A 22-year-old female client with bipolar disorder is late for her medication follow-up appointment with the PMHNP. She calls the office and reports she is lost, although she has been to the office many times. When she arrives, she is manic. She expresses psychotic delusions that people are "out to get" her, and she says she will shoot if she "has to." She does not want to be hospitalized. She states, "I am more clear-headed than I have ever been." What should be the nurse practitioner's next steps?
Call her mother to pick her up and take her directly home.
Give the client an intramuscular injection of 10 mg of Geodon, then call her mother to pick her up.
Have the mother sign a contract agreeing to administer the patient's psychiatric medications every day and return for a follow-up in 1 week.
Begin the involuntary commitment process.
The Correct Answer is D
Choice A reason: Calling her mother to take her home does not address the acute psychiatric risk. The client is experiencing psychosis, has expressed paranoid delusions, and made threatening statements. Sending her home without intervention poses a danger to herself and others.
Choice B reason: Administering Geodon (ziprasidone) may help manage agitation or psychosis temporarily, but it does not resolve the underlying safety concerns. Additionally, administering medication without consent in a non-emergency outpatient setting may violate ethical and legal standards.
Choice C reason: Having the mother sign a medication contract is inappropriate in this context. The client is acutely manic and psychotic, and her capacity to consent or adhere to treatment is compromised. Delaying intervention for a week could result in harm.
Choice D reason: Involuntary commitment is warranted when a client poses a danger to themselves or others due to mental illness. The client’s delusions, threats of violence, and impaired judgment meet criteria for involuntary hospitalization. This ensures safety and allows for stabilization and treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Hyperactivity, flight of ideas, and rapid speech are more indicative of manic or hypomanic states. These symptoms are not typically associated with intimate partner violence.
Choice B reason: Withdrawal, fearfulness, and hypersensitivity to touch are classic signs of trauma and abuse. These behaviors may reflect hypervigilance, fear of physical contact, and emotional distress, all of which are consistent with a history of intimate partner violence.
Choice C reason: Defensiveness and anger may be present in various psychiatric conditions, including personality disorders or trauma responses. However, they are not as specific or telling as the signs in choice B.
Choice D reason: Disorganized thinking and labile mood may suggest psychosis or mood disorders but are not specific indicators of intimate partner violence. They lack the trauma-related behavioral cues seen in choice B.
Correct Answer is C
Explanation
Choice A reason: The power of nursing boards is unrelated to the classification of a case as civil or criminal. Boards regulate licensure and professional conduct but do not determine legal case types.
Choice B reason: Hiring a good attorney may influence the outcome of a case but does not determine whether it is civil or criminal. The nature of the act and intent are the key factors.
Choice C reason: Civil cases typically involve negligence or malpractice where harm results from a lack of due care, not criminal intent. Since the NP did not act with malice or intent to harm, the case is classified as civil, focusing on compensation rather than punishment.
Choice D reason: Criminal charges are filed by the state, not the patient. A patient cannot “drop” criminal charges. The classification depends on the nature of the act, not the victim’s decision.
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