A newly licensed nurse is unsure if an assigned task is within their scope Of practice. Which Of the following resources should the nurse consult?

A. Bowel movement 5 days ago: Constipation is a common side effect of morphine and should be addressed, but it is not immediately life-threatening and can be managed with laxatives or stool softeners.
B. Pupil diameter 6 mm: Pupil dilation is not a typical concern with morphine; miosis (constriction) is more commonly expected. While abnormal pupil size can indicate neurologic or drug-related issues, hypotension takes priority here.
C. Blood pressure 80/40 mm Hg: Hypotension is a serious adverse effect of morphine that may indicate circulatory depression. It requires immediate intervention to prevent inadequate organ perfusion and potential shock.
D. Urinary output 120 mL/4 hr: This output equals 30 mL/hr, which is within the expected minimum range. No immediate intervention is required, though continued monitoring is appropriate.

Rationale for Correct Choices:

• Mania is characterized by an abnormally elevated, expansive, or irritable mood accompanied by increased energy or activity. This client’s obsessive cleaning, excessive spending, sleeplessness, pressured speech, and overly joyous behavior strongly support a manic episode.
• Euphoric mood refers to an exaggerated feeling of well-being or elation not consistent with the client's circumstances. It often presents in mania alongside impulsivity and grandiosity, such as the client’s obsession with hosting parties and giving away money without regard for consequences.

Rationale for Incorrect Choices:

• Delirium: Typically presents with fluctuating consciousness, acute onset confusion, and disorganized thinking often due to a medical cause. The client is alert and oriented to person and time, which is inconsistent with the inattention and acute cognitive changes of delirium.
• Catatonia: Characterized by motor immobility, extreme negativism, mutism, or stupor. The client displays hyperactivity and pressured speech, which are the opposite of the psychomotor retardation seen in catatonia.
• Panic disorder: Involves sudden onset of intense fear with physical symptoms such as palpitations, chest pain, or shortness of breath. It lacks the prolonged mood elevation, impulsivity, and grandiosity observed in this case.
• Major depressive disorder: Presents with persistent sadness, fatigue, anhedonia, and social withdrawal. The client’s symptoms of increased activity, grandiosity, and reduced need for sleep do not align with depression.

• Alogia: Refers to poverty of speech or reduced speech output, often associated with schizophrenia or severe depression. This contrasts with the client’s pressured and excessive speech.
• Magical thinking: Involves believing one’s thoughts can influence the physical world, often seen in psychotic disorders or schizotypal personality disorder. The client describes hallucinations, but no evidence of magical thinking is present.
• Hypervigilance: Describes excessive alertness or scanning for threats, commonly associated with anxiety or PTSD. The client’s symptoms point to elevated mood and disinhibition, not heightened fear or threat perception.
• Anhedonia: A core symptom of depression, characterized by a loss of interest or pleasure in activities. The client’s increased goal-directed activity and enjoyment in planning events contradict this finding.