A 30-year-old male patient, John, presents to the clinic with his wife. She reports that John has been experiencing periods of extreme energy and euphoria, followed by episodes of deep depression over the past several months. During his manic episodes, John engages in risky behaviors such as excessive spending and reckless driving. During his depressive episodes, he isolates himself and has expressed feelings of hopelessness. Based on this scenario, what is the priority nursing action for John?
Administer a mood stabilizer immediately.
Conduct a thorough assessment to evaluate John's safety and risk of harm to himself or others.
Schedule John for regular therapy sessions to manage his mood swings.
Educate John and his wife about the signs and symptoms of Bipolar Spectrum Disorder.
The Correct Answer is B
Choice A reason: While mood stabilizers are essential in treatment, medication cannot be safely administered before completing an assessment of risk and safety.
Choice B reason: The priority in this scenario is to assess safety, as John is at risk of harming himself or others due to reckless behavior during mania and suicidal ideation during depression. Safety always precedes treatment or education.
Choice C reason: Therapy is a valuable part of long-term management, but it is not the immediate priority when safety concerns exist.
Choice D reason: Education is important but cannot come before determining immediate risk and ensuring safety.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: The Hamilton Depression Scale is used to assess severity of depression, not antipsychotic side effects.
Choice B reason: The Body Attitude Test is used in eating disorder assessments, unrelated to risperidone therapy.
Choice C reason: The Abnormal Involuntary Movement Scale (AIMS) evaluates for movement disorders like tardive dyskinesia, which are possible side effects of antipsychotics. Baseline assessment is essential before starting treatment.
Choice D reason: The Recovery Attitude and Treatment Evaluator measures patient attitudes about recovery and treatment, not medication side effects.
Correct Answer is ["B","C","E"]
Explanation
Choice A reason:Sleeping for long periods is more characteristic of the depressive phase of bipolar disorder, not mania. Manic behavior typically involves reduced need for sleep, making this an incorrect choice.
Choice B reason:Spending large sums of money impulsively is a hallmark of manic behavior, reflecting poor judgment and heightened energy typical of the manic phase in bipolar disorder.
Choice C reason:Flirtatious interactions are common in mania, as clients may exhibit increased sociability, disinhibition, or hypersexuality, making this a correct indicator of manic behavior.
Choice D reason:Dressing in black or grey clothing is not specifically associated with mania. Manic clients may choose bright or eccentric clothing, but color preference alone is not a reliable indicator of manic behavior.
Choice E reason:Rapid, continuous speech, often pressured, is a classic sign of mania, reflecting the client’s heightened energy, racing thoughts, and difficulty slowing down their communication.
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