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: The belief that clients who talk about suicide are less likely to attempt it is a myth. Verbalizing suicidal ideation often reflects severe distress and heightened risk, as it may indicate prefrontal cortex dysfunction and impaired impulse control. This misconception underestimates the neurobiological basis of suicidal behavior, requiring vigilant assessment.

Choice B reason: Assuming clients who fail a suicide attempt will not try again is incorrect. Previous attempts increase future risk, as suicidal behavior is linked to persistent psychological distress and serotonin dysregulation. This assumption ignores the chronicity of underlying conditions like depression, necessitating ongoing monitoring and intervention to prevent recurrence.

Choice C reason: Claiming failed suicide attempts indicate a lack of intent to die is false. Many attempts fail due to external factors, not lack of intent. Suicidal behavior reflects complex neurobiological factors, including serotonin imbalance and prefrontal cortex deficits, requiring serious intervention regardless of outcome, as intent persists in high-risk individuals.

Choice D reason: A specific suicide plan indicates high risk, as it reflects advanced ideation and intent, often linked to prefrontal cortex dysfunction and reduced impulse control. Detailed planning suggests the client has visualized the act, increasing likelihood of completion. This principle guides nursing care to prioritize safety and immediate psychiatric intervention.

Choice A reason: Offering dessert to stop yelling uses bargaining, not distraction, and may reinforce agitation in Alzheimer’s, where cortical and amygdala damage impairs emotional regulation. This approach risks escalating distress by focusing on the behavior, which the client cannot control due to neurocognitive deficits, making it ineffective.

Choice B reason: Asking if the client wants to finish the meal focuses on the agitation’s context, potentially worsening distress in Alzheimer’s due to impaired reasoning from cortical degeneration. This confrontational approach does not redirect attention, failing to leverage preserved procedural memory, which distraction techniques use to calm neurobiological agitation.

Choice C reason: Suggesting to watch television is a distraction technique, redirecting attention from agitation triggers in Alzheimer’s. By engaging preserved sensory and procedural memory, it reduces amygdala-driven emotional distress without confronting cognitive deficits, aligning with neurobiological strategies to manage agitation and promote calm in dementia care.

Choice D reason: Stating misunderstanding focuses on the client’s communication deficits, likely increasing frustration in Alzheimer’s due to hippocampal and cortical damage. This does not distract from agitation triggers and may exacerbate distress, as the client cannot process or correct their behavior, making it an ineffective response compared to redirection.