A client has a co-occurring diagnosis of alcoholism and bipolar disorder. He was brought to the emergency department by two policemen who had broken up a fight that the client had gotten into in a neighborhood bar. The client is intrusive and verbose about having diplomatic immunity and his pressing need to tour the bistate area to promote his bid for the presidency. The client has had multiple admissions to the hospital's psychiatric unit, and he has almost always experienced alcohol withdrawal syndrome immediately after his previous admissions. Which of the following would be a priority for this client?

Correct Answer: B

Rationale: The correct answer is B because monitoring the client's vital signs is crucial in assessing for early signs of alcohol withdrawal, which is a life-threatening condition. This is a priority as the client has a history of experiencing alcohol withdrawal after previous admissions. Administering mood-stabilizing medications (A) may be necessary but not the immediate priority. Asking the client to refrain from being intrusive (C) is not addressing the underlying issue of alcohol withdrawal and bipolar disorder. Referring the client to a substance abuse treatment center (D) is important but not the priority when the client is exhibiting signs of potential alcohol withdrawal.

Correct Answer: C

Rationale: The correct answer is C: Nonfatal act with the intent to die. Parasuicide refers to self-harming behaviors that are not fatal but are carried out with the intention of causing harm or death to oneself. This differs from a voluntary act of killing oneself (Option A), as parasuicide does not result in death. It also differs from all suicide-related behaviors and thoughts (Option B), as parasuicide specifically involves nonfatal actions. Finally, it is distinct from a voluntary attempt without death as the aim (Option D), as parasuicide is characterized by the intent to die, even though death may not occur.

Correct Answer: A

Rationale: The correct answer is A because the instructor's response highlights the potential negative impact of the student's question on the client. By pointing out that the question implied criticism, the instructor is guiding the student to be more mindful of their language and approach with clients. This response promotes patient-centered care and emphasizes the importance of maintaining a non-judgmental and supportive environment for clients. Choice B is incorrect because it focuses on the positive aspect of the student's question without addressing its potential harm. Choice C is incorrect because it assumes the student's question was appropriate when it may have been insensitive. Choice D is incorrect because it only mentions the student's focus on the topic without addressing the underlying issue of possible criticism.

Correct Answer: A

Rationale: The correct answer is A: A daytime heart rate of less than 50 beats per minute. This criterion indicates severe bradycardia, which is a sign of cardiac compromise in individuals with eating disorders. Bradycardia is a serious medical complication associated with malnutrition and can lead to cardiac arrhythmias, heart failure, and even sudden death. Monitoring heart rate is crucial in assessing the severity of an eating disorder and the need for hospitalization. Choice B (an oral temperature of 100°F or more) is not a specific criterion for hospital admission in eating disorders. Choice C (90% of ideal body weight) is an important indicator of malnutrition but does not directly reflect the severity of cardiac compromise. Choice D (systolic blood pressure greater than 130 mm Hg) is not typically a criterion for hospital admission in eating disorders unless it is extremely elevated and indicating hypertensive crisis.

Correct Answer: C

Rationale: The correct answer is C: milieu management. Milieu management involves creating a therapeutic environment that promotes the patient's well-being. In this scenario, the nurse is establishing the rules and daily schedule of the unit to help the patient feel safe and understand what to expect during their hospitalization. This process aims to create a supportive and structured environment for the patient. Explanation of why the other choices are incorrect: A: Counseling typically involves providing emotional support, guidance, and advice to help the patient cope with their situation. The nurse in this scenario is not primarily providing counseling. B: Health teaching involves educating the patient about their health condition, treatment, and self-care practices. While some health teaching may occur during the tour, the primary focus is on establishing the unit rules and schedule. D: Psychobiological intervention refers to interventions that address the interaction between psychological and biological factors. The nurse's actions in this scenario are more focused on environmental factors and establishing a therapeutic milieu rather than psychobiological interventions.