A nurse is preparing to administer intermittent gastric feeding for a client who has a nasogastric tube. Which of the following actions should the nurse take prior to the feeding?

Rationale:

• Pressured speech: The client demonstrates rapid, loud, and nonstop speech, characteristic of mania. Pressured speech reflects heightened energy, distractibility, and decreased need for rest, all typical of a manic episode. It is not a primary symptom of psychosis, although severe psychotic agitation can sometimes alter speech.

• Hallucinations: The client reports seeing a person who is not present and interacting with them, which is a hallmark of psychosis. These perceptual disturbances indicate impaired reality testing. Hallucinations are less common in purely manic states unless mania is accompanied by psychotic features. Here, the client’s persistent visual hallucinations support a diagnosis of psychosis.

• Disorganized thought process: The client exhibits disorganized and tangential speech, reflecting difficulty organizing thoughts. Disorganization is characteristic of psychotic disorders due to impaired reality testing and cognitive processing. It can also appear in mania, particularly when the client exhibits distractibility, racing thoughts, and pressured speech.

• Lack of sleep: The client has gone at least 2 days without sleeping, a classic sign of mania. Decreased need for sleep with preserved energy is typical in manic episodes. Sleep deprivation alone does not indicate psychosis unless accompanied by hallucinations or delusions.

• Excessive spending habits: The client exhibits impulsive financial behavior, giving away large sums of money and overspending. This risk-taking and poor judgment are hallmark features of mania. Such behaviors are less commonly associated with psychosis unless delusions drive them.

A. Progestin oral contraceptive: Progestin-only oral contraceptives (often called the “mini-pill”) are safe to use immediately postpartum for breastfeeding clients because they do not affect milk production. They provide effective contraception without the risks associated with estrogen-containing methods.

B. Vaginal etonogestrel/ethinyl estradiol contraceptive ring: Combination estrogen-progestin contraceptives, such as the vaginal ring, are generally not recommended immediately postpartum for breastfeeding clients because estrogen can reduce milk supply and may increase the risk of thromboembolism.

C. Transdermal estrogen/progesterone patch: Similar to other estrogen-containing methods, the transdermal patch is not recommended immediately postpartum for breastfeeding clients due to potential interference with lactation and increased thromboembolism risk.

D. Injectable synthetic progestin: Injectable progestin (e.g., depot medroxyprogesterone acetate) is safe for breastfeeding, but it is not ideal for immediate postpartum use if the client wishes for rapid return to fertility later, since its effects can last for several months. It may also have delayed effects on bone density with long-term use.