A nurse is reinforcing teaching with a client who is scheduled to receive electroconvulsive therapy (ECT). Which of the following statements should the nurse include in the teaching?
"The most common adverse effects of ECT are related to the anesthesia."
"You might feel a bit confused and disoriented when you first wake up."
"You should expect to have ECT once per week for 6 weeks."
"You may experience muscle cramping from the induced seizure."
The Correct Answer is B
Electroconvulsive therapy (ECT) is a procedure used to treat certain mental health conditions. When providing teaching to a client scheduled to receive ECT, it is important to provide accurate information about what they can expect during and after the procedure.
The statement "You might feel a bit confused and disoriented when you first wake up" is important because confusion and disorientation are common side effects of ECT. Clients often experience some memory loss and temporary cognitive impairment after the procedure, which can cause these symptoms. By preparing the client for these potential effects, the nurse helps reduce anxiety and ensures that the client understands what is considered normal post-ECT.
Incorrect:
A. "The most common adverse effects of ECT are related to the anesthesia." While anesthesia is used during ECT to ensure the client's comfort and safety, the most common adverse effects of ECT are related to the procedure itself, such as memory loss and cognitive changes.
C. "You should expect to have ECT once per week for 6 weeks." The frequency and duration of ECT treatments vary depending on the individual client's condition and treatment plan. It is not appropriate to provide a specific treatment schedule without knowing the client's unique circumstances.
D. "You may experience muscle cramping from the induced seizure." Muscle cramping is not a common adverse effect of ECT. The induced seizure is typically brief and controlled, and muscle relaxants are administered to prevent any excessive muscle activity during the procedure.
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Correct Answer is B
Explanation
Building trust and rapport with a suspicious client takes time and consistency. By setting aside short, frequent times each day to spend with the client, the nurse demonstrates reliability, availability, and a commitment to the client's well-being. This approach allows the client to gradually develop trust and feel more comfortable interacting with the nurse.
The other options are not appropriate actions:
A. Waiting for the client to initiate interactions with the nurse may result in limited or no engagement, as the client's suspicion may hinder their willingness to reach out. It is important for the nurse to take an active role in building the therapeutic relationship.
C. Disclosing personal information to the client is not recommended. The nurse should maintain professional boundaries and focus on the client's needs and concerns rather than sharing personal details that may compromise the therapeutic relationship or create an imbalance of power.
D. Telling the client that he reminds the nurse of her father may inadvertently trigger the client's suspicious thoughts and reinforce their mistrust. Making such personal comparisons is not appropriate and can hinder the establishment of a therapeutic relationship. It is important to focus on the client's individual experiences and needs rather than making personal connections.
Correct Answer is C
Explanation
This response is an appropriate nursing response in this situation. It acknowledges the client's need for assistance with grocery shopping while also recognizing that shopping and personal errands are not within the nurse's job description. By suggesting to explore other resources, the nurse can help the client find alternative solutions to meet their needs. This response demonstrates a willingness to support the client and collaborate on finding appropriate assistance, while also maintaining professional boundaries and responsibilities.
A. "I won't be able to shop for you today because I have to get home to my family." This response is inappropriate because it focuses on the nurse's personal circumstances and may come across as dismissive of the client's request for help. It does not address the client's needs or offer any alternative solutions.
B. "What I think you should do is wait for the days when you feel better and do your grocery shopping then." This response is dismissive of the client's current situation and does not offer any practical assistance or support. It implies that the client should simply wait for their condition to improve without addressing their immediate needs.
D. "I would be happy to do whatever I can to help you." While this response may initially seem supportive, it is inappropriate because shopping and performing personal errands for the client are not within the nurse's job description. It is important for the nurse to establish professional boundaries and adhere to the responsibilities outlined in their job description.
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