A client receives a diagnosis of bipolar I disorder, current episode depressed. A physician prescribes paroxetine (Paxilâ) for the client. The client is encouraged to participate in unit activities and to talk about her feelings. Despite all efforts, the client's depression becomes profound. The client is in total despair and is in a vegetative state. The physician obtains consent to perform electroconvulsive therapy (ECT). What is the rationale behind this treatment for profound depression?

Correct Answer: D

Rationale: The correct answer is D because electroconvulsive therapy (ECT) is thought to increase levels of norepinephrine and serotonin, which are neurotransmitters involved in regulating mood. By increasing these neurotransmitters, ECT can help elevate mood and alleviate symptoms of depression. This rationale is supported by research and clinical evidence showing the effectiveness of ECT in treating severe depression. Choices A and C are incorrect because ECT does not work by making the client forget painful memories or by satisfying any perceived need for punishment. Choice B is incorrect because ECT does not stimulate the central nervous system in the same way as CNS stimulant medications. ECT works through different mechanisms involving changes in brain chemistry rather than direct CNS stimulation.

Correct Answer: D

Rationale: The correct answer is D because a low apical pulse rate (bradycardia) with an irregular rhythm is a classic sign of digitalis toxicity due to its effect on the heart's conduction system. Digitalis can cause bradycardia and various conduction disturbances. Choices A, B, and C do not specifically reflect the characteristic bradycardia seen in digitalis toxicity.

Correct Answer: B

Rationale: The correct answer is B because it provides an accurate and detailed explanation of what a PET scan is. Positron-emission tomography involves injecting a radioactive substance into the body to show blood flow and brain activity. This is crucial in diagnosing conditions like schizophrenia. Choice A is incorrect as it inaccurately describes a PET scan as similar to an MRI, which does not involve radioactive substances. Choice C is incorrect as a PET scan does not use X-rays to provide images. Choice D is incorrect as a PET scan does not measure electrical activity with scalp electrodes but rather shows blood flow and brain activity.

Correct Answer: A

Rationale: The correct answer is A because it provides comprehensive and appropriate instructions for managing the thickly white-coated tongue associated with fluphenazine. First, advising to avoid foods high in sugar helps prevent further irritation. Second, emphasizing good oral hygiene by brushing teeth and tongue, flossing, and gargling with mouthwash helps to reduce the coating. Third, encouraging daily tongue checks and prompt physician notification ensures monitoring and timely intervention if needed. Choice B is incorrect because it lacks the comprehensive approach of Choice A, omitting the importance of flossing and daily tongue checks. Choice C is incorrect as it dismisses the issue without providing any guidance on how to manage the side effect. Choice D is incorrect as it introduces irrelevant information about nasal inhalants that can confuse the patient and is not directly related to managing the white-coated tongue.

Correct Answer: C

Rationale: The correct answer is C because interrupted wake-sleep patterns can indeed influence mood. Night shift work disrupts the body's natural circadian rhythm, leading to sleep disturbances and affecting the production of neurotransmitters that regulate mood. This disruption can contribute to feelings of depression. Choice A is incorrect as there is a known connection between shift work and mental health. Choice B is incorrect because medication may not address the root cause of the depression in this case. Choice D is incorrect as adjustment to new sleep patterns can vary among individuals and may not necessarily take 4 months.