A client hospitalized with major depressive disorder has taken an antidepressant for 10 days. Yesterday the client slept most of the day and barely spoke. Today the client is dressed, eats breakfast, and says, "I finally have the energy to get things done. Can I go home for the weekend?" Which action should the nurse take first?
Support the request because the client's mood is clearly improving
Document the improvement and reduce the frequency of safety checks
Reassess the client directly for suicidal thoughts, plan, and intent, and share the change with the treatment team
Explain that antidepressants take several weeks to work fully and the weekend is too early
Show the answer and explanation
Answer: C. Reassess the client directly for suicidal thoughts, plan, and intent, and share the change with the treatment team
Topic: depression improving energy
Energy and motivation often return before mood lifts in depression, so the client may now have the energy to act on suicidal thoughts. A sudden unexplained improvement requires direct reassessment before privileges change.
Why the others are wrong
A – Accepting improvement at face value ignores the high-risk window when energy returns before mood.
B – Lowering observation on the basis of one day's change removes a safeguard when risk may be rising.
D – The teaching is true but does not assess safety, and it is not the first action.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
The nurse prepares a client with severe depression for electroconvulsive therapy (ECT) scheduled this morning. Which actions are appropriate?
Select all that apply.
Verify that the signed informed consent is in the chart
Keep the client NPO for the period ordered before the procedure
Ask the client to void before leaving for the treatment area
Leave dentures and hairpins in place so they are not lost
Apply hair oil so the electrodes slide into position easily
Show the answers and explanation
Answers: A, B and C.
A – Verify that the signed informed consent is in the chart
B – Keep the client NPO for the period ordered before the procedure
C – Ask the client to void before leaving for the treatment area
Topic: ECT preparation
ECT is done under brief anesthesia with a muscle relaxant, so consent, NPO status and an emptied bladder are standard. Dentures, hairpins and jewelry are removed, and the scalp must be clean and dry for electrode contact.
Why the others are wrong
D – Dentures and hairpins are removed to prevent airway obstruction and injury.
E – Oil and hair products impair electrode contact; hair must be clean and dry.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A client returns from the first ECT treatment drowsy, arousable to voice, and unsure where the unit is. Which nursing action has priority?
Position the client side-lying and monitor airway, oxygen saturation and vital signs until fully awake
Reorient the client and ask what the client remembers about the treatment
Offer breakfast as soon as the client opens the eyes
Give the as-needed analgesic for headache before any assessment
Show the answer and explanation
Answer: A. Position the client side-lying and monitor airway, oxygen saturation and vital signs until fully awake
Topic: post-ECT care
Recovery from anesthesia and a seizure puts the airway first. Side-lying position, oxygen saturation and vital signs are monitored until the client is awake and oriented; brief confusion and headache are expected and are managed after the airway is secure.
Why the others are wrong
B – Reorientation is useful but is secondary to airway and physiologic monitoring.
C – Feeding a drowsy client risks aspiration; food waits until alert and the gag reflex is intact.
D – Headache is common and treated, but not before the airway and vital signs are assessed.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A client with bipolar I disorder who is currently in a depressive episode has a new order for an antidepressant. The client takes no mood stabilizer. What is the nurse's best action?
Administer the drug as ordered because the client is currently depressed
Give the drug and monitor only for suicidal thoughts
Ask the prescriber to change to a tricyclic antidepressant, which is safer in bipolar disorder
Clarify the order with the prescriber because an antidepressant without a mood stabilizer can trigger mania or rapid cycling
Show the answer and explanation
Answer: D. Clarify the order with the prescriber because an antidepressant without a mood stabilizer can trigger mania or rapid cycling
Topic: bipolar depression antidepressant
In bipolar disorder an antidepressant given without a mood stabilizer can precipitate a manic switch or rapid cycling. The nurse questions the order before giving it.
Why the others are wrong
A – Treating only the current mood ignores the switch risk of unopposed antidepressants in bipolar disorder.
B – Monitoring for suicidality is needed but does not address the order's main hazard.
C – Tricyclic antidepressants are not safer; they carry a high risk of switching.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A client with bipolar I disorder, current episode with mixed features (low mood, agitation, racing thoughts and little need for sleep), is started on divalproex. Which monitoring should the nurse expect to be ordered?
Select all that apply.
Serum drug level
Liver function tests
Platelet count
Weekly absolute neutrophil count for the first six months
Serum creatinine and thyroid tests as the main safety checks for this drug
Show the answers and explanation
Answers: A, B and C.
A – Serum drug level
B – Liver function tests
C – Platelet count
Topic: valproate monitoring in mixed episode
Valproate can cause hepatotoxicity and thrombocytopenia, and its therapeutic range is guided by serum level. Weekly neutrophil counts belong to clozapine, and renal and thyroid surveillance is the lithium pattern.
Why the others are wrong
D – Neutrophil count monitoring is the clozapine requirement.
E – Renal and thyroid monitoring is the lithium pattern, not valproate's.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
A 78-year-old widowed man living alone, recently diagnosed with heart failure, tells the nurse he is "just a burden," sleeps poorly, eats little, and mentions his late wife's handgun is still in the closet. What should the nurse do next?
Schedule a routine follow-up in three months
Teach sleep hygiene and offer a nutrition referral
Ask directly about suicidal thoughts, plan and access to the firearm, and arrange means restriction with the team
Attribute the complaints to heart failure and age
Show the answer and explanation
Answer: C. Ask directly about suicidal thoughts, plan and access to the firearm, and arrange means restriction with the team
Topic: older adult depression suicide risk
Older white men who are widowed, medically ill and have firearm access are at high suicide risk, and depression in older adults is often missed. A direct risk assessment with means safety is the priority.
Why the others are wrong
A – Three months of delay ignores acute risk.
B – Sleep and nutrition help later but do not address safety first.
D – Dismissing depression as normal aging is a common error.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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Nursing