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?
The client's spouse reports that the client has recently gained weight.
The client responds to questions with disorganized speech.
The client reports that voices are telling him to write a novel.
The client is dressed in all black.
The Correct Answer is B
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Asking direct questions about the hallucination may validate the hallucination as real in the client’s mind.
Choice B rationale:
Instructing the client to argue with the voices could potentially increase the client’s distress.
Choice C rationale:
Acting as if the hallucination is real may reinforce the client’s belief in the hallucination.
Choice D rationale:
Telling the client that the hallucination is not a part of reality can help ground the client in reality.
Correct Answer is B
Explanation
Choice A rationale:
Asking why the client feels they will never get better might come across as dismissive or confrontational.
Choice B rationale:
This response acknowledges the client’s feelings and offers a supportive approach to managing the symptoms of somatic symptom disorder. This disorder is characterized by a significant focus on physical symptoms that cause major distress and/or problems functioning. The main treatment is psychotherapy, and medication might be given in some cases.
Choice C rationale:
Focusing only on the physical symptoms might not address the emotional distress that the client is experiencing.
Choice D rationale:
While it’s important to offer hope, this response might come across as dismissive of the client’s current feelings.
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