A client has been admited to a psychiatric-mental health facility in a manic state. The client's spouse accompanies the client to the facility and informs the nurse that the client has been displaying manic symptoms for the past 2 weeks. The spouse reports that the client has not slept for the past 2 days and that the client has not eaten anything for at least 3 days. Which would be the priority for this client?
Imbalanced nutrition.
Risk for violence.
Ineffective health maintenance.
Risk for suicide.
The Correct Answer is A
Choice A reason: This is the correct choice. Given the client has not eaten for several days, addressing nutritional needs is a priority to prevent further physical health complications.
Choice B reason: While there may be a risk for violence, the immediate physical health needs related to nutrition are more pressing.
Choice C reason: Ineffective health maintenance may be a concern, but it is not as immediate as the risk posed by imbalanced nutrition.
Choice D reason: There is no indication in the text that the client is at risk for suicide; therefore, this would not be the priority without further assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D","E","F"]
Explanation
Choice A reason: Knowing if the family is aware can help in understanding the client's support system.
Choice B reason: Understanding the method the client is considering can help assess the level of risk and immediacy.
Choice C reason: Knowing the timing can help in immediate risk assessment and prevention planning.
Choice D reason: Assessing access to means is crucial for immediate safety planning.
Choice E reason: Understanding if there is a specific plan can help gauge the seriousness and immediacy of the risk.
Choice F reason: Offering spiritual or emotional support can be an important part of the care plan.
Correct Answer is D
Explanation
Choice A reason: Separate personalities are not a characteristic of schizophrenia; this is a common misconception. The disorder involving separate personalities is more accurately associated with dissociative identity disorder.
Choice B reason: While mood swings and hostility can occur in schizophrenia, they are not defining features of the disorder. Schizophrenia is primarily characterized by psychosis, which includes delusions and hallucinations.
Choice C reason: Preoccupation with somatic symptoms is more commonly associated with somatic symptom disorder, not schizophrenia. Schizophrenia involves a range of symptoms including cognitive and emotional dysfunctions.
Choice D reason: Thought disturbances, such as disorganized thinking, and hallucinations, particularly auditory ones, are hallmark symptoms of schizophrenia and are often used in its assessment.
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