The nurse is reviewing expected outcomes for a client diagnosed with bipolar I disorder. Number the outcomes presented in the order in which the nurse would address them.

The client exhibits no evidence of physical injury.

The client eats 70% of all finger foods offered.

The client is able to access available out-patient resources.

The client accepts responsibility for own behaviors.

Answer and Explanation

The Correct Answer is A,B,D,C

Bipolar I disorder is a chronic psychiatric condition marked by alternating episodes of mania, depression, and periods of euthymia. Manic phases often present with impulsivity, poor judgment, and psychomotor agitation, increasing risk for injury and nutritional neglect. Prioritization of care must follow physiological stabilization before psychosocial rehabilitation.

Rationale for correct order

1. During acute mania, the client is at high risk for injury due to hyperactivity, poor impulse control, and impaired judgment. Immediate safety is the nurse’s top priority, aligning with physiological needs.

2. Nutritional intake is often compromised in manic states due to distractibility and hyperactivity. Finger foods support autonomy and minimize disruption, promoting caloric intake and hydration.

4. Once stabilized physically, the client can begin to engage in insight-oriented interventions. Accepting responsibility reflects progress in cognitive integration and readiness for therapeutic work.

3. Accessing outpatient resources is a long-term goal requiring insight, motivation, and stability. It is addressed after acute symptoms subside and the client demonstrates readiness for discharge planning.

Take Home Points

Bipolar I disorder requires prioritization of physiological safety before psychosocial goals.
Acute mania increases risk for injury and nutritional neglect due to hyperactivity and poor judgment.
Insight and responsibility are addressed only after stabilization of physical and behavioral symptoms.
Discharge planning and outpatient resource access are long-term goals contingent on clinical improvement.

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Correct Answer is B

Explanation

Manic phase of bipolar disorder is marked by elevated mood, hyperactivity, and distractibility, often leading to poor nutritional intake. Clients may be unable to sit through full meals, making finger foods essential for maintaining caloric intake. Nutritional strategies must accommodate erratic behavior and ensure energy-dense, portable options that can be consumed quickly. Foods should be easy to handle, require minimal utensils, and be appealing enough to encourage spontaneous eating during periods of agitation or pacing.

Rationale for correct answer

2. This option provides nutritious, high-calorie finger foods that can be eaten while moving. The sandwich, carrot sticks, grapes, and cookies are portable and require no utensils, supporting adequate intake during hyperactivity.

Rationale for incorrect answers

1. Soup and peaches require utensils and sitting still, which is impractical during manic episodes. The liquid nature of soup also increases spill risk and may discourage consumption.

3. Roast chicken and mashed potatoes are difficult to eat without sitting and using utensils. These foods are less suitable for clients who are pacing or unable to focus on structured meals.

4. Although the tuna sandwich is portable, the ice cream and apple require more effort to consume and may not be appealing or practical during periods of agitation and distractibility.

Take Home Points

Clients in manic states benefit from high-calorie, portable finger foods that accommodate hyperactivity and distractibility.
Structured meals requiring utensils are often ineffective during acute mania.
Nutritional interventions must prioritize accessibility and caloric density to prevent weight loss and exhaustion.
Food choices should be tailored to behavioral presentation, not just nutritional value.

A. Angry. B. Dependent. C. Inadequate. D. Ambivalent.

Correct Answer is A

Explanation

Manic episodes in bipolar disorder are marked by elevated mood, grandiosity, and intrusive behavior, often leading to overbearing interactions with others. Clients may exhibit inflated self-esteem and a need to control their environment, which can disrupt group dynamics and provoke negative emotional responses from peers. These behaviors are not intentional acts of malice but stem from impaired impulse control and disinhibition.

Rationale for correct answer

1. Authoritative and intrusive behavior during mania often leads to resentment among peers. Other clients may feel their autonomy is being violated, resulting in frustration and anger, especially when repeatedly instructed or corrected by someone acting superior.

Rationale for incorrect answers

2. Clients are unlikely to become dependent on someone exhibiting manic control. Instead, they may resist or reject the behavior, as it undermines their independence and personal boundaries.

3. Feelings of inadequacy are more common in depressive contexts or when clients compare themselves to others in a passive way. In this scenario, the issue is not self-worth but interpersonal conflict.

4. Ambivalence implies mixed or uncertain feelings, which does not accurately reflect the typical reaction to persistent controlling behavior. The response is more likely to be direct irritation or anger.

Take Home Points

Manic behavior often includes grandiosity and intrusive control over others.
Such behaviors disrupt group cohesion and provoke anger in peers.
Nurses must intervene to maintain therapeutic boundaries and protect client autonomy.
Emotional reactions to manic intrusiveness are typically frustration, not dependency or ambivalence.

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The nurse is reviewing expected outcomes for a client diagnosed with bipolar I disorder. Number the outcomes presented in the order in which the nurse would address them.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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