A 42-year-old client with bipolar disorder has been hospitalized on the inpatient psychiatric unit. She is dancing around, talking incessantly, and singing. Much of the time the client is anorexic and eats very little from her tray before she is up and about again. The nurse's intervention would be to?

Appeared in: NORCET 5 mains

Explanation

Patients in a manic phase exhibit extreme hyperactivity and a short attention span, making it difficult for them to sit through a complete meal.
The most effective intervention is to adapt to the patient's behavior by providing high-calorie, high-protein, portable foods (finger foods, snacks, shakes) that can be consumed on the move.
This strategy meets the patient's increased physiological demands for energy due to hyperactivity.
Continuous monitoring of intake, output, and weight is a critical nursing responsibility to prevent dehydration and malnutrition, which are significant risks.

Option A: Confronting a client in a manic state is counterproductive. It is a non-therapeutic communication technique that can escalate agitation and damage the nurse-client relationship.
Option B: A client experiencing mania has impaired concentration and is easily distractible. They are cognitively unable to focus on a detailed discussion.
Option C: This option is partially correct in offering snacks but is critically flawed because it omits the nurse's responsibility to monitor intake. Without monitoring, there is no way to ensure the client is receiving adequate nutrition and hydration.

Visual 1: Infographic - 'Foods for the Manic Phase'. This visual could show examples of ideal high-calorie, nutrient-dense, portable foods like cheese sticks, sandwiches cut into quarters, fruit smoothies, and nuts.
Visual 2: Chart - 'Comparing Nursing Interventions: Mania vs. Depression'. This chart would contrast the nutritional interventions for mania (high-calorie, frequent, portable foods) with those for depression (small, appealing meals; encouraging intake; sitting with the client).

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Nutritional management for a patient with bipolar disorder in a manic phase in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Prioritizing physiological safety is paramount in nursing care. For a manic client, the risk of physical exhaustion, dehydration, and malnutrition is acute and can be life-threatening if not managed proactively.
This scenario highlights the importance of adapting nursing interventions to the client's specific mental state. A 'one-size-fits-all' approach to mealtime is ineffective and inappropriate for a hyperactive client.
What if? If the client were in a depressive phase of bipolar disorder with poor appetite, the intervention would shift. Instead of 'on-the-go' foods, the nurse would focus on creating a calm meal environment, offering smaller portions of favorite foods, and providing gentle encouragement and company during meals to combat apathy and low motivation.

How to Approach the Question

First, identify the client's diagnosis and current clinical presentation: The client has bipolar disorder and is in a manic phase, evidenced by hyperactivity and incessant talking.
Next, identify the core nursing problem: The client's hyperactivity prevents them from sitting still to eat, leading to poor nutritional intake and a risk of malnutrition.
Evaluate the options based on established principles of psychiatric nursing for mania. The goal is to meet the client's physiological needs in a way that accommodates their behavioral symptoms.
Eliminate options that are non-therapeutic or cognitively inappropriate. Confrontation (Option A) and detailed education (Option B) are unsuitable for a manic client.
Compare the remaining practical options. Option C suggests providing snacks but lacks a key nursing action. Option D includes both providing snacks and the crucial step of monitoring intake.
Select the most comprehensive and safest option. Option D is the best choice because it is a therapeutic strategy that addresses both the client's behavior and their physiological needs while upholding the nurse's duty to monitor and ensure safety.

Concept Tested & Keywords

Concept Tested: Nutritional management for a patient with bipolar disorder in a manic phase.
Stem keywords: bipolar disorder, inpatient psychiatric unit, dancing, talking incessantly, anorexic, eats very little
Lead-in keywords: nurse's intervention
Clinical cues: The client's behaviors of 'dancing around' and 'talking incessantly' are classic signs of hyperactivity in a manic episode, which is the primary reason for their inability to eat.
Clinical cues: The term 'anorexic' in this context refers to loss of appetite or poor intake due to the manic state, not the eating disorder Anorexia Nervosa.

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Practise the full NORCET 5 mains

Attempt every question from this paper in a timed mock, then review the full solution for each one.