A nurse is collecting data from a client who has bipolar disorder. Which of the following findings should the nurse expect?
Flight of ideas
Ritualistic behaviour
Well-groomed appearance
Command hallucinations
The Correct Answer is A
A. Flight of ideas: Flight of ideas is a classic finding in clients experiencing a manic episode of bipolar disorder. It is characterized by rapid, continuous shifts from one topic to another, often making it difficult for the listener to follow the conversation. This reflects the elevated mood and pressured speech typical of mania.
B. Ritualistic behavior: Ritualistic behaviors, such as repetitive actions or strict routines, are more commonly associated with obsessive-compulsive disorder (OCD) rather than bipolar disorder. While clients with bipolar disorder may show disorganized behavior during mania, ritualism is not a hallmark feature.
C. Well-groomed appearance: During manic or depressive episodes of bipolar disorder, clients often experience a decline in self-care and grooming. A consistently well-groomed appearance would be more typical of a stable, euthymic phase rather than during an active mood episode.
D. Command hallucinations: Command hallucinations are typically linked to psychotic disorders such as schizophrenia. Although severe mania can include psychotic features, hallucinations are not a primary or consistent symptom in bipolar disorder unless it becomes a psychotic manic or depressive episode.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
A. Show the client pictures that illustrate the surgery: Visual aids can help bridge language barriers by providing a clear understanding of complex procedures. Pictures can reinforce verbal explanations and improve the client's ability to comprehend the surgical process, especially when language proficiency is limited.
B. Provide the client with written information in the client's primary language: Providing written materials in the client's native language ensures that the client has access to accurate, understandable information. This supports informed consent and allows the client to review the details at their own pace, enhancing comprehension.
C. Provide the client with a professional interpreter to explain the surgery: Using a professional medical interpreter is crucial for accurately conveying medical information. It ensures the client fully understands the procedure, risks, and benefits, which is necessary for informed consent and legal protection of client rights.
D. Ask a member of the client's family to discuss the surgery with the client: Family members should not be used as interpreters because they may lack medical knowledge and can introduce bias or inaccuracies. Relying on family could compromise the client's understanding and confidentiality.
E. Ask the client if they understand the risks of the surgery: Simply asking if the client understands without first ensuring effective communication through appropriate language services does not guarantee true understanding. The nurse must first use proper communication tools, like an interpreter or translated materials.
Correct Answer is A
Explanation
A. Epinephrine relaxes the bronchioles and counteracts the effect of histamine: Epinephrine is the first-line treatment for anaphylaxis because it rapidly relaxes bronchial smooth muscles, reducing airway constriction, and counteracts histamine's effects, which include vasodilation, edema, and hypotension. This helps restore breathing and circulation.
B. Epinephrine should be given along with a beta blocker: Administering epinephrine with a beta blocker is dangerous because beta blockers can reduce the effectiveness of epinephrine and may worsen bronchospasm. Beta blockers are not recommended during acute management of anaphylaxis.
C. Epinephrine should be administered intranasally: Epinephrine is typically administered intramuscularly (IM), usually into the thigh, during anaphylactic emergencies for rapid absorption. Intranasal administration is not effective for treating life-threatening systemic allergic reactions.
D. Epinephrine causes a decrease in blood pressure: Epinephrine actually increases blood pressure by causing vasoconstriction. This counters the dangerous hypotension that occurs during anaphylaxis, helping to stabilize cardiovascular function quickly.
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