rather than explicit, informed agreement. For procedures like ECT, it is essential to have documented, explicit, and voluntary consent from the client before proceeding. Relying solely on implied consent would not meet the ethical and legal requirements for informed consent.

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Correct Answer is C

Explanation

A. Naltrexone:
Naltrexone is an opioid receptor antagonist. It blocks the effects of opioids and alcohol in the brain. It's often used as part of a long-term treatment plan to prevent relapse in individuals who have already stopped drinking and are trying to maintain sobriety. Naltrexone does not directly manage acute alcohol withdrawal symptoms. Instead, it helps individuals reduce or quit drinking over the long term by reducing the pleasure associated with alcohol consumption.

B. Disulfiram:
Disulfiram is an aversion therapy medication used as a deterrent to drinking. When someone taking disulfiram consumes alcohol, it causes unpleasant physical reactions, such as nausea, flushing, and palpitations. This discourages individuals from drinking while they are on the medication. Disulfiram is not used to manage acute withdrawal symptoms but rather serves as a deterrent to drinking for individuals who are trying to maintain sobriety.

C. Lorazepam:
Lorazepam is a benzodiazepine medication that acts as a central nervous system depressant. It is commonly used to manage acute alcohol withdrawal symptoms. Benzodiazepines like lorazepam help to reduce anxiety, agitation, and the risk of seizures associated with alcohol withdrawal. They are typically used in a controlled manner to provide relief during the acute phase of withdrawal.

D. Acamprosate:
Acamprosate is used in the maintenance phase of alcohol use disorder treatment. It helps individuals maintain abstinence by stabilizing the chemical imbalances in the brain that occur after prolonged alcohol use. Acamprosate is not used for acute withdrawal management but is instead prescribed to support individuals who have already stopped drinking and are trying to avoid relapse over the long term.

A. Pseudoephedrine B. Docusate sodium C. Ranitidine D. Ibuprofen

Correct Answer is A

Explanation

A. Pseudoephedrine
Clients taking phenelzine, which is a monoamine oxidase inhibitor (MAOI) used to treat depression, need to avoid certain over-the-counter medications, especially those containing sympathomimetic amines like pseudoephedrine. Combining MAOIs with sympathomimetic medications can lead to a severe increase in blood pressure, potentially causing a hypertensive crisis.

B. Docusate sodium:
Docusate sodium is a stool softener and is generally safe to use with phenelzine. It does not have significant interactions with MAOIs.

C. Ranitidine:
Ranitidine is an H2 blocker used to reduce stomach acid production. It does not have significant interactions with phenelzine.

D. Ibuprofen:
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. While it does not interact directly with phenelzine, individuals taking phenelzine should avoid other medications, especially NSAIDs, that can increase the risk of bleeding due to phenelzine's effects on platelet function. However, this interaction is not as severe as the interaction between phenelzine and sympathomimetic medications like pseudoephedrine.

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A nurse is caring for a client who has major depressive disorder. After discussing the treatment with his partner, the client verbally agrees to electroconvulsive therapy (ECT) but will not sign the consent form. Which of the following actions should the nurse take?

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Correct Answer is A

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