A nurse in an acute mental health unit is admitting a client diagnosed with bipolar disorder. The nurse recognizes which of the following findings supports the admitting diagnosis of acute mania?
The client responds to questions with disorganized speech.
The client reports that voices are telling him to write a novel.
The client's spouse reports that the client has recently gained weight.
The client is dressed in all black.
The Correct Answer is A
The correct answer is Choice A.
Choice A rationale: Disorganized speech is a hallmark symptom of acute mania in bipolar disorder. Clients may exhibit pressured speech, tangentiality, and flight of ideas, reflecting the heightened energy and cognitive disruptions associated with manic episodes.
Choice B rationale: Reporting auditory hallucinations, such as voices telling the client to write a novel, is more indicative of a psychotic disorder rather than acute mania in bipolar disorder. Mania typically involves elevated mood and activity levels, not hallucinations.
Choice C rationale: Weight gain reported by the spouse is not specific to acute mania. While changes in appetite and weight can occur in bipolar disorder, they are not defining features of manic episodes, which are characterized by heightened mood and activity.
Choice D rationale: Being dressed in all black does not specifically indicate acute mania. Mania is characterized by mood disturbances and increased activity levels rather than specific choices in clothing color, which can vary widely among individuals.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C. Walk with the client at a gradually slower pace.
Choice A rationale:
Instructing the client to sit down and stop pacing (Choice A) might come across as authoritarian and dismissive of the client's anxiety. It's important to provide a more supportive and empathetic approach.
Choice B rationale:
Having a staff member escort the client to her room (Choice B) might further escalate the client's anxiety. The client may interpret this action as a form of containment or punishment.
Choice C rationale:
Walk with the client at a gradually slower pace (Choice C) is the most appropriate action. This approach acknowledges the client's anxiety and provides a calming presence. Gradually slowing down can help the client naturally transition from pacing to a calmer state.
Choice D rationale:
Allowing the client to pace alone until physically tired (Choice D) might prolong the episode of anxiety. Providing support and engagement is essential in managing the client's distress effectively.
Correct Answer is C
Explanation
Choice A rationale:
Bipolar disorder is a mood disorder characterized by alternating periods of depression and mania. While mental health issues can certainly be prevalent among the homeless population, bipolar disorder may not be the most prevalent in this context. Homelessness often exposes individuals to harsh living conditions, which might contribute to mood disturbances, but substance addiction is more commonly associated with this population.
Choice B rationale:
Depression is a significant concern among homeless individuals due to the many challenges they face, but substance addiction is generally more prevalent. Substance abuse often becomes a coping mechanism for dealing with the stressors of homelessness, making it a primary concern in this population.
Choice C rationale:
Substance addiction is a critical mental health issue that is highly prevalent among homeless individuals. The stress, trauma, and lack of stable support systems experienced by the homeless population contribute to a higher risk of substance abuse as a way to cope with their circumstances.
Choice D rationale:
Schizophrenia involves a disconnection from reality, including symptoms like hallucinations and delusions. While schizophrenia can certainly affect homeless individuals, substance addiction remains a more widespread concern due to its association with the challenges of homelessness.
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