A nurse is contributing to the plan of care for a client who has bipolar disorder and whose admission was voluntary. For which of the following interventions should the nurse confirm that the client has given informed consent?

Attending a cognitive behavioral therapy class

Taking an experimental medication

Participating in a group exercise program

Receiving light therapy

Answer and Explanation

The Correct Answer is B

A.   Cognitive behavioral therapy (CBT) is a commonly used psychotherapy approach for bipolar disorder. Attending a CBT class typically does not require specific informed consent beyond the general consent for treatment, as it involves non-invasive, non-experimental therapeutic techniques aimed at improving coping skills and managing symptoms. In most cases, attending therapy sessions like CBT is considered part of routine care for mental health conditions.
B.   Experimental medications involve drugs or treatments that are not yet approved by regulatory agencies (such as the FDA in the United States) for general use. For a client to participate in a clinical trial or receive an experimental medication, they must provide explicit informed consent after being informed about the potential risks, benefits, and uncertainties associated with the treatment. This process ensures that the client understands they are participating in research and not receiving standard care.
C.   Participating in a group exercise program is generally considered a routine therapeutic intervention aimed at promoting physical health and well-being. While informed consent is important for all interventions, including exercise programs, it typically involves providing general information about the program's goals, activities, and any potential risks. Clients are not consenting to experimental treatments or procedures that go beyond standard exercise protocols.

D.   Light therapy, also known as phototherapy, is a treatment often used for seasonal affective disorder (SAD) and other mood disorders. It involves exposure to specific wavelengths of light to regulate circadian rhythms and improve mood. While light therapy is a specialized treatment, it is a standard intervention for mood disorders and does not typically require separate informed consent beyond what is provided for standard medical treatments.

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Correct Answer is B

Explanation

A. Obsessive behaviors, such as repetitive actions or fixations on specific thoughts or tasks, can be indicative of delirium. Delirium often manifests with altered behavior patterns that are unusual for the individual, including obsessive or compulsive-like behaviors that are not typical of their baseline mental status. However, this is not specific to delirium.
B. Fluctuating orientation, where the client is sometimes alert and oriented and at other times confused or disoriented, is a hallmark of delirium. Unlike dementia, which typically presents with a more steady decline in cognitive function, delirium is characterized by rapid changes in mental status over hours to days. This fluctuation is important to note as it strongly suggests delirium rather than other chronic cognitive impairments.
C. Gradual memory loss reported by family members is more suggestive of chronic conditions such as dementia rather than delirium. Delirium, in contrast, is characterized by acute onset and fluctuating course rather than a gradual decline in cognitive abilities over time.
D. Depression can coexist with delirium, but a consistent state of depression without acute changes in mental status is less indicative of delirium. Delirium is characterized by rapid changes in cognition and behavior rather than a persistent mood disorder. Therefore, while depression should be assessed and managed appropriately, it is not typically a sign of delirium unless there are acute changes in mental status accompanying it.

A. "I should use role-playing to enhance new behavioral skills." B. "I should move closer to my child when they are agitated." C. "I should ignore attention-seeking behaviors." D. "I should re-engage my child in an appropriate activity."

Correct Answer is D

Explanation

A. Role-playing is a useful technique to teach and reinforce new behaviors by allowing the child to practice appropriate responses in simulated situations. While role-playing can be beneficial, it is not specifically related to redirection technique. Redirection involves diverting a child's attention or behavior away from inappropriate or disruptive actions towards more acceptable behaviors.
B. Moving closer to a child who is agitated can be a strategy to provide physical proximity and support, especially to prevent escalation of behavior or to intervene if necessary. However, it is not directly related to redirection technique.
C. Ignoring attention-seeking behaviors is a common behavior management strategy aimed at reducing reinforcement of undesirable behaviors. While ignoring can be effective in some situations, it is not specifically redirection technique.
D. This statement correctly reflects the redirection technique. Redirection involves redirecting the child's focus or behavior from negative or inappropriate actions towards positive and appropriate activities or tasks. By re-engaging the child in an appropriate activity, the parent can effectively redirect their attention and energy, potentially preventing or diffusing disruptive behaviors.

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A nurse is contributing to the plan of care for a client who has bipolar disorder and whose admission was voluntary. For which of the following interventions should the nurse confirm that the client has given informed consent?

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