Correct Answer: D

Rationale: The correct action for the LPN/LVN to take first is to ask the client to inform the staff if she has negative thoughts about other clients. This approach is crucial as it helps in monitoring the client's thoughts and behaviors, potentially preventing any harmful actions towards others on the unit. Asking for the client's definition of 'provocative sluts' (
Choice
A) may not address the immediate concern of monitoring the client's harmful thoughts. Asking the young female clients to dress less provocatively (
Choice
B) is inappropriate and victim-blaming. Asking the client to discuss her concerns in the next group session (
Choice
C) may not be effective in addressing the potential harm the client's thoughts could pose to others on the unit.

Correct Answer: C

Rationale: During the manic phase of bipolar disorder, individuals may experience heightened levels of energy and agitation. Engaging in activities that are overly stimulating, such as playing basketball with others (choice
A) or taking a walk in a garden (choice
B), can exacerbate these symptoms. Writing in a journal (choice
D) may also be too stimulating and may not provide the necessary distraction. Working on a puzzle in a quiet room (choice
C) can offer a calming and focused activity that helps reduce anxiety and channel excess energy into a structured task, making it the most appropriate choice for a client in the manic phase of bipolar disorder.

Correct Answer: A

Rationale: The correct response is to ask the client what she believes the news commentator said, as it helps the nurse assess the client's perception and delve into her delusions without being confrontational.
Choice B is not helpful in addressing the client's delusions.
Choice C jumps to conclusions about potential harm without assessing the client's beliefs.
Choice D is dismissive and does not address the client's reality.

Correct Answer: D

Rationale: The correct answer is D:
Torticollis. Common side effects of aripiprazole include headaches, mild anxiety, and insomnia. These side effects are manageable during treatment.
Torticollis is not a common adverse effect associated with aripiprazole and is more commonly seen with other medications or conditions.
Therefore, the nurse should not include torticollis in the teaching plan about the most common adverse effects of aripiprazole.

Correct Answer: B

Rationale: The correct answer is B. SSRIs like sertraline may take several weeks to reach their full therapeutic effect, so it's important to inform the client to be patient with the treatment.
Choice A is not the most crucial information regarding sertraline.
Choice C is not a common side effect of sertraline.
Choice D is important but not as crucial as informing about the delayed onset of action.