A nurse on an acute care mental health unit is examining the belongings of a client who is being admitted following a suicide attempt. Which of the following belongings should the nurse ask the client's partner to take back home? (Select All that Apply.)
Nylon socks
Glass framed picture of the client's partner
Lace-up tennis shoes
Cotton underwear
Necklace
Correct Answer : B,C,E
Rationale:
A. Nylon socks are generally not considered a risk for self-harm and can be safely kept with the client.
B. A glass-framed picture presents a risk as the glass could be broken and used for self-harm. This item should be taken home.
C. Lace-up tennis shoes have long laces that could be used for self-harm, making them unsafe for a client at risk of suicide.
D. Cotton underwear does not pose a significant risk for self-harm and can be kept with the client.
E. A necklace could be used for self-harm, such as strangulation, and should be taken home to ensure the client's safety.
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Correct Answer is B
Explanation
Rationale:
A. Eating breakfast prior to the procedure is generally not allowed due to the requirement for anesthesia, which requires the stomach to be empty to reduce the risk of aspiration.
B. Brief seizures are a key component of ECT, as the procedure involves inducing controlled seizures to achieve therapeutic effects. This statement indicates an accurate understanding of the procedure.
C. One ECT treatment is not typically sufficient for treating depression; multiple sessions are usually required for therapeutic benefit.
D. A pre-ECT workup is necessary to ensure the client is physically prepared for the procedure and to assess any potential risks.
Correct Answer is D
Explanation
Rationale:
A. Clients with active tuberculosis should not be placed in a room with other clients, even if they require droplet precautions, as TB requires airborne precautions.
B. While PPE protocols are important, the most critical precaution for TB is ensuring the client is in the correct environment to prevent airborne transmission.
C. Wearing gowns, masks, and gloves is important, but the most essential measure is the room's ventilation system.
D. Active tuberculosis is an airborne infectious disease, so the client should be placed in a private room with a negative pressure ventilation system to prevent the spread of the bacteria through the air.