Which of the following nursing diagnosis take priority immediately after electroconvulsive therapy (ECT)
Chronic confusion r/t ECT treatment
Activity intolerance r/t weakness
Impaired social interaction r/t confusion
Risk for injury r/t altered mental status
The Correct Answer is D
A. Chronic confusion r/t ECT treatment. Memory impairment may occur but is not the immediate priority.
B. Activity intolerance r/t weakness. Weakness can occur but is not the most urgent concern post-ECT.
C. Impaired social interaction r/t confusion. Social interaction is a lower priority compared to physical safety.
D. Risk for injury r/t altered mental status. Post-ECT, clients may be confused or disoriented, increasing their risk of falls or injury. Ensuring safety is the top priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D"]
Explanation
A. Insomnia: Mood stabilizers like lithium and valproate generally cause sedation rather than insomnia.
B. Nausea and vomiting: Gastrointestinal upset is a common side effect of mood stabilizers, especially lithium and valproate.
C. Hair growth: Some mood stabilizers, like valproate, may cause hair loss (alopecia), not increased hair growth.
D. Liver & kidney damage: Lithium can cause kidney damage with prolonged use, while valproate and carbamazepine can lead to liver toxicity.
Correct Answer is D
Explanation
A. Ensure an NPO status is maintained for the length of the prescribed treatment: While some ventilated patients are NPO, others receive enteral feeding. NPO status alone does not prevent aspiration.
B. Perform chest physiotherapy as prescribed by the practitioner: Chest physiotherapy helps clear secretions but does not directly reduce aspiration risk.
C. Limit each suctioning event to no more than 10 seconds: While limiting suction time is important to avoid hypoxia, it does not directly prevent aspiration.
D. Elevate the head of the bed between 30 to 45 degrees: Keeping the head of the bed elevated reduces the risk of aspiration, partic
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