A nurse working in an outpatient mental health facility is caring for a client who has anxiety and was discharged from an inpatient mental health facility one week ago.

Exhibits

A nurse in an outpatient mental health facility is assessing a client who has anxiety. Click to highlight the findings in the Nurses’ Notes that indicate an improvement in the client’s condition. To deselect, click on the finding again.

The client appears to be well-groomed.

The client’s current weight is 54 kg (119 lb.).

The client states they are sleeping 5 to 6 hours per night, but having an occasional nightmare.

The client verbalizes a decreased appetite and gastrointestinal discomfort.

The client states, “I feel anxious about leaving my house. I feel like everyone is staring at me and judging me.”

The client verbalizes that bullying experienced during high school has led to anxiety.

The client engages in thought-stopping behavioral therapy and cognitive restructuring.

The client reports taking escitalopram 20 mg daily, 2 hours after breakfast.

Choice A reason: Identifying when the client engages in splitting behaviors is more relevant to borderline personality disorder than schizoid personality disorder. Splitting is a defense mechanism where individuals fail to integrate positive and negative aspects of self and others into cohesive images. People with schizoid personality disorder typically exhibit detachment from social relationships and a restricted range of emotional expression, not splitting.

Choice B reason: Giving the client a choice of solitary activities aligns with the characteristics of schizoid personality disorder. Individuals with this disorder often prefer to engage in activities alone, as they feel more comfortable being by themselves than in social situations. Providing options for solitary activities can help meet the client's needs for privacy and personal space while also respecting their autonomy.

Choice C reason: Setting limits on the client's need for constant social contact is not applicable to schizoid personality disorder. In fact, individuals with this disorder typically do not desire social contact and may already isolate themselves. The intervention would be more appropriate for disorders where the individual seeks excessive social interaction.

Choice D reason: Assisting the client in identifying sources of anger may not be a priority in the care of someone with schizoid personality disorder unless there is a specific indication for it. These individuals often do not express emotions openly and may not experience or show anger in the same way as those without the disorder. The focus should be on interventions that respect the client's emotional expression, or lack thereof.

Choice A reason: Constant talking is a common indicator of mania in individuals with bipolar disorder. During manic episodes, clients may experience pressured speech, which is fast, incessant, and difficult to interrupt. This symptom reflects the increased energy and reduced need for sleep that are characteristic of mania.

Choice B reason: While memory loss is not a definitive indicator of mania, it can occur in bipolar disorder. However, it is more commonly associated with either depressive episodes or the aftermath of a manic episode, rather than the manic phase itself.

Choice C reason: Excessive sleep is typically not associated with mania. In fact, a decreased need for sleep is one of the diagnostic criteria for a manic episode. Clients in a manic phase often feel rested after only a few hours of sleep.

Choice D reason: Expressing feelings of inferiority is not typically indicative of mania. Such feelings are more commonly associated with depressive episodes. Manic episodes often involve inflated self-esteem or grandiosity.