The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which of the following?

Aggression

Anger

Anxiety

Psychomotor agitation

Answer and Explanation

The Correct Answer is D

Psychomotor agitation is a behavioral manifestation of mental tension and internal restlessness, often seen in mood disorders like bipolar I disorder. It involves excessive, purposeless motor activity such as pacing, rapid speech, and exaggerated gestures. These movements are not goal-directed but serve as an outlet for emotional dysregulation. In manic episodes, psychomotor agitation reflects heightened arousal and poor impulse control, and may escalate to aggression if not addressed. It differs from anxiety or anger by its physical intensity and lack of clear emotional focus.

Rationale for correct answer

4. The client’s pacing, loud rapid speech, and elaborate gestures are hallmark signs of psychomotor agitation. These behaviors reflect restlessness and internal tension, commonly seen in manic phases of bipolar disorder.

Rationale for incorrect answers

1. Aggression involves intent to harm or confront others. The client’s behavior lacks hostility or directed threat, making this an inaccurate interpretation.

2. Anger is an emotional state often accompanied by verbal or physical aggression. The client’s actions are more consistent with restlessness than emotional expression.

3. Anxiety may cause restlessness, but psychomotor agitation is more intense and physically expressive. The client’s symptoms exceed typical anxious behavior.

Take Home Points

Psychomotor agitation involves purposeless, excessive motor activity driven by internal tension.
It is commonly seen in manic episodes of bipolar disorder and requires early intervention to prevent escalation.
Differentiating agitation from aggression or anxiety is critical for accurate nursing assessment.
Behavioral signs like pacing, rapid speech, and exaggerated gestures are key indicators of psychomotor agitation.

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Correct Answer is B

Explanation

Bipolar I disorder during manic episodes presents with elevated mood, hyperactivity, and impaired judgment, often leading to risk-taking behaviors and physical exhaustion. Clients may exhibit distractibility, impulsivity, and psychomotor agitation, which significantly increase the risk for injury. Immediate interventions must target physiological stabilization and behavioral containment using pharmacologic and environmental strategies.

Rationale for correct answer

2. PRN antipsychotic medications help reduce agitation and stabilize mood by modulating dopamine activity. They are appropriate for acute symptom control when hyperactivity poses a risk for injury and non-pharmacologic methods are insufficient.

Rationale for incorrect answers

1. Placing the client with another symptomatic peer increases stimulation and risk of behavioral escalation. It compromises safety and violates principles of environmental control in psychiatric care.

3. Discussing consequences requires insight, which is impaired during acute mania. The client may be unable to process or retain such information, making this intervention ineffective in the short term.

4. Reinforcing coping skills assumes cognition and emotional regulation, which are compromised during manic episodes. The client is unlikely to engage meaningfully with learned strategies until stabilized.

Take Home Points

Bipolar I disorder with hyperactivity requires immediate pharmacologic intervention to reduce risk of injury.
Antipsychotics are effective in managing acute agitation and restoring behavioral control.
Environmental stimulation must be minimized to prevent escalation of manic symptoms.
Insight-based and cognitive interventions are deferred until the client achieves symptom stabilization.

A. The client exhibits no evidence of physical injury. B. The client eats 70% of all finger foods offered. C. The client is able to access available out-patient resources. D. The client accepts responsibility for own behaviors.

Correct Answer is A,B,D,C

Explanation

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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The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which of the following?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client newly admitted with bipolar I disorder has a nursing diagnosis of risk for injury related to extreme hyperactivity. Which nursing intervention is appropriate?

Correct Answer is B

Explanation

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.

Correct Answer is A,B,D,C

Explanation

A client is admitted to the facility in the manic phase of bipolar disorder. When placing a diet order for the client, which foods are most appropriate?

A client who is being admitted to the mental health unit with bipolar disorder is depressed, avoids eye contact, responds in a very low voice, and is tearful. What is most therapeutic for a nurse to say during the assessment interview?

The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which of the following?

A client with bipolar disorder, manic episode, has a superior, authoritative manner and constantly instructs other clients about how to dress, what to eat, and where to sit. The nurse should intervene because these behaviors eventually will cause the other clients to feel:

A major principle the nurse should observe when communicating with a patient experiencing elated mood is to:

What should the nurse include when developing a plan of care for a client in the manic phase of bipolar disorder?