A nurse is teaching a client about skin cancer prevention. Which of the following statements by the client indicates an understanding of the teaching?

Rationale for Correct Choices:

• Mania: The client demonstrates hallmark signs of a manic episode including euphoric mood, impulsive and excessive spending, decreased sleep, pressured and disorganized speech, and grandiosity. Mania also often presents with hyperactivity and distractibility, both of which are present.
• Euphoric mood: Euphoric mood refers to an elevated, expansive emotional state beyond appropriate bounds of context. In this case, the client’s overly joyous affect and heightened self-confidence, along with insomnia and excessive sociability, clearly reflect this finding.

Rationale for Incorrect Choices:

• Delirium: Delirium typically presents with fluctuating levels of consciousness, reduced awareness, and inattention due to acute medical or substance-related causes. Although this client is disoriented to place, they are alert and oriented to person and time, and there's no acute medical condition or toxic exposure noted, making delirium unlikely.
• Catatonia: Catatonia involves motor abnormalities such as stupor, mutism, negativism, or waxy flexibility. The client in this scenario is exhibiting hyperactivity, pressured speech, and constant movement, which are contrary to the reduced motor activity seen in catatonia. These findings rule out this condition.
• Panic disorder: Panic disorder is characterized by sudden, recurrent panic attacks with physical symptoms like chest pain, palpitations, and a sense of impending doom. It is episodic and does not explain the client’s persistent mood elevation, insomnia, or grandiosity.
• Major depressive disorder: This disorder involves persistent low mood, loss of interest or pleasure (anhedonia), sleep disturbances (often hypersomnia), and low energy. The client instead demonstrates an elevated, not depressed, mood with excessive energy and activity.
• Hypervigilance: Hypervigilance refers to a heightened state of sensory sensitivity, often seen in anxiety or PTSD. The client shows distractibility but not constant scanning or suspicion of danger, making hypervigilance an unfitting descriptor of their state.
• Anhedonia: Anhedonia, or lack of pleasure in previously enjoyable activities, is a core symptom of depression. The client, on the contrary, is described as overly sociable, excited about events, and highly active, which indicates a heightened—not blunted—capacity for pleasure.
• Alogia: Alogia involves poverty of speech and is typically seen in schizophrenia or severe depression. The client has loud, rapid, and disorganized speech, which is the opposite of speech reduction. Thus, this finding does not apply to the clinical picture.
• Magical thinking: Magical thinking refers to believing that one’s thoughts or actions can influence unrelated external events. While the client is hallucinating, there is no indication they are attributing unrealistic powers or connections to their thoughts.

Rationale:

A. The client slept 5 hr the previous night: Restorative sleep reflects stabilization in manic episodes, where insomnia is a key symptom. Sleeping for five hours is a significant improvement, indicating reduced hyperactivity and improved mood regulation.

B. The client consumes 8 oz of high-calorie fluids each hour: Adequate nutritional intake and hydration are often compromised in mania due to distractibility and hyperactivity. Regular consumption of fluids shows enhanced attention, cooperation, and reduced psychomotor agitation.

C. The client takes short naps during the day: Napping during the day may actually signal persistent hyperactivity or fragmented sleep cycles. Restful, consolidated nighttime sleep is a better indicator of clinical improvement than sporadic daytime naps.

D. The client engages in quiet activities in their room: Participation in low-stimulation activities reflects improved impulse control, attention span, and reduced need for excessive stimulation positive signs of response to lithium and therapeutic interventions.

E. The client appears to listen to unseen others: Persistent auditory hallucinations suggest ongoing psychotic features. Although lithium can reduce mood-related psychosis, hallucinations at this stage indicate incomplete resolution of manic or psychotic symptoms.