A nurse is conducting an admission assessment for a client who is experiencing a manic episode of bipolar disorder. Which of the following behaviors should the nurse expect? (Select all that apply.)

Grandiosity

Flight of ideas

Splitting

Hyperactivity

Answer and Explanation

Correct Answer : A,B,D

Choice A reason:

Grandiosity is a common symptom of a manic episode. Clients may have an inflated sense of self-importance and believe they have special abilities or powers.

Choice B reason:

Flight of ideas is characterized by rapid and continuous speech with frequent changes in topic. This is a typical behavior during a manic episode.

Choice C reason:

Splitting, which involves viewing people or situations as all good or all bad, is more commonly associated with borderline personality disorder rather than bipolar disorder.

Choice D reason:

Hyperactivity is a hallmark of mania. Clients may exhibit increased energy levels, restlessness, and engage in excessive activities.

Choice E reason:

Withdrawal is not typically associated with manic episodes. It is more commonly seen in depressive episodes or other mental health conditions.

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Correct Answer is D

Explanation

Choice A reason:

Urinary retention can be a side effect of both diazepam and hydromorphone, but it is not typically life-threatening. While it should be monitored and addressed, it is not the most urgent concern compared to respiratory issues.

Choice B reason:

Blurred vision can occur with the use of diazepam and hydromorphone, but it is generally not an immediate threat to the client’s life. It should be reported and managed, but it is not the highest priority.

Choice C reason:

Headache is a common side effect of many medications, including diazepam and hydromorphone. While it can be uncomfortable and may need treatment, it is not usually a sign of a life-threatening condition.

Choice D reason:

Bradypnea, or slow breathing, is a serious side effect that can occur with the use of both diazepam and hydromorphone, as both medications depress the central nervous system. This can lead to respiratory depression, which is potentially life-threatening and requires immediate medical attention.

A. A nurse did not clarify a client’s prescription that was difficult to read resulting in a medication error. B. A nurse posted private information on social media about a client who has substance use disorder. C. A nurse placed a client in mechanical restraints without obtaining a prescription, resulting in injury. D. A nurse threatened a client with physical harm after the client became verbally abusive to staff members.

Correct Answer is A

Explanation

Choice A reason:

An unintentional tort occurs when a healthcare provider’s actions or inactions cause harm to a patient without intent to harm. In this scenario, the nurse’s failure to clarify a difficult-to-read prescription, resulting in a medication error, is an example of negligence, which is an unintentional tort.

Choice B reason:

Posting private information about a client on social media is a breach of confidentiality and an intentional tort. This action is deliberate and violates the client’s right to privacy.

Choice C reason:

Placing a client in mechanical restraints without obtaining a prescription, resulting in injury, is an intentional tort. This action involves a deliberate decision to restrain the client without proper authorization, leading to harm.

Choice D reason:

Threatening a client with physical harm is an example of assault, which is an intentional tort. This involves a deliberate act to cause the client to fear imminent harm.

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A nurse is conducting an admission assessment for a client who is experiencing a manic episode of bipolar disorder. Which of the following behaviors should the nurse expect? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who takes diazepam for anxiety and hydromorphone for severe pain. Which of the following is the priority finding that the nurse should report to the provider?

Correct Answer is D

Explanation

A charge nurse is planning an in-service for newly licensed nurses on tort law in mental health care. Which of the following scenarios should the charge nurse provide as an example of an unintentional tort?

Correct Answer is A

Explanation

A nurse in an urgent-care clinic is caring for a school-age child who has several visible bruises. The child’s parent states, “My partner got fired today and came home angry. I don’t think this will happen again.” Which of the following responses should the nurse make?

A nurse is creating a plan of care for a newly admitted client who has obsessive-compulsive disorder (OCD). Which of the following interventions should the nurse include?

A nurse is caring for a client who has bipolar disorder. The client says to the nurse, “Give me your pen to cut the pain out of my chest.” The nurse should identify that the client is at risk for which of the following?

A nurse is preparing to teach a client who has major depressive disorder and is scheduled to undergo electroconvulsive therapy (ECT). Which of the following statements should the nurse include in the teaching?

A home health nurse is caring for a client who reports feeling tired and being unable to grocery shop. Which of the following responses by the nurse is an example of therapeutic communication?

A nurse is caring for a client who has a new diagnosis of major depressive disorder. Which of the following medications should the nurse expect the provider to prescribe to the client as a first-line treatment?

A nurse is caring for a client who has a history of suicide attempts. Which of the following findings places the client at risk for another suicide attempt? (Select all that apply.)

A nurse is admitting a client who has borderline personality disorder and is at risk for self-mutilation. Which of the following interventions should the nurse incorporate in the plan of care?