A nurse is caring for a client who is taking clozapine. Which of the following findings should the nurse report to the provider?

Rationale for Correct Choices:

• Mania: The client demonstrates hallmark signs of a manic episode including euphoric mood, impulsive and excessive spending, decreased sleep, pressured and disorganized speech, and grandiosity. Mania also often presents with hyperactivity and distractibility, both of which are present.
• Euphoric mood: Euphoric mood refers to an elevated, expansive emotional state beyond appropriate bounds of context. In this case, the client’s overly joyous affect and heightened self-confidence, along with insomnia and excessive sociability, clearly reflect this finding.

Rationale for Incorrect Choices:

• Delirium: Delirium typically presents with fluctuating levels of consciousness, reduced awareness, and inattention due to acute medical or substance-related causes. Although this client is disoriented to place, they are alert and oriented to person and time, and there's no acute medical condition or toxic exposure noted, making delirium unlikely.
• Catatonia: Catatonia involves motor abnormalities such as stupor, mutism, negativism, or waxy flexibility. The client in this scenario is exhibiting hyperactivity, pressured speech, and constant movement, which are contrary to the reduced motor activity seen in catatonia. These findings rule out this condition.
• Panic disorder: Panic disorder is characterized by sudden, recurrent panic attacks with physical symptoms like chest pain, palpitations, and a sense of impending doom. It is episodic and does not explain the client’s persistent mood elevation, insomnia, or grandiosity.
• Major depressive disorder: This disorder involves persistent low mood, loss of interest or pleasure (anhedonia), sleep disturbances (often hypersomnia), and low energy. The client instead demonstrates an elevated, not depressed, mood with excessive energy and activity.
• Hypervigilance: Hypervigilance refers to a heightened state of sensory sensitivity, often seen in anxiety or PTSD. The client shows distractibility but not constant scanning or suspicion of danger, making hypervigilance an unfitting descriptor of their state.
• Anhedonia: Anhedonia, or lack of pleasure in previously enjoyable activities, is a core symptom of depression. The client, on the contrary, is described as overly sociable, excited about events, and highly active, which indicates a heightened—not blunted—capacity for pleasure.
• Alogia: Alogia involves poverty of speech and is typically seen in schizophrenia or severe depression. The client has loud, rapid, and disorganized speech, which is the opposite of speech reduction. Thus, this finding does not apply to the clinical picture.
• Magical thinking: Magical thinking refers to believing that one’s thoughts or actions can influence unrelated external events. While the client is hallucinating, there is no indication they are attributing unrealistic powers or connections to their thoughts.

Rationale:

A. Apply the largest cuff available: Using a cuff that is too large for the client can yield inaccurately low readings. Cuff size should match the client’s arm circumference, not be chosen randomly or for convenience.

B. Use the palpatory method to determine blood pressure: When auscultation is difficult, the palpatory method helps estimate the systolic pressure by palpating the radial pulse. This guides proper cuff inflation and avoids missing the auscultatory gap.

C. Place the arm above the level of the client's heart: Elevating the arm above heart level can result in falsely low readings. The arm should be supported at heart level to obtain accurate results.

D. Deflate the cuff quickly: Rapid deflation can cause the nurse to miss key Korotkoff sounds, leading to an inaccurate measurement. Cuff deflation should be slow and controlled (2–3 mm Hg/sec).