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Soup and peaches require utensils and sitting still, which is impractical during manic episodes. The liquid nature of soup also increases spill risk and may discourage consumption.

Roast chicken and mashed potatoes are difficult to eat without sitting and using utensils. These foods are less suitable for clients who are pacing or unable to focus on structured meals.

Although the tuna sandwich is portable, the ice cream and apple require more effort to consume and may not be appealing or practical during periods of agitation and distractibility.

Delusions of grandeur involve inflated self-worth or identity, such as believing one is famous or has special powers. Margaret’s statement does not reflect exaggerated self-importance but rather suspicion of others.

Delusions of reference involve interpreting neutral events as having personal meaning, such as believing TV shows are sending messages. Margaret’s accusation is directed at a person, not an external event.

Delusions of control involve the belief that one’s thoughts or actions are being manipulated by external forces. Margaret’s statement does not suggest external control over her behavior or thoughts.

Aggression involves intent to harm or confront others. The client’s behavior lacks hostility or directed threat, making this an inaccurate interpretation.

Anger is an emotional state often accompanied by verbal or physical aggression. The client’s actions are more consistent with restlessness than emotional expression.

Anxiety may cause restlessness, but psychomotor agitation is more intense and physically expressive. The client’s symptoms exceed typical anxious behavior.

Expanded explanations overwhelm the client’s limited attention span during mania. They may increase confusion or trigger tangential thinking, making communication ineffective.

Abstract concepts are poorly processed during manic states due to cognitive disorganization. Concrete, simple language is more appropriate for maintaining clarity.

Lightheartedness and joking may reinforce grandiosity or escalate manic behavior. It undermines the seriousness of the situation and may compromise therapeutic boundaries.

Avoiding self-help groups contradicts supportive care principles. Peer support enhances coping and reduces isolation, especially during recovery phases.

Euphoric mood is a symptom of mania, not a desired outcome. The goal is mood stabilization, not emotional elevation, which may signal relapse.

While maintaining weight is beneficial, it is not the primary objective in the continuation phase. Psychiatric stability and medication adherence take precedence.

Discouraging daytime naps may be appropriate later, but without understanding the client’s baseline, it risks worsening fatigue or agitation. Assessment must precede behavioral modification.

While caffeine and nicotine can impair sleep, this intervention is secondary. It assumes causality without first evaluating the client’s specific sleep behaviors and contributing factors.

Relaxation exercises are useful but not the first step. Without assessment, they may be mismatched to the client’s needs or ineffective due to manic energy levels.

One-on-one interaction requires initiative, emotional regulation, and social reciprocity, which may be premature for a client still struggling with egocentrism and impaired interpersonal skills.

Exchanging personal information implies a level of trust and social comfort that is typically achieved in later stages of therapeutic progress, not within early short-term goals.

Initiating a social relationship demands judgment and sustained interpersonal effort, which exceeds the scope of a short-term outcome for a client with impaired social interaction.

Administering a PRN intramuscular injection is a chemical restraint, appropriate only after non-invasive methods fail. It is not the first-line intervention unless the client poses imminent danger.

Telling the client to lower their voice may provoke defensiveness or escalate agitation. It lacks therapeutic engagement and does not address the underlying behavioral dysregulation.

Seclusion is a restrictive intervention requiring justification and physician order. It is reserved for situations where the client poses a threat and other strategies have failed.

Placing the client with another symptomatic peer increases stimulation and risk of behavioral escalation. It compromises safety and violates principles of environmental control in psychiatric care.

Discussing consequences requires insight, which is impaired during acute mania. The client may be unable to process or retain such information, making this intervention ineffective in the short term.

Reinforcing coping skills assumes cognition and emotional regulation, which are compromised during manic episodes. The client is unlikely to engage meaningfully with learned strategies until stabilized.

This statement implies pressure and conditional support, which may increase guilt or resistance. It lacks empathy and fails to validate the client’s current emotional experience.

Physical contact may be perceived as intrusive, especially when the client is withdrawn or tearful. It risks breaching boundaries and may not be appropriate without established rapport.

This approach is task-oriented and dismissive of the client’s emotional state. It prioritizes procedure over therapeutic engagement and may reinforce feelings of isolation.

Completing a puzzle alone reinforces isolation and may be cognitively demanding for a client with impaired concentration. It lacks interpersonal engagement and therapeutic value at this stage.

Playing cards with several clients requires social energy and sustained attention, which may be too taxing during a depressive episode. It risks overstimulation and withdrawal if the client cannot keep up.

Ping-Pong involves coordination and physical exertion, which may exceed the client’s current energy level. It is more appropriate during recovery or euthymic phases, not early in depressive hospitalization.

This response is judgmental and lacks therapeutic value. It may escalate the client’s defensiveness and does not acknowledge the psychiatric basis of the behavior.

Ignoring vulgarity may reinforce inappropriate behavior and compromise the therapeutic environment. It fails to model boundaries or protect other clients from verbal aggression.

Withholding communication until the client complies is punitive and risks emotional withdrawal. It undermines rapport and may worsen manic symptoms due to perceived rejection.

Clients are unlikely to become dependent on someone exhibiting manic control. Instead, they may resist or reject the behavior, as it undermines their independence and personal boundaries.

Feelings of inadequacy are more common in depressive contexts or when clients compare themselves to others in a passive way. In this scenario, the issue is not self-worth but interpersonal conflict.

Ambivalence implies mixed or uncertain feelings, which does not accurately reflect the typical reaction to persistent controlling behavior. The response is more likely to be direct irritation or anger.

Humor may be perceived as mocking or dismissive, especially during mania. It risks escalating the client’s behavior or provoking agitation in others, undermining therapeutic rapport.

Sympathy may reinforce dependency or validate inappropriate behavior. It lacks structure and does not address the need for behavioral containment or environmental control.

Confrontation increases defensiveness and may escalate manic symptoms. It challenges the client’s impaired judgment and can provoke aggression or further disruption in the unit.

Focusing on reality may be ineffective due to grandiosity and poor insight during mania. The client may resist or misinterpret attempts to reorient, leading to frustration or confrontation.

Encouraging unrestricted talking reinforces pressured speech and disorganized thought. It may overwhelm others and increase manic intensity, compromising therapeutic boundaries.

Persuading task completion assumes attention and follow-through, which are impaired in mania. The client may become irritable or abandon tasks midway, making this approach ineffective.

Playing cards with several clients increases arousal and social stimulation, which may exacerbate manic symptoms. The client may dominate the activity or provoke agitation in others.

Introspection requires insight, which is impaired during mania. The client may be unable to reflect meaningfully or engage in therapeutic self-examination until symptoms stabilize.

Communal dining may lead to disruption due to excessive talking or intrusive behavior. It risks overstimulation and conflict with peers, especially in early stages of admission.

Asking for reasons assumes insight, which is often absent during mania. The client may respond with defensiveness or further agitation, making this approach ineffective and potentially unsafe.

Nonthreatening assessment is appropriate once stabilized, but not as a first response when behavior is disruptive and frightening others. Immediate containment is required before therapeutic engagement.

Seclusion is a restrictive intervention requiring clinical justification and physician order. It is not the first-line response and should only be considered if less invasive methods fail to ensure safety.

Restraints must be justified by imminent danger, not history alone. Using restraints preemptively violates legal standards and patient rights, and may be considered abusive or excessive.

Sedation without clinical indication or behavioral escalation is unlawful and unethical. It disregards the principle of least restrictive intervention and may lead to liability for chemical restraint.

Even if in contact with reality, a client with a history of aggression requires monitoring. Reality orientation does not eliminate risk, and failure to supervise may result in preventable harm and legal consequences.

Deferring responsibility undermines collaboration and delays intervention. As co-leader, the nurse shares accountability for maintaining structure and must act promptly to manage disruptive behavior.

Instructing Ms. B to respond invites conflict and emotional escalation. It risks reinforcing accusatory dynamics and compromising the psychological safety of both clients.

Telling Ms. M to stop and promising investigation may provoke defensiveness or further outbursts. It lacks therapeutic containment and may be perceived as invalidating or dismissive.