A nurse is assisting with the plan of care for a client who is in the manic phase of bipolar disorder.
Which of the following interventions should the nurse recommend to include?

Choice A rationale:

Placing a client in restraints should be a last resort, as it can be traumatizing and can escalate agitation.

Restraints can also cause physical injury and psychological distress.

They should only be used when there is an immediate risk of harm to the client or others.

Choice B rationale:

Haloperidol is an antipsychotic medication that can be used to calm agitated clients.

However, it should not be the first-line intervention, as it can have significant side effects, including drowsiness, dizziness, and muscle stiffness.

It is important to assess the client's individual needs and risks before administering haloperidol.

Choice C rationale:

Asking a client to talk about their feelings can be helpful in some situations, but it is not appropriate when a client is agitated and yelling.

The client is likely to be too overwhelmed to engage in meaningful conversation.

It is important to first de-escalate the situation and ensure the safety of everyone involved.

Choice D rationale:

Moving the client to a seclusion room with continuous observation is the most appropriate intervention in this situation.

This will provide the client with a safe and quiet space to calm down.

It will also allow staff to monitor the client closely and intervene if necessary.

Continuous observation is essential to ensure the client's safety and to prevent self-harm.

Choice A rationale:

Disorientation is a significant neurological finding that can signal a serious adverse reaction to lorazepam, particularly in older adults. It's crucial to report it immediately to the provider for prompt assessment and intervention.

Lorazepam, a benzodiazepine, can cause central nervous system (CNS) depression, which can manifest as disorientation, confusion, memory impairment, and even delirium.

Older adults are more vulnerable to CNS depressant effects due to age-related physiological changes, such as decreased metabolism and clearance of medications, as well as increased brain sensitivity.

Early identification and management of disorientation can prevent potential complications, such as falls, injuries, and worsening cognitive decline.

Choice B rationale:

Increased anxiety can be a paradoxical reaction to lorazepam, but it's not as immediately concerning as disorientation in terms of potential for serious harm.

The nurse should still monitor anxiety levels and report any significant changes to the provider, as dosage adjustments or alternative medications may be necessary.

Choice C rationale:

Blurred vision is a common side effect of lorazepam, but it's typically mild and transient.

It's important to assess the severity and duration of blurred vision and report it to the provider if it persists or interferes with daily activities.

Choice D rationale:

Anorexia, or loss of appetite, can be a side effect of lorazepam, but it's not as urgent as disorientation.

The nurse should monitor the patient's nutritional intake and weight, and report any significant changes to the provider.