The spouse of a patient diagnosed with bipolar I disorder says, ...

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The spouse of a patient diagnosed with bipolar I disorder says, We want to have children, but I worry they could inherit this problem. There is also bipolar disorder on my side of the family. What is the nurse's most appropriate action?
 
  a. Direct the couple to seek genetic counseling.
  b. Encourage the couple to consider adopting children.
  c. Encourage the spouse to discuss options with a spiritual advisor.
  d. Educate the spouse about environmental determinants of bipolar disorder.

Question 2

A 14-year-old is sent to a residential program after arrests for truancy and assault. At the program, the teen refused to participate in scheduled activities and pushed a staff member, causing a fall. Which strategy by nursing staff is indicated?
 
  a. Begin social skills training.
  b. Coax to gain compliance.
  c. Neutrally allow refusals.
  d. Establish firm limits.

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Answer to Question 1

A
The nurse's advice should be based on knowledge that there appears to be a genetic role in the cause of bipolar disorder. Genetic counseling will provide the couple with the best possible basis for decision making. The other options will not provide the information that the couple needs to make an informed decision.

Answer to Question 2

D
Firm limits are necessary to ensure physical safety and emotional security. Limit-setting will also protect other patients from the teen's thoughtless or aggressive behavior. Permitting refusals to participate in the treatment plan, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or structure.