A nurse identifies that the environment is important when caring for a client with hypomanic episodes. What should the nurse do when caring for clients with this disorder?

Encourage interaction with others by having the client share a room with other clients.

Provide a calm atmosphere by placing the client in a private room.

Create a cheerful environment by having bright drapes in the client's room.

Promote access to activities by assigning the client to a room near the dayroom.

Answer and Explanation

The Correct Answer is B

Choice A reason: Encouraging interaction with others by having the client share a room might be overwhelming for a client experiencing hypomanic episodes. Hypomania can involve irritability and impulsivity, making shared spaces potentially stressful. It's important to balance social interaction with the need for a controlled environment¹.

Choice B reason: Providing a calm atmosphere by placing the client in a private room can be beneficial for someone experiencing hypomanic episodes. A private room can reduce overstimulation and help manage symptoms like restlessness, agitation, and sleep disturbances. It allows the client to have a quiet space to retreat to, which can be crucial in managing mood swings¹².

Choice C reason: While a cheerful environment may seem beneficial, having bright drapes in the client's room could potentially contribute to overstimulation. Clients with hypomania are often sensitive to environmental stimuli, so it's important to keep the setting subdued to avoid exacerbating symptoms¹.

Choice D reason: Promoting access to activities by assigning the client to a room near the dayroom can be a double-edged sword. While it facilitates engagement in structured activities, which can be therapeutic, it also increases the risk of overstimulation due to the proximity to a potentially busy and noisy area. Careful consideration of the client's current state is necessary when making this decision¹.

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Correct Answer is C

Explanation

Choice A reason : The plantar reflex, also known as the Babinski sign, is elicited by stroking the lateral aspect of the sole of the foot. A positive response is indicated by dorsiflexion of the big toe and fanning of the other toes. This reflex is normal in infants but may indicate central nervous system damage in adults¹. However, it is not specifically associated with meningeal irritation.

Choice B reason : Kernig's sign is a clinical sign wherein the patient experiences severe stiffness of the hamstrings causing an inability to straighten the leg when the hip is flexed to 90 degrees. This sign can indicate meningeal irritation but is not as early a sign as Brudzinski's sign².

Choice C reason : Brudzinski's sign is one of the most indicative signs of meningeal irritation. When the neck is flexed, there is involuntary flexion of the hips and knees. This reflex is an early sign of meningeal irritation and is considered a critical manifestation in assessing meningitis following head trauma².

Choice D reason : Sunsetting eyes, characterized by the downward deviation of the eyes, is associated with increased intracranial pressure, which can occur in conditions like hydrocephalus. While it may be seen in the context of brain injury, it is not a specific sign of meningeal irritation³.

A. The catheter can become infected even with sterile precautions. B. The volume of the output solution should be greater than the input solution. C. The fluid from my abdomen will be clear or slightly yellow. D. The microwave in my kitchen can warm the solution before I use it.

Correct Answer is D

Explanation

Choice A reason : The statement is correct; even with sterile precautions, there is a risk of infection. It's important for clients to understand this risk and recognize signs of infection early¹.

Choice B reason : This statement is incorrect and indicates a misunderstanding. The volume of the output solution should be equal to or slightly less than the input solution due to fluid removal from the body¹.

Choice C reason : The fluid from the abdomen should indeed be clear or slightly yellow. Cloudy or discolored fluid can indicate an infection or other complication¹.

Choice D reason : Using a microwave to warm the solution is not recommended as it can lead to uneven heating and potentially damage the solution. The solution should be warmed to body temperature using a warming device designed for this purpose¹³.

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A nurse identifies that the environment is important when caring for a client with hypomanic episodes. What should the nurse do when caring for clients with this disorder?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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