The emergency department (ED) is calling to report on a patient who will be admitted to your acute psychiatric unit. He has a history of bipolar disorder and was in an altercation that resulted in the death of another. He has contusions, abrasions, and minor lacerations. What is the priority question that you should ask?
“When will the patient be transferred?”
“Will a police officer be with him while he is on the unit?”
“Why isn’t the patient being admitted to the trauma unit?”
“What is the patient’s current mood and behavior?”
The Correct Answer is D
Acute mania in bipolar disorder can present with extreme agitation, impulsivity, and poor judgment, often escalating to aggressive or dangerous behavior. When admitting a client with recent violent involvement, the priority is to assess current mental status, including mood, behavior, and risk factors such as psychosis, suicidality, or homicidality. This guides immediate safety planning, medication needs, and level of observation. Physical injuries are secondary to psychiatric stabilization in this context, especially when the client is medically cleared.
Rationale for correct answer
4. Determining the client’s current mood and behavioral presentation is essential for psychiatric triage. It informs risk assessment, safety measures, and initial treatment planning, especially in the context of recent violence and bipolar history.
Rationale for incorrect answers
1. While transfer timing is operationally relevant, it does not address clinical urgency. Psychiatric units must first prepare for the client’s behavioral presentation and safety needs.
2. Police presence may be necessary depending on legal status, but asking this first overlooks clinical priorities. Risk assessment should precede logistical or custodial concerns.
3. The client’s physical injuries are minor and medically cleared, making psychiatric admission appropriate. Questioning trauma unit placement diverts focus from psychiatric stabilization.
Take Home Points
- Psychiatric triage prioritizes mental status and behavioral risk over logistical or custodial details.
- Acute mania may involve aggression, requiring immediate assessment of mood and safety risk.
- Physical injuries are managed medically before psychiatric admission; they do not override psychiatric needs.
- Understanding current behavior guides observation level, medication initiation, and staff safety planning.
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 A
Explanation
Bipolar I disorder is a chronic psychiatric condition marked by alternating episodes of mania and depression. During manic phases, clients exhibit elevated mood, hyperactivity, grandiosity, and poor impulse control. These episodes often impair judgment and increase risk-taking behaviors, including aggression, self-harm, and harm to others. The manic state may also include psychotic features such as hallucinations or delusions, but the most immediate concern is safety—especially when disinhibition and impulsivity escalate to violent behavior.
Rationale for correct answer
1. During acute mania, impulsivity and poor judgment heighten the risk of aggressive outbursts toward others. The client may misinterpret interactions or act on grandiose beliefs, making violence a priority concern for nursing safety interventions.
Rationale for incorrect answers
2. Although hallucinations may occur in manic episodes, they are not the most immediate threat unless they directly provoke harmful behavior. The priority is safety, not perceptual disturbances.
3. Manic clients are typically hyper-social and intrusive, not withdrawn. Isolation is more characteristic of depressive phases, making this diagnosis less relevant during acute mania.
4. Feelings of guilt and low self-esteem are more prominent in depressive episodes. During mania, clients often display inflated self-worth and lack insight into inappropriate behaviors.
Take Home Points
- In acute mania, safety risks due to impulsivity and aggression take precedence over other psychosocial concerns.
- Bipolar I disorder includes manic episodes that may escalate to psychosis or violence, requiring close monitoring.
- Differentiating manic symptoms from depressive or psychotic features is essential for accurate nursing diagnosis.
- Nursing priorities shift with phase of illness—mania demands safety-focused interventions, while depression may focus on mood and cognition.
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