A client has been prescribed lithium for the treatment of bipolar disorder. Which of the following instructions should the nurse include?

Correct Answer: A

Rationale: The correct instruction for the nurse to provide is to advise the client to avoid driving until they know how the medication affects them. Lithium can lead to side effects like dizziness and drowsiness, which could impair one's ability to drive safely. Choice B is incorrect because lithium is usually taken on an empty stomach. Choice C may be true but is not as critical as the potential side effects affecting driving. Choice D is important but not as immediate as ensuring the client's safety while driving.

Correct Answer: B

Rationale: The correct answer is B: Delusions of grandeur. Clients with paranoid schizophrenia often experience delusions of grandeur or persecution, auditory hallucinations, and a flat affect. However, the most characteristic finding for paranoid schizophrenia is the presence of delusions, which are fixed false beliefs that are not based in reality. Delusions of grandeur, where individuals believe they are exceptionally powerful or important, are commonly seen in paranoid schizophrenia. Choice A, auditory hallucinations, are more commonly associated with other types of schizophrenia such as paranoid or disorganized schizophrenia. Choice C, a flat affect, is a symptom that can be seen across various types of schizophrenia. Choice D, disorganized speech, is more indicative of disorganized schizophrenia.

Correct Answer: B

Rationale: The correct instruction for the nurse to include in the discharge teaching is to advise the client to avoid drinking alcohol while taking sertraline (Zoloft). Alcohol can exacerbate the side effects of the medication, such as drowsiness and dizziness, and may also decrease the effectiveness of the treatment for depression. Choice A is incorrect as sertraline is usually taken in the morning. Choice C is not a specific instruction related to the medication. Choice D is incorrect as abruptly stopping sertraline can lead to withdrawal symptoms and should only be done under medical supervision.

Correct Answer: C

Rationale: The correct response is **C: "Why do you think you are the president?"** This approach aligns with therapeutic communication techniques, particularly when working with clients experiencing delusions, as it neither directly challenges the belief nor reinforces it. Instead, it encourages the client to explore their thoughts, which can provide insight into their cognitive distortions and emotional state. This open-ended question allows the nurse to assess the severity of the delusion, identify potential triggers, and build rapport by showing genuine interest in the client's perspective without judgment. **A: "You are not the president. You are a client in the hospital."** This response is incorrect because it directly confronts the client’s delusion, which is likely to provoke defensiveness, agitation, or further withdrawal. Challenging delusional beliefs outright can damage the therapeutic relationship and escalate distress. Instead of fostering trust, this approach may reinforce the client's sense of being misunderstood or persecuted, exacerbating their symptoms. Therapeutic communication requires validating the client’s feelings without endorsing the delusion, which this response fails to achieve. **B: "Tell me more about being the president."** While this response may seem non-confrontational and exploratory, it risks reinforcing the delusion by engaging with it as though it were reality. Encouraging elaboration on a false belief can deepen the client’s preoccupation with it, making it harder to address later. The nurse should acknowledge the client’s feelings (e.g., "I hear that you feel important") without validating the delusional content. This response could inadvertently prolong or intensify the distorted thinking. **D: "Let's talk about something else."** This response avoids addressing the delusion altogether, which misses an opportunity to understand the client’s thought process and provide support. Redirecting too abruptly may make the client feel dismissed or unheard, potentially increasing their frustration or isolation. While distraction can sometimes be useful in de-escalating distress, it should not replace efforts to explore and address the underlying concerns contributing to the delusion. In contrast, **C** strikes a balance by neither validating nor dismissing the delusion. It invites the client to reflect, which can help the nurse gather clinically relevant information while maintaining a supportive and nonjudgmental stance. This approach aligns with evidence-based practices for managing psychotic symptoms, where the goal is to reduce distress rather than immediately correct the belief. By exploring the client's reasoning, the nurse can identify themes (e.g., grandiosity, paranoia) that may inform treatment planning and interventions. Additionally, this technique fosters a collaborative relationship, which is critical for long-term engagement and recovery. The incorrect choices either disrupt therapeutic rapport (A), risk reinforcing the delusion (B), or neglect the opportunity for meaningful assessment and intervention (D). **C** remains the most clinically appropriate because it prioritizes empathy, assessment, and the gradual exploration of distorted thinking without confrontation or avoidance. This method is consistent with psychiatric nursing principles that emphasize meeting the client where they are while gently guiding them toward reality-based thinking over time.

Correct Answer: B

Rationale: The priority action for the nurse is to assess the client's risk for suicide. By asking if the client has a plan to commit suicide, the nurse can determine the immediate safety of the client and take appropriate interventions to prevent harm. Administering antidepressant medication is not the first action to take in this situation as assessing the client's safety is the priority. Encouraging the client to attend a support group or contacting the client's family, although beneficial, are not immediate actions to ensure the client's safety in a crisis situation.