A nurse is conducting an admission assessment for a client who is experiencing a manic episode of bipolar disorder. Which of the following behaviors should the nurse expect? (Select all that apply.)

A. Illusion: An illusion is a misinterpretation or misperception of a real external stimulus. It involves a distortion of sensory perception, but the client's statement does not suggest a misperception of reality.

B. Hallucination: A hallucination is a sensory perception in the absence of any external stimulus. It involves experiencing something that is not present in reality. The client's statement does not indicate experiencing a sensory perception that is not real.

C. Attention-seeking behavior: While the client's statement may draw attention to their distress, it is important not to dismiss it as merely attention-seeking behavior. The client's request for the pen to alleviate emotional pain suggests a deeper psychological issue and a genuine risk for self-harm.

D. Self-mutilation: Self-mutilation refers to intentional self-inflicted injury or harm to one's body tissue without the intent to die. The client's statement about using the pen to cut the pain out of their chest indicates a clear risk for self-mutilation.

A. Cognitive reframing:

Cognitive reframing involves helping individuals change their perspective or interpretation of a situation to see it in a more positive or balanced light. While this technique can be helpful in various situations, it may not be suitable for addressing delusions or misconceptions in clients with dementia who firmly believe in their reality, such as the client who perceives a doll as her infant child.

B. Thought stopping:

Thought stopping is a cognitive-behavioral technique used to interrupt or stop intrusive or distressing thoughts. It typically involves mentally or verbally interrupting negative thoughts with a cue word or phrase. However, this technique may not be effective for addressing the belief of a client with dementia that a doll is her infant child because it does not acknowledge or validate the client's reality.

C. Validation therapy:

Validation therapy is a person-centered approach that acknowledges and validates the emotions and experiences of individuals with dementia, even if their perceptions do not align with objective reality. It involves empathetic listening, validation of emotions, and entering the individual's reality to provide comfort and support. This approach can help reduce agitation and distress in clients with dementia and foster a therapeutic connection between the client and the caregiver.

D. Operant conditioning:

Operant conditioning is a behavior modification technique based on the principles of reinforcement and punishment to strengthen or weaken behaviors. While it may be used to modify behaviors in some situations, it is not typically employed to address delusions or misconceptions in clients with dementia. Using operant conditioning techniques with a client who believes a doll is her infant child would not address the underlying emotional needs or provide therapeutic support for the client's reality.