The nurse is planning the care for a client who is hospitalized with bipolar disorder. The client wanders the hallways, talks excessively, and makes sexual comments about the staff. Which intervention(s) should the nurse include in the plan of care? (Select all that apply.)

Invite for a walk when the client's energy is high.

Engage the client in competitive activities.

Assign the client to a single room.

Provide television programs with suspense to keep attention engaged.

Give concise and firm directions for hygiene and dressing.

Answer and Explanation

Correct Answer : A,C,E

A.   Inviting for a walk when the client's energy is high can help channel excess energy and reduce restlessness.
B.   Engaging the client in competitive activities might escalate the situation and isn't suitable for managing hyperactivity in bipolar disorder.
C.   Assigning the client to a single room can reduce external stimuli and potentially decrease overstimulation that might contribute to the behavior.
D.   Providing television programs with suspense might not effectively engage the client or address their needs.
E.   Giving concise and firm directions for hygiene and dressing can help provide structure and guidance during times of excessive energy or impulsivity.

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Correct Answer is A

Explanation

A. Providing personal space allows the client to feel less threatened and gives them room to express their emotions without feeling cornered.
B. Standing in the doorway might block the client's exit and could escalate the situation.
C. Requesting backup might be necessary in some situations but should not be the initial response to the client's agitation.
D. Encouraging the client to sit down might not be well-received and could escalate the situation further.

A. Both the nurse and therapist are reprimanded for divulging confidential patient information to others. B. The nurse and therapist will be asked to educate other team members on appropriate sharing of client information. C. The nurse is reprimanded for divulging confidential patient information without obtaining informed consent. D. The therapist is reprimanded for divulging confidential patient information without obtaining consent.

Correct Answer is B

Explanation

A. Both the nurse and therapist took action to ensure safety; therefore, reprimanding might not be appropriate.
B. The best outcome is an educational approach for the team to understand appropriate information sharing in cases of potential harm to others while maintaining patient confidentiality.
C. The nurse's immediate notification was based on safety concerns, which may take precedence over obtaining informed consent.
D. The therapist's action aimed at ensuring safety but might have breached confidentiality without explicit consent.

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The nurse is planning the care for a client who is hospitalized with bipolar disorder. The client wanders the hallways, talks excessively, and makes sexual comments about the staff. Which intervention(s) should the nurse include in the plan of care? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When responding to a call light, the nurse finds a client with aggressive behaviors pacing and restless in the room. The client shouts, "What took you so long to get in here!" Which action should the nurse implement?

Correct Answer is A

Explanation

Correct Answer is B

Explanation

A male client tells the nurse that he does not want to take the atypical antipsychotic drug olanzapine because of the side effects he experienced when he took the drug for a year. Which experience is most likely related to taking olanzapine?

A client with borderline personality disorder tells the nurse, "You are the best nurse on the unit! The other nurses don't care about me the way you do." Which response should the nurse provide to this client?

The nurse is preparing the physical environment to interview a new client for admission to the mental health unit. Which environmental setting facilitates the best outcome of the interview?

Following the visit, what are appropriate actions for the nurse? Select all that apply.

The nurse is planning the care for a client who is hospitalized with bipolar disorder. The client wanders the hallways, talks excessively, and makes sexual comments about the staff. Which intervention(s) should the nurse include in the plan of care? (Select all that apply.)

Prior to initiating a treatment regimen with the antidepressant sertraline, it is most important for the nurse to obtain which information?

The nurse is conducting client assessments in an outpatient psychiatric clinic. Which client finding is characteristic of illness anxiety disorder?