A client with bipolar disorder, manic type, exhibits extreme excitement, delusional thinking, and command hallucinations. Which of the following is the priority nursing diagnosis?

Correct Answer: D

Rationale: The priority nursing diagnosis for a client with bipolar disorder, manic type, exhibiting extreme excitement, delusional thinking, and command hallucinations is "D: Risk for other-directed violence." This is the most critical because it addresses the immediate safety concern of potential harm to others due to the client's altered mental state. Anxiety (A) may be present but is secondary to the risk of violence. Impaired social interaction (B) and disturbed sensory-perceptual alteration (C) are important but not as urgent as ensuring the safety of others. It is crucial to prioritize interventions to prevent harm to others in this scenario.

Correct Answer: B

Rationale: The correct answer is B: Diphenhydramine (Benadryl). Phenelzine is an MAOI, which interacts with many medications, including diphenhydramine, leading to potential hypertensive crisis. Acetaminophen (A) is safe with MAOIs. Furosemide (C) can cause low blood pressure but not a significant interaction. Isosorbide dinitrate (D) is a vasodilator and should be used cautiously with MAOIs, but it is not the most concerning interaction compared to diphenhydramine.

Correct Answer: D

Rationale: The correct answer is D because confabulation is a symptom of dementia where the individual unknowingly fills memory gaps with fabricated information or fantasy to compensate for memory loss. In this case, the 75-year-old client with Alzheimer's type dementia is likely confabulating due to cognitive impairment. Choice A is incorrect because being jovial does not directly relate to confabulation. Choice B is incorrect as confabulation is not intentional deception. Choice C is incorrect as rationalizing behaviors is different from confabulation, which involves filling in memory gaps with fantasy.

Correct Answer: C

Rationale: The correct answer is C: Enmeshment. Enmeshment is a relationship style where boundaries between family members are blurred, leading to a lack of individual autonomy. In this scenario, the parents' inability to understand their daughter's behavior despite her hospitalization for anorexia nervosa suggests a lack of recognition of her autonomy and individual needs. The parents' expectation for her to always please them reflects enmeshment, as they may prioritize their own desires over her well-being. Choice A: Differentiation refers to the ability to maintain a sense of self within a relationship, which is not evident in the parents' behavior. Choice B: Disengagement involves emotional distance between family members, which is not the case here as the parents are actively involved in their daughter's life. Choice D: Scapegoating involves unfairly blaming one family member for issues, which is not apparent in the scenario.

Correct Answer: A

Rationale: The correct answer is A because it directly asks the client to provide an explanation, which can come off as confrontational and may make the client feel defensive or judged. This blocks effective communication by putting the client on the spot and may hinder trust-building in the therapeutic relationship. Explanation for other choices: B: This response offers reassurance and support, which can be therapeutic in nature. C: This response acknowledges the complexity of human behavior but does not necessarily block communication. D: This response seeks clarification and understanding, which can be beneficial for effective communication.