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The nurse is planning care for a client with bipolar I disorder who is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care?
- A. Attend group therapy while hospitalized
- B. Confront aggressive behavior
- C. Provide structured solitary activities
- D. Provide small, frequent low-calorie foods
Correct Answer: C
Rationale: Structured solitary activities help reduce stimulation and manage manic behavior safely.
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The following scenario applies to the next 1 items
The nurse in the emergency department (ED) is caring for a pregnant client.
Item 1 of 1
Nurses' Notes
Emergency Department
0735: Client reports sudden onset of nausea and vomiting, heavy vaginal bleeding with dark red blood, frequent low-intensity contractions, lower abdominal pain rated 9/10 on the Numerical Rating Scale for past two hours, and dull lower back pain rated 2/10 on the Numerical Rating Scale for the past 24 hours. Client is 30 weeks gestation (G=4 T=3 P=0 A=0 L=3) and is Rh-positive. Vital signs: T 99.8 ⁰ F (37.7 ⁰ C), P 99, RR 16, BP 112/76, pulse oximetry reading 94% on room air. Uterine tenderness present with gentle palpation. Client states they are a one-pack per day cigarette smoker and denies any alcohol or illicit drug use.
The nurse reviews the client's admission data to begin the plan of care. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress.
- A. initiate electronic fetal monitoring (EFM), administer Rh immune globulin, assess for signs of hyperemesis gravidarum, start peripheral access device, perform an ultrasound examination
- B. placenta previa, preterm labor, placental abruption, preeclampsia
- C. continuous electronic fetal monitoring (EFM), 24-hour urine specimen, strict intake & output, vital signs, serum creatinine levels
Correct Answer: B (placental abruption), A (initiate EFM, start peripheral access device), C (fetal heart rate pattern, vital signs)
Rationale: The client's heavy vaginal bleeding, severe abdominal pain, and frequent contractions at 30 weeks suggest placental abruption. EFM and peripheral access are critical interventions, and monitoring fetal heart rate and vital signs assesses progress.
The following scenario applies to the next 1 items
The nurse in the obstetrics department is caring for a 29-year-old primigravida client.
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History and Physical
2300: Client is a primigravida at 33 weeks gestation, who awoke to moderate bright red vaginal bleeding. She reports noticing light spotting earlier in the day, which she dismissed as benign. She denies abdominal pain, cramping, or contractions. Her pregnancy has been uncomplicated until recently. She reports increased fetal movement over the last 48 hours. One week ago, she presented to the ED with fever, fatigue, and body aches, and was diagnosed with influenza A. She was treated supportively and discharged home with hydration instructions. Over the past 24 hours, she has experienced nasal congestion and fatigue.
Four days ago, a transabdominal ultrasound showed:
• Fetus in cephalic position
• Normal amniotic fluid volume
Exam findings
• Abdomen: Soft, non-tender
• No uterine contractions noted on palpation
• Moderate amount of dried bright red blood was seen on the undergarments
• 1+ pedal edema
• Peripheral pulses 2+
•
Diagnostics
2342: Fetal Heart Rate (FHR): 144 bpm, moderate variability, no decelerations
Vital Signs
• Temperature: 99.5°F (37.5°C)
• HR 88 bpm
• BP 137/78 mmHg
• RR 18/min
• Pulse oximetry 98% on room air
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress.
- A. Request a prescription for indomethacin, Prepare the client for a transvaginal ultrasound, Place the client in the lithotomy position for a manual cervical exam, Establish a peripheral vascular access device, Place the client in a room with monitored negative airflow
- B. Placental abruption, Preeclampsia, Placenta previa, Influenza recurrence
- C. Fetal heart rate pattern, Pedal edema, Amount and color of vaginal bleeding, Temperature, Nasal congestion and fatigue level
Correct Answer: C (placenta previa), A (prepare for transvaginal ultrasound, establish peripheral vascular access device), C (fetal heart rate pattern, amount and color of vaginal bleeding)
Rationale: Moderate bright red vaginal bleeding without pain at 33 weeks suggests placenta previa. Transvaginal ultrasound confirms the diagnosis, peripheral access prepares for potential intervention, and monitoring fetal heart rate and bleeding assesses progress.
The following scenario applies to the next 1 items
The case manager is reviewing the medical record of a client with schizophrenia
Item 1 of 1
Progress Notes
Discharge Summary
0900: Third involuntary admission in the past six months. The client was admitted four days ago because of florid psychosis. During the stay, the client was stabilized with their prescribed aripiprazole. Once stabilized, the client reported nonadherence to aripiprazole because they 'forget.' It is documented that the client also missed two follow-up appointments for some unknown reason. The client was prescribed aripiprazole oral disintegrating tablet (ODT) to optimize adherence versus tablets. Provided two refills and a follow-up appointment at discharge. Thorough counseling was provided regarding the dosing schedule. Considering the client's repeated nonadherence, there is a high probability of readmission. Will consult case management for follow-up.
Orders
0815:
• discharge client home
• case management consultation for repeated readmissions
• arrange outpatient follow-up appointment prior to discharge
• give morning dose of aripiprazole prior to discharge
• discharge with a prescription for aripiprazole 15 mg ODT daily
The case manager reviews the physician's progress notes and orders. Select the actions the case manager should take to reduce the client's risk of readmission.
- A. perform a post discharge follow-up phone call
- B. recommend the client be prescribed a long acting injectable antipsychotic
- C. review the client's advanced directives
- D. assess the client's social determinants of health
- E. arrange for more frequent follow-up appointments
Correct Answer: A, B, D, E
Rationale: Follow-up calls, long-acting injectable antipsychotics, assessing social determinants, and frequent appointments address nonadherence and reduce readmission risk.
The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question?
- A. captopril for a client with congestive heart failure
- B. metoprolol for a client with multiple premature ventricular contractions (PVCs)
- C. verapamil for a client with atrial fibrillation
- D. spironolactone for a client with end-stage renal disease
Correct Answer: D
Rationale: Spironolactone can cause hyperkalemia, which is dangerous in end-stage renal disease, and should be questioned.
The nurse is caring for a client who has been prescribed prednisone. Which of the following statements, if made by the nurse, would be correct?
- A. This medication may make you gain weight.
- B. It is best to take this medication in the morning with food.
- C. If you have pain, it is okay to take ibuprofen.
- D. Your blood pressure may decrease while taking this medication.
- E. You may experience mood changes while on this medicine.
Correct Answer: A, B, E
Rationale: Prednisone can cause weight gain, should be taken in the morning with food to reduce GI upset, and may cause mood changes. Ibuprofen should be avoided due to increased GI risk, and prednisone may increase, not decrease, blood pressure.