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[Expert Solution]: Before answering this question, review the…

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Before answering this question, review the client’s health information in the EHR. Identify the assessment cues that are concerning to the nurse. Select to highlight. Neuro/Cognitive: Alert, oriented to person, place. Unable to identify the reason for a health care visit. Disoriented to time. Speech clear. Intermittent changes in tone and character. Psychosocial: Denies suicidal or homicidal ideation. Unemployed. The client has appropriate hygiene and is wearing clothes appropriate for the season. Easily distracted and having auditory hallucinations. States, “We’re just having a conversation. He isn’t telling me to do anything.” Shifts rapidly to different personalities. Emotional lability ranges from docile and subdued to angry and threatening. Averages 3-4 hours sleep per night. Decreased appetite.

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