A nurse is assessing a patient with bipolar disorder.
Which of the following aspects of the assessment should the nurse consider as part of the physical assessment? Select all that apply:.

Monitoring signs of psychomotor agitation.

Assessing the patient's memory and attention.

Documenting the patient's medication history.

Measuring vital signs and laboratory tests.

Observing signs of impaired judgment.

Answer and Explanation

Correct Answer : A,B,C,D,E

Choice A rationale:

Monitoring signs of psychomotor agitation is an important aspect of assessing a patient with bipolar disorder. Psychomotor agitation is a common feature of bipolar disorder, and recognizing its signs can help in managing the patient's condition effectively.

Choice B rationale:

Assessing the patient's memory and attention is crucial in the assessment of bipolar disorder. It helps in evaluating cognitive function, which can be affected during manic or depressive episodes in bipolar disorder.

Choice C rationale:

Documenting the patient's medication history is essential when assessing a patient with bipolar disorder. Knowing the medications the patient is currently taking, as well as their medication history, is vital for understanding their treatment plan and ensuring the safe and effective management of the condition.

Choice D rationale:

Measuring vital signs and laboratory tests is an integral part of the physical assessment for a patient with bipolar disorder. Bipolar disorder can have physical health implications, and monitoring vital signs and conducting laboratory tests can help identify any underlying medical issues or side effects of medication.

Choice E rationale:

Observing signs of impaired judgment is another important aspect of assessing a patient with bipolar disorder. Impaired judgment can be a characteristic feature during manic episodes, and recognizing it is crucial for the safety and well-being of the patient.

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Correct Answer is B

Explanation

Choice A rationale:

Offering prophylactic medication to prevent STIs is an important intervention in cases of sexual assault; however, it is not the next immediate step. The priority at this stage is to ensure the client's safety and emotional support.

Choice B rationale:

Providing a trained advocate to stay with the client is the most appropriate and immediate action. This helps ensure the client's emotional well-being and provides support during a traumatic experience. Advocates can also help the client navigate the healthcare system and legal processes.

Choice C rationale:

Conducting a pregnancy test is important, but it is not the next immediate step. Safety and emotional support should be the priority.

Choice D rationale:

Requesting a mental health consultation for the client is important, but it should not be the next immediate action. Safety and support should come first.

A. Withhold the next dose of the medication. B. Ask the client about a recent change in laundry detergent. C. Apply hydrocortisone cream on the client's rash. D. Explain that the medication causes a temporary rash.

Correct Answer is A

Explanation

The correct answer is: A. Withhold the next dose of the medication.

Choice A rationale: Lamotrigine can cause serious skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Any rash should be taken seriously, and the medication should be withheld immediately to prevent potential severe reactions1.

Choice B rationale: While a change in laundry detergent could cause a rash, it is less likely to be the cause if the rash appeared after starting lamotrigine.

Choice C rationale: Applying hydrocortisone cream may help with mild skin irritations, but it does not address the potential severity of a drug-induced rash.

Choice D rationale: Explaining that the medication causes a temporary rash is not appropriate without first assessing the severity of the rash and withholding the medication.

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A nurse is assessing a patient with bipolar disorder.Which of the following aspects of the assessment should the nurse consider as part of the physical assessment? Select all that apply:.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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A nurse is assessing a patient with bipolar disorder.
Which of the following aspects of the assessment should the nurse consider as part of the physical assessment? Select all that apply:.