Correct answer: A) Decreased need for sleep

Rationale: A client who is experiencing a manic episode may have a decreased need for sleep, as they feel energized, restless, and euphoric. They may also engage in multiple activities, projects, or plans without completing them.

Incorrect options:

B) Social withdrawal - This is more characteristic of a depressive episode, where the client may isolate themselves from others and lose interest in activities they previously enjoyed.

C) Slow and monotonous speech - This is also more indicative of a depressive episode, where the client may have psychomotor retardation, which affects their speech and movement.

D) Low self-esteem - This is another sign of a depressive episode, where the client may have negative thoughts about themselves, their abilities, and their worth.

Correct answer: C) "That must be very frightening for you. I am here to help you."

Rationale: The nurse should respond with empathy and support, acknowledging the client's feelings and offering assistance. The nurse should also assess the client's risk for self-harm and implement safety measures as needed.

Incorrect options:

A) "You should ignore those voices. They are not real." - This is a dismissive and invalidating response that may make the client feel misunderstood and alienated. The nurse should not challenge the client's perception of reality, as this may increase their anxiety and paranoia.

B) "What do the voices sound like? Are they familiar or unfamiliar to you?" - This is an inappropriate response that may encourage the client to focus on the voices and reinforce their delusions. The nurse should not ask questions that may stimulate the client's hallucinations or delusions, as this may worsen their symptoms.

D) "Why do you think the voices are telling you to harm yourself?" - This is a potentially harmful response that may imply that the client is responsible for their hallucinations or that there is a rational explanation for them. The nurse should not ask questions that may increase the client's guilt or confusion.

Correct answer: B) "I understand that you are upset, but this is the policy of the unit. You can see your visitors again tomorrow."

Rationale: The nurse should respond with empathy and assertiveness, acknowledging the client's feelings but also setting clear and consistent boundaries. The nurse should explain the rationale for the policy and offer reassurance that the client can see their visitors again.

Incorrect options:

A) "You have no right to talk to me like that. I am only doing my job." - This is a defensive and confrontational response that may escalate the situation and damage the therapeutic relationship. The nurse should not take the client's anger personally or react emotionally.

C) "If you continue to behave this way, I will have to call security and have them escort your visitors out." - This is a threatening and punitive response that may increase the client's fear of abandonment and provoke more hostility. The nurse should not use coercive or authoritarian tactics unless there is an imminent risk of harm.

D) "You are being manipulative and unreasonable. You need to calm down and accept the situation." - This is a judgmental and invalidating response that may make the client feel misunderstood and rejected. The nurse should not label or criticize the client's behavior or emotions.

Correct answer: C) Allow the client to express their emotions and provide support.

Rationale: The nurse should allow the client to express their emotions and provide support, as this can help the client process their trauma and cope with their feelings. The nurse should also acknowledge the client's courage and strength for sharing their story and thank them for their contribution to the group.

Incorrect options:

A) Ask the client to stop crying and focus on their breathing. - This is a dismissive and insensitive response that may make the client feel ashamed or embarrassed for crying. The nurse should not try to suppress or minimize the client's emotions, as this can hinder their healing process.

B) Encourage the other group members to comfort and hug the client. - This is an inappropriate and potentially harmful response that may violate the client's personal boundaries and trigger more distress. The nurse should not assume that the client wants or needs physical contact, as this may remind them of their trauma or make them feel unsafe.

D) Redirect the conversation to a less distressing topic. - This is an avoidant and unhelpful response that may make the client feel ignored or invalidated. The nurse should not try to distract or divert the client from their emotions, as this can prevent them from working through their trauma.

Correct answer: A) "You should avoid driving or operating heavy machinery for at least 24 hours after your last ECT session."

Rationale: The nurse should instruct the client to avoid driving or operating heavy machinery for at least 24 hours after their last ECT session, as they may still have residual effects of anesthesia, such as drowsiness, impaired coordination, or slowed reaction time.

Incorrect options:

B) "You should expect to experience some memory loss and confusion for several months after your ECT treatment." - This is an inaccurate and alarming statement that may discourage the client from continuing their ECT treatment. The nurse should inform the client that memory loss and confusion are common side effects of ECT, but they are usually mild and transient, lasting only a few days or weeks after each session.

C) "You should discontinue your antidepressant medication once you complete your ECT course." - This is a dangerous and incorrect instruction that may increase the risk of relapse or recurrence of depression. The nurse should advise the client to continue taking their antidepressant medication as prescribed, unless otherwise instructed by their provider. Antidepressant medication can help maintain the therapeutic effects of ECT and prevent depression from returning.

D) "You should monitor your vital signs daily and report any changes to your provider." - This is an unnecessary and unrealistic instruction that may overwhelm or confuse the client. The nurse should not ask the client to monitor their vital signs daily, as this is not a routine part of ECT follow-up care. The nurse should only instruct the client to report any signs or symptoms of complications, such as severe headache, chest pain, or fever.

Correct answer: B) "You should write down your worries in a journal and set them aside until the next day."

Rationale: The nurse should suggest that the client write down their worries in a journal and set them aside until the next day, as this can help them reduce their anxiety and clear their mind before going to sleep. Writing down worries can also help the client gain perspective and identify possible solutions.

Incorrect options:

A) "You should drink a glass of wine or take a sleeping pill before going to bed." - This is an unhealthy and risky strategy that may cause more harm than good. Alcohol and sleeping pills can interfere with sleep quality, worsen anxiety symptoms, and lead to dependence or other negative effects. It is important to promote healthy sleep habits and avoid relying on substances for sleep.

C) "You should watch TV or read a book in bed until you feel sleepy." - This strategy may actually interfere with sleep as electronic devices emit blue light that can disrupt the sleep-wake cycle. It is recommended to avoid electronic screens before bedtime and create a calm and relaxing sleep environment.

D) "You should exercise vigorously right before bedtime to tire yourself out." - While exercise is beneficial for overall sleep quality, engaging in vigorous exercise right before bedtime can actually stimulate the body and make it harder to fall asleep. It is better to schedule exercise earlier in the day and allow time for the body to wind down before sleep.

Correct answer: D) Redirect the client's attention to reality-based topics and activities.

Rationale: The nurse should redirect the client's attention to reality-based topics and activities, as this can help to decrease the client's agitation, distractibility, and impulsiveness. The nurse should also use clear, concise, and calm communication with the client and set consistent limits and expectations.

Incorrect options:

A) Encourage the client to participate in group activities with other clients. - This is an incorrect intervention, as group activities may increase the client's stimulation, agitation, and inappropriate behavior. The nurse should limit the client's interactions with other clients and staff during a manic episode.

B) Provide the client with a quiet, private room and limit stimulation. - This is an incorrect intervention, as isolating the client may increase their feelings of loneliness, rejection, and paranoia. The nurse should provide the client with a safe and structured environment that allows for some social contact and supervision.

C) Allow the client to make decisions about their care and treatment. - This is an incorrect intervention, as the client may have impaired judgment, insight, and decision-making ability during a manic episode. The nurse should involve the client in their care as much as possible, but also consult with the client's family, health care provider, and legal representative if needed.

Correct answer: B) "Do you have any plans or goals for the future?"

Rationale: The nurse should ask the client about their plans or goals for the future, as this can help to assess the client's hopelessness, which is a common symptom of major depressive disorder. Hopelessness is defined as a negative outlook on oneself, one's situation, and one's future. A client who expresses no plans or goals for the future may indicate a lack of hope and motivation.

Incorrect options:

A) "Do you have any hobbies or interests that you enjoy doing?" - This is an important question to ask, as it can help to assess the client's anhedonia, which is another common symptom of major depressive disorder. Anhedonia is defined as a loss of interest or pleasure in previously enjoyed activities. However, this question does not directly assess the client's hopelessness.

C) "Do you have any friends or family members who support you?" - This is an important question to ask, as it can help to assess the client's social support network, which can influence their coping and recovery from major depressive disorder. However, this question does not directly assess the client's hopelessness.

D) "Do you have any religious or spiritual beliefs that give you comfort?" - This is an important question to ask, as it can help to assess the client's spiritual well-being, which can also influence their coping and recovery from major depressive disorder. However, this question does not directly assess the client's hopelessness.

Correct answer: C) Establish eye contact with the client and call them by name.

Rationale: The first action that the nurse should take when administering medication to a client who has schizophrenia and is experiencing auditory hallucinations is to establish eye contact with

the client and call them by name. This can help to gain the client's attention, orient them to reality, and establish rapport and trust.

Incorrect options:

A) Ask the client what they are hearing and how they are feeling. - This is an important action to take, as it can help to assess the client's hallucinations and emotional state, and provide empathy and validation. However, this is not the first action that the nurse should take, as the client may not be able to focus on the nurse's questions or respond appropriately.

B) Explain to the client what medication they are receiving and why. - This is an important action to take, as it can help to educate the client about their medication and its benefits, and obtain their informed consent. However, this is not the first action that the nurse should take, as the client may not be able to comprehend or retain the information.

D) Assess the client's vital signs and check for any adverse effects. - This is an important action to take, as it can help to monitor the client's physical condition and response to the medication. However, this is not the first action that the nurse should take, as the client may not cooperate or tolerate the assessment.

Correct answer: A) Use open-ended questions to encourage the client to express their feelings.

Rationale: Open-ended questions are those that cannot be answered with a simple yes or no, and they allow the client to explore and elaborate on their feelings, thoughts, and experiences. This helps the nurse to gain a better understanding of the client's perspective and needs, and to build trust and rapport with the client.

Incorrect options:

B) Use closed-ended questions to obtain specific information from the client. - Closed-ended questions are those that can be answered with a yes or no, or a short factual response. They are useful for obtaining specific information, such as medical history or symptoms, but they do not facilitate therapeutic communication or rapport building, as they limit the client's opportunity to express themselves fully.

C) Use leading questions to direct the client's thoughts and responses. - Leading questions are those that suggest a desired answer or imply a judgment or opinion from the nurse. They are not appropriate for therapeutic communication, as they can make the client feel pressured, manipulated, or defensive, and they can interfere with the client's autonomy and self-determination.

D) Use clichés to reassure the client and minimize their concerns. - Clichés are overused or trite expressions that have lost their original meaning or impact. They are not helpful for therapeutic communication, as they can convey a lack of empathy, sincerity, or interest from the nurse, and they can invalidate or dismiss the client's feelings and concerns.

Correct answer: C) "I'm having trouble following your thoughts. Can you slow down a bit?"

Rationale: The nurse should use a calm, clear, and concise communication style when interacting with a client who is experiencing mania, as this can help to reduce stimulation and confusion for the client. The nurse should also provide feedback on the client's behavior and speech patterns, and gently redirect the client to focus on one topic at a time.

Incorrect options:

A) "You need to calm down and stop talking so much." - This is an inappropriate response by the nurse, as it is rude, dismissive, and authoritarian. It does not acknowledge or address the underlying cause of the client's behavior, which is a symptom of their mental illness. It also does not promote therapeutic communication or rapport building, as it can make the client feel criticized, rejected, or angry.

B) "Tell me more about your plans for becoming a famous singer." - This is an inappropriate response by the nurse, as it encourages the client to elaborate on their grandiose ideas, which are unrealistic and indicative of impaired judgment. It also does not provide any feedback or guidance for the client, who may benefit from reality orientation and limit setting.

D) "You are being unrealistic and delusional. You need to face reality." - This is an inappropriate response by the nurse, as it is harsh, confrontational, and judgmental. It does not demonstrate empathy or respect for the client's feelings and experiences, which may be very real and meaningful for them. It also does not foster therapeutic communication or rapport building, as it can make the client feel attacked, humiliated, or defensive.

Correct answer: A) "I understand that this is a difficult situation for you and your family. How can I support you in making this decision?"

Rationale: The nurse should respect the client's autonomy, which is the right to make one's own decisions and choices, especially regarding end-of-life care. The nurse should also acknowledge the client's feelings and the complexity of the situation, and offer support and assistance in facilitating communication and decision making between the client and the family.

Incorrect options:

B) "I think you should reconsider your decision. Your family knows what is best for you and they love you very much." - This statement does not respect the client's autonomy, as it implies that the client's decision is wrong or invalid, and that the family's wishes should override the client's preferences. It also does not acknowledge or address the client's feelings or concerns, and it may increase the client's guilt or distress.

C) "I agree with your decision. It is your right to choose where you want to die and I will advocate for you." - This statement does not respect the client's autonomy, as it expresses the nurse's personal opinion or agreement with the client's decision, which may influence or pressure the client. It also does not acknowledge or address the family's feelings or concerns, and it may create conflict or resentment between the nurse and the family.

D) "I don't think you are in the right state of mind to make this decision. You should listen to your doctor's advice." - This statement does not respect the client's autonomy, as it questions the client's mental capacity or competence to make their own decision, and it suggests that the doctor's authority or expertise should prevail over the client's wishes. It also does not demonstrate empathy or compassion for the client, and it may undermine the client's trust or confidence in the nurse.

Correct answer: C) "What do you think is causing these symptoms?"

Rationale: The nurse should ask open-ended questions that invite the client to share their thoughts, feelings, and perceptions about their health condition and its possible causes. This can help the nurse to identify any contributing factors, such as stress, lifestyle habits, or environmental triggers, that may be associated with the client's symptoms. It can also help the nurse to assess the client's level of insight, awareness, and readiness for change.

Incorrect options:

A) "How long have you been experiencing these symptoms?" - This is a closed-ended question that can be answered with a specific time frame, such as days, weeks, or months. It does not elicit information about the possible cause of the symptoms, but rather about their duration or frequency.

B) "How do these symptoms affect your daily activities?" - This is an open-ended question that can elicit information about the impact or severity of the symptoms on the client's functioning and quality of life. It does not elicit information about the possible cause of the symptoms, but rather about their consequences or outcomes.

D) "What have you done to manage these symptoms?" - This is an open-ended question that can elicit information about the client's coping strategies, self-care practices, or treatment options for their symptoms. It does not elicit information about

the possible cause of the symptoms, but rather about their management or resolution.