A client has had a major stroke and is struggling to adjust to living with consequent changes and permanent disabilities related to speech and mobility. The nurse assesses the client closely based on the understanding that the client is at increased risk for which of the following?

Correct Answer: B

Rationale: The correct answer is B: Major depressive disorder. Following a major stroke, individuals often experience feelings of grief, sadness, and hopelessness due to the significant life changes and disabilities. This can lead to the development of major depressive disorder. Depression is common post-stroke due to neurobiological changes and psychosocial factors. The other choices are incorrect because bipolar I disorder is characterized by distinct episodes of mania and depression, which are not directly related to stroke. Generalized anxiety disorder and posttraumatic stress disorder are also not directly associated with the typical emotional response following a stroke.

Correct Answer: C

Rationale: The correct answer is C: A lower dosage. This adjustment is appropriate for maintenance therapy in bipolar I disorder to prevent toxicity and maintain therapeutic levels. Lowering the dose reduces the risk of adverse effects while still providing the necessary benefits. Increasing the dosage (choice A) may lead to toxicity. Once a week dosing (choice B) is not standard for lithium. Switching to a different drug (choice D) is not necessary if the patient has been responding well to lithium.

Correct Answer: C

Rationale: Rationale for Choice C (Correct Answer): 1. Hormones like leptin and ghrelin regulate appetite and energy balance. 2. Lack of sleep disrupts these hormones, leading to increased appetite. 3. Larry's sleep deprivation may have dysregulated his appetite hormones. 4. This dysregulation could result in increased food intake and subsequent weight gain. Summary of Incorrect Choices: A. Diabetes: No information suggests Larry has diabetes symptoms. B. Cardiovascular disease: Weight gain may be a risk factor, but sleep deprivation's direct impact on hormones is more likely. D. Depression: While depression can contribute to weight gain, there's no indication of comorbidity in Larry's case.

Correct Answer: A

Rationale: The correct answer is A because it acknowledges and validates the patient's feelings without making assumptions or imposing personal beliefs. It focuses on the patient's emotions and provides empathy and support. B: Imposes a religious belief that may not align with the patient's beliefs. C: Implies the patient should feel a certain way, which can be invalidating. D: Assumes what the patient wants without considering their feelings or preferences.

Correct Answer: B

Rationale: The correct answer is B because when the nurse has a therapeutic relationship with the client, it means they work collaboratively. The nurse considers the client a partner in care planning, involving them in decision-making and respecting their autonomy. This approach fosters trust and empowers the client in their care. A: The nurse should maintain professional boundaries and not become friends with the client to avoid conflicts of interest. C: Adhering strictly to the plan of care without flexibility may not meet the client's individual needs and preferences. D: While avoiding a directive approach is important, there are times when the nurse needs to provide guidance and direction for the client's benefit.