NCLEX Practice Test

What is the priority intervention for a client with bipolar disorder and acute mania who is being admitted involuntarily?

1. Assist the client with dressing by giving instructions one at a time

2. Collaborate with unit staff to set consistent limits on manipulative behaviors

3. Offer high-calorie snacks the client can eat while on the move and during tasks

4. Secure the client's credit cards to prevent compulsive spending and bankruptcy

The correct answer is: Assist the client with dressing by giving instructions one at a time

The priority intervention for a client experiencing acute mania in bipolar disorder focuses on the immediate need for safety and stability. Assisting the client with dressing by giving instructions one at a time addresses their functional needs while also providing structure and support. During a manic episode, clients may have racing thoughts, increased energy, and impulsivity, making it challenging for them to focus on multiple instructions or tasks at once. By breaking tasks into smaller, manageable steps, the nurse can help the client feel more grounded and reduce the risk of frustration or agitation. Other interventions, while important in their own right, do not address the client's immediate need for structured support in this acute phase. For instance, collaborating with unit staff to set limits may be necessary for ongoing management but does not directly assist the client in regaining stability upon admission. High-calorie snacks can help address nutritional needs, but during acute mania, the client may be less focused on eating and more on constant activity. Securing credit cards might prevent financial issues, but this concern becomes secondary to the immediate need for calming and supportive interventions tailored to the client's disorganized state.