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A nurse is caring for a client who has bipolar disorder and is experiencing mania.

Which of the following actions should the nurse take?

Frequently remind the client of the expectations for her behavior.

Encourage the client to participate in a group activity in the dayroom.

Allow the client to pick her own choice of clothing.

Encourage the client to increase physical activity during the day.

Answer and Explanation

The Correct Answer is A

Answer: A. Frequently remind the client of the expectations for her behavior.

Rationale:

A) Frequently remind the client of the expectations for her behavior:

Clients experiencing mania may have difficulty maintaining appropriate behavior due to their heightened energy levels and impulsivity. Frequently reminding them of behavioral expectations helps provide structure and boundaries, which can promote a safer and more controlled environment.

B) Encourage the client to participate in a group activity in the dayroom:

While social interaction can be beneficial, clients in a manic state might be overly stimulated by group activities. This can exacerbate their symptoms, leading to increased agitation or disruptive behavior. It's often more appropriate to provide a calm and low-stimulation environment.

C) Allow the client to pick her own choice of clothing:

Allowing a manic client to choose their own clothing can lead to choices that are inappropriate for the setting or the weather, as judgment may be impaired during mania. Providing guidance in clothing choices can help ensure the client is dressed suitably and safely.

D) Encourage the client to increase physical activity during the day:

While physical activity is generally beneficial, clients in a manic state may already be overly active and may not need encouragement to increase their activity. Overexertion can lead to exhaustion and further exacerbate manic symptoms. It is often more beneficial to encourage activities that promote relaxation and calmness.

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Correct Answer is C

Explanation

The nurse should apply a heat pack 5 to 10 minutes prior to the procedure when planning to obtain blood from a newborn via a heel stick. This helps to increase blood ﬂow to the area and makes it easier to obtain the specimen.

a) Puncturing the heel to a depth of 4 mm is too deep and can cause injury to the newborn. The recommended depth for a heel stick is 2.4 mm or less.

b) Withholding feeding prior to collecting the specimen is not necessary.

d) Elevating the newborn's foot for 15 minutes following the procedure is not necessary.

A. Use written signs to assist the client with locating the bathroom. B. Limit the number of choices for the client. C. Provide a stimulating environment for the client. D. Use confrontation to manage the client's behavior.

Correct Answer is ["B"]

Explanation

Answer: B

Rationale:

A) Use written signs to assist the client with locating the bathroom: While written signs may be helpful in the earlier stages of Alzheimer's disease, as the disease progresses, clients may lose the ability to read and comprehend written language. Visual cues, such as pictures or color-coded indicators, tend to be more effective in helping clients navigate their environment.

B) Limit the number of choices for the client: Limiting choices reduces confusion and anxiety for clients with Alzheimer's disease. Providing too many options can overwhelm them, making decision-making difficult. Offering simple, clear choices helps to maintain a sense of autonomy while minimizing stress.

C) Provide a stimulating environment for the client: Although some stimulation can be beneficial, excessive stimulation can overwhelm a client with Alzheimer's disease, leading to agitation and confusion. It's important to create a calm, structured environment that promotes safety and reduces anxiety.

D) Use confrontation to manage the client’s behavior: Confrontation should be avoided when managing the behavior of clients with Alzheimer's disease. Confronting or challenging them can increase agitation and lead to further confusion. Instead, caregivers should use distraction, redirection, and a calm approach to manage difficult behaviors effectively.

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A nurse is caring for a client who has bipolar disorder and is experiencing mania. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning to obtain blood from a newborn via a heel stick. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is assisting with a community health program for caregivers of clients who have Alzheimer's disease. Which of the following information should the nurse include?

Correct Answer is ["B"]

Explanation

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A nurse is caring for a client who has bipolar disorder and is experiencing mania.

Which of the following actions should the nurse take?