questions and answers
Nurse Ben performs Susan Choi's initial mental status assessment. Which of the following categories
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indicates correct nursing assessment findings? (You will find hot spots to select in the artwork below. - Correct
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Answer ✔✔ - The client is experiencing a manic episode with inappropriate responses that are not within
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appropriate limits. (Grandulose thinking)
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Nurse Ben and the nursing staff conduct a care planning conference to discuss nursing actions to promote
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Susan Choi's recovery. Which of the following nursing actions should Ben implement? (Select all that apply.) -
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Correct Answer ✔✔ - Using a firm, calm, matter-of-fact approach can provide structure and offer security to a
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client who is feeling out of control. Offering high-calorie drinks can compensate for increased caloric
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expenditures during hyperactivity and prevent serious dehydration. Decreasing light, noise, and interactions
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can minimize anxiety and agitation. Using distraction to redirect the client to constructive behaviors makes
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positive use of the client's distractibility. Use of open-ended statements does not provide structure or direction
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for a client experiencing a manic episode. Encouraging competitive activities can increase excitability and
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evoke angry outbursts.
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Nurse Ben develops an initial meal plan for Susan Choi and is preparing to discuss the plan with Susan and her
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mother. Which of the following menus represents an appropriate diet for Susan? (Select the appropriate
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image.) - Correct Answer ✔✔ - A client who is experiencing a manic episode is hyperactive and typically
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unable to sit for meals. This meal offers "finger foods," and a non-caffeinated beverage, which the client can
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consume while moving around. But the bagel could be difficult to chew and a peach is messy when eaten. The
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meal also offers high-protein, high-calorie foods with no utensils. (option c)
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Nurse Ben is planning care for Susan and is reviewing manifestations of lithium toxicity. The nurse should
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monitor for which of the following findings? - Correct Answer ✔✔ - ataxia
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Nurse Ben reviews Susan Choi's assessment data. Which of the following assessment tools should he use to
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identify suicide risk factors and the need for hospitalization? - Correct Answer ✔✔ - SAFE-T
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Nurse Ben is reviewing the adverse effects of lamotrigine. Which of the following is a serious adverse effect of
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this medication? - Correct Answer ✔✔ - Stevens johnsons syndrome
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Nurse Ben responds to Susan's despondent behavior. Which of the following is an appropriate response by
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Ben? - Correct Answer ✔✔ - "Do you have a plan for how you would end your life?"
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Nurse Ben is planning discharge outcomes for Susan Choi. Identify client outcomes for Susan in the following
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areas: lifestyle support/bipolar management, medication management, and crisis management. (Include
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three or more outcomes for each category.) - Correct Answer ✔✔ - Maintain consistent patterns in sleep,
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meals, and activities,Take prescribed medication, even when feeling well,Identify signs of bipolar relapse and
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possible precipitating factors (disturbance in sleep patterns, intake of caffeine, alcohol, drug abuse, and
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discontinuing prescribed medications)
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Nurse Ben continues to collect information related to Susan Choi's episode of manic behavior. Which of the
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following responses to the question asked by the client's mother is appropriate? - Correct Answer ✔✔ -
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"According to the literature, there is strong genetic predisposition for bipolar disorders."
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Susan Choi behaves seductively towards Nurse Ben. Which of the following responses by Ben is appropriate?
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- Correct Answer ✔✔ - Give clear expectations of behavior
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