Question

the community health nurse talks to a male client who has bipolar disorder. the client explains that he sleeps 4 to 5 hours a night and is working with his partner to start two new businesses and build an empire. the client stopped taking his medications several days ago. which nursing problem has the highest priority?

excessive work activity.
decreased need for sleep.
medication management.
inflated self-esteem.

Explanation:

Analyze the client's clinical presentation

The client with bipolar disorder presents with classic manic symptoms:

• Decreased need for sleep (sleeping 4 to 5 hours a night)
• Grandiosity / inflated self-esteem ("build an empire")
• Hyperactivity / excessive work activity ("start two new businesses")
• Non-adherence to treatment ("stopped taking his medications several days ago")

Apply nursing prioritization frameworks

• Maslow's Hierarchy of Needs prioritizes physiological needs (sleep, nutrition, elimination) over safety, social, and esteem needs.
• A decreased need for sleep directly impacts physiological stability and can rapidly lead to physical exhaustion, cognitive decline, and worsening mania.
• Medication management, excessive work, and inflated self-esteem are important but rank lower in immediate physiological priority compared to the acute lack of sleep.

Answer:

• Excessive work activity.
• Decreased need for sleep. (Correct answer)
• Medication management.
• Inflated self-esteem.