A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior?

Set limits on aggressive and intimidating behaviors

Offer to hold a group about healthy coping skills

Administer the client’s PRN medications

Insist the client take a “time-out” in their room

Answer and Explanation

The Correct Answer is A

Choice A reason: Setting limits on aggressive behavior during mania ensures safety by addressing the immediate threat. Mania involves elevated mood and impulsivity, which can lead to harmful actions. Clear boundaries reduce escalation, protect others, and help de-escalate the client’s heightened state without immediate medication or isolation.

Choice B reason: Offering a group on coping skills is inappropriate during acute mania with threatening behavior, as the client’s impulsivity and agitation impair their ability to engage in group therapy. Safety and de-escalation are priorities before addressing long-term coping strategies.

Choice C reason: Administering PRN medications, such as antipsychotics or benzodiazepines, may help calm mania but is not the initial action. Setting limits addresses immediate safety concerns first, allowing for safer medication administration if needed, as medications take time to act.

Choice D reason: Insisting on a “time-out” may escalate agitation in a manic client, as isolation can increase feelings of persecution or agitation. This approach is less effective than setting clear, calm limits to de-escalate threatening behavior and ensure unit safety.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is D

Explanation

Choice A reason: Anorexia nervosa was described as a medical condition in the late 19th century by physicians like William Gull. It was recognized well before the 1960s, though diagnostic criteria were formalized later, making this statement false.

Choice B reason: Anorexia nervosa often leads to social isolation due to physical and psychological effects, not popularity. Thinness may be idealized, but the disorder’s behaviors (e.g., food restriction) and health decline typically impair peer relationships, making this false.

Choice C reason: Eating disorders, including anorexia nervosa, are a global health issue, not limited to the United States and Europe. They occur in various cultures, particularly where thinness is idealized, making this statement inaccurate and overly restrictive.

Choice D reason: Cultures emphasizing thinness as a beauty standard increase the risk of eating disorders like anorexia nervosa by promoting body dissatisfaction and extreme dieting behaviors. Social pressures amplify psychological vulnerabilities, contributing to higher incidence rates, making this statement true.

A. Mild B. Panic C. Moderate D. Severe

Correct Answer is B

Explanation

Choice A reason: Mild anxiety is characterized by slight restlessness or discomfort, with intact concentration and problem-solving abilities. The client’s symptoms, including rapid pacing, trembling, and inability to concentrate, indicate a more intense physiological and cognitive impairment, ruling out mild anxiety as the correct assessment.

Choice B reason: Panic-level anxiety involves extreme physiological arousal, with symptoms like rapid pacing, trembling, high-pitched speech, and inability to concentrate or problem-solve. These reflect a severe sympathetic nervous system response, overwhelming the client’s ability to function, making panic the most accurate description of the client’s state.

Choice C reason: Moderate anxiety involves noticeable discomfort, with some difficulty concentrating but retained problem-solving ability. The client’s severe symptoms, including high-pitched speech and restricted problem-solving, exceed this level, indicating a more intense state of anxiety that aligns with panic rather than moderate anxiety.

Choice D reason: Severe anxiety includes significant distress and impaired function but typically allows some concentration and problem-solving, unlike panic. The client’s extreme symptoms, such as inability to concentrate and restricted problem-solving, suggest a higher level of distress consistent with a panic state.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which statement is true?

Correct Answer is D

Explanation

The nurse observes a client who is rapidly pacing, wringing their hands, and trembling. Their speech is high-pitched, they are unable to concentrate, and have restricted problem-solving. The nurse identifies the client’s anxiety level as:

Correct Answer is B

Explanation

A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not see, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms?

When a psychiatrist prescribes lorazepam (Ativan) for acute anxiety experienced by a client with agoraphobia, health teaching should include which instructions?

A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client?

Calculate the initial rate for a Heparin infusion. The infusion is ordered as 18 units/kg/hr. The client weighs 90 kg. The concentration of the Heparin bag is 25,000 units/250 mL. You are administering the Heparin drip via an electronic infusion device. Calculate the infusion rate in mL/hr.

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in one week. What teaching should the nurse provide to the client related to this activity?

A client with heart failure is taking an angiotensin-converting enzyme inhibitor (ACE-I) and reports a nagging cough. Which replacement medication will the nurse expect to be prescribed for this client?

A client asks the nurse why they have to go to therapy and cannot just take the prescribed antidepressant medication. Which would be the most therapeutic response by the nurse?

The nurse is caring for a client with obsessive-compulsive disorder (OCD). Which action by the nurse will increase the client’s sense of security?