A nurse is creating a plan of care for a client who is experiencing mania. Which of the following interventions should the nurse include in the plan? (Select all that apply.).

Discourage the client from taking a nap during the day.

Weigh the client every 3 to 4 days.

Maintain an environment with low stimuli.

Offer finger foods to the client every 2 hr.

Monitor vital signs every 1 to 2 hr throughout the day.

Answer and Explanation

Correct Answer : C,D,E

Correct answers: C, D, E

Choice A rationale:
While a consistent sleep schedule is important in the long term, a short nap during the day might be helpful for someone experiencing mania to prevent complete exhaustion, which can worsen symptoms.

Choice B rationale:
Weighing the client every 3 to 4 days (Choice B) might not be as crucial as the other options provided. While changes in weight can occur during mania, this intervention may not be as directly related to managing the acute symptoms of mania as other interventions.

Choice C rationale:
Maintaining an environment with low stimuli (Choice C) is essential during a manic episode. Clients with mania often experience heightened sensory sensitivity, and reducing environmental stimuli can help decrease agitation and promote a more stable mood.

Choice D rationale:
A client in a manic episode has increased caloric needs due to constant physical activity but may be unable to sit down for regular meals. Providing finger foods allows them to eat while remaining active.

Choice E rationale:

Mania can cause physiological changes like increased heart rate, blood pressure, and body temperature. Frequent monitoring helps detect potential complications and guide treatment decisions.

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Correct Answer is C

Explanation

A.While it is important to understand changes in behavior, the sudden shift from depression to a cheerful state could be indicative of a potential risk, such as a plan to self-harm, particularly if the client is showing improved mood quickly.

B.It is not appropriate to reward a change in behavior without understanding the underlying reasons for the change. The sudden improvement in mood could be a sign of a potential risk, such as suicidal ideation or a temporary lift in mood before a possible crisis.

C.This is a crucial intervention. A sudden change in mood can sometimes be associated with an increased risk of self-harm or suicidal ideation, particularly if the client’s mood improves significantly before a more stable improvement in their depressive symptoms. Continuous monitoring helps ensure the client’s safety.

D.This could be premature and potentially unsafe, given the sudden and significant change in the client's condition. It is more important to ensure that the client’s mood change is not indicative of an underlying risk before allowing unsupervised activities.

A. "Postpartum depression usually begins 48 hours after childbirth.". B. "Postpartum depression is more likely to occur in women who have a history of depression.". C. "It's common for clients who have postpartum depression to exhibit psychotic behavior.". D. "The most common manifestation of postpartum depression is harming the infant.".

Correct Answer is B

Explanation

A. "Postpartum depression usually begins 48 hours after childbirth."Postpartum depression can begin at any time within the first year after childbirth, but it typically starts between 1 to 3 weeks after delivery, not specifically 48 hours after.

B. "Postpartum depression is more likely to occur in women who have a history of depression."This statement reflects an understanding of the risk factors associated with postpartum depression. Women with a personal or family history of depression or mental health issues are at a higher risk of experiencing postpartum depression.

C. "It's common for clients who have postpartum depression to exhibit psychotic behavior."While severe cases of postpartum depression can lead to postpartum psychosis, this is a much rarer condition. Postpartum depression itself typically does not involve psychotic symptoms.

D. "The most common manifestation of postpartum depression is harming the infant."While thoughts of harming the infant can occur in extreme cases, the most common manifestations of postpartum depression include symptoms such as sadness, anxiety, fatigue, and difficulty bonding with the baby, rather than intentions to harm.

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A nurse is creating a plan of care for a client who is experiencing mania. Which of the following interventions should the nurse include in the plan? (Select all that apply.).

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A nurse is discussing postpartum depression with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of this condition?

Correct Answer is B

Explanation

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