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A client with bipolar disorder is experiencing a manic episode. Which of the following interventions should the nurse implement? Select one that does not apply.
- A. Provide a structured environment
- B. Encourage rest periods
- C. Limit setting on inappropriate behaviors
- D. Allow the client to engage in stimulating activities
Correct Answer: D
Rationale: During a manic episode, it is essential to provide a structured environment to help the client maintain stability. Encouraging rest periods is crucial as excessive activity during mania can lead to exhaustion. Setting limits on inappropriate behaviors helps ensure the client's safety and the safety of others. Allowing the client to engage in stimulating activities can exacerbate manic symptoms by further increasing their energy levels and impulsivity. This can lead to a worsening of the manic episode and potentially risky behaviors. Therefore, allowing the client to engage in stimulating activities is not an appropriate intervention during a manic episode.
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A client has been diagnosed with obsessive-compulsive personality disorder. Which of the following behaviors should the nurse expect?
- A. Perfectionism
- B. Flexibility
- C. Generosity
- D. Spontaneity
Correct Answer: A
Rationale: Individuals with obsessive-compulsive personality disorder commonly exhibit perfectionism, a need for orderliness, and a preoccupation with details. This behavior often interferes with task completion and can impact interpersonal relationships. Choice A is correct because perfectionism is a key characteristic of this disorder. Choices B, C, and D are incorrect because individuals with obsessive-compulsive personality disorder typically lack flexibility, may not display generosity, and tend to avoid spontaneity.
A nurse is caring for a client who has been diagnosed with schizoaffective disorder. The client states, 'I am the president of the United States.' Which of the following responses should the nurse make?
- A. You are not the president. You are a client in the hospital.
- B. Tell me more about being the president.
- C. Why do you think you are the president?
- D. Let's talk about something else.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
When assessing a client diagnosed with major depressive disorder who states, 'I feel like I can't go on,' which of the following actions should the nurse take first?
- A. Administer a prescribed antidepressant medication.
- B. Ask the client if they have a plan to commit suicide.
- C. Encourage the client to attend a support group.
- D. Contact the client's family to provide support.
Correct Answer: B
Rationale: The priority action for the nurse is to assess the client's risk for suicide. By asking if the client has a plan to commit suicide, the nurse can determine the immediate safety of the client and take appropriate interventions to prevent harm. Administering antidepressant medication is not the first action to take in this situation as assessing the client's safety is the priority. Encouraging the client to attend a support group or contacting the client's family, although beneficial, are not immediate actions to ensure the client's safety in a crisis situation.
Why is the DSM-5 useful in the practice of psychiatric nursing?
- A. It guides the nurse in making accurate and reliable medical diagnoses.
- B. It represents progress toward a more holistic view of mind and body.
- C. It provides a framework for interdisciplinary communication.
- D. It provides a template for nursing care plans.
Correct Answer: A
Rationale: The DSM-5 is a crucial tool in psychiatric nursing as it guides nurses in making accurate and reliable medical diagnoses of mental health conditions. Using the DSM-5 ensures that diagnoses are standardized, improving the quality and precision of care for clients. While the DSM-5 also supports a holistic view, interdisciplinary communication, and care plan development, its primary role in psychiatric nursing is to assist clinicians in diagnosing mental health conditions accurately.
A client has been diagnosed with generalized anxiety disorder and expresses worrying about their job, family, and health, feeling a loss of control. What should the nurse do first?
- A. Administer a prescribed antianxiety medication.
- B. Encourage the client to attend a support group.
- C. Identify triggers of the client's anxiety.
- D. Teach the client deep breathing techniques.
Correct Answer: D
Rationale: The initial step for the nurse is to teach the client deep breathing techniques to aid in managing anxiety symptoms. Deep breathing exercises can help the client relax, reduce anxiety levels, and regain a sense of control. This intervention is non-invasive, empowering the client to develop a coping strategy for immediate use when feeling overwhelmed by anxiety. Administering medication (Choice A) should not be the first action unless the client is in severe distress. Encouraging attendance at a support group (Choice B) and identifying triggers of anxiety (Choice C) are important but teaching coping strategies like deep breathing comes first to help the client feel more in control of managing their anxiety.