What should the nurse include when developing a plan of care for a client in the manic phase of bipolar disorder?
Focus the client’s interest in reality.
Encourage the client to talk as much as needed.
Redirect the client’s excess energy to constructive channels.
Persuade the client to complete any task that has been started.
The Correct Answer is C
Manic phase of bipolar disorder is marked by elevated mood, hyperactivity, and impaired concentration, often accompanied by distractibility, impulsivity, and rapid speech. Clients may exhibit excessive goal-directed activity without completion, leading to exhaustion and interpersonal disruption. Nursing care must prioritize behavioral containment and energy redirection to reduce risk and promote functional engagement.
Rationale for correct answer
3. Redirecting excess energy into constructive channels helps manage agitation and prevents escalation. Structured activities like walking or folding laundry provide physical outlet while minimizing overstimulation and promoting behavioral regulation.
Rationale for incorrect answers
1. Focusing on reality may be ineffective due to grandiosity and poor insight during mania. The client may resist or misinterpret attempts to reorient, leading to frustration or confrontation.
2. Encouraging unrestricted talking reinforces pressured speech and disorganized thought. It may overwhelm others and increase manic intensity, compromising therapeutic boundaries.
4. Persuading task completion assumes attention and follow-through, which are impaired in mania. The client may become irritable or abandon tasks midway, making this approach ineffective.
Take Home Points
- Manic episodes involve hyperactivity, distractibility, and poor impulse control.
- Structured redirection of energy helps contain behavior and reduce agitation.
- Reality orientation and task completion are limited by impaired insight and attention.
- Unrestricted verbalization may escalate symptoms and disrupt the therapeutic environment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Manic episode in bipolar disorder is marked by elevated mood, hyperactivity, and impaired impulse control, often accompanied by distractibility, grandiosity, and intrusive behavior. Clients may overstimulate easily and disrupt group settings due to excessive energy and pressured speech. Nursing interventions must prioritize environmental control to reduce stimulation and promote behavioral containment.
Rationale for correct answer
1. Assigning the client to a private room minimizes stimulation and protects other clients from disruptive behavior. It allows for better behavioral monitoring and supports de-escalation in a controlled setting.
Rationale for incorrect answers
2. Playing cards with several clients increases arousal and social stimulation, which may exacerbate manic symptoms. The client may dominate the activity or provoke agitation in others.
3. Introspection requires insight, which is impaired during mania. The client may be unable to reflect meaningfully or engage in therapeutic self-examination until symptoms stabilize.
4. Communal dining may lead to disruption due to excessive talking or intrusive behavior. It risks overstimulation and conflict with peers, especially in early stages of admission.
Take Home Points
- Manic episodes require environmental control to reduce stimulation and prevent escalation.
- Private rooms support behavioral containment and minimize disruption to others.
- Insight-based interventions are deferred until the client achieves symptom stabilization.
- Group activities and communal settings may worsen manic symptoms and compromise safety.
Correct Answer is B
Explanation
Continuation phase of bipolar disorder treatment follows acute symptom stabilization and focuses on relapse prevention, medication adherence, and psychosocial recovery. This phase typically spans 4 to 9 months and aims to consolidate gains made during the acute phase. The most critical goal is ensuring adherence to pharmacologic therapy, as discontinuation is a major predictor of relapse. Psychosocial education, monitoring for side effects, and gradual reintegration into daily routines are emphasized. Mood stabilization—not euphoria—is the therapeutic target, and weight management is monitored but not prioritized over psychiatric stability.
Rationale for correct answer
2. Adherence to the medication regimen is the cornerstone of the continuation phase. It prevents recurrence of mood episodes and supports long-term stability, making it the most appropriate outcome for this phase.
Rationale for incorrect answers
1. Avoiding self-help groups contradicts supportive care principles. Peer support enhances coping and reduces isolation, especially during recovery phases.
3. Euphoric mood is a symptom of mania, not a desired outcome. The goal is mood stabilization, not emotional elevation, which may signal relapse.
4. While maintaining weight is beneficial, it is not the primary objective in the continuation phase. Psychiatric stability and medication adherence take precedence.
Take Home Points
- The continuation phase focuses on preventing relapse and reinforcing medication adherence.
- Mood stabilization—not emotional highs—is the therapeutic goal in bipolar disorder.
- Support groups and psychosocial interventions enhance recovery and reduce isolation.
- Physical health monitoring is important but secondary to psychiatric stabilization during continuation treatment.
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