A nurse in an outpatient mental health facility is preparing to administer phenelzine to a client who has been taking this medication for several years. The client reports eating a grilled cheese sandwich and a banana for lunch and is feeling dizzy. Which of the following vital signs should the nurse assess first?

Choice A reason: Assertiveness training is typically used to help individuals communicate more effectively and assert their needs and rights while respecting others. However, for someone with narcissistic personality disorder (NPD), this approach may not address the core issues of grandiosity and lack of empathy.

Choice B reason: Response prevention therapy is often used in the treatment of obsessive-compulsive disorder to help prevent the individual from engaging in compulsive behaviors. It is not typically indicated for NPD, as it does not address the underlying issues of self-esteem and empathy.

Choice C reason: Schema-focused therapy is designed to help individuals with NPD by identifying and changing deeply ingrained patterns of thinking and behavior, known as schemas, that are often maladaptive. This therapy can help address the root causes of NPD, such as feelings of inadequacy and the need for admiration, making it a suitable recommendation for someone with NPD³.

Choice D reason: Cognitive behavioral therapy (CBT) can be effective for a range of mental health disorders by helping individuals recognize and change negative thought patterns. While CBT can be beneficial for someone with NPD, schema-focused therapy is often preferred because it goes deeper into the personality structure and addresses the specific challenges of NPD³.

Choice A reason: Intensive Outpatient Programs (IOPs) offer structured treatment for mental health and substance misuse concerns, providing therapy for a few hours a day, several days a week. While beneficial, they may not offer the comprehensive, round-the-clock support needed by someone with a chronic mental illness.

Choice B reason: Assertive Community Treatment (ACT) is a form of community-based mental health care designed to help individuals with serious mental illnesses manage their symptoms and live independently in the community. ACT involves a multidisciplinary team approach and provides round-the-clock services, making it an ideal resource for chronic mental illness management.

Choice C reason: Patient-Centered Medical Homes (PCMHs) focus on providing comprehensive, coordinated care that is patient-centered and culturally appropriate. Although PCMHs offer a broad range of services, they may not be as intensive as ACT for managing chronic mental illness.

Choice D reason: Partial Hospitalization Programs (PHPs) are intensive outpatient treatment programs that allow patients to live at home while receiving daily treatment at a facility. PHPs are more intensive than IOPs but less so than inpatient care, and they may not provide the continuous support that ACT offers for chronic mental illness.