A nurse is caring for a client who is receiving a blood transfusion at 125 ml/hr and develops a hemolytic reaction. Which of the following actions should the nurse perform?

A. Provide a flexible activity schedule: Clients experiencing acute mania often have high energy levels and may be unable to follow a flexible or self-directed schedule. Structured, brief, and supervised activities are more effective than a flexible schedule in managing behavior and ensuring safety.

B. Provide high-calorie nutritional supplements: Clients in acute mania may be too hyperactive or distracted to consume adequate meals. Offering high-calorie supplements helps prevent malnutrition and weight loss by providing concentrated nutrition in a format that is easier for the client to consume amidst hyperactivity.

C. Allow the client to eat meals alone in her room: Eating alone may increase the risk of inadequate intake because manic clients can be easily distracted or forget to eat. Supervised meals in a calm environment promote adequate nutrition and monitoring of intake.

D. Allow the client to choose her clothes independently: While promoting autonomy is generally important, clients in acute mania may select inappropriate or unsafe clothing due to impaired judgment. Providing guidance or limiting choices temporarily ensures safety and appropriateness of dress.

A. Bedtime: The client’s bedtime of 2330 has remained unchanged despite the shift in work hours, providing some stability to the circadian rhythm. A consistent bedtime typically supports sleep regulation rather than disrupting it. Although the new routine may affect sleep pressure, the bedtime is not the primary contributor to the new difficulties falling asleep.

B. Use of chronic devices: The client turns off their phone at 2230, limiting blue-light exposure well before bedtime. There is no indication of prolonged screen use or other electronic stimulation that would interfere with melatonin release. With the device turned off an hour before bed, this factor is unlikely to be influencing the client’s disrupted sleep.

C. Evening meal: The client now eats dinner late in the evening after a 1200–2000 work shift, placing the meal close to their 2330 bedtime. Eating late can increase gastrointestinal activity and delay the body’s transition into restful sleep, contributing to both difficulty falling asleep and nighttime awakenings.

D. Medication: The client’s medications ethinyl estradiol/desogestrel and ferrous sulphate have remained consistent for months without changes in timing or dosage. These medications are not known to disrupt sleep when taken as prescribed and do not coincide with the recent onset of nighttime symptoms.

E. Caffeine use: Although the client now drinks 2 to 3 cups of coffee, it is consumed early in the morning and remains outside the usual window in which caffeine impacts nighttime sleep. Morning intake allows adequate time for caffeine metabolism before bedtime. The timing makes it a less significant factor in the client’s difficulties initiating and maintaining sleep.

F. Exercise schedule: The client exercises immediately after a shift that ends at 2000, pushing vigorous activity close to bedtime. Late-evening exercise can increase sympathetic activity and core body temperature, which can interfere with the body’s ability to relax and initiate sleep.