A nurse is providing discharge teaching to the family of a client who has Alzheimer's disease. Which of the following instructions should the nurse include in the teaching?

Rationale for Correct Choices:

• Mania is characterized by an abnormally elevated, expansive, or irritable mood accompanied by increased energy or activity. This client’s obsessive cleaning, excessive spending, sleeplessness, pressured speech, and overly joyous behavior strongly support a manic episode.
• Euphoric mood refers to an exaggerated feeling of well-being or elation not consistent with the client's circumstances. It often presents in mania alongside impulsivity and grandiosity, such as the client’s obsession with hosting parties and giving away money without regard for consequences.

Rationale for Incorrect Choices:

• Delirium: Typically presents with fluctuating consciousness, acute onset confusion, and disorganized thinking often due to a medical cause. The client is alert and oriented to person and time, which is inconsistent with the inattention and acute cognitive changes of delirium.
• Catatonia: Characterized by motor immobility, extreme negativism, mutism, or stupor. The client displays hyperactivity and pressured speech, which are the opposite of the psychomotor retardation seen in catatonia.
• Panic disorder: Involves sudden onset of intense fear with physical symptoms such as palpitations, chest pain, or shortness of breath. It lacks the prolonged mood elevation, impulsivity, and grandiosity observed in this case.
• Major depressive disorder: Presents with persistent sadness, fatigue, anhedonia, and social withdrawal. The client’s symptoms of increased activity, grandiosity, and reduced need for sleep do not align with depression.

• Alogia: Refers to poverty of speech or reduced speech output, often associated with schizophrenia or severe depression. This contrasts with the client’s pressured and excessive speech.
• Magical thinking: Involves believing one’s thoughts can influence the physical world, often seen in psychotic disorders or schizotypal personality disorder. The client describes hallucinations, but no evidence of magical thinking is present.
• Hypervigilance: Describes excessive alertness or scanning for threats, commonly associated with anxiety or PTSD. The client’s symptoms point to elevated mood and disinhibition, not heightened fear or threat perception.
• Anhedonia: A core symptom of depression, characterized by a loss of interest or pleasure in activities. The client’s increased goal-directed activity and enjoyment in planning events contradict this finding.

A. "Why do you think your partner's symptoms are progressing so quickly?” This question can feel blaming and may cause the partner to become defensive, which is not therapeutic. This response shifts the burden of explanation to the partner and doesn't directly address their expressed feeling of being overwhelmed.
B. “You did the right thing by bringing your partner in for treatment.” While supportive, this statement shuts down further discussion and does not encourage the partner to express feelings or concerns.
C. “Can you talk about what was happening with your partner at home.” This open-ended question encourages the partner to share feelings and experiences, fostering communication and therapeutic rapport.
D. “You should make sure your partner takes the prescribed medication.” This response is prescriptive and shifts immediately to an action plan without first acknowledging or exploring the partner's current emotional state and the overwhelming situation they are describing. .