# A 28-year-old patient with bipolar I disorder is admitted with acute mania: pressured speech, no sleep for 4 nights, grandiosity, easy distractibility, and 8 lb weight loss in a week. Which environmental and care interventions should the nurse plan? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372754&lang=en  
> language: en  
> subject: Abuse or Neglect  
> category: PSI

## Question

A 28-year-old patient with bipolar I disorder is admitted with acute mania: pressured speech, no sleep for 4 nights, grandiosity, easy distractibility, and 8 lb weight loss in a week. Which environmental and care interventions should the nurse plan? Select all that apply.

1

Set firm, consistent limits on intrusive or sexually inappropriate behaviors using brief, calm, neutral statements.

2

Reinforce one-on-one redirection rather than confrontation, and use a structured daily routine.

3

Offer high-calorie finger foods, juices, and protein shakes that the patient can carry while moving.

4

Place the patient in a single low-stimulation room away from the nurses' station, dayroom, and other agitated patients.

5

Encourage the patient to participate in competitive group games and crafts to channel the high energy.

## Explanation

Acute mania is a state of high arousal, distractibility, poor judgment, and physical exhaustion. Care planning: (1) low-stimulation private room reduces sensory input that fuels arousal; (2) high-calorie portable foods address the weight loss and inability to sit for meals; (3) firm, consistent limits delivered briefly and neutrally protect the patient and others without escalating power struggles; (5) one-on-one redirection and structured routine externalize the structure the patient cannot self-generate. Choice 5 is incorrect — competitive games and complex crafts increase stimulation and frustration; mania needs single-task, simple, non-competitive activities such as walking, simple drawing, or a quiet exercise space.

## In-depth explanation

Acute mania care principles include decreasing environmental stimuli with a private low-stimulation room, providing portable high-calorie nutrition, setting firm, consistent, and brief limits, redirecting rather than confronting, structuring the day, ensuring rest opportunities, and monitoring for exhaustion and risk of harm to self or others. Limit setting uses brief, calm, neutral statements that name the unacceptable behavior and redirect — for example, "Mr. K, that comment is inappropriate. Let's walk to the courtyard." Avoid debating, lecturing, or matching the patient's pressured speech, and stay consistent across staff and shifts. Activity selection in mania favors simple, non-competitive, motor-driven activities (walking, drawing, simple stretching) over complex crafts, competitive games, or anything requiring sustained attention; the goal is to channel motor energy without raising frustration or stimulation.

## Clinical scenario

A **28-year-old patient with bipolar I disorder** is admitted with **acute mania**: **pressured speech, no sleep for 4 nights, grandiosity, distractibility, 8 lb weight loss in a week**. The nurse plans environmental and care interventions.

## Key concepts

- **Acute Mania Care** — Decrease environmental stimuli (private low-stim room), provide portable high-calorie nutrition, set firm/consistent/brief limits, redirect rather than confront, structure the day, ensure rest opportunities, monitor for exhaustion and risk of harm to self or others.
- **Limit Setting** — Brief, calm, neutral statements that name the unacceptable behavior and redirect — "Mr. K, that comment is inappropriate. Let's walk to the courtyard." Avoid debating, lecturing, or matching the patient's pressured speech. Consistent across staff and shifts.
- **Activity Selection** — Mania prefers simple, non-competitive, motor-driven activities (walking, drawing, simple stretching) over complex crafts, competitive games, or anything requiring sustained attention. The goal is to channel motor energy without raising frustration or stimulation.

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