A nurse is planning care for a child who has constipation-predominant irritable bowel syndrome (IBS-C). Which of the following actions should the nurse anticipate?

Choice A reason: Confusion upon waking is a common and expected side effect of electroconvulsive therapy (ECT). Clients often experience transient disorientation, memory impairment, or headache immediately after the procedure. This occurs because ECT induces a controlled seizure, which temporarily alters brain activity. Nurses must prepare clients for these short-term cognitive effects and reassure them that confusion typically resolves within hours.

Choice B reason: Lorazepam is not administered before ECT because benzodiazepines can raise the seizure threshold and interfere with the therapeutic effect. Instead, clients are given a short-acting anesthetic and a muscle relaxant (commonly methohexital and succinylcholine) to induce unconsciousness and prevent musculoskeletal injury during the seizure. Therefore, this statement is inaccurate.

Choice C reason: ECT does not work by stimulating the vagus nerve. Vagus nerve stimulation (VNS) is a separate treatment modality used for refractory depression and epilepsy. ECT works by inducing a generalized seizure through controlled electrical currents applied to the brain, which alters neurotransmitter activity and improves mood regulation.

Choice D reason: A magnet placed on the scalp is associated with transcranial magnetic stimulation (TMS), not ECT. TMS uses magnetic fields to stimulate specific brain regions without inducing seizures. ECT, in contrast, uses direct electrical currents to trigger a therapeutic seizure. Confusing these modalities can mislead clients, so nurses must clarify the distinction.

Choice A reason: Monitoring for abdominal ascites is essential in cirrhosis because portal hypertension and hypoalbuminemia lead to fluid accumulation in the peritoneal cavity. Ascites can cause respiratory compromise, infection risk (spontaneous bacterial peritonitis), and discomfort. Early detection allows timely interventions such as diuretics, paracentesis, or sodium restriction.

Choice B reason: A low-carbohydrate diet is not indicated in cirrhosis. Clients with cirrhosis often require adequate calories, including carbohydrates, to prevent muscle wasting and maintain energy. Restricting carbohydrates could worsen malnutrition.

Choice C reason: Reviewing serum amylase levels is more relevant to pancreatitis, not cirrhosis. Liver function is better assessed with ALT, AST, bilirubin, and albumin levels. Amylase does not provide useful information in cirrhosis management.

Choice D reason: Warm compresses may temporarily relieve pruritus, but they do not address the underlying cause, which is bile salt accumulation due to impaired liver function. More effective interventions include cholestyramine or antihistamines.