A nurse is completing medication reconciliation on a client.

Exhibits

For each potential provider's prescription, click to specify if the potential prescription is anticipated, or contraindicated for the client.

A. A client who has new-onset delirium. Delirium is characterized by acute confusion, disorientation, and impaired cognition, making it difficult for the client to participate meaningfully in assertiveness training. The priority would be treating the underlying cause of delirium, such as infection or medication effects.
B. A client who is experiencing auditory hallucinations. Hallucinations indicate active psychotic symptoms, which can impair concentration and the ability to engage in structured therapy. The client would first require stabilization with antipsychotic medications and reality-based interventions before participating in assertiveness training.
C. A client who is experiencing mania. Clients in a manic state often display impulsivity, pressured speech, and hyperactivity, making it difficult for them to focus on structured therapy sessions. Mood stabilization through medication is necessary before engaging in assertiveness training.
D. A client who has somatic symptom disorder. Individuals with somatic symptom disorder often struggle with expressing their emotional needs and may internalize distress through physical symptoms. Assertiveness training helps these clients develop healthier communication skills, enabling them to express their thoughts and emotions more effectively rather than manifesting distress through physical complaints.

A. Slow speech. Clients with delirium typically exhibit disorganized, incoherent, or rapid speech rather than slow speech. Their communication may fluctuate along with their mental status changes.
B. Rapid mood changes. Delirium is characterized by sudden mood shifts, including agitation, anxiety, or emotional instability. A client may appear calm one moment and extremely irritable or fearful the next.
C. Hallucinations. Visual and auditory hallucinations are common in delirium, especially in cases related to infection, substance withdrawal, or metabolic imbalances. Clients may see things that aren’t there or misinterpret sensory input.
D. Unaltered level of consciousness. Delirium involves fluctuations in consciousness, meaning the client’s awareness may shift from alert to drowsy or confused throughout the day. Unlike dementia, which causes gradual cognitive decline, delirium results in acute, noticeable changes in mental status.
E. Restlessness. Clients with delirium often exhibit restlessness, agitation, and hyperactivity due to confusion and disorientation. They may have difficulty staying still and may wander or pull at IV lines.