Exhibits

A nurse is reviewing the medical record of a client who has COPD. The nurse should notify the provider about which of the following findings? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Rationale:

A. Place the client in a supine position: The supine position may impair respiratory function and increase discomfort, especially in terminal clients who may experience dyspnea. A semi-Fowler’s or side-lying position is often preferred for comfort and easier breathing.

B. Remind the client to eat scheduled meals daily: For clients nearing end of life, appetite naturally decreases, and forcing meals can cause distress. Care should focus on comfort, allowing the client to eat only if and when they desire rather than adhering to structured meal times.

C. Speak in a loud tone when addressing the client: Loud speech is not appropriate unless the client has documented hearing impairment. A calm, soft tone is more comforting and respectful, especially in the emotionally sensitive context of end-of-life care.

D. Offer the client a blanket to keep warm: Clients nearing the end of life often experience poor circulation and may feel cold. Providing a blanket is a comfort-focused, non-invasive intervention that promotes warmth and dignity during this phase.

Rationale for Correct Choices:

• Mania: The client demonstrates hallmark signs of a manic episode including euphoric mood, impulsive and excessive spending, decreased sleep, pressured and disorganized speech, and grandiosity. Mania also often presents with hyperactivity and distractibility, both of which are present.
• Euphoric mood: Euphoric mood refers to an elevated, expansive emotional state beyond appropriate bounds of context. In this case, the client’s overly joyous affect and heightened self-confidence, along with insomnia and excessive sociability, clearly reflect this finding.

Rationale for Incorrect Choices:

• Delirium: Delirium typically presents with fluctuating levels of consciousness, reduced awareness, and inattention due to acute medical or substance-related causes. Although this client is disoriented to place, they are alert and oriented to person and time, and there's no acute medical condition or toxic exposure noted, making delirium unlikely.
• Catatonia: Catatonia involves motor abnormalities such as stupor, mutism, negativism, or waxy flexibility. The client in this scenario is exhibiting hyperactivity, pressured speech, and constant movement, which are contrary to the reduced motor activity seen in catatonia. These findings rule out this condition.
• Panic disorder: Panic disorder is characterized by sudden, recurrent panic attacks with physical symptoms like chest pain, palpitations, and a sense of impending doom. It is episodic and does not explain the client’s persistent mood elevation, insomnia, or grandiosity.
• Major depressive disorder: This disorder involves persistent low mood, loss of interest or pleasure (anhedonia), sleep disturbances (often hypersomnia), and low energy. The client instead demonstrates an elevated, not depressed, mood with excessive energy and activity.
• Hypervigilance: Hypervigilance refers to a heightened state of sensory sensitivity, often seen in anxiety or PTSD. The client shows distractibility but not constant scanning or suspicion of danger, making hypervigilance an unfitting descriptor of their state.
• Anhedonia: Anhedonia, or lack of pleasure in previously enjoyable activities, is a core symptom of depression. The client, on the contrary, is described as overly sociable, excited about events, and highly active, which indicates a heightened—not blunted—capacity for pleasure.
• Alogia: Alogia involves poverty of speech and is typically seen in schizophrenia or severe depression. The client has loud, rapid, and disorganized speech, which is the opposite of speech reduction. Thus, this finding does not apply to the clinical picture.
• Magical thinking: Magical thinking refers to believing that one’s thoughts or actions can influence unrelated external events. While the client is hallucinating, there is no indication they are attributing unrealistic powers or connections to their thoughts.