UPUMS Nsg.Officer-2024
Mental Health Nursing
Medium
A neuromuscular blocking agent is administered to a client before ECT therapy. The nurse should carefully observe the client for...
Appeared in: UPUMS Nsg.Officer-2024
Explanation
- Neuromuscular blocking agents (e.g., succinylcholine) are standard in modified ECT to prevent injury by paralyzing skeletal muscles.
- This paralysis is systemic and affects all skeletal muscles, including the diaphragm and intercostal muscles, which are essential for breathing.
- The paralysis of respiratory muscles leads to temporary apnea (cessation of breathing).
- This makes monitoring for respiratory difficulties and providing ventilatory support the most critical, life-sustaining nursing intervention.
Why Other Options Were Wrong
- Option A: Dizziness is a potential side effect of the anesthetic agents used or the postictal state following ECT, not a direct, life-threatening effect of the neuromuscular blocker.
- Option B: The seizure is the intended therapeutic outcome of ECT. The neuromuscular blocker is administered to suppress the motor convulsions of the seizure, not to cause it.
- Option D: Nausea and vomiting are common side effects of general anesthesia (e.g., propofol, methohexital), not the neuromuscular blocker itself.
Related Visual
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing Nursing responsibilities and side effects of neuromuscular blocking agents used in Electroconvulsive Therapy (ECT) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- The primary responsibility of the nurse during ECT is patient safety, with airway, breathing, and circulation (ABCs) as the top priority.
- Failure to recognize and manage respiratory paralysis from neuromuscular blockers can lead to hypoxia, brain injury, and death.
- What if? If a patient has a history of pseudocholinesterase deficiency, the metabolism of succinylcholine is impaired, leading to prolonged apnea. In this case, an alternative non-depolarizing blocker (e.g., atracurium) would be used, and the nurse must be prepared for a much longer period of mechanical ventilation.
How to Approach the Question
- First, identify the core subject of the question: the effect of a 'neuromuscular blocking agent' in the context of 'ECT therapy'.
- Recall the primary function of this drug class. The name 'neuromuscular blocker' implies it blocks nerve signals to muscles, causing paralysis.
- Consider which muscles are affected. Neuromuscular blockers are non-selective for skeletal muscles.
- Realize that the muscles for breathing (diaphragm, intercostals) are also skeletal muscles and will be paralyzed.
- Conclude that the most immediate and life-threatening consequence of this paralysis is the inability to breathe.
- Evaluate the options based on this conclusion. 'Respiratory difficulties' directly relates to this primary effect, making it the highest priority for observation.
Concept Tested & Keywords
- Concept Tested: Nursing responsibilities and side effects of neuromuscular blocking agents used in Electroconvulsive Therapy (ECT).
- Stem keywords: neuromuscular blocking agent, ECT therapy, observe
- Lead-in keywords: carefully observe
- Negative lead-in flag: false
Question ID
QJGktGHEqkQ14GZb-tG8vh
Reference Book
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2304-2306
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 11193-11195, 11192-11194
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