A nurse in a mental health facility is caring for a client.
Medical History: Antisocial personality disorder.
Substance use disorder.
Nurses' Notes:. 1400: Client admitted to facility by court order for evaluation following arrest for disorderly conduct and resisting arrest.
Client states, "That judge is so stupid.
I don't belong here!" Client has rigid posture, is pacing around the room attempting to intimidate staff and other clients on the unit.
Extra staff members gather.
1500: Client escorted to room.
Client becomes flirtatious with assistant personnel (AP). Client introduced to roommate, whom they ignore.
Continues to flirt with AP. 1800: Client refuses to go to dining room for dinner.
States, "I'm not sitting down with a bunch of nuts.
Bring my food to me!". For each potential nursing action, click to specify if the potential action is anticipated or contraindicated for the client.
Use bargaining to improve behavior.
Provide rewards for positive behavior.
Ignore negative behavior.
Maintain a low-stimuli environment.
The Correct Answer is B
Choice A rationale:
Using bargaining to improve behavior is not recommended for individuals with Antisocial Personality Disorder. It can reinforce manipulative behaviors.
Choice B rationale:
Providing rewards for positive behavior can be beneficial. It can encourage the development of healthier behaviors.
Choice C rationale:
Ignoring negative behavior is not recommended. It’s important to address these behaviors directly and establish clear consequences.
Choice D rationale:
Maintaining a low-stimuli environment can be beneficial for individuals with Antisocial Personality Disorder. It can help reduce agitation and aggressive behaviors.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Group discussions about local elections can be stimulating and may exacerbate the client’s manic symptoms.
Choice B rationale:
Watching a video with a group in the day room may not provide enough engagement for a client in a manic phase.
Choice C rationale:
Walking with the nurse in the courtyard provides physical activity and one-on-one interaction, which can help manage energy levels and provide a calming influence.
Choice D rationale:
Participating in a basketball game in the gym could overstimulate the client and potentially lead to injury.
Correct Answer is B
Explanation
Choice A rationale:
Vitamin K is not specifically related to the management of bipolar disorder or the use of lithium.
Choice B rationale:
Clients under lithium therapy don’t need to limit their sodium intake. It is recommended to keep salt intake the same as before prescription of the lithium medication.
Choice C rationale:
While potassium is an important dietary element, it is not specifically related to the management of bipolar disorder or the use of lithium.
Choice D rationale:
Vitamin C is not specifically related to the management of bipolar disorder or the use of lithium.
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