A nurse is taking care of a client who has generalized anxiety disorder and is taking buspar (Buspirone). Which of the following adverse effects should the nurse report to the provider?

The correct answer is choice B. The client reports that voices are telling him to write a novel.

Choice A rationale:

The client responds to questions with disorganized speech. Disorganized speech is a characteristic of schizophrenia and can be present in acute mania as well. However, in this scenario, the client's speech is not described as disorganized. Instead, the client's experience is centered around auditory hallucinations.

Choice B rationale:

The client reports that voices are telling him to write a novel. Auditory hallucinations are a common feature of acute mania and can involve hearing voices that instruct or command the individual to perform certain actions. The client's belief that voices are compelling them to write a novel aligns with this characteristic.

Choice C rationale:

The client's spouse reports that the client has recently gained weight. Weight gain is not a specific symptom of acute mania. While changes in appetite and weight can occur during manic episodes, they are not a defining characteristic for diagnosing acute mania.

Choice D rationale:

The client is dressed in all black. Unusual or eccentric clothing choices can sometimes be seen in individuals with manic episodes, as their behavior and judgment can be impaired. However, dressing in all black is not a definitive indicator of acute mania and does not support the diagnosis on its own.

Choice A rationale:

The ethical concept of autonomy centers on respecting an individual's right to make decisions about their own care, even if those decisions go against medical advice. By supporting the client's wish to refuse prescribed medications, the nurse is upholding the principle of autonomy. In mental health care, it is crucial to acknowledge and respect the client's right to make choices about their treatment, even if those choices might not align with the healthcare provider's recommendations. This action promotes patient empowerment and informed decision-making.

Choice B rationale:

While client feedback about satisfaction with the facility experience is important for quality improvement, it is not directly related to the ethical concept of autonomy. Autonomy pertains to the client's right to make decisions about their treatment and care, particularly when it comes to medical interventions and choices about their own body.

Choice C rationale:

Ensuring that the client understands expectations for client participation is more aligned with the principle of informed consent and effective communication rather than autonomy. While communication is important for respecting the client's autonomy, this choice does not directly demonstrate the core concept of allowing the client to make decisions about their treatment even if they differ from medical advice.

Choice D rationale:

Explaining unit rules and policies regarding unacceptable behaviors is related to maintaining a safe and structured environment within the psychiatric unit, but it does not directly reflect the ethical concept of autonomy. Autonomy pertains to decisions specifically related to the client's medical treatment and care, not just the rules of the unit.