A nurse in a mental health facility is assessing a client.

Exhibits

For each client assessment finding, click to specify if the finding is a potential risk for suicide or a protective factor against suicide.

A. Encourage frequent ambulation is not appropriate in acute glomerulonephritis (GN) when the client may be experiencing symptoms such as edema or hypertension, which can be worsened by excessive physical activity. The focus should be on managing fluid balance and preventing further complications.
B. Obtain weight weekly is not frequent enough. In acute glomerulonephritis, daily weight monitoring is essential to assess fluid retention and guide management of edema. Weight gain may indicate fluid retention, which is a key concern.
C. Encourage increased fluid intake is contraindicated in acute glomerulonephritis. The kidneys are already compromised, and excessive fluid intake can worsen edema and hypertension. Fluid restriction is typically recommended, depending on the client’s condition.
D. Administer antibiotics is correct. Acute glomerulonephritis can often follow a streptococcal infection, such as a strep throat or skin infection. If there is evidence of an ongoing infection, antibiotic therapy is necessary to treat the underlying cause and prevent further damage to the kidneys.

Potential Condition: Narcissistic Personality Disorder (NPD)

The client shows classic traits of NPD, including: Grandiosity: Claims their office is "falling apart without me." Entitlement and arrogance: Shows irritation at being brought to the appointment and lacks insight into why others might be concerned. Lack of empathy: Belittles a homeless person and fails to understand the inappropriateness of the remark. Boasting: Exaggerates the achievements of their children, aligning with inflated self-image.

Actions to Take

Maintain a neutral demeanor: Helps the nurse stay objective and reduces the likelihood of reinforcing the client’s manipulative or confrontational behaviors.

Avoid becoming defensive when the client makes disparaging remarks: Clients with NPD may challenge or provoke others; staying calm avoids power struggles and maintains therapeutic boundaries.

Parameters to Monitor

Manipulative behavior: Clients with NPD may attempt to control or influence others to serve their own needs.

Lack of empathy: Key diagnostic feature of NPD; monitoring helps assess therapeutic progress or regression.