A nurse in a mental health facility is caring for a client.

Medical History: Antisocial personality disorder.

Substance use disorder.

Nurses' Notes:. 1400: Client admitted to facility by court order for evaluation following arrest for disorderly conduct and resisting arrest.

Client states, "That judge is so stupid.

I don't belong here!" Client has rigid posture, is pacing around the room attempting to intimidate staff and other clients on the unit.

Extra staff members gather.

1500: Client escorted to room.

Client becomes flirtatious with assistant personnel (AP). Client introduced to roommate, whom they ignore.

Continues to flirt with AP. 1800: Client refuses to go to dining room for dinner.

States, "I'm not sitting down with a bunch of nuts.

Bring my food to me!". For each potential nursing action, click to specify if the potential action is anticipated or contraindicated for the client.

A nurse on an inpatient mental health unit is caring for a client who was admitted for suicidal ideation.

Which of the following statements by the client should the nurse identify as a continuation of suicidal ideation?

A nurse is caring for a client who has been hospitalized for treatment of bipolar disorder and will be discharged with a prescription for lithium. The nurse's discharge teaching should include information cautioning against which of the following factors that may cause lithium toxicity?

A nurse is reviewing abnormal laboratory values for four clients who have schizophrenia and take clozapine.

For which of the following clients should the nurse withhold the medication and notify the provider immediately to have clozapine therapy discontinued?

A nurse is caring for a young adult client who has acute schizophrenic disorder and tells the nurse, "Yesterday noon the sun moon went over the rover to see the lawnmower.”. Which of the following manifestations is the client exhibiting?

Medical History: Borderline personality disorder.

Alcohol use disorder.

History of suicidal ideation.

Medication Administration Record: Fluoxetine 20 mg PO daily.

Nurses' Notes: . 1500: Client admitted for evaluation and treatment following arrest for driving while under the influence of alcohol.

Client reports recent breakup of romantic relationship and subsequent job loss.

States, "I was too upset to go to work, and then they fired me. Like I needed that stress, too.”. 1700: Noted client has multiple cuts on arms and legs and there is a broken mirror with blood on it on the floor.

Client states, "I feel so alone.

There is no one that cares about me.”. For each potential nursing action, click to specify if the potential action is anticipated, nonessential, or contraindicated for the client.

A nurse is talking with a client who has schizophrenia.

Suddenly the client states, "I'm frightened.

Do you hear that? The voices are telling me to do terrible things.”. Which of the following responses by the nurse is appropriate?.

A nurse is assessing a client who is receiving treatment with multiple antipsychotic medications and who suddenly became ill.

Findings include blood pressure changes, hyperpyrexia, and diaphoresis.

The nurse should recognize that which of the following adverse effects may be occurring?

A nurse is caring for a client who has been diagnosed with schizophrenia.

The client has been wearing the same clothes for the past week and appears unkempt and unbathed.

Which of the following statements should the nurse make to the client?

A nurse in a mental health facility is caring for a client.

Medical History: Antisocial personality disorder.

Substance use disorder.

Nurses' Notes:. 1400: Client admitted to facility by court order for evaluation following arrest for disorderly conduct and resisting arrest.

Client states, "That judge is so stupid.

I don't belong here!" Client has rigid posture, is pacing around the room attempting to intimidate staff and other clients on the unit.

Extra staff members gather.

1500: Client escorted to room.

Client becomes flirtatious with assistant personnel (AP). Client introduced to roommate, whom they ignore.

Continues to flirt with AP. 1800: Client refuses to go to dining room for dinner.

States, "I'm not sitting down with a bunch of nuts.

Bring my food to me!". For each potential nursing action, click to specify if the potential action is anticipated or contraindicated for the client.

A nurse is conducting an in-service for a group of newly licensed nurses about the interventions used for clients experiencing non-suicidal self-harm (NSSH). Which of the following should the nurse include?.