The nurse is assisting in the care of a client who is hyperactive, pacing down the hallway, and exhibiting poor concentration during group therapy. When collecting data, the nurse should identify that which of the following is characteristic of the client's manifestations?
Depression
Delusions
Hallucinations
Mania
The Correct Answer is D
A. Depression. Depression is typically characterized by low energy, feelings of sadness, and withdrawal from activities. Hyperactivity and pacing are not consistent with depressive symptoms, as individuals with depression often exhibit psychomotor retardation rather than excessive movement.
B. Delusions. Delusions are fixed, false beliefs that are not based on reality, such as paranoia or grandiosity. While delusions can occur in mania, the client's primary symptoms of hyperactivity, pacing, and poor concentration are more indicative of a manic episode rather than delusional thinking alone.
C. Hallucinations. Hallucinations involve sensory perceptions that occur without external stimuli, such as hearing voices or seeing things that are not there. The client’s symptoms do not indicate hallucinations but rather heightened activity levels and distractibility.
D. Mania. Mania is characterized by hyperactivity, excessive energy, rapid speech, and poor concentration. Pacing and an inability to focus during group therapy suggest an elevated mood state, making mania the most appropriate identification of the client’s manifestations.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Suspiciousness of others: Paranoid personality disorder is characterized by pervasive distrust and suspicion of others, leading to difficulty forming relationships. Clients may misinterpret benign actions as malicious and hold long-standing grudges.
B. Requiring frequent reassurance from others: This is more characteristic of dependent personality disorder, where individuals struggle with self-confidence and rely on others for decision-making and emotional support.
C. Inflated sense of self: This is commonly seen in narcissistic personality disorder, where individuals display grandiosity, a need for admiration, and a lack of empathy for others.
D. Lack of feelings of remorse: This trait is associated with antisocial personality disorder, where individuals exhibit disregard for the rights of others, manipulative behavior, and a lack of guilt or remorse for their actions.
Correct Answer is C
Explanation
A. "Do you need any more resources or information?" This question focuses on offering additional resources rather than encouraging the client to explore their emotions. While it is useful for providing support, it does not promote self-reflection or invite the client to clarify their feelings. Therapeutic communication should aim to encourage deeper discussion rather than just addressing practical needs.
B. "Do you understand your next step in treatment?" Although this question ensures the client comprehends their treatment plan, it does not foster emotional expression or self-awareness. Understanding the next steps in care is important, but therapeutic communication should focus on exploring the client’s internal experiences rather than just confirming information. Encouraging open-ended reflection is more effective for clarifying emotions.
C. "You feel like you have the support needed to be successful." This statement encourages self-reflection and allows the client to clarify their feelings about their support system. It promotes therapeutic communication by inviting the client to assess their emotional needs and level of confidence. Open-ended statements like this help build trust and provide insight into the client’s concerns and perceptions.
D. "Tell me what kind of coping skills you have." While this question assesses the client's coping strategies, it does not directly facilitate emotional clarification. Asking about coping skills is useful for intervention planning, but it does not specifically address the client’s feelings. A more effective therapeutic approach would involve asking how the client feels about their ability to manage stress.
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