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The nurse continues to care for the client.

Exhibits

For each assessment finding, click to specify if the finding is consistent with psychosis or mania. Each finding may support more than one diagnosis.

A.

Excessive spending habits

B.

Hallucinations

C.

Pressured speech

D.

Lack of sleep

E.

Disorganized thought process

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"A,B"}}

Rationale:

  • Excessive spending habits: This behavior is hallmark for mania, where impaired judgment, impulsivity, and inflated self-esteem lead to reckless financial decisions.
  • Hallucinations: Hallucinations, especially visual or auditory ones, are classic signs of psychosis. They indicate a break from reality and are not a diagnostic feature of mania alone unless psychotic features are present.
  • Pressured speech: Pressured, rapid, and loud speech is a diagnostic feature of mania, reflecting heightened psychomotor activity and racing thoughts.
  • Lack of sleep: Insomnia without fatigue is typical in mania. Clients may stay awake for days with increased energy levels and no perceived need for rest.
  • Disorganized thought process: This can appear in both mania and psychosis. In mania, it stems from flight of ideas and distractibility. In psychosis, it results from impaired reality testing and cognitive disintegration.


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Related Questions

Correct Answer is A

Explanation

Rationale:

A. First-degree atrioventricular block: A first-degree AV block is characterized by a prolonged but consistent P-R interval greater than 0.20 seconds. A P-R interval of 0.35 seconds with no dropped beats is a classic sign of this dysrhythmia.

B. Atrial fibrillation: Atrial fibrillation presents with an irregularly irregular rhythm and absent distinct P waves. The presence of a consistent P-R interval rules out atrial fibrillation.

C. Premature atrial complexes: PACs are identified by early P waves that may look different from sinus P waves, often followed by a normal QRS complex. They do not cause consistently prolonged P-R intervals.

D. Complete heart block: Complete (third-degree) heart block involves no association between P waves and QRS complexes. The atria and ventricles beat independently, which contradicts the presence of a consistent P-R interval.

Correct Answer is D

Explanation

Rationale:

A. "My home has running water and electricity": Access to utilities like water and electricity supports hygiene and food safety. This statement does not indicate a health risk and instead suggests a stable living environment.

B. “I wear a hat and long sleeves while I am working”: Wearing protective clothing helps reduce exposure to the sun, pesticides, and other environmental hazards, thereby promoting health and safety during outdoor labor.

C. “I am currently sharing my home with two roommates”: Sharing housing is common among migrant or seasonal workers. While crowding can pose a potential health risk, this specific scenario doesn’t indicate excessive crowding or direct danger.

D. “I eat vegetables directly from the field where I work”: Consuming unwashed produce from the field poses a significant risk for pesticide exposure and ingestion of harmful microbes. This practice is unsafe and could lead to acute or chronic health issues.

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