Mental Health Disorders: Practice Questions & Explanations

Major Depressive Disorder (DSM-5 criteria): five or more of the following symptoms present during the same 2-week period and representing a change from previous functioning. At least one symptom must be depressed mood or anhedonia. Symptoms: (1) Depressed mood most of the day, nearly every day — sad, empty, hopeless; (2) Markedly diminished interest or pleasure in activities (anhedonia); (3) Significant weight loss or gain (>5% body weight in a month) or appetite changes; (4) Insomnia or hypersomnia nearly every day; (5) Psychomotor agitation or retardation observable by others; (6) Fatigue or loss of energy nearly every day; (7) Feelings of worthlessness or excessive/inappropriate guilt; (8) Diminished ability to think or concentrate, or indecisiveness; (9) Recurrent thoughts of death, suicidal ideation, suicide attempt or specific plan. Symptoms cause clinically significant distress or impairment, not attributable to substance or medical condition, not better explained by other disorder. Treatment: psychotherapy (CBT, IPT especially); antidepressants (SSRIs first-line, SNRIs, atypicals); ECT for severe/treatment-resistant; light therapy for seasonal pattern; exercise as adjunct; emerging treatments (ketamine, TMS). Onset of antidepressant effect: 2-6 weeks for full effect; suicide risk may transiently increase as energy returns before mood lifts — close monitoring critical. Recurrence common; treatment continuation often recommended for at least 6-12 months after remission.

Bipolar disorder involves episodes of mood elevation and depression. Mania (Bipolar I) — duration ≥7 days OR severe enough for hospitalization. Criteria: distinct period of abnormally elevated, expansive, or irritable mood AND increased goal-directed activity/energy; plus 3+ of (or 4+ if irritable): (1) Inflated self-esteem or grandiosity (sometimes delusional); (2) Decreased need for sleep (3 hours and feels rested); (3) More talkative than usual or pressured speech; (4) Flight of ideas or racing thoughts; (5) Distractibility; (6) Increased goal-directed activity or psychomotor agitation; (7) Excessive involvement in activities with painful consequences (spending sprees, sexual indiscretions, foolish business). Hypomania (Bipolar II): similar but less severe, lasting ≥4 days, no severe functional impairment. Bipolar I: mania required (depression typical but not required). Bipolar II: hypomania plus major depression. Cyclothymic disorder: chronic, less severe fluctuations. Treatment: mood stabilizers (lithium — gold standard, requires blood level monitoring 0.6-1.2 mEq/L therapeutic, narrow window, toxicity at 1.5+, watch for dehydration); anticonvulsants (valproate, lamotrigine, carbamazepine); atypical antipsychotics (quetiapine, olanzapine, risperidone, lurasidone, others); ECT for severe/treatment-resistant. Antidepressants used cautiously — can trigger mania. Nursing care during mania: low-stimulation environment, simple structured activities, brief frequent meals and snacks (they can't sit for full meals), set limits on intrusive behavior, ensure rest, monitor for exhaustion.

Schizophrenia (DSM-5): 2+ symptoms present for significant portion of 1 month (or less if treated successfully): (1) Delusions — fixed false beliefs (persecutory, grandiose, somatic, religious, referential — believing TV is talking to you); (2) Hallucinations — false perceptions in any sense; auditory hallucinations (hearing voices) most common; (3) Disorganized speech — derailment, tangentiality, incoherence; (4) Grossly disorganized or catatonic behavior; (5) Negative symptoms — diminished emotional expression, alogia (poverty of speech), avolition (lack of motivation), anhedonia (inability to feel pleasure), asociality. At least one must be hallucinations, delusions, or disorganized speech. Significant impairment in work, relationships, self-care. Continuous signs for 6+ months. Typically: prodromal phase with subtle changes, active phase with full symptoms, residual phase with continuing negative symptoms. Treatment: antipsychotic medications — first-generation (typical) like haloperidol, chlorpromazine; second-generation (atypical) like risperidone, olanzapine, quetiapine, aripiprazole, clozapine. Atypicals are first-line — fewer extrapyramidal symptoms (EPS) but more metabolic side effects (weight gain, diabetes, lipid changes). Side effects to monitor: EPS (tremor, rigidity, akathisia, tardive dyskinesia, neuroleptic malignant syndrome), metabolic changes, anticholinergic effects, sedation. Clozapine — most effective but requires WBC monitoring due to agranulocytosis risk. Psychosocial interventions: psychotherapy, family education, supported employment, social skills training, assertive community treatment. Nursing care: therapeutic communication, reality orientation when needed without arguing about delusions, monitor for medication adherence and side effects, recognize relapse early.

Panic Attack: a discrete period of intense fear or discomfort with abrupt onset, peaking within minutes, including 4+ symptoms: (1) Palpitations, pounding heart, or accelerated heart rate; (2) Sweating; (3) Trembling or shaking; (4) Shortness of breath or smothering sensation; (5) Choking sensation; (6) Chest pain or discomfort (often mistaken for heart attack); (7) Nausea or abdominal distress; (8) Dizziness, unsteadiness, lightheaded, faint; (9) Chills or hot flashes; (10) Paresthesias (numbness/tingling); (11) Derealization or depersonalization (feeling unreal); (12) Fear of losing control or going crazy; (13) Fear of dying. Panic Disorder: recurrent unexpected panic attacks plus persistent concern about additional attacks or maladaptive behavior changes related to attacks (e.g., avoiding situations). Often co-occurs with agoraphobia (fear of situations where escape may be difficult — open spaces, crowds, public transport). Acute panic attack management: (1) Stay with client; (2) Calm, reassuring voice — speak in short simple sentences; (3) Decrease stimulation — quiet environment, dim lights; (4) Encourage slow breathing — count breaths together, breathe with the client; (5) Grounding techniques — name 5 things you see, 4 you hear, 3 you can touch, 2 you smell, 1 you taste; (6) Reassure that the attack will pass and won't cause harm; (7) Acute medications (benzodiazepines like lorazepam) per orders. Long-term treatment: CBT (especially exposure therapy); SSRIs/SNRIs first-line; benzodiazepines used short-term; relaxation techniques, mindfulness. Caffeine and stimulants worsen anxiety. ER presentation of panic attack often mistaken for cardiac event; appropriate medical evaluation rules out other causes.

PTSD (DSM-5) develops in some individuals exposed to trauma — actual or threatened death, serious injury, or sexual violence. Exposure types: directly experiencing, witnessing, learning about (close family/friend), or repeated/extreme exposure (first responders). Symptoms persist >1 month and cause significant distress/impairment. Four symptom clusters (1+ from each cluster required): (1) INTRUSION — recurrent, involuntary memories; nightmares; flashbacks (dissociative reactions where the person feels they are re-experiencing); intense psychological distress at trauma cues; physiological reactivity to trauma cues. (2) AVOIDANCE — efforts to avoid trauma-related memories/thoughts/feelings; efforts to avoid external reminders (people, places, situations). (3) NEGATIVE ALTERATIONS in cognition/mood — inability to remember important aspects of trauma; persistent negative beliefs ('I'm bad,' 'No one can be trusted'); distorted blame; persistent negative emotional state; diminished interest in activities; detachment; inability to experience positive emotions. (4) AROUSAL AND REACTIVITY — irritability/anger outbursts; reckless or self-destructive behavior; hypervigilance; exaggerated startle; concentration problems; sleep disturbance. Subtypes: with dissociative symptoms; with delayed expression (symptoms develop 6+ months later). Acute Stress Disorder: similar to PTSD but lasts 3 days to 1 month. Treatment: (1) Trauma-focused therapy — Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), EMDR (Eye Movement Desensitization and Reprocessing) — gold standard treatments; (2) Medications — SSRIs (sertraline, paroxetine FDA-approved); SNRIs (venlafaxine); prazosin for nightmares; (3) Group therapy; (4) Mind-body practices — yoga, mindfulness; (5) Service animals. Nursing care: trauma-informed approach throughout; recognize triggers; safety; therapeutic alliance.

SPLITTING is a primitive defense mechanism characteristic of BORDERLINE PERSONALITY DISORDER (BPD) in which the person cannot integrate the good and bad qualities of people (or themselves) and instead perceives them as either entirely good or entirely bad. In a clinical setting, splitting often manifests as: one nurse is 'perfect' while another is 'terrible'; complaints that other staff are cruel while the target nurse is wonderful; rapidly shifting perceptions of the same person from idealized to devalued ('I love you/I hate you'). The intensity can shift rapidly, sometimes within the same day. NURSING APPROACH to splitting: AVOID SPLITTING BACK — the nurse must not compete with staff or align exclusively with the client's idealized version; TEAM CONSISTENCY — the multidisciplinary team must maintain consistent, unified responses; TEAM COMMUNICATION — all staff must be aware of the dynamic and communicate regularly; CONSISTENT BOUNDARIES — consistent, clear limits that are enforced by all staff, not selectively; MATTER-OF-FACT, non-emotionally reactive responses; DIALECTICAL BEHAVIOR THERAPY (DBT): the gold-standard treatment for BPD, developed by Marsha Linehan; combines cognitive-behavioral techniques with mindfulness and acceptance strategies; targets emotional dysregulation, impulsivity, self-destructive behaviors. BPD CORE FEATURES (DSM-5 — five or more required): intense unstable relationships; unstable self-image; impulsivity; self-harm or suicidal behaviors; emotional instability; chronic emptiness; intense anger; transient paranoid ideation or dissociation; frantic efforts to avoid abandonment. NURSING AWARENESS: splitting is a symptom of the disorder, not a moral failing; maintaining a non-punitive, therapeutic stance is essential.

POST-ACUTE WITHDRAWAL SYNDROME (PAWS) — also called protracted withdrawal — is a second phase of withdrawal symptoms that emerge after the acute withdrawal phase resolves. CLINICAL PRESENTATION for alcohol (and other CNS depressants): Anxiety and irritability; sleep disturbances (insomnia, vivid dreams); mood instability, depression; cognitive difficulties (brain fog, difficulty concentrating, memory problems); reduced ability to handle stress; fatigue; strong cravings; TIMELINE: Can persist from weeks to 2 years depending on severity and duration of use; symptoms are typically episodic (good days and bad days) rather than constant; MECHANISM: Long-term alcohol use causes neuroadaptation (the brain's chemistry and structure change); acute withdrawal represents the overcorrection when alcohol is removed; PAWS reflects the slower process of the brain re-regulating its neurotransmitter systems to baseline; WHY IT MATTERS FOR RECOVERY: PAWS symptoms are a major trigger for relapse — clients feel the discomfort and may use substances to relieve it; clients who don't know about PAWS may interpret symptoms as mental illness or permanent damage, leading to hopelessness; NURSING TEACHING: Normalize PAWS as expected and temporary; identify coping strategies (exercise, sleep hygiene, stress management); connect to peer support; PAWS does NOT require benzodiazepines (risk of cross-dependence); non-pharmacological management is preferred; SSRIs and naltrexone may help some symptoms.

SCHIZOPHRENIA SYMPTOM CLASSIFICATION — POSITIVE vs NEGATIVE SYMPTOMS: POSITIVE SYMPTOMS (presence of abnormal experiences not normally present): HALLUCINATIONS — false sensory perceptions; auditory most common in schizophrenia (hearing voices, often commenting, criticizing, or commanding); can be visual, tactile, olfactory; DELUSIONS — fixed false beliefs; paranoid (being followed, controlled), grandiose (special powers), referential (events have special meaning for the client), somatic; DISORGANIZED SPEECH — loose associations, word salad, tangentiality, derailment; DISORGANIZED BEHAVIOR — unpredictable agitation, catatonia, inappropriate affect; NEGATIVE SYMPTOMS (absence or reduction of normal function): ALOGIA — poverty of speech (brief, empty replies); ANHEDONIA — inability to experience pleasure; AVOLITION — lack of motivation, inability to initiate goal-directed activities; FLAT AFFECT — reduced emotional expression (face, voice); ASOCIALITY/SOCIAL WITHDRAWAL; ALOGIA combined with flat affect and social withdrawal = 'the 5 A's': Alogia, Anhedonia, Avolition, Affect (flat), Asociality. CLINICAL IMPORTANCE: Positive symptoms tend to respond better to antipsychotics; negative symptoms are harder to treat and contribute more to long-term functional disability; clozapine and some newer atypical antipsychotics have some effect on negative symptoms; positive vs negative symptom distinction guides treatment planning.

TYPES OF DELUSIONS: PERSECUTORY (most common in schizophrenia): Belief that someone or something is spying on, persecuting, or plotting against the client ('the government is monitoring me', 'my food is poisoned', 'I'm being followed'); GRANDIOSE: Belief that the client has special powers, status, or identity ('I am actually the messiah', 'I discovered the cure for all disease'); SOMATIC: False beliefs about the body ('I have insects living in my blood', 'my organs are rotting'); EROTOMANIC: Belief that someone (often a public figure) is in love with the client; REFERENTIAL: Belief that external events (TV, newspaper) have special personal meaning; THERAPEUTIC APPROACH TO PERSECUTORY DELUSIONS: Do not argue or try to convince the client the belief is false — this increases agitation and distrust; do not pretend to believe the delusion; acknowledge the client's emotional experience ('I can see this is very frightening/distressing for you'); refocus on here-and-now and safety; administer antipsychotics as prescribed (dopamine blocking agents are the primary treatment).

PARADOXICAL IMPROVEMENT IN DEPRESSION is a well-documented and dangerous phenomenon: EXPLANATION: Severely depressed clients often lack the energy to act on suicidal thoughts; when they 'improve' slightly, they have enough energy to act but their hopelessness has not resolved; their apparent improvement may actually reflect a decision to act — the 'calm before the storm'; BEHAVIORAL WARNING SIGNS OF IMMINENT SUICIDAL INTENT: Giving away valued possessions (rings, jewelry, meaningful items); saying goodbye in unusual ways; writing final notes/letters; sudden calm after prolonged distress; putting affairs in order; IMMEDIATE NURSING ACTIONS: DO NOT leave the client alone; NOTIFY physician/psychiatrist immediately; implement safety precautions (1:1 observation, remove ligatures and sharps, check belongings); REASSESS suicide risk using validated tool; HOSPITALIZATION is likely indicated. NEVER interpret these signs as reassuring improvement without thorough investigation.

MANIA NURSING PRIORITIES: Safety is always first — mania creates serious risks: PHYSICAL: Exhaustion (3 days of sleep deprivation can cause hallucinations and medical complications); dehydration and poor nutrition (too agitated to eat/drink); cardiovascular strain from sustained hyperactivity; BEHAVIORAL: Impulsive decisions (financial, sexual, dangerous); disinhibited and possibly aggressive behavior; inability to assess danger; PRIORITY INTERVENTIONS: SAFETY ENVIRONMENT: Low-stimulation room; remove dangerous objects; monitor for escalating agitation; PHYSIOLOGICAL SUPPORT: Ensure hydration (offer finger foods/liquids frequently — won't sit for meals); monitor vital signs; MEDICATION: Mood stabilisers (lithium, valproate) take time to work; atypical antipsychotics (quetiapine, olanzapine) provide faster sedation; benzodiazepines for acute agitation; SLEEP: Priority — even 4-6 hours significantly improves functioning; COMMUNICATION: Calm, non-confrontational, brief interactions; avoid arguments; redirect rather than challenge.

SPLITTING IN BORDERLINE PERSONALITY DISORDER: DEFINITION: Seeing people as entirely good or entirely bad — unable to hold the ambivalent complexity that everyone is both; 'You're wonderful, everyone else is terrible'; RECOGNITION: Is a classic BPD interpersonal pattern; the 'wonderful' nurse gets idealized; the 'bad' nurses get devalued; this can create division in nursing teams if not recognized; THERAPEUTIC RESPONSE: Acknowledge feelings without reinforcing: 'I'm glad you feel heard. I also want you to know that all of your nurses care about you and work as a team'; WHAT NOT TO DO: Agree that other nurses are bad; become a 'special' nurse who is different from the team; allow special treatment that breaks unit rules; TEAM COMMUNICATION: CRITICAL — document the pattern; hold a team meeting to ensure all staff respond consistently; inconsistent responses allow the splitting to continue; LIMITS AND CONSISTENCY: Clear, compassionate consistent limits from all team members is the most therapeutic approach; BPD clients benefit from predictability and consistency.

LITHIUM TOXICITY — HIGH-YIELD NCLEX CONTENT: THERAPEUTIC RANGE: 0.6-1.2 mEq/L (some sources 0.8-1.2 for bipolar treatment); TOXIC LEVELS: >1.5 mEq/L early toxicity; >2.0 mEq/L serious toxicity; EARLY TOXICITY SIGNS: Coarse tremors; nausea/vomiting; diarrhoea; polyuria; ataxia (coordination problems); slurred speech; SEVERE TOXICITY: Seizures; confusion; cardiac arrhythmias; coma; death; RISK FACTORS FOR TOXICITY: Dehydration (lithium follows sodium — loss of sodium/water concentrates lithium); sodium-restricted diet; NSAIDs (reduce renal excretion); thiazide diuretics; ACE inhibitors; NSAID use; MONITORING: Serum lithium level 12 hours post-dose; BMP (renal function — lithium cleared by kidneys); thyroid function (lithium causes hypothyroidism in 30-40% long-term); PATIENT TEACHING: Maintain adequate sodium and fluid intake; avoid dehydration (illness, excessive sweating); do not change sodium intake dramatically; keep lab appointments; TREATMENT OF TOXICITY: Hold lithium; IV fluids; haemodialysis for severe toxicity.

ANOREXIA NERVOSA — PHYSIOLOGICAL PRIORITY: While the psychological aspects (body image distortion, control issues) are central to the disorder, the IMMEDIATE LIFE THREAT is physiological. CARDIAC AND ELECTROLYTE COMPLICATIONS are the leading cause of death: Hypokalemia (low potassium) → fatal cardiac dysrhythmias; bradycardia and hypotension; cardiac muscle wasting; prolonged QT interval; REFEEDING SYNDROME: A dangerous complication when nutrition is reintroduced too quickly — rapid shifts in phosphate, potassium, and magnesium can cause cardiac failure; refeeding must be SLOW and monitored; MONITORING PRIORITIES: Cardiac rhythm, electrolytes (K+, phosphate, magnesium), vital signs, weight; OTHER COMPLICATIONS: Amenorrhea, osteoporosis, lanugo, electrolyte imbalances from purging; TREATMENT: Multidisciplinary — medical stabilization first, then nutritional rehabilitation, then psychotherapy (CBT, family therapy); ABCs/physiological needs take priority (Maslow) — address life-threatening cardiac/electrolyte issues before psychological interventions; nursing role: monitor cardiac/electrolyte status, implement refeeding protocol safely, address psychological needs.

LITHIUM TOXICITY: Lithium has a NARROW THERAPEUTIC RANGE (0.6-1.2 mEq/L) — toxicity can occur even slightly above range. EARLY TOXICITY (1.5-2.0 mEq/L): Nausea, vomiting, diarrhea, fine tremor worsening, drowsiness, muscle weakness; MODERATE-SEVERE (2.0-2.5+): COARSE tremors, confusion, ataxia, slurred speech, hyperreflexia, seizures; SEVERE (>2.5): Seizures, coma, cardiac dysrhythmias, death; NURSING ACTION: Hold the lithium; check serum lithium level; notify the provider; the toxic client's symptoms in this question (coarse tremor, confusion, GI symptoms) indicate moderate toxicity; TOXICITY RISK FACTORS: Dehydration, sodium depletion (low sodium increases lithium retention), renal impairment, diuretics, NSAIDs, drug interactions; PATIENT EDUCATION: Maintain consistent sodium and fluid intake; don't change diet drastically; regular lithium level monitoring; report toxicity signs; stay hydrated, especially in hot weather or illness; THERAPEUTIC LEVELS: Acute mania may target 1.0-1.5; maintenance 0.6-1.0; nursing role: monitor levels, recognize toxicity, hold and notify, educate on prevention.

PANIC ATTACK — ACUTE NURSING INTERVENTION: Once medical causes (cardiac, respiratory) are ruled out, the therapeutic approach is calm, supportive presence. INTERVENTIONS: STAY with the client (do not leave them alone — abandonment increases panic); remain CALM yourself (anxiety is contagious; calmness is reassuring); speak in SHORT, SIMPLE sentences (panic impairs processing of complex information); guide SLOW breathing (model it; breathe with them) to counteract hyperventilation; provide reassurance that they are safe and the symptoms will pass; reduce stimulation (quiet environment); AVOID: Leaving them alone; dismissing their feelings ('nothing's wrong, relax' — invalidating); long explanations; high-flow oxygen (hyperventilation already causes respiratory alkalosis); PANIC ATTACK: Peaks within 10 minutes, intense fear with physical symptoms (palpitations, chest pain, dyspnea, dizziness, sense of doom); LONGER-TERM: CBT, SSRIs, teaching coping/breathing techniques for future attacks; nursing role: calm supportive presence, guide breathing, reassure, ensure safety, never abandon during acute panic.

OCD — COMPULSIONS AND NURSING APPROACH: Compulsions are anxiety-reducing rituals; the client feels compelled to perform them to relieve obsession-driven anxiety. INITIAL APPROACH: Do NOT abruptly stop the ritual — preventing a compulsion suddenly causes severe, sometimes intolerable anxiety; ALLOW the ritual initially while ensuring SAFETY (skin care for the hand-washing breakdown, prevent harm); build trust and a therapeutic relationship; GRADUALLY, with the treatment team, set reasonable limits and reduce the behavior; provide structure and a schedule; help the client find alternative anxiety-reduction strategies; TREATMENT: ERP (Exposure and Response Prevention) — the gold-standard therapy, gradually exposing the client to triggers while preventing the compulsion, done therapeutically over time; SSRIs (often higher doses than for depression); ALLOW TIME for rituals in the schedule initially; reduce environmental stressors; AVOID: Forcibly stopping rituals, ridiculing, or punishing; nursing role: ensure safety, allow rituals initially, build trust, support gradual reduction with the team, never abruptly prevent compulsions in the acute phase.

SUNDOWNING: A pattern of increased confusion, agitation, anxiety, and behavioral disturbances that occurs in the LATE AFTERNOON AND EVENING in some clients with dementia. CONTRIBUTING FACTORS: Fatigue, reduced lighting/increased shadows, disrupted circadian rhythm, overstimulation or understimulation, unmet needs; MANAGEMENT (non-pharmacological first): Maintain a consistent daily routine; increase lighting in late afternoon/evening (reduce shadows); reduce noise and overstimulation in the evening; encourage daytime activity and limit daytime napping; calm, reassuring approach; address unmet needs (toileting, hunger, pain, comfort); avoid caffeine late in the day; familiar objects and people; PHARMACOLOGICAL: Used cautiously and as a last resort (antipsychotics carry risks in dementia — increased mortality, used only when necessary for safety); DISTINGUISH from DELIRIUM (acute, fluctuating, often reversible cause — infection, medication; requires medical workup) — sundowning is a pattern within chronic dementia; nursing role: implement environmental/routine modifications, ensure safety, calm approach, address underlying needs, minimize pharmacological intervention.

MAOI DIETARY RESTRICTIONS — TYRAMINE: MAOIs (phenelzine, tranylcypromine, isocarboxazid, selegiline) inhibit the enzyme that breaks down tyramine; consuming tyramine-rich foods while on an MAOI causes a dangerous spike in blood pressure (HYPERTENSIVE CRISIS). TYRAMINE-RICH FOODS TO AVOID: Aged cheeses; cured/smoked/processed meats (salami, pepperoni); fermented foods (sauerkraut, kimchi, miso); draft/tap beer; red wine; soy sauce; fava beans; overripe fruits; aged/fermented anything; HYPERTENSIVE CRISIS SIGNS: Severe occipital headache, palpitations, neck stiffness, nausea/vomiting, sweating, severe hypertension — MEDICAL EMERGENCY; DRUG INTERACTIONS: MAOIs interact dangerously with many drugs (SSRIs, sympathomimetics, opioids like meperidine) — risk of serotonin syndrome and hypertensive crisis; require washout periods between MAOIs and other antidepressants; PATIENT EDUCATION: Strict dietary compliance, avoid OTC cold/decongestant medications, report severe headache immediately; nursing role: thorough dietary and drug-interaction teaching, monitor for hypertensive crisis, ensure the client understands the serious consequences of dietary non-compliance.

ELECTROCONVULSIVE THERAPY (ECT): An effective treatment for severe, treatment-resistant depression, acute mania, and catatonia, especially when rapid response is needed or medications have failed. PROCEDURE: Brief electrical stimulation induces a controlled seizure under general anesthesia with a muscle relaxant; typically a series of treatments (6-12); MOST COMMON SIDE EFFECTS: Transient memory loss (especially short-term and around the treatment time) and confusion — usually temporary, resolving over days to weeks; some retrograde amnesia for events around treatment; headache, muscle soreness, nausea (transient); NURSING CARE: Pre-procedure (informed consent, NPO, baseline assessment, remove dentures/jewelry); post-procedure (monitor airway and vitals during recovery from anesthesia, reorient frequently, ensure safety due to confusion, provide reassurance about memory effects); MEMORY: Reassure the client and family that memory issues are usually temporary; provide a calm, oriented environment; ECT is safe and effective — modern ECT with anesthesia and muscle relaxants is very different from historical portrayals; nursing role: pre/post-procedure care, reorientation, safety, reassurance about transient memory effects, monitor recovery.