A nurse is conducting an admission assessment for a client who is experiencing a manic episode of bipolar disorder. Which of the following behaviors should the nurse expect? (Select all that apply.)

Choice A reason:

An illusion is a misinterpretation of a real external stimulus. The client’s statement does not indicate a misinterpretation of reality but rather a direct expression of intent to harm themselves.

Choice B reason:

A hallucination is a perception of something that is not present, such as hearing voices or seeing things that are not there. The client’s statement does not suggest they are experiencing a hallucination but rather expressing a desire to self-harm.

Choice C reason:

Attention-seeking behavior involves actions taken to gain attention from others. While the client’s statement may draw attention, it is more indicative of a serious risk of self-harm rather than merely seeking attention.

Choice D reason:

Self-mutilation refers to deliberate self-injury without suicidal intent. The client’s statement about using a pen to cut the pain out of their chest indicates a risk of self-harm, which requires immediate intervention to ensure their safety.

Choice A reason:

A client with new-onset delirium is experiencing an acute and often fluctuating disturbance in attention and cognition. Delirium is typically caused by an underlying medical condition, substance intoxication, or withdrawal. Assertiveness training would not be appropriate for this client as the primary focus should be on identifying and treating the underlying cause of the delirium.

Choice B reason:

A client experiencing auditory hallucinations is likely dealing with a psychotic disorder such as schizophrenia. The primary treatment for such clients involves antipsychotic medications and psychotherapy aimed at managing symptoms and improving reality orientation. Assertiveness training is not suitable for clients in the acute phase of psychosis as their ability to engage in and benefit from such training is compromised.

Choice C reason:

A client experiencing mania, a state characterized by elevated mood, hyperactivity, and impulsive behavior, is typically seen in bipolar disorder. During a manic episode, the client may have difficulty focusing and controlling their impulses, making it challenging to participate effectively in assertiveness training. The priority for these clients is to stabilize their mood with medication and supportive therapy.

Choice D reason:

A client with somatic symptom disorder experiences excessive thoughts, feelings, and behaviors related to physical symptoms. Assertiveness training can be beneficial for these clients as it helps them express their needs and concerns more effectively, reducing the focus on physical symptoms and improving their overall functioning.