Nursing Elites

1. The purpose of ECT in clients with depression is to:

• A. Stimulation in the brain to increase brain conduction and counteract depression
• B. Mainly Biologic, increasing the norepinephrine and serotonin level
• C. Creates a temporary brain damage that will increase blood flow to the brain
• D. Involves the conduction of electrical current to the brain to charge the neurons and combat depression

Correct answer: A

Rationale: Patient safety and efficacy of care depend on actions rooted in established nursing protocols that consider both the immediate and long-term needs of the patient.

2. To ensure client safety before starting blood transfusions, the following are needed before the procedure can be done EXCEPT:

• A. take baseline vital signs
• B. warm the blood to room temperature for 30 minutes before administering the transfusion
• C. have two nurses verify client identification, blood type, unit number, and expiration date of blood
• D. get consent signed for blood transfusion

Correct answer: D

Rationale: To ensure client safety before starting blood transfusions, taking baseline vital signs, warming the blood to room temperature, and having two nurses verify client identification, blood type, unit number, and expiration date of blood are crucial steps. Consent for blood transfusion is required but is typically obtained before the procedure. The focus before the procedure should be on confirming the right client, blood product, and ensuring the blood is prepared correctly to minimize risks of transfusion reactions.

3. Instruction on health promotion regarding urinary elimination is important. Which would you include?

• A. Hold urine as long as possible before emptying the bladder to strengthen the sphincter muscles
• B. If a burning sensation is experienced while voiding, drink water
• C. After urination, wipe from the anal area towards the pubis
• D. Tell the client to empty the bladder at each voiding

Correct answer: D

Rationale: The correct answer is to instruct the client to empty the bladder at each voiding. This is essential to prevent urinary retention and reduce the risk of urinary tract infections. Choice A is incorrect because holding urine for prolonged periods can lead to urinary retention and increase the risk of infections. Choice B is incorrect as pineapple juice can exacerbate a burning sensation due to its acidity; the correct approach is to drink water to dilute the urine. Choice C is incorrect as wiping from the anal area towards the pubis can introduce bacteria into the urinary tract, potentially causing infections.

4. A nurse is teaching a client about iron-rich foods. Which food is the best source of heme iron?

• A. Spinach
• B. Lentils
• C. Beef liver
• D. Tofu

Correct answer: C

Rationale: Heme iron, found in animal products like beef liver, is more easily absorbed than non-heme iron from plant sources.

5. What side effect is commonly associated with ECT?

• A. Transient loss of memory, confusion, and disorientation
• B. Nausea and vomiting
• C. Fractures
• D. Hypertension and increased heart rate

Correct answer: A

Rationale: The correct answer is A, as Electroconvulsive Therapy (ECT) is commonly associated with side effects such as transient loss of memory, confusion, and disorientation. While nausea and vomiting (Choice B) can occur, they are not as common as the memory-related side effects. Fractures (Choice C) are unlikely unless a mishap occurs during the procedure. Hypertension and increased heart rate (Choice D) might occur during the procedure due to the physiological stress of the treatment, but these are not the most commonly associated side effects. The rationale provided did not effectively explain this, so it's important to note that ECT is a procedure often used for severe depression and other mental illnesses, and understanding its side effects is crucial for patient safety and effective care.

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