A client who is in a manic phase of bipolar disorder threatens staff and clients on an acute psychiatric unit. Place the following interventions in priority order from the least restrictive to the most restrictive.
Seclusion
Restraints
Limit setting
Diversional activities
Medication administration
The Correct Answer is D,C,E,A,B
Manic phase of bipolar disorder is marked by elevated mood, impulsivity, and agitation, which can escalate into threatening or aggressive behavior. Management follows a least-to-most restrictive approach to preserve autonomy while ensuring safety. Initial strategies focus on redirecting energy and setting boundaries. If these fail, pharmacologic intervention is used to reduce symptoms. Physical containment measures like seclusion and restraints are reserved for imminent risk when other interventions are ineffective.
Rationale for answer
4. Diversional activities are the least restrictive and aim to redirect excess energy into safe, structured outlets. They help reduce agitation and promote engagement without limiting freedom.
3. Limit setting involves establishing behavioral boundaries and expectations. It maintains safety while preserving the client’s autonomy and is essential in early behavioral de-escalation.
5. Medication administration is more restrictive as it involves pharmacologic intervention to manage symptoms. It is used when behavioral strategies are insufficient to control agitation or risk.
1. Seclusion removes the client from the environment to prevent harm. It is restrictive and used only when the client poses a danger to others and cannot be managed through verbal or pharmacologic means.
2. Restraints are the most restrictive, involving physical containment. They are used as a last resort when all other measures fail and there is an immediate threat to safety.
Take Home Points
- Managing mania requires a stepwise approach from behavioral redirection to physical containment.
- Diversional activities and limit setting preserve autonomy and reduce escalation.
- Medications are used when non-pharmacologic strategies fail to control symptoms.
- Seclusion and restraints are reserved for imminent risk and must follow strict legal and ethical protocols.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Manic episodes in bipolar I disorder are marked by elevated mood, hyperactivity, and reduced need for sleep, often leading to poor nutritional intake and weight loss. Clients may be too distracted or restless to sit for meals, and their impulsivity can interfere with structured routines. Nutritional strategies must accommodate their erratic behavior while ensuring caloric sufficiency. High-calorie, nutrient-dense finger foods are ideal because they can be consumed quickly and frequently, even during periods of excessive movement or agitation.
Rationale for correct answer
3. Providing finger foods allows Beldine to maintain her hyperactive behavior while still consuming calories. These foods are portable, easy to eat, and can be offered frequently, supporting nutritional intake without requiring her to sit still.
Rationale for incorrect answers
1. Sitting with Beldine may not be effective due to her restlessness. She may resist structured meal times or leave the table prematurely, making this approach impractical during a manic phase.
2. While familiar foods may be comforting, relying on a family member to bring meals does not address the need for accessibility and caloric density. It also lacks consistency and clinical oversight.
4. Room restriction is punitive and may escalate agitation or noncompliance. It does not address the underlying issue of poor intake and may worsen behavioral symptoms during mania.
Take Home Points
- Clients in manic episodes often require flexible, high-calorie nutrition strategies due to hyperactivity and distractibility.
- Finger foods and snacks are more effective than structured meals for promoting intake during mania.
- Punitive measures like room restriction are contraindicated and may exacerbate agitation or noncompliance.
- Nutritional interventions should be tailored to behavioral presentation, especially in psychiatric conditions with fluctuating energy and attention.
Correct Answer is D
Explanation
Disturbed thought process in bipolar I disorder is often linked to biochemical alterations affecting neurotransmitter systems such as dopamine, serotonin, and norepinephrine. During manic episodes, clients may experience delusions, flight of ideas, and impaired reality testing. These cognitive disruptions stem from neurochemical dysregulation and can be severe enough to interfere with judgment, perception, and social functioning. Treatment aims to restore neurochemical balance and improve insight, making reality orientation a central therapeutic goal.
Rationale for correct answer
4. The ability to distinguish reality from delusions directly addresses the disturbed thought process. It reflects improvement in cognitive clarity and insight, aligning with the biochemical basis of the diagnosis and expected therapeutic outcomes.
Rationale for incorrect answers
1. Preventing injury is a safety goal, not a cognitive one. While important, it does not specifically target the disturbed thought process or reflect progress in reality testing.
2. Appropriate interaction is a behavioral goal that may improve with cognitive clarity, but it does not directly measure resolution of delusional thinking or thought disturbance.
3. Medication compliance supports treatment but is a behavioral outcome. It does not confirm cognitive improvement or resolution of disturbed thought processes.
Take Home Points
- Disturbed thought process in bipolar I disorder involves impaired reality testing and delusional thinking.
- Neurochemical dysregulation underlies cognitive symptoms and guides pharmacologic intervention.
- Outcomes should reflect cognitive improvement, such as distinguishing reality from delusions.
- Behavioral goals like safety and compliance are supportive but not primary indicators of thought process resolution.
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