A client with bipolar disorder is exhibiting signs of impaired judgment and poor insight. What should the nurse assess and document about the client's cognitive abilities?

Choice A rationale:

The correct answer is A, "The quality, intensity, range, and appropriateness of emotional expression." This choice reflects the comprehensive assessment of a patient's affect. The nurse should document aspects such as the quality (e.g., sad, angry, euphoric), intensity (e.g., blunted, intense), range (e.g., flat, labile), and appropriateness (e.g., congruent with the situation or not) of the patient's emotional expression.

Choice B rationale:

"Signs of flat, blunted, labile, or incongruent affect" are important to assess, but this choice is not as comprehensive as choice A. It focuses solely on specific features of affect without addressing the full spectrum of emotional expression.

Choice C rationale:

"The patient's thought content, such as themes, topics, and beliefs" is unrelated to assessing affect. Thought content pertains to the patient's cognitive processes and the content of their ideas, not their emotional expression.

Choice D rationale:

"Signs of flight of ideas, racing thoughts, tangentiality" pertain to thought processes, particularly in the context of assessing thought disorders like in bipolar disorder's manic phase. This is not directly related to the assessment of emotional expression.

Choice A rationale:

This statement is not accurate for a depressive episode. Excessive involvement in risky activities is more characteristic of a manic episode in bipolar disorder, not a depressive one. Manic episodes are marked by increased energy levels and impulsivity.

Choice B rationale:

An increase in goal-directed activity is not a typical symptom of a depressive episode. Depressive episodes are associated with a decrease in energy, motivation, and interest in previously enjoyed activities, leading to reduced activity levels.

Choice C rationale:

A decreased need for sleep is more commonly associated with manic episodes, where individuals experience a reduced need for sleep due to heightened energy levels. In depressive episodes, sleep disturbances such as insomnia are more prevalent.

Choice D rationale:

Significant weight loss or gain without intentional effort is a possible symptom. Changes in appetite and weight are hallmark features of a depressive episode. Clients may experience a loss of interest in food and subsequently lose weight, or they might engage in "comfort eating," leading to weight gain.