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 {"dropdown-group-1":"B","dropdown-group-2":"E"}

Explanation

Pyrexia, also known as fever, refers to an elevated body temperature that is above the normal range. The normal body temperature is typically around 37°C (98.6°F), and a temperature of 38.4°C (101.1°F) indicates a fever.

Alternative Choices:

1. "tachycardia" due to "heart rate of 92/min"

Incorrect. Tachycardia refers to an abnormally high heart rate, usually above 100 beats per minute (bpm) in adults. A heart rate of 92/min is within normal limits and does not qualify as tachycardia.

2. "hypertension" due to "blood pressure of 130/78 mm Hg"

Incorrect. Hypertension is defined as having a blood pressure reading consistently above 140/90 mm Hg. The reading of 130/78 mm Hg falls into the elevated category but does not reach the threshold for hypertension.

3. "respiratory distress" due to "respiratory rate of 18/min"

Incorrect. A respiratory rate of 18 breaths per minute is considered normal for adults, so this finding does not indicate respiratory distress.

4. "obesity" due to "current BMI of 29.9"

Partially correct. A BMI of 29.9 places the client in the "overweight" category, just below the threshold for obesity (BMI of 30 or higher). However, the presence of pyrexia is the more immediate clinical concern based on the provided vital signs.

A. Determine if the client's health care surrogate is aware of the risks and benefits of the procedure. B. Ensure that the client's family supports the provider's decision for surgery. C. Determine if the procedure is medically necessary for the client. D. Send the unsigned informed consent form to the facility's risk manager.

Correct Answer is A

Explanation

A. Correct. In cases where the client is unable to provide informed consent due to incapacitation, the health care surrogate or legally authorized representative should be involved in the decision-making process.
B. Incorrect. While family support is important, the decision for surgery should primarily be based on medical necessity and the best interests of the client.
C. Incorrect. Determining medical necessity is the responsibility of the medical team, not the nurse.
D. Incorrect. Sending the unsigned informed consent form to the risk manager is not a standard nursing responsibility and does not address the issue of informed consent.

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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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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?