# Situation: On an acute psychiatric ward, the nurse cares for two clients: a 31-year-old woman in a manic episode of bipolar I disorder, who talks rapidly and has slept little for 2 nights, and a 29-year-old woman with borderline personality disorder who was admitted after a crisis at home. The woman in the manic episode jumps from her plan to quit her job, to a new business, to a trip abroad. The nurse says, "Let's stay with one topic: your plan to quit your job." Which technique is this?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630246  
> 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: On an acute psychiatric ward, the nurse cares for two clients: a 31-year-old woman in a manic episode of bipolar I disorder, who talks rapidly and has slept little for 2 nights, and a 29-year-old woman with borderline personality disorder who was admitted after a crisis at home.

The woman in the manic episode jumps from her plan to quit her job, to a new business, to a trip abroad. The nurse says, "Let's stay with one topic: your plan to quit your job." Which technique is this?

## 보기

1. Exploring
2. Summarizing
3. Focusing **✔ 정답**
4. Clarifying

**정답: 3**

## 해설

Focusing narrows a scattered conversation to one topic so that it can be discussed in depth. It is especially useful when a client's speech jumps between ideas.

## 심화 해설

The technique is focusing
The client in a manic episode jumps from quitting her job, to a new business, to a trip abroad. The nurse says, "Let's stay with one topic: your plan to quit your job." This is focusing, a therapeutic technique that narrows a scattered conversation to one topic so that it can be discussed in depth. Focusing is especially useful when a client's speech jumps between ideas, as in mania with flight of ideas.

Why focusing helps in mania
In mania, racing thoughts and flight of ideas make conversation scattered and hard to follow, and the client is highly distractible. A long, open conversation feeds this pattern. By choosing one concrete, realistic topic, the nurse provides structure, slows the pace, and helps the client test her plans against reality. The topic chosen here, her plan to quit her job, has real consequences, so focusing on it also supports her safety and judgment. The nurse keeps sentences brief, speaks calmly, and gently returns to the chosen topic when she drifts.

| Technique | Purpose | Example |
| --- | --- | --- |
| Focusing | Narrows a scattered talk to one topic | "Let's stay with one topic: your plan to quit your job." |
| Exploring | Examines a chosen topic in more depth | "Tell me more about that." |
| Summarizing | Reviews the main points, usually near the end | "Today we talked about your job and your sleep." |
| Clarifying | Asks the client to explain a vague message | "I'm not sure I follow. What do you mean by that?" |

Why the other techniques do not fit
Watch out! Exploring is the closest distractor, because it also deepens discussion. But exploring works on a topic already in focus; here the nurse first had to select one topic from several, which is focusing. Exploring might follow, for example, "Tell me more about why you want to quit." Summarizing reviews what has been discussed, usually as the interaction closes, and clarifying asks the client to explain something unclear; the nurse did not ask for an explanation.

Communication tips for a manic client
Use short, simple, concrete statements; avoid debating or joking along with grandiose ideas; reduce stimulation by talking in a quiet area; and set gentle limits on intrusive behavior. Because she has slept little for 2 nights, the nurse also attends to rest, nutrition, and fluid intake, which are often neglected during mania.

Exam takeaway
Key point! Selecting one topic from a scattered conversation = focusing. Going deeper into a topic already chosen = exploring. Focusing is a first-choice technique for clients with flight of ideas.

## 임상 시나리오

Focusing With a Manic ClientBringing a scattered conversation to one topic
"Let's stay with one topic: your plan to quit your job" is focusing: narrowing a scattered talk to one topic so it can be discussed in depth.

It suits mania, where flight of ideas and distractibility make conversation jump between plans.

Exploring goes deeper into a topic already chosen, summarizing reviews main points near the end, and clarifying asks the client to explain a vague message.

CautionKeep statements short and calm, reduce stimulation, and watch rest, nutrition, and fluids, since she has slept little for 2 nights.

## 핵심 개념

- **Focusing** — A therapeutic technique that narrows a scattered conversation to a single topic.
- **Flight of ideas** — Rapid, continuous speech that jumps between loosely connected topics, typical of mania.
- **Exploring** — A technique that examines a chosen topic in greater depth.
- **Summarizing** — A technique that reviews the main points of an interaction, usually near its end.
- **Clarifying** — A technique that asks the client to explain a vague or unclear message.

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