A client with bipolar disorder is monitored by the community ...

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A client with bipolar disorder is monitored by the community mental health nurse. The client's
  mood disorder is under good control when the client takes the prescribed doses of lithium.
 
  The client
  tells the nurse she is pregnant as the result of her boyfriend committing date rape. The nurse makes
  the following assessments: lithium taken throughout pregnancy may result in a baby born with birth
  defects; the client is likely to have a relapse of her illness if she stops taking lithium; and the client is
  a devout Catholic who believes her boyfriend will marry her even if he did get carried away and
  care for their child. Which option would be congruent with the client's values and ethical beliefs?
  a. Continue lithium; deal with the issue of a baby with birth defects if it occurs.
  b. Continue lithium and encourage the client to undergo a therapeutic abortion.
  c. Discontinue lithium, use alternative medication, and prepare for hospitalization
  prn.
  d. Arrange for involuntary hospitalization for the duration of the pregnancy.

Question 2

A depressed client is to have his first electroconvulsive therapy session tomorrow morning.
 
  The
  interventions that would routinely be implemented in preparing the client for treatment include
  (more than one answer may be correct)
  A. administering pretreatment medication as ordered 30 to 45 minutes before treatment.
  B. withholding food and fluids for a minimum of 6 hours before treatment.
  C. removing dentures, glasses, contact lenses, and hearing aids.
  D. restraining the client in bed with padded limb restraints.

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Answer to Question 1

ANS: C
Discontinuing lithium will protect the fetus. Taking a safe or nonteratogenic psychotropic
medication may avert decompensation, but preparing the client for the possibility of hospitalization
in the event she becomes manic is ethical. Option A is in conflict with the client's plans to marry and
care for the child. Option B is contrary to the client's religious beliefs. Option D violates the client's
rights to the least restrictive treatment.

Answer to Question 2

A, B, C
Rationale: Options A, B, and C reflect routine electroconvulsive therapy preparation, which is
similar to preoperative preparation: sedation and anticholinergic medication before anesthesia,
maintaining nothing-by-mouth status to prevent aspiration during and after treatment, airway
maintenance, and general safety by removal of prosthetic devices. Option C: Restraint is not part of
pretreatment protocol.

[Pea0909berry]

TYSM

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