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A client has been diagnosed with borderline personality disorder, and a nurse is providing care. Which intervention should the nurse implement to promote the client's safety?
- A. Implement a no-harm contract with the client.
- B. Monitor the client closely for signs of self-harm.
- C. Encourage the client to participate in recreational activities.
- D. Encourage the client to maintain a structured daily routine.
Correct Answer: A
Rationale: Implementing a no-harm contract is a crucial intervention for clients with borderline personality disorder as it helps establish an agreement between the client and the healthcare provider to abstain from self-harming behaviors. This contract aims to promote the client's safety by enhancing awareness and providing a structured approach in managing impulses and emotions.
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When assessing a client with bipolar disorder who is experiencing a depressive episode, which of the following findings should the nurse not expect?
- A. Low energy
- B. Feelings of hopelessness
- C. Insomnia or hypersomnia
- D. Difficulty concentrating
Correct Answer: D
Rationale: In a client experiencing a depressive episode in bipolar disorder, common findings include low energy, feelings of hopelessness, insomnia or hypersomnia, and decreased appetite. Difficulty concentrating is more indicative of attention deficit disorders or cognitive impairment rather than a typical presentation of a depressive episode in bipolar disorder.
A client has generalized anxiety disorder (GAD), and a nurse is providing care. Which of the following interventions should the nurse avoid implementing?
- A. Encourage the client to express their feelings
- B. Monitor daily caloric intake and weight
- C. Promote regular physical activity
- D. Discourage the use of caffeine
Correct Answer: B
Rationale: In caring for a client with generalized anxiety disorder (GAD), it is important to encourage the client to express their feelings, promote regular physical activity, and discourage the use of caffeine. Addressing weight and caloric intake monitoring may exacerbate anxiety related to body image, and focusing on these aspects can be distressing for the client. Therefore, monitoring daily caloric intake and weight should be avoided in this scenario.
A client diagnosed with schizophrenia is receiving discharge teaching. Which of the following instructions should the nurse exclude?
- A. Continue taking medications as prescribed
- B. Avoid all social interactions
- C. Report any side effects of medications to the healthcare provider
- D. Develop a daily routine
Correct Answer: B
Rationale: The nurse should exclude the instruction to 'Avoid all social interactions' when providing discharge teaching to a client with schizophrenia. It's important for individuals with schizophrenia to continue taking medications as prescribed, report any medication side effects to the healthcare provider, and develop a daily routine to promote stability. Social interactions, albeit with appropriate boundaries, can be beneficial for the client's well-being and integration into the community.
Which of the following statements should a healthcare provider recognize as true about defense mechanisms? Select all that apply.
- A. They are employed when there is a threat to biological or psychological integrity.
- B. They are controlled by the id and deal with primal urges.
- C. They are used in an effort to increase anxiety.
- D. They are protective devices for the superego.
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which of the following interventions is inappropriate for a client experiencing a panic attack?
- A. Provide a well-lit environment.
- B. Encourage deep breathing.
- C. Move the client to a quiet environment.
- D. Administer prescribed antianxiety medication.
Correct Answer: A
Rationale: During a panic attack, a well-lit environment might exacerbate the client's symptoms due to sensory overload. Therefore, it is inappropriate to provide a well-lit environment during a panic attack. Encouraging deep breathing, moving the client to a quiet environment, and administering prescribed antianxiety medication are appropriate interventions for managing a panic attack. These actions help create a calming atmosphere and address the physiological symptoms associated with panic attacks.