A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first?

Choice A reason: Ordering items online during the day does not affect sleep hygiene. It is unrelated to sleep patterns or behaviors that interfere with rest.

Choice B reason: Drinking coffee before bed is poor sleep hygiene. Caffeine is a stimulant that delays sleep onset and reduces sleep quality.

Choice C reason: Taking daytime naps, especially long or late naps, can interfere with nighttime sleep. It reduces sleep drive and contributes to insomnia.

Choice D reason: Smoking a cigarette before bed is poor sleep hygiene. Nicotine is a stimulant that increases arousal and delays sleep onset.

Choice A reason: A supportive approach may be helpful in many therapeutic relationships, but with narcissistic personality disorder, it can inadvertently reinforce manipulative or grandiose behaviors. These clients often exploit supportive interactions to maintain control.

Choice B reason: A cheerful approach may be perceived as insincere or patronizing by clients with narcissistic traits. They may dismiss or devalue the nurse’s efforts, making this approach ineffective.

Choice C reason: A friendly approach can blur professional boundaries. Clients with narcissistic personality disorder may manipulate friendliness to gain special treatment or attention, which undermines therapeutic goals.

Choice D reason: A matter-of-fact approach is the most effective. It maintains professional boundaries, avoids feeding into the client’s grandiosity, and provides clear, consistent communication. This approach helps the nurse remain neutral and objective, which is essential in managing narcissistic behaviors.