A nurse is caring for a client who has received nine electroconvulsive therapy (ECT) treatments and reports short-term memory loss. Which of the following responses should the nurse make?
Memory loss is common and usually improves after a few weeks.
"You will likely experience long-term memory loss as well."
"You should focus on how much better you feel."
"I am going to notify your provider about your memory loss."
The Correct Answer is A
Memory loss is a known side effect of electroconvulsive therapy (ECT), particularly in the short term. It is important for the nurse to provide accurate information to the client about this
potential side effect. Assuring the client that memory loss is common and tends to improve over time can help alleviate their concerns and provide reassurance. It is important to convey that this is a temporary effect and not necessarily indicative of long-term memory problems.
The other options are not appropriate responses:
B. "You will likely experience long-term memory loss as well": This statement provides inaccurate and potentially alarming information. While some individuals may experience persistent memory issues, it is not appropriate to assume or predict long-term memory loss in every case.
C. "You should focus on how much better you feel": This response dismisses the client's concerns about memory loss and may not address their needs or worries adequately. It is important to acknowledge and validate the client's experience.
D. "I am going to notify your provider about your memory loss": While it is important for the nurse to communicate any concerning symptoms to the client's healthcare provider, simply stating this without providing further information or reassurance may increase the client's anxiety without addressing their immediate concerns about memory loss.
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Related Questions
Correct Answer is C
Explanation
This statement implies that the nurse is taking sides and suggesting a specific course of action to the client. It is important for the nurse to remain neutral and non-directive during family therapy sessions. The nurse's role is to facilitate open communication, active listening, and understanding between the family members, rather than imposing their own opinions or suggesting specific solutions.
To ensure a therapeutic and unbiased approach, the nurse should intervene and provide feedback to the newly licensed nurse, reminding them to maintain a neutral stance and encourage the client to explore their own perspectives and feelings about the relationship.
Incorrect:
A. "We should invite your partner to be a part of our discussion." This statement suggests involving the partner, which is a common practice in family therapy. It recognizes the importance of including all relevant family members in the therapeutic process.
B. "Tell me about the concerns that you have regarding your relationship." This statement encourages the client to express their concerns and provides an opportunity for them to share their thoughts and feelings about the relationship. It promotes open communication and active listening.
D. "Relationship difficulties are stressful and require effort to resolve." This statement acknowledges the challenges in relationships and emphasizes the need for active participation and effort to address and resolve issues. It sets a realistic expectation for the client and supports their engagement in the therapeutic process.
Correct Answer is B
Explanation
Determining if the client has thoughts of self-harm: This is the priority action for the nurse in this situation. Assessing the client's risk of self-harm or suicide is crucial to determine the level of immediate intervention required. It helps identify the severity of the crisis and enables the nurse to implement appropriate measures to ensure the client's safety.
In the context of a client with generalized anxiety disorder who is exhibiting signs of distress and seeking to be taken care of, it is essential to assess for suicidal ideation or intent. Clients with mental health disorders, especially when experiencing high levels of stress, may be at an increased risk of self-harm or suicide. Therefore, it is vital for the nurse to prioritize the assessment of the client's safety and risk of self-harm in order to provide appropriate care and interventions.
Incorrect:
A- Asking the client to identify the cause of the crisis: While it is important to gather information about the cause of the crisis to understand the client's situation, it is not the nurse's priority at this moment. Assessing the client's safety and immediate risk of self-harm takes precedence.
C- Identifying if friends or family are available to help: While social support from friends and family can be valuable in managing a crisis, it is not the nurse's priority in this situation. The immediate concern is to assess the client's safety and risk of self-harm.
D-Identifying the client's coping skills: Assessing the client's coping skills is an important aspect of the overall assessment process, but it is not the priority at this moment. The nurse needs to first ensure the client's safety and address any immediate risks.
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