Which of the following explanations should the nurse include when teaching parents why it is difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? Select all that apply.

Choice A: The narcotic count is incorrect when the nurse ends the shift

An incorrect narcotic count at the end of a shift is a serious issue that could indicate potential drug diversion. It's crucial for nurses to accurately count and document narcotics to ensure patient safety and maintain legal and ethical standards. Therefore, this behavior should be reported to the nurse manager.

Choice B: The nurse has poor hygiene practices and has an offensive body odor

While poor hygiene and offensive body odor can be disruptive and unpleasant in a workplace setting, they are not direct indicators of substance use disorder. However, it's important to note that changes in personal hygiene can sometimes be a sign of other health or personal issues.

Choice C: The observing nurse finds oral narcotics blister packs torn in the back

Finding torn narcotics blister packs could indicate that a nurse is diverting drugs for personal use. This is a serious violation of nursing practice and should be reported immediately.

Choice D: The clients are reporting a lack of pain control when the nurse is working

If patients consistently report a lack of pain control when a specific nurse is working, it could suggest that the nurse is not administering the prescribed pain medications properly¹?¹?¹?¹?¹?. This could be due to a variety of reasons, including potential drug diversion, and should be reported.

Choice E: The nurse administers narcotics and then goes to use the bathroom

Frequent bathroom breaks immediately after administering narcotics could be a red flag for drug diversion. While there could be other explanations, this behavior in the context of the other signs could indicate a substance use disorder and should be reported.

Choice A reason: Not feeling relief after an explosive episode can indicate that the behavior is not a controlled release of tension, which is characteristic of intermittent explosive disorder.

Choice B reason: Being mild-mannered and kind does not necessarily indicate intermittent explosive disorder; this behavior could be part of a normal range of personality traits.

Choice C reason: Feeling embarrassed and apologetic after an episode is common in intermittent explosive disorder, as individuals often regret their actions.

Choice D reason: Physical aggression, such as punching walls and breaking furniture, is a key indicator of intermittent explosive disorder.

Choice E reason: Anger that is disproportionate to the situation, especially over minor issues, is a hallmark of intermittent explosive disorder.