Psych and Mental Health
A nurse with burnout asks the nurse manager, "What can I do to prevent burnout in the future?" What is the best response by the nurse manager?
"Develop a wide variety of coping strategies."
The nurse finds a client with schizophrenia lying under a bench in the hall. The client says, "God told me to lie here." What is the best response by the nurse?
"I didn't hear anyone talking; come with me to your room."
An adolescent who is extremely underweight and disappears into the bathroom after meals angrily says to the nurse, "I don't need to be here. I don't have any problems. Stop watching me." What is the most therapeutic response by the nurse, aimed at reducing the client's feeling of being threatened?
"I hear how frustrated you are to be here."
A client with the diagnosis of obsessive-compulsive disorder who has a need to wash his hands 50 to 60 times a day tearfully tells the nurse, "I know that my hands aren't dirty, but I just can't stop washing them." What is the best response by the nurse?
"I understand that—maybe we can work together to limit the number of times you wash them."
A 15-year-old client tearfully states that her father has been sexually abusing her for the past 8 years. What statement should the nurse initially respond with?
"Sharing this information is a positive step in getting help."
A nurse is working with a client experiencing a major depressive episode. What is a long-term outcome for this client?
Verbalizing realistic perceptions of self and others
A nurse is preparing a teaching plan for a client who is to undergo electroconvulsive therapy. What instructions should the nurse include?
Void just before the procedure.
A client in the mental health clinic has pressured speech and mumbles incoherently. What is the most appropriate nursing intervention?
A client in the mental health clinic has pressured speech and mumbles incoherently. What is the most appropriate nursing intervention?
A nurse is caring for a client who has been hospitalized for alcohol withdrawal. The client decides to attend an Alcoholics Anonymous (AA) meeting. What is a basic principle of this group?
Amends must be made to each person who has been harmed.
A nurse in a long-term care facility is caring for a bedridden client with multiple chronic illnesses. Although usually continent, the client expresses anger through urinary incontinence. What should the nurse do to best address this situation?
Assist the client in setting realistic short-term goals.
A client exhibits physical symptoms in response to stress. What nursing intervention may help the client reduce this physiological response to stress?
Assisting the client in developing new coping mechanisms
A nurse is caring for a client admitted to a mental health unit because of suicidal ideation. Which intervention provides the greatest safety for this client?
Constant one-on-one supervision
When planning nursing care for a client with severe agoraphobia, what should the nurse do first?
Determine the client's degree of impairment
A nurse is caring for a client with vascular dementia. What does the nurse expect of this client's mental status?
Difficulty recalling recent events related to cerebral hypoxia Rationale: Cell damage seems to interfere with how input stimuli are registered, which affects the ability to register and recall recent events; vascular dementia is related to multiple vascular lesions of the cerebral cortex and subcortical structures. The remote memory usually is not impaired to any great degree. The loss of abstract thinking is related to cell damage, not the emotional state. The inability to concentrate is related to cell damage, not decreased stimuli.
A 16-year-old boy with a diagnosis of adolescent adjustment disorder and his family are beginning family therapy. What is the best initial nursing approach?
Encouraging each family member to share how the problem is perceived
A client has recently undergone what was personally considered "a third unsuccessful cosmetic surgery." The primary healthcare provider diagnoses body dysmorphic disorder. What is the primary nursing objective?
Exploring the issues that influence the client's self-perception
A registered nurse who is a beginning group leader in a community mental health center has been assigned to start a new group with regressive long-term clients. The nurse manager explains that in the beginning new group leaders are expected to do what?
Feel uncomfortable handling conflicts between members of the group.
A nurse is caring for a female client during the manic phase of bipolar disorder. What should the nurse do to help the client with personal hygiene?
Guide her to dress appropriately in her own clothing.
Which outcome specific to a client with impaired verbal communication related to a psychologic barrier should be documented in the client's clinical record?
Interacting appropriately with others in the therapeutic milieu
An adult is found to have schizotypal personality disorder. How should a nurse describe the client's behavior?
Introverted and emotionally withdrawn
A client has been actively hallucinating for several days. What is the most therapeutic nursing intervention?
Involving the client in simple activities on the unit
A 5-year-old with attention deficit-hyperactivity disorder (ADHD) exhibits a short attention span and demonstrates intermittent head-banging and hair-pulling, as well as excessive motor activity. What is the priority nursing objective for this child?
Maintaining safety
A client with schizophrenia is demonstrating waxy flexibility. Which intervention is the best way to manage the possible outcome of this behavior?
Performing passive range-of-motion exercises three times a day for effective joint health
A client says, "Since my husband died I've got nothing to live for. I just want to die." The nurse hears the nursing assistant say, "Things will get better soon." What does the nurse identify this response as?
Providing false reassurance
The primary objective of nursing intervention for clients with dementia, delirium, and other cognitive disorders is to maintain what?
Safety within the environment
During a group therapy session, after several members relate traumatic incidents that happened during the week, a client says with a smile, "Things haven't gone well in my life this week either." It is most appropriate for the nurse to what?
Say to the client, "You say things have been bad this week, but you're smiling." Rationale: "You say things have been bad this week, but you're smiling" is an open-ended, nonjudgmental response that points out incongruity between the client's verbal and nonverbal communication. Asking the client to share, remaining silent but making a note of the incongruity, or noting that it has been a bad week for several of the group's members will not help the client recognize the incongruity.
A nurse is caring for several extremely depressed clients. What type of setting does the nurse recognize these clients do best in?
Simple daily routines
An autistic toddler is sitting in a corner, rocking and spinning a top. How can the nurse be most therapeutic when approaching this toddler?
Sitting with the toddler while watching the spinning top to provide a nonintrusive presence
After a conference with the primary healthcare provider, a client with a borderline personality disorder cries bitterly, pounds the bed in frustration, and threatens suicide. What is the most helpful response by the nurse?
Staying with the client and listening attentively if the client wishes to talk about the problem
A nurse is counseling a client who has had an angry episode that subsided after several minutes. What is the most important short-term objective for the client?
Talking about situations that cause angry outbursts
A hyperactive 9-year-old child with a history of attention deficit-hyperactivity disorder is admitted for observation after a motor vehicle collision. On what should nursing actions be focused when the nurse is teaching about personal safety?
Talking with the child about the importance of using a seat belt
A client with a history of violence is increasingly agitated. Which immediate nursing intervention will most likely increase the risk of acting-out behavior?
Teaching relaxation
While watching television in the dayroom, a client who has demonstrated withdrawn, regressed behavior suddenly screams, bursts into tears, and runs from the room to the far end of the hallway. What is the most therapeutic intervention by the nurse?
Walking to the end of the hallway where the client is standing
A male client is preparing to leave the hospital and return to college. When saying goodbye he hugs the nurse and kisses her on the cheek. What is the most appropriate response by the nurse?
Wish him well with his future studies.
The nurse interviews a young client with anorexia nervosa to obtain information for the nursing history. What will the client's history most likely reveal? Select all that apply.
!!!!!!! Ritualistic behaviors Desire to improve self-image
What response from the nurse demonstrates an understanding of hallucinating behavior by a client?
Asking, "What are the voices telling you to do?"
What should a nurse consider when planning care for a client who is using ritualistic behavior?
Clients do not want to repeat their rituals but feel compelled to do so
An older adult who lives alone tells a nurse at the community health center, "I really don't need anyone to talk to. The TV is my best friend." What defense mechanism does the nurse identify?
Denial
A 23-year-old client is admitted to a psychiatric unit after several episodes of uncontrolled rage at her parents' home, and borderline personality disorder is diagnosed. While watching a television newscast describing an incident of violence in the home, the client says, "People like that need to be put away before they kill someone." The nurse concludes that the client is using what?
projection
During an assessment the nurse realizes that the client is experiencing a hallucination when the client says what?
!!!!!!"My insides smell like they're going to just rot away."
A terminally ill client is moving gradually toward resolution of feelings about impending death. In a plan of care based on Elisabeth Kübler-Ross' research, the nurse should use nonverbal interventions after having assessed that the client is in which stage?
Acceptance stage Rationale: When acceptance is reached, the individual is beginning to withdraw from life; communication is simple, concise, and most often nonverbal. Kübler-Ross' research has shown that at this stage, verbal communication is typically less important and touch and presence are most important. The client has moved past the anger, denial, and bargaining stages.
A client is admitted to the psychiatric unit after attempting suicide by taking an overdose of barbiturates. What is the most common precipitator of suicide that the nurse should consider when performing an assessment interview?
A severe overreaction to stress
A client with a diagnosis of major depression refuses to participate in unit activities, claiming to be "just too tired." What is the best nursing approach?
Accepting the client's feelings about activities calmly while setting firm limits
The nurse at the mental health clinic is counseling a client with obsessive-compulsive disorder who spends a lot of time each day engaged in handwashing and has trouble keeping appointments on time as a result. What is the most therapeutic initial intervention by the nurse?
Accepting the ritualistic behavior with a matter-of-fact attitude without displaying criticism
A nurse on the pediatric unit is assigned to care for a 2-year-old child with a history of physical abuse. What does the nurse expect the child to do?
Be wary of physical contact initiated by anyone.
A client remains depressed even after an 8-week trial on several antidepressant medications. A decision to initiate electroconvulsive therapy (ECT) is being considered by the treatment team. Which condition is a contraindication to ECT?
Brain tumor
A hospitalized client with borderline personality disorder consistently breaks the unit's rules. How will confronting the client about this behavior help the client?
By fostering self-awareness
A client with an inoperable temporal lobe tumor is experiencing frightening auditory hallucinations, especially when alone. How can the nurse best help the client cope with these hallucinations?
By suggesting that the client turn on the radio or television when alone
A nurse who is working on a psychiatric unit notes that a client with schizophrenia is beginning to pace around the lounge while glaring at other clients. How should the nurse respond to this behavior?
By walking with the client to a quiet area on the unit
A cachectic adolescent with the diagnoses of anorexia nervosa, dehydration, and electrolyte imbalances is admitted to a mental health facility. The adolescent has been obsessed with weight, has exercised for hours every day, has taken enemas and laxatives several times a week, and has engaged in self-induced vomiting. What outcome is a priority for the nurse planning care for this client?
Correcting electrolyte imbalances
The parents of a toddler with recently diagnosed moderate cognitive impairment state, "Our child should be able to attend college with help and medication." What should the nurse conclude?
Denial is being used as a defense mechanism Rationale: Use of denial involves a failure to acknowledge the reality of a situation. Intellectualization would involve discussing the child's problem in a technical manner; this is not being demonstrated in this situation. A desire to explore the child's limitations or to put the diagnosis into perspective is not demonstrated in this situation. Children with moderate cognitive impairment are unable to succeed with a higher education. Medication may help symptoms but will not be able to change the outcome of the disorder. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes.
A client's parents ask about the treatment of their child who has a recent diagnosis of schizophrenia. Before responding, what should the nurse consider?
Drug therapy, although it does not eliminate the underlying problem, reduces the symptoms of acute schizophrenia.
A nurse is caring for a client who was recently admitted to the psychiatric unit with the diagnosis of bulimia nervosa. Which assessment findings support the diagnosis of bulimia nervosa?
!!!!!!!Lack of control over binge-eating episodes
What should the nurse do when planning continuing care for a moderately depressed client?
!!!!!!!Offer the client the opportunity to make some decisions.
A client with a borderline personality disorder is admitted to the mental health unit. What should the nurse do to maintain a therapeutic relationship with the client?
Be firm, consistent, and understanding and focus on specific target behaviors.
When caring for a newly admitted depressed client, a nurse arranges for a staff member to remain with the client continuously. What information supports the nurse's decision to institute this precaution? Select all that apply.
!!!!!!! Agitated pacing in the hall History of suicide attempts Statements that life is not worth living
A client exhibiting manic behavior is admitted to the psychiatric hospital. Which room assignment is the most appropriate for this client?
!!!!!!! Alone in a sparsely furnished room
When a client who has a bipolar mood disorder is hyperactive, it is difficult to entice her to sit still long enough to eat a complete meal. The plan of care states, "Provide finger foods such as carrots, celery, and cheese sticks at 10 am, 2 pm, and 7 pm." Recent assessment of this client indicates that all of the food provided at mealtimes is being eaten but that snacks have been refused. What should the nursing staff do?
!!!!!!!Change the plan, depending on evaluation findings.
A client is admitted to the acute care psychiatric unit with a diagnosis of panic disorder with agoraphobia. During the initial assessment phase, what should the nurse focus on?
!!!!!!!Easing the client's anxiety so further interviewing may be done
A young mother of three children, all born 1 year apart, has been hospitalized after trying to hang herself. The client is being treated with milieu therapy. The nurse understands that this therapeutic modality consists of what?
!!!!!!!Providing a supportive environment to benefit the client
A male client with the diagnosis of bipolar disorder, depressed episode, is found lying on the floor in his room in the psychiatric unit. He states, "I don't deserve a comfortable bed; give it to someone else." What is the best response by the nurse?
"Everyone has a bed. This one is yours."
A depressed client tells the nurse, "I don't get out of bed most mornings because I don't feel like it." What is the best reply by the nurse?
"Getting up and involved in an activity should help lift your mood."
A 65-year-old retired baker is admitted to the hospital with the diagnosis of dementia. What question by the nurse best tests the client's capacity for abstract thinking?
"How are a television and a radio alike?"
A nurse sits with a depressed client twice a day, but there is little verbal communication. One afternoon the client asks, "Do you think they'll ever let me out of here?" What is the best reply by the nurse?
"How do you feel about leaving here?"
A client with a mood disorder is being discharged from a psychiatric hospital after agreeing to continue follow-up visits with a therapist. During the last interview with the nurse before discharge, the client says, "I've told you a lot about my life and my problems, but there are a few things that bother me that I've told no one." What is the most therapeutic response by the nurse once it has been determined that the client is not at risk for self-harm or harming others?
"One purpose of continuing counseling is to allow you to discuss things that bother you."
What is the most appropriate response by a nurse to a parent's question about childhood suicide?
"Suicide threats in children should be taken seriously."
A nurse leads an assertiveness training program for a group of clients. Which statement by a client indicates that the treatment has been effective?
"It annoys me when people call me 'sweetie,' so I told him not to do it anymore."
A client is admitted to the surgical unit with superficial wounds of both wrists, the result of a suicide attempt. When the nurse enters the room, the client says, "I suppose you're going to ask me about my suicide attempt." What is the best response by the nurse?
"Tell me how you feel about it."
While admitting a young client with anorexia nervosa to the unit, the nurse finds a bottle of assorted pills in the client's luggage. The client tells the nurse that they are antacids for stomach pains. What is the best initial response by the nurse?
"Tell me more about these stomach pains."
A male client with a history of schizophrenia comes to the emergency department, accompanied by his wife. What is the emergency department nurse's priority intervention?
!!!!!!Observing and evaluating his behavior
A nurse is counseling a recently widowed client, who says, "His death has complicated my life even more than the hassles he caused when he was alive!" The nurse realizes the client is having difficulty with the grieving process and concludes that the relationship with the husband was probably what?
!!!!!Ambivalent
A client on the psychiatric unit tells the nurse, "I'm a movie star, and the other clients are my audience." What is an appropriate conclusion for the nurse to document about what the client is experiencing?
!!!!!!!! delusion of grandeur
The nurse is caring for a client with a somatoform disorder, conversion-type paralysis. What is the best nursing approach?
!!!!!!!!! Discussing topics other than the paralysis
The nurse explores the possibility of joining Narcotics Anonymous (NA) with a client who has a history of drug abuse. What is a major reason that NA is helpful in treating addictive behavior?
!!!!!!!!!Group members are supportive of one another's problems.
A pregnant client with a history of delusions, hallucinations, and suspiciousness tells the nurse she is fearful about the upcoming birth and the health of her baby. What is the best initial approach by the nurse?
!!!!!!!!Commending the client on her ability to express her concerns
A paranoid client is scheduled to begin group therapy. The client refuses to attend. What should the nurse do next?
!!!!!!!Accept the client's decision without discussion.
What should the nurse include when developing a plan of care for a client in the manic phase of bipolar disorder?
!!!!!! Redirecting the client's excess energy to more constructive activities
A client with obsessive-compulsive disorder is working toward discussing how the anxiety influences feelings and the ability to function. What should the nurse include when planning care for this client? Select all that apply.
!!!!!!!!Exploration of anxiety-provoking situations Assisting the client in examining personal standards
A client with a history of depression tells the nurse about planning to retire from work next year. What common dynamic about retirement should the nurse consider when interacting with this client?
!!!!!!!!It is a developmental task of significance.
A nurse concludes that a client has successfully achieved the long-term outcome of mobilizing effective coping responses when the client states the plan to do what when feelings of anxiety begin?
!!!!!!!!Perform a relaxation exercise
What is most appropriate for a nurse to say when interviewing a newly admitted depressed client whose thoughts are focused on feelings of worthlessness and failure?
"Tell me how you feel about yourself."
One evening a nurse finds a client who has been experiencing persecutory delusions trying to get out the door. The client begs, "Please let me go. I trust you. The Mafia is going to kill me tonight." Which response is most therapeutic?
"You're frightened. Come with me to your room, and we can talk about it."
A client with a diagnosis of paranoid schizophrenia throws a chair across the room and starts screaming at the other clients. Several of these clients have frightened expressions, one starts to cry, and another begins to pace. A nurse removes the agitated client from the room. What should the nurse remaining in the room do next?
Arrange a unit meeting to discuss what has just happened. Rationale: Arranging a unit meeting to discuss what has just happened provides an opportunity for the other clients to voice and share feelings and to identify and separate real from imaginary fears; an open expression of feelings allows the nurse to address clients' fears and provide reassurance. Ignoring the situation denies reality and may precipitate or reinforce feelings of vulnerability and fear in the other clients. Refocusing clients' negative comments to more positive topics denies clients' concerns and could increase their anxiety and fear. Having a private talk with the clients who cried or started to pace may meet the needs of these two clients but ignores the needs of the other clients.
A depressed, withdrawn client exhibits sadness through nonverbal behavior. What should the nurse plan to help the client to do?
Cope with painful feelings by sharing them.
A hyperactive, acting-out 9-year-old boy is started on a behavior modification program in which tokens are given for acceptable behavior. When he begins to lose a game he is playing with other children, he begins to kick the other children under the table and call them names. What is the most appropriate behavior modification technique for the nurse to use?
Placing the child in a time-out Rationale: Placing the child in a short time-out will be most successful, because it provides a period in which the hyperactive child can regain control. It is neither a positive nor a negative reinforcement of acting-out behavior; it prevents injury to the other children. Ignoring the behavior may force the child to act out even more to gain attention. Taking the child's daily allotment of tokens away will not change the acting-out behavior. Engaging the child in a conversation about good sportsmanship rewards acting-out behavior by providing special attention.
A nurse anticipates that most clients with phobias will use which defense mechanisms?
Projection and displacement Rationale: Clients with phobias cope with anxiety by placing it on specific persons, objects, or situations through displacement, projection, or both. The person with a phobia recognizes and admits the exaggerated fear as a real part of the self and does not deny it. Neither introjection, whereby a person internalizes and incorporates the traits of another, nor sublimation, whereby socially acceptable behavior is substituted for unacceptable instincts, is related to phobic activity. A less valued object is not substituted for one more highly valued (substitution), nor are the expressed feelings opposite of the experienced feelings of fear (reaction formation).
A client with a conversion disorder is experiencing paralysis of a leg. What should the nurse expect this client to do?
Recover use of the affected leg but, under stress, to again experience these symptoms Rationale: A conversion type of defense tends to be a learned behavioral response that the individual will use when experiencing excessive stress. A spread of the paralysis to other body parts is not likely. Psychiatric treatment may be needed at different times throughout life, but usually not on a continuous basis. Studies of this disorder have revealed that its course is somewhat predictable; it usually returns when the client is under severe stress.
A 17-year-old client is admitted to the hospital because of weight loss and malnutrition, and the primary healthcare provider diagnoses anorexia nervosa. After the client's physical condition is stabilized, the provider, in conjunction with the client and parents, institutes a behavior-modification program. What component of behavior modification verbalized by parents leads the nurse to conclude that the parent has an understanding of the therapy?
Rewarding positive behavior
What is the priority nursing intervention in the planning of nursing care for an adolescent client with anorexia nervosa?
Rewarding weight gain by increasing privileges
A 15-year-old client is being assessed in the adolescent clinic. He has a history of drug abuse, stealing, refusing to comply with rules, and demonstrating an inability to get along with others in any setting. When obtaining the health history, the nurse may be prevented from accurately listening to what the client is saying because of what?
The nurse's personal cultural beliefs Rationale: Without an awareness of personal beliefs, the nurse unconsciously may stop listening if the client expresses actions and beliefs that contradict those of the nurse's. Although the client's disease process and time pressures and the nurse's personal need to obtain information may all create some anxiety, usually none of these interferes with accurate listening.
A male college student who is smaller than average and unable to participate in sports becomes the life of the party and a stylish dresser. What defense mechanism does the nurse determine that the client is using?
compensation Rationale: By developing skills in one area, the individual compensates for a real or imagined deficiency in another, thereby maintaining a positive self-image. Had the student incorporated the qualities of the college athlete, that would be introjection. Sublimation is related to unacceptable impulses that may pose a threat. This person is trying to make amends not for unacceptable feelings (reaction formation), but rather for a believed deficiency and an inadequate self-image.
What is most important for a nurse to do when initially helping clients resolve a crisis situation?
support coping behaviors Rationale: In a crisis situation, the individual frequently just needs support to regroup and re-establish the ability to cope. Socialization is part of recovery; this is not done during the initial stage of a crisis. Meeting dependency needs is not possible or realistic. Involving clients in a therapy group may have the effect of increasing anxiety, thereby making the crisis situation worse
After a week on the mental health unit, a client with the diagnosis of paranoid schizophrenia continues to say, "They're trying to kill me. They all are." What is the best response by the nurse?
!!!!!!!"You're having very frightening thoughts."
The nurse is caring for a client who has attempted suicide. What is the most desirable short-term client outcome during this crisis situation?
!!!!!!!Establishing a no-suicide contract
The nurse is working with a client who talks freely about feeling depressed. During the interaction the client states, "Things will never change." What findings support the nurse's conclusion that the client is experiencing hopelessness? Select all that apply.
!!!!!!!bouts of crying self-destructive acts feelings of worthlessness
A client is heard saying, "I like eggs, fried by Meg, served on a keg, kicked in the leg and don't want her to hoopanize them ever again." What should the nurse note in the client's record?
!!!!!!"Client demonstrates clang association and neologism speech patterns."
A client who has severe anxiety starts to cry while talking with the nurse. The client is so upset that the crying becomes uncontrollable. What is the best response by the nurse?
!!!!!!"It's okay to cry; I'll just stay with you for now."
One day the nurse and a young adult client sit together and draw. The client draws a face with horns and says, "This is me. I'm a devil." What is the best response by the nurse?
!!!!!!"When I look at you I see a person, not a devil."
What treatment should a nurse anticipate will be prescribed for a client with severe, persistent, intractable depression and suicidal ideation?
!!!!!!Electroconvulsive therapy
To therapeutically relate to parents who are known to have maltreated their child, what must the nurse do first?
!!!!!!Identify personal feelings about child abusers.
What should be the nurse's first intervention in the care of a client with a generalized anxiety disorder?
!!!!!!Removing as many stimuli from the client's environment as possible
What should a nurse who is caring for a hospitalized older client with dementia consider before planning care?
!!!!!!Routines provide stability for clients with dementia.
A nurse in a community therapeutic recreation program is working with a client with dysthymia. The treatment plan suggests group activities when possible for this client. What is the priority rationale for this intervention?
!!!!!A group can offer increased support.
A nurse is caring for a young, hyperactive child with attention deficit-hyperactivity disorder who engages in self-destructive behavior. What is the most important nursing objective in the planning of care for this child?
!!!!!Keeping the child from inflicting any self-injury
A primary healthcare provider prescribes an antidepressant for a hospitalized client who has been severely depressed. Eight days later the nurse notes that the client is neatly dressed and well groomed. The client smiles at the nurse and says, "Things sure look better today." What nursing response is appropriate in light of the client's statement?
Arranging for constant supervision of the client
A 25-year-old woman with the diagnosis of bipolar disorder, manic episode, is admitted to the psychiatric unit. A nurse on the unit reviews the admission information provided by the client's husband and assesses the client. In light of the information in the chart, what is an appropriate nursing intervention?
Assigning the client to a private room Rationale: During the acute phase of mania, care should be focused on maintaining the safety of the client and others and decreasing the client's energy expenditure. Hypersexuality is often associated with the manic episode of bipolar disorder. Obtaining sexual pleasure by exposing the genitals (exhibitionism) is a paraphilia. A private room protects the other clients and provides privacy for the client. The client is too hyperactive to engage in group activities, and hypersexual behavior may precipitate anxiety in the other clients. Also, manic clients can be overly competitive, which may disturb the other clients. Activities at this time should be solitary or one-on-one with the nurse or nursing assistant. Manic clients have flight of ideas (rapid racing thoughts) and are easily distracted. Introspection and the development of insight cannot occur during this phase of the illness. The hyperactive client will not have the self-control to sit long enough to eat a meal. The nurse should provide finger foods and other portable foods (e.g., sandwich, fruit, milkshake) and encourage the intake of food with short declarative statements that direct the client to eat (e.g., "Finish your sandwich." or "Eat this banana.").
The nurse is facilitating group therapy for clients with the diagnosis of chronic undifferentiated schizophrenia. The nurse begins the first meeting with an introduction of all group participants. What should the nurse do next?
Share with the clients the purpose of the meetings and explain the rules of behavior.