A nurse suspects the client is experiencing delirium. Which of the following assessment findings would support the nurse's suspicion?

A decreased level of consciousness with intermittent periods of hypervigilance.

A slow onset of confusion and agitation.

A decrease in the client's output and vital signs.

The symptoms have lasted longer than a month.

Answer and Explanation

The Correct Answer is A

A.   Delirium is characterized by a fluctuating level of consciousness, which can include periods of hypervigilance.
B.   A slow onset of confusion and agitation is more characteristic of dementia rather than delirium.
C.   A decrease in output and vital signs may indicate a different condition, but it is not specific to delirium.
D.   Delirium is characterized by an acute onset and is typically short-lived, usually lasting days to weeks. Symptoms lasting longer than a month would suggest a different diagnosis.

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Correct Answer is A

Explanation

A) Correct. Schizoaffective disorder is characterized by a combination of symptoms of schizophrenia (such as delusions and hallucinations) and mood disorders (such as depression or mania).

B) Incorrect. Waxy flexibility and catatonic excitement are more commonly associated with catatonic schizophrenia, not schizoaffective disorder.

C) Incorrect. Bizarre mannerisms and hostility may be seen in various psychiatric disorders but are not specific to schizoaffective disorder.

D) Incorrect. While agitation and ideas of reference can occur in schizoaffective disorder, they are not the defining features of this diagnosis.

A. Encourage participation in various physical activities. B. Encourage participation in a group card game. C. Encourage participation in a BINGO game. D. Encourage the creation of a new interactive game for the unit.

Correct Answer is A

Explanation

A) Correct. Encouraging participation in physical activities can help channel excess energy and agitation associated with manic episodes.

B) Incorrect. Group card games may not provide an outlet for the high energy level typically seen in a manic episode.

C) Incorrect. While Bingo is a social activity, it may not be sufficient to address the high energy and potential restlessness seen in a manic episode.

D) Incorrect. Creating a new interactive game may not be feasible or appropriate in the acute setting, and it may not effectively address the client's current needs.

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A nurse suspects the client is experiencing delirium. Which of the following assessment findings would support the nurse's suspicion?

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Naxlex Comprehensive Predictor Exams

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