A nurse is caring for a client in a manic state of her Bipolar disorder. The client is dancing around the dayroom of the inpatient lounge. When she twirled her skirt it was obvious she was not wearing any underwear. The nurse enters the area and distracts her. She takes her to her room to put on underwear. Why did the nurse take this action?

To avoid her embarrassing herself in her manic state/behavior

Because there is no dancing allowed in the day room with other clients

To avoid her sexual passes at the clients

Because she was not following policy

Answer and Explanation

The Correct Answer is A

A.   The nurse’s primary concern is preventing the client from embarrassing herself due to the impulsive and disinhibited behaviors typical of a manic episode.
B.   There is no indication that dancing is prohibited; the issue is with inappropriate behavior.
C.   The focus of the action is not on sexual behavior but on ensuring the client is appropriately dressed in a social setting.
D.   Following policy is important, but the nurse’s action is more about protecting the client from social
embarrassment.

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Correct Answer is A

Explanation

A. Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and a need for control.
B. Believing achievements are superior is a hallmark of narcissistic personality disorder, not obsessive- compulsive personality disorder.
C. Requiring excessive advice is more typical of dependent personality disorder.
D. Using physical appearance to gain attention is characteristic of histrionic personality disorder.

A. Schedule daily seclusion times. B. Encourage group activities. C. Provide a stimulating environment. D. Encourage short rest periods throughout the day.

Correct Answer is D

Explanation

A. Seclusion is not generally recommended for mania unless necessary for safety; it may increase feelings of isolation.
B. Group activities are often not recommended for clients in the manic phase, as they may become overstimulated and disruptive.
C. A stimulating environment may increase hyperactivity and agitation.
D. Short rest periods are recommended for clients in a manic state to help manage their energy levels and prevent exhaustion.

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Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a client who has obsessive-compulsive personality disorder. Which of the following findings should the nurse include?

Correct Answer is A

Explanation

A nurse is assisting with the plan of care for a client who is in the manic phase of bipolar disorder. Which of the following interventions should the nurse recommend to include?

Correct Answer is D

Explanation

A nurse is reinforcing discharge teaching with a client who has several new prescriptions for psychotropic medications. The client tells the nurse that she has always had trouble following a medication regimen. Which of the following responses should the nurse make?

A nurse is reinforcing teaching with the spouse of a client about how to take a blood pressure. Which of the following actions by the spouse indicates a need for further instruction?

If a silence is heard between sounds when auscultating blood pressure, it is termed a(n)

A nurse is collecting data from a client who is taking chlorpromazine. Which of the following findings should the nurse identify as extrapyramidal symptoms (EPS)? (Select all that apply.)

A nurse assisting in the care of a client who has a mood disorder. Which of the following client statements by the client indicates readiness for discharge?

A nurse is caring for a client who is unable to make any decisions for themself and needs constant reassurance. The nurse should identify that these are manifestations of which of the following personality disorders?

A nurse on the mental health unit is caring for a client who has bipolar disorder and comes to the nurse's station at 0300 demanding to see the provider. Which of the following responses should the nurse make?

A nurse is preparing to administer diphenhydramine 35 mg IM to a client who has schizophrenia. Available is diphenhydramine for injection 50 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)