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Depression is a mood disorder characterized by persistent sadness, hopelessness, and loss of interest. While patients with schizophrenia may also experience depression, the described behavior of withdrawal and lack of self-care is specifically a negative symptom rather than a mood disorder.

Waxy flexibility refers to a catatonic symptom where a patient maintains positions for long periods when placed by another person. This is not the same as withdrawal or lack of motivation to perform self-care.

Auditory hallucinations are positive symptoms of schizophrenia, involving perception of voices or sounds that are not present. The scenario describes absence of activity and motivation, not hallucinations.

Gabapentin is used for partial seizures and neuropathic pain but is not effective for acute management of status epilepticus. It has a slower onset and is not appropriate for emergency seizure control.

Pregabalin is primarily used for neuropathic pain and generalized anxiety disorder. It is not indicated for acute seizure management and does not act quickly enough to stop status epilepticus.

Carbamazepine is used for partial and generalized tonic-clonic seizures but is not effective for acute status epilepticus. It requires oral administration and has a delayed onset, making it unsuitable for emergency seizure control.

Flat affect reflects blunted emotional expression, commonly associated with depressive disorders, negative symptoms of schizophrenia, or neurocognitive conditions, not mania. While suicidal ideation can occur across mood episodes (including mixed features), it is not a defining or expected hallmark of a classic manic presentation. Mania typically features elevated or expansive affect, labile mood, and heightened emotional reactivity rather than flattened affect. Therefore, this option does not align with the cardinal symptom profile of a manic episode.

Increased appetite and hypersomnia are vegetative symptoms typically seen in atypical depression, not mania. In mania, sleep need is decreased; patients often report feeling rested after very little sleep and exhibit sustained high energy despite curtailed sleep. Appetite changes in mania more often trend toward decreased appetite due to heightened activity and distractibility, though variability exists; the pairing of hypersomnia with increased appetite strongly points away from manic physiology and toward depressive spectrum features.

Psychomotor retardation and fatigue are classic depressive features, indicating slowed movement, diminished speech, and reduced energy. Mania presents with the opposite motor profile: psychomotor acceleration, restlessness, increased goal-directed activity, and reduced fatigue perception. Selecting retardation and fatigue would mischaracterize the manic state, which is distinguished by heightened activation and drive rather than slowing and exhaustion.

Tyramine reactions are associated with monoamine oxidase inhibitors (MAOIs), not lithium. Foods high in tyramine can precipitate hypertensive crises in patients taking MAOIs, but lithium does not interact with tyramine in this way. Therefore, this option is unrelated to the patient’s presentation.

Tolerance to lithium does not develop in the sense of diminishing therapeutic effect. Lithium remains effective at stable doses, and side effects do not indicate tolerance. Instead, adverse effects such as tremor and gastrointestinal upset signal toxicity, not tolerance.

Non-adherence to lithium would more likely result in recurrence of manic or depressive symptoms, not the acute physical signs described. The presence of tremor, gastrointestinal upset, and gait disturbance indicates lithium is being taken but at toxic levels, not missed doses.

Redirecting the patient to a case manager for charity options validates the delusion and encourages potentially harmful behavior. It does not set appropriate boundaries and may reinforce the grandiose thinking.

Telling the patient directly that their behavior is inappropriate is confrontational and may escalate agitation. It lacks therapeutic communication and does not respect the patient’s dignity.

Asking the patient why they feel the need to give money away invites exploration of the delusion, which may reinforce it. During mania, patients are not able to rationally process such questions, and this approach is not therapeutic.

Inserting an oral airway during an active seizure is contraindicated. Attempting to place objects in the mouth can cause injury to teeth, gums, or airway structures and may obstruct breathing.

Opening the airway manually is not possible during tonic-clonic activity due to jaw clenching and muscle rigidity. Airway management is addressed after seizure activity subsides.

Restraining limbs during seizure activity is contraindicated. It can cause musculoskeletal injury and does not stop seizure activity. The nurse should allow movements to occur naturally while ensuring safety.

Sweating, nausea, and diarrhea are not typical side effects of haloperidol. These symptoms are more consistent with gastrointestinal upset or other medication reactions.

Headache, watery eyes, and runny nose are nonspecific and not characteristic of haloperidol. They may reflect allergies or viral illness rather than medication effects.

Mild fever, sore throat, and skin rash could indicate infection or allergic reaction, but they are not common side effects of haloperidol.

Waiting until the prescriber arrives later is unsafe. The patient is showing signs of neuroleptic malignant syndrome (NMS), a life-threatening emergency requiring immediate action.

Tardive dyskinesia is a chronic movement disorder, not an acute emergency. The patient’s presentation—high fever, autonomic instability, rigidity—indicates NMS, not tardive dyskinesia.

Benztropine treats acute dystonia, not NMS. The patient’s symptoms are systemic and life-threatening, requiring discontinuation of the antipsychotic and urgent medical intervention.