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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Incorrect. Family history of malignant hypertension is not a contraindication for alteplase.
B. Incorrect. COPD itself is not a contraindication for alteplase. While it can complicate overall management, it does not increase the immediate risk of bleeding associated with thrombolytics.
C. Correct. Recent surgery, especially orthopedic surgery like hip arthroplasty, is a contraindication for thrombolytic therapy due to the increased risk of bleeding and hematoma formation at the surgical site.
D. Incorrect. Acute renal failure from six months ago is not a contraindication for alteplase.
Correct Answer is D
Explanation
A. Incorrect. Releasing the tourniquet is a step that can be taken after advancing the catheter into the vein.
B. Incorrect. Retracting the stylet at this point could disrupt the position of the catheter and cause leakage or damage.
C. Incorrect. Flushing the catheter with saline is an appropriate step after ensuring the catheter is correctly placed in the vein.
D. Correct. After noting a blood return in the flashback chamber, the next step is to advance the catheter into the vein to ensure proper placement for intravenous access.
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