A client diagnosed with bipolar disorder is experiencing a severe depressive episode. Which client behavior would alert the nurse to the highest priority intervention? The client:

is not responding to other clients on the unit.

angrily argues with another client stating, "God is dead."

is refusing to take his prescribed mood stabilizer.

states, "There is no future when you feel so depressed."

Answer and Explanation

The Correct Answer is D

D. This behavior suggests the possibility of suicidal ideation, which is a medical emergency in mental health care. The nurse should assess the client for suicidal thoughts, intentions, and plans, and provide a safe environment to prevent self-harm. It's crucial to address this as a priority to ensure the safety and well- being of the client.
A. Withdrawing from social interactions can be a symptom of depression. However, it may not always be the highest priority intervention
B. This behavior suggests agitation and potential delusional thinking, which can be indicative of a severe depressive episode or a mixed state in bipolar disorder. This however, does not indicate the need for immediate intervention.
C. Non-adherence to prescribed medication, particularly mood stabilizers, can significantly impact the management of bipolar disorder and increase the risk of mood destabilization. However, addressing adherence is not the priority intervention.

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Correct Answer is B

Explanation

B. Tricyclic antidepressants (TCAs) are known to take some time before their full therapeutic effects are realized, which can indeed be up to four weeks. This delay is due to the gradual changes they induce in the brain's biochemistry.
A. TCAs can cause a variety of side effects but hypomania and recent memory impairment are not typically associated with these medications.
C. TCAs do not have a known interaction with antianxiety agents that would prohibit their concurrent use.
D. The restriction on eating strong or aged cheese is associated with another class of antidepressants known as monoamine oxidase inhibitors (MAOIs), not TCAs.

A. Turkey sandwich, cheese slices, milk B. Fried chicken, mashed potatoes, milk C. Peanut butter sandwich, chips, cola D. Spaghetti, garlic bread, salad, tea

Correct Answer is A

Explanation

A. Turkey contains tryptophan, which can have a calming effect and aid in sleep, while cheese provides calcium, and milk is a good source of protein and hydration.
B. Fried foods can be heavy and may exacerbate agitation or restlessness. Additionally, mashed potatoes are high in simple carbohydrates, which may cause rapid spikes and crashes in energy levels.
C. Chips are typically high in unhealthy fats and low in essential nutrients, and cola provides little to no nutritional value while containing high amounts of sugar and caffeine, which may exacerbate symptoms of mania.
D. Caffeine content in tea may not be ideal for someone experiencing mania, as it can further stimulate agitation or hyperactivity.

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A client diagnosed with bipolar disorder is experiencing a severe depressive episode. Which client behavior would alert the nurse to the highest priority intervention? The client:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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