A nurse assisting with the discharge plan of care for a group of children. For which of the following children should the nurse recommend a referral Speech therapy?

A. Frequently remind the client of the expectations for her behavior: Clients experiencing mania may have impaired judgment, impulsivity, and difficulty focusing. Repeated, calm reminders of behavioral expectations help set limits, maintain safety, and reduce the risk of disruptive or harmful actions while promoting structure in the therapeutic environment.

B. Encourage the client to participate in a group activity in the dayroom: Group activities can be overstimulating for a client in the manic phase, increasing agitation, distractibility, and risk of conflict with others. Individual or low-stimulation interventions are safer and more appropriate during acute mania.

C. Allow the client to pick her own choice of clothing: While autonomy is generally encouraged, a manic client may make choices that are socially inappropriate, unsafe, or erratic. Guiding clothing selections may help maintain dignity and safety without restricting personal expression entirely.

D. Encourage the client to increase physical activity during the day: Although physical activity can be beneficial, clients in a manic state may already have excessive energy and impulsivity. Additional encouragement for activity could exacerbate agitation, increase risk of injury, and worsen overstimulation.

A. Coordinating client care: Coordination of care involves synthesizing assessments, planning interventions, and collaborating with multiple disciplines, which requires independent clinical judgment. This responsibility falls within the registered nurse’s scope of practice, not the LPN’s.

B. Providing direct client care: LPNs are trained to provide hands-on care, including administering medications (excluding certain IV medications), monitoring vital signs, assisting with activities of daily living, and implementing established care plans. Direct client care is a primary LPN responsibility and aligns with their scope of practice under RN supervision.

C. Assessing a client's health status: Comprehensive assessment, interpretation of findings, and determining nursing diagnoses require independent critical thinking and clinical decision-making. These tasks are within the RN scope and exceed the LPN’s role, which focuses on collecting data and reporting changes.

D. Providing a client with discharge instructions: Teaching clients about medications, follow-up care, or lifestyle modifications involves patient education and clinical judgment. LPNs may reinforce previously taught instructions but do not independently initiate discharge teaching, which is an RN responsibility.