A client with the diagnosis of bipolar disorder, manic episode, is extremely active, talks constantly, and tends to badger the other clients, some of whom are now becoming agitated. What is the best strategy for a nurse to use with this client?
Humor
Sympathy
Distraction
Confrontation
The Correct Answer is C
Manic episode in bipolar disorder presents with elevated mood, hyperactivity, and excessive talkativeness, often accompanied by intrusive or disruptive behavior. Clients may lack insight and impulse control, leading to overstimulation of others in the milieu. Nursing strategies must focus on behavioral redirection using non-confrontational, therapeutic techniques that preserve safety and reduce agitation.
Rationale for correct answer
3. Distraction is a non-invasive method that redirects energy and attention without escalating conflict. It helps manage intrusive behavior by shifting focus to a neutral or structured activity, reducing stimulation and protecting group dynamics.
Rationale for incorrect answers
1. Humor may be perceived as mocking or dismissive, especially during mania. It risks escalating the client’s behavior or provoking agitation in others, undermining therapeutic rapport.
2. Sympathy may reinforce dependency or validate inappropriate behavior. It lacks structure and does not address the need for behavioral containment or environmental control.
4. Confrontation increases defensiveness and may escalate manic symptoms. It challenges the client’s impaired judgment and can provoke aggression or further disruption in the unit.
Take Home Points
- Manic episodes involve hyperactivity, pressured speech, and poor impulse control.
- Distraction is an effective strategy to redirect behavior without confrontation.
- Humor and sympathy may be misinterpreted and are not therapeutic in acute mania.
- Confrontation should be avoided as it escalates agitation and compromises safety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Manic episode in bipolar disorder is marked by elevated mood, hyperactivity, and impaired impulse control, often accompanied by distractibility, grandiosity, and intrusive behavior. Clients may overstimulate easily and disrupt group settings due to excessive energy and pressured speech. Nursing interventions must prioritize environmental control to reduce stimulation and promote behavioral containment.
Rationale for correct answer
1. Assigning the client to a private room minimizes stimulation and protects other clients from disruptive behavior. It allows for better behavioral monitoring and supports de-escalation in a controlled setting.
Rationale for incorrect answers
2. Playing cards with several clients increases arousal and social stimulation, which may exacerbate manic symptoms. The client may dominate the activity or provoke agitation in others.
3. Introspection requires insight, which is impaired during mania. The client may be unable to reflect meaningfully or engage in therapeutic self-examination until symptoms stabilize.
4. Communal dining may lead to disruption due to excessive talking or intrusive behavior. It risks overstimulation and conflict with peers, especially in early stages of admission.
Take Home Points
- Manic episodes require environmental control to reduce stimulation and prevent escalation.
- Private rooms support behavioral containment and minimize disruption to others.
- Insight-based interventions are deferred until the client achieves symptom stabilization.
- Group activities and communal settings may worsen manic symptoms and compromise safety.
Correct Answer is C
Explanation
Manic phase of bipolar disorder is marked by elevated mood, hyperactivity, and impaired concentration, often accompanied by distractibility, impulsivity, and rapid speech. Clients may exhibit excessive goal-directed activity without completion, leading to exhaustion and interpersonal disruption. Nursing care must prioritize behavioral containment and energy redirection to reduce risk and promote functional engagement.
Rationale for correct answer
3. Redirecting excess energy into constructive channels helps manage agitation and prevents escalation. Structured activities like walking or folding laundry provide physical outlet while minimizing overstimulation and promoting behavioral regulation.
Rationale for incorrect answers
1. Focusing on reality may be ineffective due to grandiosity and poor insight during mania. The client may resist or misinterpret attempts to reorient, leading to frustration or confrontation.
2. Encouraging unrestricted talking reinforces pressured speech and disorganized thought. It may overwhelm others and increase manic intensity, compromising therapeutic boundaries.
4. Persuading task completion assumes attention and follow-through, which are impaired in mania. The client may become irritable or abandon tasks midway, making this approach ineffective.
Take Home Points
- Manic episodes involve hyperactivity, distractibility, and poor impulse control.
- Structured redirection of energy helps contain behavior and reduce agitation.
- Reality orientation and task completion are limited by impaired insight and attention.
- Unrestricted verbalization may escalate symptoms and disrupt the therapeutic environment.
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