A client diagnosed with bipolar disorder has a nursing diagnosis of sleep pattern disturbance. Which intervention should the nurse implement initially?

Assess normal sleep patterns.

Discourage napping during the day.

Discourage the use of caffeine and nicotine.

Teach relaxation exercises.

Answer and Explanation

The Correct Answer is A

Sleep pattern disturbance in bipolar disorder is often linked to manic episodes, where clients experience reduced need for sleep, hyperactivity, and racing thoughts. Sleep disruption can exacerbate mood instability and impair recovery. Before implementing behavioral or environmental interventions, the nurse must first assess the client’s baseline sleep habits, triggers, and patterns. This foundational data guides individualized care planning and helps differentiate between chronic sleep issues and those specific to the current mood phase.

Rationale for correct answer

1. Assessing normal sleep patterns is the initial step in managing sleep disturbances. It provides essential data for tailoring interventions and identifying whether the disturbance is episodic or chronic, linked to mania or other factors.

Rationale for incorrect answers

2. Discouraging daytime naps may be appropriate later, but without understanding the client’s baseline, it risks worsening fatigue or agitation. Assessment must precede behavioral modification.

3. While caffeine and nicotine can impair sleep, this intervention is secondary. It assumes causality without first evaluating the client’s specific sleep behaviors and contributing factors.

4. Relaxation exercises are useful but not the first step. Without assessment, they may be mismatched to the client’s needs or ineffective due to manic energy levels.

Take Home Points

Initial nursing interventions must begin with assessment to guide individualized care.
Sleep disturbances in bipolar disorder often reflect underlying mood phase and require tailored strategies.
Behavioral modifications like nap restriction or relaxation are secondary to understanding baseline patterns.
Accurate assessment informs safe and effective sleep management in psychiatric care.

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Correct Answer is ["A","B","C","D","E"]

Explanation

Bipolar I disorder is a chronic psychiatric illness marked by alternating episodes of mania, depression, and periods of remission. Discharge planning must address both symptom management and psychosocial reintegration. Clients often face challenges in medication adherence, interpersonal relationships, and functional stability. A comprehensive support system is essential to reduce relapse risk and promote long-term recovery.

Rationale for correct answers

1. Financial and legal assistance supports clients with impaired judgment during manic episodes, which may result in debt, legal issues, or loss of employment. These services help stabilize external stressors that can trigger relapse.

2. Crisis hotlines provide immediate support during emotional distress or symptom recurrence. They are vital for early intervention and suicide prevention, especially during post-discharge adjustment.

3. Individual psychotherapy facilitates insight development, emotional regulation, and adherence to treatment plans. It is a cornerstone of long-term management for bipolar I disorder.

4. Support groups offer peer-based validation and shared coping strategies. They reduce isolation and promote accountability for treatment adherence and lifestyle adjustments.

5. Family education groups enhance understanding of the disorder, improve communication, and equip families to recognize early warning signs. This strengthens the client’s home support system and reduces hospitalization risk.

Take Home Points

Discharge planning for bipolar I disorder must include clinical, emotional, and social support systems.
Financial and legal services mitigate consequences of manic behaviors and promote stability.
Crisis hotlines and psychotherapy provide immediate and ongoing emotional support.
Family and peer-based interventions reduce isolation and improve treatment adherence.

A. Ask the client the reason for running down the hall. B. Approach the client along with several staff members. C. Assess the client’s behavior in a nonthreatening manner. D. Contact the client’s health care provider for an order for seclusion.

Correct Answer is B

Explanation

Manic phase of bipolar disorder presents with elevated mood, disinhibition, and impaired judgment, often resulting in intrusive, aggressive, or exhibitionistic behavior. Clients may act impulsively and pose a risk to themselves or others. Immediate nursing actions must prioritize safety using structured, non-confrontational approaches that prevent escalation and maintain control of the environment.

Rationale for correct answer

2. Approaching the client with several staff members ensures containment and safety. It provides a calm but firm presence that can de-escalate behavior while minimizing risk to others. This strategy also reinforces therapeutic boundaries without confrontation.

Rationale for incorrect answers

1. Asking for reasons assumes insight, which is often absent during mania. The client may respond with defensiveness or further agitation, making this approach ineffective and potentially unsafe.

3. Nonthreatening assessment is appropriate once stabilized, but not as a first response when behavior is disruptive and frightening others. Immediate containment is required before therapeutic engagement.

4. Seclusion is a restrictive intervention requiring clinical justification and physician order. It is not the first-line response and should only be considered if less invasive methods fail to ensure safety.

Take Home Points

Manic episodes may involve impulsive, disruptive, and exhibitionistic behavior requiring immediate containment.
Safety is the nurse’s first priority, and structured staff intervention prevents escalation.
Insight-based or therapeutic assessment follows only after behavioral control is achieved.
Seclusion is reserved for extreme cases and must follow protocol after other strategies fail.

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A client diagnosed with bipolar disorder has a nursing diagnosis of sleep pattern disturbance. Which intervention should the nurse implement initially?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client diagnosed with bipolar I disorder experienced an acute manic episode and was admitted to the in-patient psychiatric unit. The client is now ready for discharge. Which of the following resource services should be included in discharge teaching? Select all that apply.

Correct Answer is ["A","B","C","D","E"]

Explanation

A client in a mental health facility with the diagnosis of bipolar disorder, manic phase, is argumentative, domineering, and exhibitionistic. A visitor reports that this client is running down the hall scaring people. What should the nurse do first?

Correct Answer is B

Explanation

A client is admitted to the facility in the manic phase of bipolar disorder. When placing a diet order for the client, which foods are most appropriate?

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A client diagnosed with bipolar disorder has a nursing diagnosis of sleep pattern disturbance. Which intervention should the nurse implement initially?

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A client diagnosed with bipolar II disorder has a nursing diagnosis of impaired social interactions related to egocentrism. Which short-term outcome is an appropriate expectation for this client problem?

A client diagnosed with bipolar I disorder in the manic phase is yelling at another peer in the milieu. Which nursing intervention takes priority?