A nurse in an inpatient mental health facility is reviewing the medical record of a client who has bipolar disorder. When planning to establish a nurse-client relationship with the client, which of the following actions should the nurse plan to take first?
Assist the client to use new coping strategies.
Establish confidentiality guidelines with the client.
Help the client to make behavioral changes.
Share information with the client about their disorder.
The Correct Answer is B
Choice A reason: Assisting the client to use new coping strategies is an important part of managing bipolar disorder, but it is not the first action a nurse should take when establishing a nurse-client relationship. Coping strategies will be more effective once a trusting relationship has been established and the client feels secure in sharing personal information.
Choice B reason: Establishing confidentiality guidelines with the client is the first and most crucial step in forming a therapeutic nurse-client relationship. It sets the foundation for trust and openness, ensuring the client understands that their personal information will be protected and shared only with those directly involved in their care.
Choice C reason: Helping the client to make behavioral changes is a goal in the treatment of bipolar disorder. However, before any interventions can be planned or implemented, the nurse must first establish a rapport and trust with the client, which begins with ensuring confidentiality.
Choice D reason: Sharing information with the client about their disorder is essential for their understanding and participation in care. However, this should occur after establishing a relationship in which the client feels comfortable and secure, knowing their privacy is respected.
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Correct Answer is B
Explanation
Choice A reason: Telling the client that the symptoms will improve over time without further assessment could be misleading. These symptoms could indicate lithium toxicity, which requires immediate medical attention.
Choice B reason: Lethargy, muscle weakness, and blurred vision can be signs of lithium toxicity. The nurse should recommend blood tests to check lithium levels and kidney function to rule out toxicity.
Choice C reason: Decreasing sodium intake is not recommended without a healthcare provider's advice, as sodium levels can affect lithium levels in the body. Sudden changes in sodium intake should be avoided unless directed by a healthcare provider.
Choice D reason: Continuing the medication as prescribed without addressing the symptoms could be dangerous. The symptoms reported by the client need to be evaluated to ensure they are not due to lithium toxicity.
Correct Answer is B
Explanation
Choice A reason: Avoiding television when hearing voices is not a recognized strategy for relapse prevention in schizophrenia. While reducing stimuli during episodes of auditory hallucinations can be helpful, it is not a substitute for professional treatment and medication adherence, which are key to relapse prevention.
Choice B reason: Informing a counselor about trouble sleeping is important because sleep disturbances can be an early indicator of a potential relapse. Maintaining open communication with healthcare providers about changes in sleep patterns allows for timely interventions and adjustments in treatment to prevent a relapse.
Choice C reason: Listening to the voices is not advisable as it may reinforce the hallucinations. Instead, clients are encouraged to engage in reality-based activities and to discuss their experiences with their healthcare providers to manage symptoms effectively.
Choice D reason: Isolation can exacerbate symptoms of schizophrenia and increase the risk of relapse. It is important for individuals to maintain social contacts and support systems as part of a comprehensive relapse prevention strategy.
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