# Situation: A 27-year-old woman is admitted to the psychiatric unit with a manic episode. For 10 days she has slept 2 to 3 hours a night, spent all her savings on clothes, and talked almost nonstop. She has lost 3 kg in the past week because she will not sit down to eat. She has no other medical illness. At lunch she leaves the dining table after one or two bites to walk the hallway. Which plan BEST meets her nutritional needs?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630077  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 27-year-old woman is admitted to the psychiatric unit with a manic episode. For 10 days she has slept 2 to 3 hours a night, spent all her savings on clothes, and talked almost nonstop. She has lost 3 kg in the past week because she will not sit down to eat. She has no other medical illness.

At lunch she leaves the dining table after one or two bites to walk the hallway. Which plan BEST meets her nutritional needs?

## 보기

1. High-calorie finger foods and drinks she can take while walking **✔ 정답**
2. Three full meals served at a table with a staff member beside her
3. Keeping her seated at the table until she finishes her tray
4. Waiting until she feels hungry and then serving a large meal

**정답: 1**

## 해설

A client in acute mania is too active and distractible to sit through a meal. High-calorie, high-protein finger foods and portable drinks that she can take while moving meet her energy needs, with daily weights and intake monitoring.

## 심화 해설

Food she can eat on the move
A client in acute mania is hyperactive, distractible, and unable to sit still long enough to finish a meal. This woman has slept only 2 to 3 hours a night for 10 days, talks almost nonstop, and has lost 3 kg in the past week because she will not sit down to eat. Her energy use is very high while her intake is very low. High-calorie, high-protein finger foods and portable drinks that she can take while walking meet her energy needs without requiring her to sit. Examples include sandwiches, fruit, cheese, and nutritious shakes that can be carried.

Why this approach works
Mania increases physical activity and metabolic demand and reduces attention to bodily signals such as hunger and thirst. Rather than fighting her restlessness, the plan adapts to it. Finger foods can be offered frequently in small amounts, eaten without utensils, and carried as she walks. Fluids are offered regularly to prevent dehydration, which is especially important if she is started on lithium. Daily weights and records of intake allow the nurse to judge whether the plan is working.

| Option | Problem |
| --- | --- |
| High-calorie finger foods and drinks while walking | Correct: meets needs without requiring her to sit |
| Three full meals at a table with staff | She cannot sit through a full meal during acute mania |
| Keeping her seated until she finishes | Invites a power struggle and does not get food into her |
| Waiting until she feels hungry | Mania blunts hunger; weight loss worsens |

Why the other plans fail
Three full meals at a table, even with a staff member beside her, still require her to sit, which she cannot do at this stage. Insisting that she stay seated until her tray is finished creates a power struggle, increases agitation, and is unlikely to result in more food eaten. Waiting until she feels hungry ignores the fact that mania blunts awareness of hunger; she is already losing weight, and waiting would deepen the deficit.

Watch out! Reduce stimulation at mealtimes when possible, since the busy dining room adds to her distractibility. Some clients do better eating in a quieter area, but the priority remains getting calories in, not enforcing a setting.

Exam takeaway
Key point! For a client in acute mania, offer high-calorie, high-protein finger foods and portable drinks frequently, and monitor weight and intake daily. Avoid power struggles over sitting or finishing a tray.

## 임상 시나리오

Nutrition in Acute ManiaAdapting meals to hyperactivity
A client in acute mania cannot sit through meals and burns many calories. She has lost 3 kg in a week.

Offer high-calorie, high-protein finger foods and portable drinks often, so she can eat while she keeps moving. Offer fluids regularly.

Weigh her daily and record intake. A quieter eating area may help reduce distraction.

CautionForcing her to stay seated or waiting for hunger leads to power struggles and further weight loss.

## 핵심 개념

- **Mania** — A period of abnormally elevated or irritable mood with increased energy, reduced sleep, and hyperactivity.
- **Finger foods** — Foods that can be eaten by hand without utensils, useful for clients who cannot sit for meals.
- **Power struggle** — A conflict in which nurse and client oppose each other, increasing agitation and resistance.
- **Hypermetabolic state** — A condition of increased energy use, as in mania, that raises caloric needs.

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