Beldine, age 68, is diagnosed with bipolar I disorder, current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Beldine is to:
Sit with her during meals to ensure that she eats everything on her tray.
Have her sister-in-law bring all her food from home because she knows Beldine’s likes and dislikes.
Provide high-calorie, nutritious finger foods and snacks that Beldine can eat “on the run.”
Tell Beldine that she will be on room restriction until she starts gaining weight.
The Correct Answer is C
Manic episodes in bipolar I disorder are marked by elevated mood, hyperactivity, and reduced need for sleep, often leading to poor nutritional intake and weight loss. Clients may be too distracted or restless to sit for meals, and their impulsivity can interfere with structured routines. Nutritional strategies must accommodate their erratic behavior while ensuring caloric sufficiency. High-calorie, nutrient-dense finger foods are ideal because they can be consumed quickly and frequently, even during periods of excessive movement or agitation.
Rationale for correct answer
3. Providing finger foods allows Beldine to maintain her hyperactive behavior while still consuming calories. These foods are portable, easy to eat, and can be offered frequently, supporting nutritional intake without requiring her to sit still.
Rationale for incorrect answers
1. Sitting with Beldine may not be effective due to her restlessness. She may resist structured meal times or leave the table prematurely, making this approach impractical during a manic phase.
2. While familiar foods may be comforting, relying on a family member to bring meals does not address the need for accessibility and caloric density. It also lacks consistency and clinical oversight.
4. Room restriction is punitive and may escalate agitation or noncompliance. It does not address the underlying issue of poor intake and may worsen behavioral symptoms during mania.
Take Home Points
- Clients in manic episodes often require flexible, high-calorie nutrition strategies due to hyperactivity and distractibility.
- Finger foods and snacks are more effective than structured meals for promoting intake during mania.
- Punitive measures like room restriction are contraindicated and may exacerbate agitation or noncompliance.
- Nutritional interventions should be tailored to behavioral presentation, especially in psychiatric conditions with fluctuating energy and attention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Disturbed thought process in bipolar I disorder is often linked to biochemical alterations affecting neurotransmitter systems such as dopamine, serotonin, and norepinephrine. During manic episodes, clients may experience delusions, flight of ideas, and impaired reality testing. These cognitive disruptions stem from neurochemical dysregulation and can be severe enough to interfere with judgment, perception, and social functioning. Treatment aims to restore neurochemical balance and improve insight, making reality orientation a central therapeutic goal.
Rationale for correct answer
4. The ability to distinguish reality from delusions directly addresses the disturbed thought process. It reflects improvement in cognitive clarity and insight, aligning with the biochemical basis of the diagnosis and expected therapeutic outcomes.
Rationale for incorrect answers
1. Preventing injury is a safety goal, not a cognitive one. While important, it does not specifically target the disturbed thought process or reflect progress in reality testing.
2. Appropriate interaction is a behavioral goal that may improve with cognitive clarity, but it does not directly measure resolution of delusional thinking or thought disturbance.
3. Medication compliance supports treatment but is a behavioral outcome. It does not confirm cognitive improvement or resolution of disturbed thought processes.
Take Home Points
- Disturbed thought process in bipolar I disorder involves impaired reality testing and delusional thinking.
- Neurochemical dysregulation underlies cognitive symptoms and guides pharmacologic intervention.
- Outcomes should reflect cognitive improvement, such as distinguishing reality from delusions.
- Behavioral goals like safety and compliance are supportive but not primary indicators of thought process resolution.
Correct Answer is B
Explanation
Aripiprazole is a second-generation antipsychotic used in the management of acute mania in bipolar I disorder. It acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, and antagonist at 5-HT2A receptors. Its pharmacologic profile allows it to stabilize mood and reduce excitability without excessive sedation. When administered intramuscularly in acute settings, it rapidly targets agitation and hyperactivity, making it suitable for de-escalation. Unlike sedatives, its goal is behavioral control rather than sedation, and it does not immediately equalize mood swings.
Rationale for correct answer
2. Aripiprazole’s primary effect in acute mania is reducing excitability and agitation. Its dopaminergic modulation calms hyperactive behavior without causing oversedation, allowing for safer interaction and stabilization.
Rationale for incorrect answers
1. Sedation is not the therapeutic goal of aripiprazole. While some calming may occur, excessive sedation suggests overmedication or use of a different pharmacologic class like benzodiazepines.
3. Although aripiprazole can reduce psychotic symptoms over time, its immediate IM use in acute mania targets agitation and excitability first. Psychotic symptom relief is not the primary indicator of short-term effectiveness.
4. Mood stabilization is a long-term goal in bipolar management. Acute IM administration does not equalize mood swings immediately; it primarily addresses behavioral dysregulation.
Take Home Points
- Aripiprazole IM is used for rapid control of agitation and excitability in acute manic episodes.
- Sedation is not the intended outcome; behavioral calming without oversedation is preferred.
- Psychotic symptom relief and mood stabilization are longer-term therapeutic goals.
- In acute psychiatric emergencies, medication effectiveness is judged by reduction in dangerous or disruptive behaviors.
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