# 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. On the second day the nurse sees her handing her watch and money to other clients and promising to buy them all new phones. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630078  
> 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.

On the second day the nurse sees her handing her watch and money to other clients and promising to buy them all new phones. What should the nurse do?

## 보기

1. Store her money and valuables in the unit safe for now **✔ 정답**
2. Ask the other clients to return everything to her room
3. Confine her to her room so she cannot reach the others
4. Let her give them away, since the items belong to her

**정답: 1**

## 해설

Poor judgment and impulsive generosity in mania can cause losses she will regret, so the nurse protects her from the consequences of her behavior by securing her valuables until her judgment returns. Leaving the items with her or returning them to her room leaves the risk in place, and seclusion is not used to manage behavior that is not dangerous.

## 심화 해설

Clinical situation

A 27-year-old woman in a manic episode has slept only 2–3 hours per night for 10 days, spent all her savings, and lost 3 kg in one week. On the second hospital day, she is giving away her watch and money and promising to buy phones for other clients.

Priority nursing action

The correct action is to store her money and valuables in the unit safe for now. In mania, impaired judgment and impulsive generosity can lead to significant personal losses that the patient will later regret. The nurse acts to protect the patient from the consequences of her own behavior while her judgment remains impaired.

Why the other options are not appropriate

| Option | Problem |
| --- | --- |
| Ask the other clients to return everything to her room | This does not stop her from giving items away again. The risk remains because the valuables are still accessible to her. |
| Confine her to her room so she cannot reach the others | Seclusion is a restrictive intervention used only when there is imminent danger to self or others. Giving away possessions is not dangerous behavior that justifies seclusion. |
| Let her give them away, since the items belong to her | Although the items are legally hers, her current mental state impairs her capacity to make sound decisions. Allowing the behavior would permit harm that she may later regret. |

Pathophysiology and clinical reasoning

Bipolar mania involves dysregulation of mood and cognitive control circuits. Neuroimaging studies have identified structural and functional abnormalities in the dorsolateral prefrontal cortex (DLPFC), anterior cingulate, amygdala, and related anterior-limbic networks in individuals with bipolar disorder [2]. These regions are critical for impulse control, judgment, and the regulation of emotional responses. When this network is disrupted, the patient may act on immediate desires without considering long-term consequences, which explains the impulsive spending and gift-giving seen in this scenario.

Key point! The nurse’s role is not to punish or restrict the patient unnecessarily, but to provide external structure and protection until the patient’s own judgment returns. Securing valuables is a temporary, least-restrictive measure that prevents harm while preserving dignity.

Connection to aggression and safety monitoring

Although this patient is not currently aggressive, mood disorder patients in manic or mixed states can show rapid escalation of behavior. Machine learning research in psychiatric emergency settings has identified aggression as a clinically important variable in detecting progression from hypomania to full mania . This supports the broader nursing principle that early, proactive management of impulsive behavior helps prevent more serious safety events, including aggression or financial exploitation by others on the unit.

Watch out! Do not confuse protecting the patient from financial loss with punishing or isolating her. The intervention must be framed as supportive and temporary, not as a consequence for behavior she cannot fully control during mania.

Nursing process application

In the assessment phase, the nurse identifies impaired judgment and risk for self-harm related to financial loss. The nursing diagnosis may be Risk for injury related to poor impulse control or Ineffective impulse control. The intervention of securing valuables is an independent nursing action that addresses the identified risk without requiring a physician’s order. Evaluation focuses on whether the patient’s valuables are safe and whether impulsive giving has stopped while the manic symptoms are treated.

The decision to hold valuables is time-limited. As mood stabilizers take effect and the patient’s judgment improves, the team can gradually return items and discuss the episode with the patient. This approach respects autonomy while recognizing that capacity for financial decision-making is currently impaired by the manic state.References (research sources)

- [2]Magnetic resonance findings in bipolar disorder.Research articleBrambilla P, Glahn DC, Balestrieri M, Soares JC (2005) · DOI: 10.1016/j.psc.2005.01.006

## 임상 시나리오

Protecting Valuables in Acute ManiaPreventing impulsive losses until judgment returns
In mania, impaired judgment and impulsive generosity can cause significant personal losses the patient will later regret. The nurse protects the patient by securing money and valuables in the unit safe until judgment improves.

Document the items carefully and provide a receipt. Reassure the patient that this is a temporary protective measure, not a punishment, and revisit the decision as her mental status stabilizes.

CautionSeclusion is reserved for imminent danger to self or others. Giving away possessions is not dangerous behavior and does not justify restrictive intervention. Returning items to her room leaves the risk of repeated giving in place.

## 핵심 개념

- **mania** — A state of elevated, expansive, or irritable mood with increased energy, decreased need for sleep, impulsivity, and impaired judgment, commonly seen in bipolar disorder.
- **impulsive generosity** — Giving away money or possessions without considering consequences, a manifestation of poor judgment during manic episodes.
- **seclusion** — A restrictive intervention involving confining a patient alone in a room, used only when there is imminent danger to self or others.
- **unit safe** — A locked storage area on a psychiatric unit used to secure patients' valuables and money when their judgment is impaired.
- **bipolar disorder** — A mood disorder characterized by alternating episodes of mania or hypomania and depression, involving dysregulation of mood and cognitive control circuits.

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