A nurse on an acute care mental health unit is examining the belongings of a client who is being admitted following a suicide attempt. Which of the following belongings should the nurse ask the client's partner to take back home? (Select All that Apply.)
Nylon socks
Glass framed picture of the client's partner
Lace-up tennis shoes
Cotton underwear
Necklace
Correct Answer : B,C,E
Rationale:
A. Nylon socks are generally not considered a risk for self-harm and can be safely kept with the client.
B. A glass-framed picture presents a risk as the glass could be broken and used for self-harm. This item should be taken home.
C. Lace-up tennis shoes have long laces that could be used for self-harm, making them unsafe for a client at risk of suicide.
D. Cotton underwear does not pose a significant risk for self-harm and can be kept with the client.
E. A necklace could be used for self-harm, such as strangulation, and should be taken home to ensure the client's safety.
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Correct Answer is B
Explanation
Rationale:
A. Anabolic steroids are associated with mood swings and aggressive behavior but are less likely to cause the acute symptoms of paranoia, hallucinations, and severe agitation described here.
B. Hallucinogens, such as LSD or PCP, can cause intense paranoia, hallucinations, and erratic behavior, as seen in the client’s symptoms. These substances often lead to altered perceptions of reality, including visual and auditory hallucinations.
C. Stimulants like cocaine or methamphetamines can cause paranoia and hyperactivity but are less likely to cause the vivid hallucinations described.
D. Opioids typically cause drowsiness, respiratory depression, and a sense of euphoria rather than hallucinations and severe agitation.
Correct Answer is B
Explanation
Rationale:
A. A sense of power from restricting food intake is more indicative of anorexia nervosa, not bulimia nervosa.
B. An emotional high during binge-purge episodes is consistent with bulimia nervosa, as individuals with this disorder often experience a temporary sense of relief or pleasure during these episodes.
C. While bingeing and purging in secret can be a behavior seen in bulimia nervosa, the statement does not directly address the emotional aspects of the disorder.
D. Using laxatives solely for constipation is not specific to bulimia nervosa; it is a broader symptom management issue.