A nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize which client statement would provide supportive evidence of this symptom?
I'm the world's most perceptive attorney.
The FBI is out to get me
I can't stop my sexual urges. They have led me to numerous affairs.
My wife is distraught about my overspending
The Correct Answer is A
A. "I'm the world's most perceptive attorney.": This statement reflects grandiosity, a common feature of grandiose delusions. The client is expressing an exaggerated belief in their own importance and abilities, indicating a distorted perception of reality.
B. "The FBI is out to get me": This statement suggests paranoid delusions, where the client believes they are being persecuted or conspired against. It does not specifically indicate grandiose delusions.
C. "I can't stop my sexual urges. They have led me to numerous affairs": This statement reflects impulsivity and hypersexuality, which are common features in manic episodes but do not specifically indicate grandiose delusions.
D. "My wife is distraught about my overspending": This statement reflects a consequence of manic behavior (overspending) but does not directly indicate grandiose delusions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Favoring clients over others based upon their mental health diagnosis is not an indication of bias: This statement is incorrect. Favoring or discriminating against clients based on their mental health diagnosis is a clear indication of bias, and it is an issue that the nursing profession aims to address.
B. Displaying basis & conscious art: It seems like there might be a typo in this option. Assuming it means "Displaying bias, conscious or not," this could be a relevant point in discussing unconscious biases that individuals may hold, impacting their interactions with clients.
C. There is a negative stigmatization for mental lives: This is the correct answer. This statement acknowledges the existence of negative stigmatization associated with mental health. Addressing and reducing mental health stigma is an essential aspect of providing quality mental health care.
D. Bias is often isolated to inpatient hospitalization: This statement is not accurate. Bias can manifest in various healthcare settings, not just inpatient hospitalization. It is important to address bias across all levels of care to ensure equitable and unbiased treatment for individuals with mental health concerns.
Correct Answer is A
Explanation
A. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss: This is the correct priority nursing diagnosis. The client's significant weight loss is indicative of altered nutrition and poses a more immediate threat to their well-being. Addressing the nutritional deficit takes precedence to ensure the client's physical health and stability.
B. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights: While altered sleep patterns are a concern, the priority in this scenario is the significant weight loss, which is indicative of altered nutrition. Nutritional deficits can have more immediate health consequences.
C. Knowledge deficit R/T bipolar disorder AEB concern about symptoms: While addressing knowledge deficits is important for the client's understanding of their condition, the immediate concern is the client's significant weight loss. Nutritional deficits can lead to serious health issues and should be addressed as a priority.
D. Risk for suicide R/T powerlessness AEB insomnia and anorexia: While the client's symptoms may contribute to a risk for suicide, the immediate focus should be on addressing the altered nutrition, which is a more direct threat to the client's physical health.
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