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.

Answer and Explanation

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

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Correct Answer is B

Explanation

Choice A rationale:

Weight gain is not typically associated with acute mania in bipolar disorder.

Choice B rationale:

Disorganized speech can be a symptom of acute mania, which is characterized by increased energy, feelings of euphoria, racing thoughts, risky behaviors, and an inflated self-image.

Choice C rationale:

While hallucinations can occur in severe bipolar episodes, the client reporting that voices are telling him to write a novel is not specifically indicative of acute mania.

Choice D rationale:

Dressing in all black is not a specific symptom of acute mania.

A. "You will need to stop this medication if you experience diarrhea.”. B. "You will need to take this medication on an empty stomach.”. C. "You will need to consume a low-salt diet while on this medication.”. D. "You will need your blood levels drawn weekly during the first month.”.

Correct Answer is D

Explanation

Choice A rationale:
Diarrhea is not a specific reason to stop lithium. However, severe diarrhea can affect lithium levels and should be reported to a healthcare provider.
Choice B rationale:
Lithium does not need to be taken on an empty stomach. It can be taken with or without food.
Choice C rationale:
A low-salt diet is not recommended while on lithium. In fact, a consistent, normal sodium intake is important because low sodium levels can cause lithium levels to become too high.
Choice D rationale:
Regular blood tests are necessary when taking lithium to ensure therapeutic levels and prevent toxicity. Weekly blood tests may be required during the first month of treatment.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in an acute mental health unit is admitting a client who has bipolar disorder. Which of the following findings supports the admitting diagnosis of acute mania?

Correct Answer is B

Explanation

A nurse is preparing to teach a client about his prescription of lithium for the treatment of bipolar disorder. Which of the following statements should the nurse include in the teaching?

Correct Answer is D

Explanation

A nurse is planning care for a client who is in the manic phase of bipolar disorder. Which of the following interventions should the nurse include in the client's plan of care?.

A nurse is caring for a client who has schizophrenia and is taking haloperidol. The nurse should monitor for which of the following adverse effects of haloperidol?

A nurse is reviewing abnormal laboratory values for four clients who have schizophrenia and take clozapine. For which of the following clients should the nurse withhold the medication and notify the provider immediately to have clozapine therapy discontinued?

A nurse in a mental health clinic is conducting a staff education session on schizophrenia. Which of the following manifestations should the nurse identify as negative symptoms? (Select all that apply.).

A nurse is teaching a client who has bipolar disorder about lithium. Which of the following statements should the nurse include in the teaching?.

A nurse is reviewing medication records for several clients who have bipolar disorder. The nurse should recognize that which of the following medications are used to treat clients who have bipolar disorder.(Select all that apply.).

A nurse on an inpatient mental health unit is caring for a client who was admitted for suicidal ideation. Which of the following statements by the client should the nurse identify as a continuation of suicidal ideation?