A nurse in an acute mental health unit is caring for a group of clients. For which of the following clients is seclusion contraindicated?

An adolescent client who throws objects at other clients

An older adult client who is manic and crying due to overstimulation

A school-age client who attempts to repeatedly bite staff

An adult client following a suicide attempt

Answer and Explanation

The Correct Answer is D

A. An adolescent client who throws objects at other clients:

Explanation: Seclusion is contraindicated for this client due to safety concerns. The behavior of throwing objects at others indicates a potential danger to both the client and others in a confined space. Placing the client in seclusion could escalate the situation and potentially lead to further harm.

B. An older adult client who is manic and crying due to overstimulation:

Explanation: Seclusion might be contraindicated for this client as well. Older adults experiencing manic behavior and emotional distress could be further traumatized by seclusion. Alternatives like providing a calm and soothing environment, along with appropriate medications, might be more beneficial for this client.

C. A school-age client who attempts to repeatedly bite staff:

Explanation: Seclusion is a potential option for this client. The repeated attempts to bite staff pose a risk of physical harm to both the client and staff members. Seclusion might be used as a last resort to ensure the safety of everyone involved.

D. An adult client following a suicide attempt:

Explanation: Seclusion is generally contraindicated for clients who have attempted suicide. Placing them in isolation can worsen feelings of despair and isolation, potentially increasing the risk of self-harm or suicide. These clients require close monitoring, support, and therapeutic interventions to address the underlying issues.

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Correct Answer is ["A","B","C","D"]

Explanation

A. Lithium: Lithium is a mood stabilizer commonly used in the treatment of bipolar disorder. It helps to control mood swings and prevent the recurrence of manic and depressive episodes.

B. Carbamazepine: Carbamazepine is an anticonvulsant medication that has been found effective in managing mood swings in bipolar disorder. It can help stabilize mood and prevent manic episodes.

C. Valproate (Valproic acid or Divalproex sodium): Valproate is another anticonvulsant medication that is used as a mood stabilizer in bipolar disorder. It can help control manic and mixed episodes.

The following options are not used to treat bipolar disorder:

D. Paroxetine: SSRIs, including paroxetine, carry a risk of inducing mania or hypomania in individuals with bipolar disorder. This risk is why these medications are usually avoided or used cautiously, always in conjunction with a mood stabilizer like lithium, valproate, or atypical antipsychotics. Before initiating paroxetine, it’s crucial that the client is stabilized with a mood stabilizer to minimize the risk of mood switching (i.e., moving from depression to mania or hypomania).

E. Donepezil: Donepezil is a medication used to treat Alzheimer's disease and other forms of dementia. It is not used to treat bipolar disorder.

A. identify the client's nutritional status. B. Provide a structured environment for the client. C. Plan a therapeutic diet for the client D. Request à mental health consult.

Correct Answer is A

Explanation

A. Identify the client's nutritional status.

Explanation:

Given the significant weight loss and the client's distorted belief about her body image (believing she is fat despite losing weight), it is crucial to assess the client's nutritional status first. Rapid weight loss and distorted body image are characteristic features of an eating disorder, such as anorexia nervosa. The nurse needs to determine the extent of malnutrition and potential medical complications related to inadequate nutrition. This assessment will guide the subsequent interventions.

Why the other choices are incorrect:

B. Provide a structured environment for the client.

While providing a structured environment can be important in managing eating disorders, such as anorexia nervosa, it is not the first priority. Understanding the client's nutritional status and medical condition takes precedence.

C. Plan a therapeutic diet for the client.

Planning a therapeutic diet may be part of the client's care plan, but without understanding the underlying nutritional status and potential eating disorder, creating a diet plan may not be effective or appropriate.

D. Request a mental health consult.

While a mental health consult is important for addressing the client's distorted body image and potential eating disorder, it should follow the assessment of nutritional status. The nutritional assessment provides critical information for both medical and psychological interventions.

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A nurse in an acute mental health unit is caring for a group of clients. For which of the following clients is seclusion contraindicated?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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.)

Correct Answer is ["A","B","C","D"]

Explanation

A nurse is admitting a client who has experienced a weight loss of 11 kg (25 lb) in the past 3 months. The client weighs 40 kg (88 lbs) and believes she is fat. Which of the following aspects of care should the nurse consider the first priority for this client?

Correct Answer is A

Explanation

A nurse is preparing to minister amoxicillin 350 mg PO. Available is amoxicillin 250 mg/5 mL. How many mL should the nurse administer? (Round to the nearest whole number.)

A nurse is caring for a client who has major depressive disorder and attempted suicide. The client tells the nurse, "I should have died because I am totally worthless." Which of the following responses should the nurse make?

A nurse is providing discharge teaching for a client who has multiple medication prescriptions and must take the medications at specific intervals when at home. Which of the following instructions should the nurse include in the teaching?

A nurse is performing an admission assessment for a client who is receiving treatment following a situational crisis. Which of the following assessments by the nurse is the highest priority?

A nurse is admitting an older adult client who has a suspected cognitive disorder. Which of the following inventories should be included as part of the admission assessment?

A nurse is caring for an adolescent who is experiencing indications of depression. Which of the following findings are risk factors of depression? (Select all that apply.)