A nurse is planning care for a client who has bipolar disorder and is experiencing mania.
Which of the following interventions should the nurse include in the plan?

Place the client in seclusion when he exhibits signs of anxiety.

Encourage the client to spend time in the dayroom.

Encourage the client to take frequent rest periods.

Withdraw the client's TV privileges if he does not attend group therapy.

Answer and Explanation

The Correct Answer is C

A.   Incorrect. Placing the client in seclusion is not an appropriate intervention for managing mania.
B.   Incorrect. Encouraging the client to spend time in the dayroom may exacerbate symptoms of mania by providing more stimulation.
C.   Correct. Encouraging the client to take frequent rest periods helps prevent overactivity and exhaustion, common in manic episodes.
D.   Incorrect. Withdrawing privileges are not directly related to managing manic symptoms and may not be therapeutic.

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Correct Answer is A

Explanation

A. Correct. Measuring gastric residual volumes every 4 hours is important to assess gastric emptying and to determine if the client can tolerate the feedings. If residuals are high, it may indicate delayed gastric emptying and the need to adjust the feeding rate.

B. Incorrect. While flushing the NG tube before and after medications is important to maintain patency, it is typically done with sterile water, not sodium chloride, unless otherwise specified by a protocol. Therefore, this statement may not be fully accurate.

C. Incorrect. The head of the bed should be elevated to a 30-45° angle to help prevent aspiration during enteral feedings.

D. Incorrect. The rate of the feeding should be advanced gradually to prevent overloading the client's gastrointestinal tract. This does not involve advancing the rate every 2 hours.

A. Client rates lower back pain a 0 on a scale from 0 to 10. No reports of vaginal discharge. B. Membranes intact. C. No uterine contractions noted. D. FHR baseline 138 E. minimal variability. F. No further reports of burning with urination. G. WBC 12.000/mm3 H. Platelet count 188,000/mm3 (150,000 to 400,000/mm3) I. Temperature 37.1° C (98.7° F) J. Blood pressure 120/78 mm Hg

Correct Answer is ["A","B","C","D","E","F","G","H","I","J"]

Explanation

Client rates lower back pain a 0 on a scale from 0 to 10. No reports of vaginal discharge.

Membranes intact.

No uterine contractions noted.

FHR baseline 138, with minimal variability. No further reports of burning with urination.

Laboratory Results: WBC 12,000/mm3 (within the normal range of 5,000 to 10,000/mm3). Platelet count 188,000/mm3 (within the normal range of 150,000 to 400,000/mm3).

Vital Signs: Temperature 37.1°C (98.7°F), Blood pressure 120/78 mm Hg.

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A nurse is planning care for a client who has bipolar disorder and is experiencing mania. Which of the following interventions should the nurse include in the plan?

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Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who has a prescription for continuous enteral feedings through an NG tube. Which of the following actions should the nurse plan to take?

Correct Answer is A

Explanation

Correct Answer is ["A","B","C","D","E","F","G","H","I","J"]

Explanation

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A nurse is planning care for a client who has bipolar disorder and is experiencing mania.
Which of the following interventions should the nurse include in the plan?