A nurse is planning care for a newly admitted client who has bipolar disorder and is experiencing acute mania. Which of the following client goals should the nurse identify as the priority?

Choice A reason: Aricept (donepezil) is a cholinesterase inhibitor that increases acetylcholine levels in the brain, temporarily improving cognitive symptoms in Alzheimer’s disease. It does not stop disease progression, as Alzheimer’s involves progressive neuronal loss due to amyloid plaques and tau tangles. This statement is scientifically inaccurate, as no medication halts Alzheimer’s neurodegenerative process.

Choice B reason: Taking Aricept on an empty stomach is not required, as it can be taken with or without food. Its absorption is not significantly affected by food, as it is metabolized hepatically via CYP2D6 and CYP3A4. This statement is incorrect, as it misrepresents the administration guidelines, potentially causing unnecessary restrictions for the patient.

Choice C reason: While Aricept may improve concentration by enhancing cholinergic activity in Alzheimer’s, this statement focuses on expectation rather than understanding its therapeutic role. It does not address the drug’s primary effect of temporarily slowing cognitive decline. Concentration improvement is a secondary benefit, not the primary mechanism, making this less precise scientifically.

Choice D reason: Aricept temporarily slows Alzheimer’s disease progression by inhibiting acetylcholinesterase, increasing acetylcholine, and supporting cognitive function in mild to moderate cases. It does not cure or stop the disease, as neuronal degeneration continues due to amyloid and tau pathology. This statement accurately reflects the drug’s mechanism and temporary symptomatic relief, aligning with clinical evidence.

Choice A reason: In severe PTSD exacerbation, flashbacks and hypervigilance indicate amygdala hyperactivity and impaired prefrontal cortex regulation, increasing risk of impulsive or self-harming behaviors. Ensuring safety addresses immediate dangers, as heightened arousal can lead to disorientation or panic, necessitating a secure environment to stabilize the client’s neurobiological stress response.

Choice B reason: Promoting self-esteem is valuable in PTSD but secondary to safety. Low self-esteem may stem from trauma-related guilt, linked to serotonin dysregulation, but does not pose immediate risk. Flashbacks and hypervigilance, driven by amygdala overactivity, require urgent safety measures to prevent harm during acute episodes.

Choice C reason: Helping cope with stress and emotions is important in PTSD management, addressing cortisol dysregulation and amygdala hyperactivity. However, during severe exacerbation with flashbacks, safety is the priority, as acute episodes can lead to disorientation or self-harm. Coping strategies are secondary to stabilizing the immediate neurobiological crisis.

Choice D reason: Establishing a community support system aids long-term PTSD recovery by enhancing oxytocin-mediated emotional regulation. However, during acute exacerbation with flashbacks, immediate safety is critical due to heightened amygdala-driven arousal. Community support is a secondary intervention, as it does not address the urgent risk of harm in acute episodes.