A nurse prepares the plan of care for a patient experiencing an acute manic episode. Which nursing diagnoses are most likely? (Select all that apply).
Social isolation
Impaired mood regulation
Imbalanced nutrition: more than body requirements
Chronic confusion
Sleep deprivation
Correct Answer : B,E
Rationale:
A. Social isolation is more typical in depression or withdrawal, not acute mania, where patients are often excessively social or intrusive.
B. Impaired mood regulation is characteristic of mania, involving mood swings, irritability, and poor impulse control.
C. Imbalanced nutrition: more than body requirements is unlikely during mania; patients often have decreased appetite.
D. Chronic confusion is not typical in acute mania; cognitive impairment may be present but is usually not chronic.
E. Sleep deprivation is common in manic episodes due to decreased need for sleep and hyperactivity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D","E"]
Explanation
Rationale:
A. This is a form of disorganized speech where the person rapidly shifts from one topic to another, often without logical connection.
B. This is a type of delusional thinking, not a speech pattern. It involves an inflated sense of self-importance or abilities.
C. This occurs when the person begins to answer a question but veers off-topic and never returns to the original point.
D. This involves including excessive and unnecessary detail but eventually returning to the point, demonstrating disorganized but not completely illogical thought.
E. This is rapid, excessive speech that is difficult to interrupt, common in manic episodes and a sign of disorganized communication.Top of Form
Correct Answer is B
Explanation
Rationale:
A. This approach is confrontational and accusatory, which may escalate agitation in a hyperactive or manic patient.
B. This response sets clear limits in a calm, supportive, and non-threatening manner, while also offering assistance with impulse control.
C. This statement is shaming and could escalate aggression rather than de-escalate the situation.
D. This is a threat rather than a therapeutic intervention, and it may increase the patient's agitation or resistance.
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