A nurse is planning care for a client who is receiving continuous enteral tube feedings through an open system.
Which of the following interventions should the nurse include in the plan of care?

The correct answer is: b. Determine goals of the day.

Choice A: Schedule daily activities.

Rationale: Scheduling daily activities is crucial for time management but should follow establishing goals. The nurse must first determine the priorities and objectives for the day before organizing the tasks.

Choice B: Determine goals of the day.

Rationale: Identifying the goals of the day is the first step in effective time management for a nurse. This enables the nurse to prioritize patient care and other responsibilities, ensuring that essential tasks are accomplished and patient needs are met. Goals can include completing assessments, administering medications, and attending to patient concerns.

Choice C: Delegate tasks to the AP.

Rationale: Delegating tasks is vital in managing time and resources, but it should occur after the goals and priorities are determined. The nurse must first know which tasks need to be completed before assigning responsibilities to the LPN and AP.

Choice D: Develop an hourly time frame for tasks.

Rationale: Creating a timeline for tasks is essential for time management but should be done after setting goals and prioritizing tasks. This will enable the nurse to allocate an appropriate amount of time for each task and help ensure that all necessary tasks are completed within the shift.

In conclusion, by first determining the goals of the day, the nurse can effectively manage time and ensure that all essential tasks are completed. Prioritizing patient care and other responsibilities will enable the nurse to collaborate effectively with the LPN and AP in delegating tasks and scheduling activities.

Choice A rationale:

Auditory hallucinations are more commonly associated with conditions like schizophrenia or certain types of psychosis. In bipolar disorder, individuals may experience mood swings between depression and mania, but auditory hallucinations are not a typical symptom during a depressive episode.

Choice B rationale:

Illusions of grandeur involve an exaggerated sense of one's importance, power, knowledge, or identity. This symptom is more commonly associated with manic episodes in bipolar disorder, not depressive episodes.

Choice C rationale:

Rapid speech and moving quickly from one idea to the next are characteristic symptoms of a manic episode in bipolar disorder, not a depressive episode. During depressive episodes, individuals often exhibit symptoms such as low energy, feelings of worthlessness, and difficulty concentrating.

Choice D rationale:

Inability to carry out a simple task is a common symptom of depression. Depressed individuals often struggle with daily activities, lose interest in hobbies, and have difficulty concentrating. This symptom aligns with the depressive episode of bipolar disorder.