A client is hyperactive and not sleeping. She will not remain at the table during mealtime. She is getting very limited calories and is using a lot…

A client experiencing hyperactivity, consistent with a manic episode, has significant energy expenditure and difficulty sitting still for structured activities like meals. The most therapeutic nursing action is to adapt the plan of care to the client's behavior. Providing high-calorie, high-protein, nutritious finger foods allows the client to eat while moving, which accommodates their hyperactivity and short attention span. This approach meets their physiological need for increased caloric intake without creating a power struggle or escalating their agitation, making it the most effective and client-centered intervention.

A. Insisting the client remain seated is confrontational and unrealistic for someone in a hyperactive state. This approach is likely to increase agitation and will be ineffective.

B. While a high-calorie diet is appropriate, simply ordering it does not solve the problem of the client's inability to sit down and consume a traditional meal.

D. This action addresses paranoia or suspiciousness about food, which is not the primary problem described. The core issue is hyperactivity and inability to remain seated.

1. Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F.A. Davis Company. In the chapter on Bipolar and Related Disorders, the nursing care plan for "Imbalanced nutrition: Less than body requirements" specifies the intervention: "Provide client with high-protein, high-calorie, nutritious finger foods and drinks that can be eaten 'on the run'." (Chapter 24, Nursing Care Plan for Mania).

2. Varcarolis, E. M. (2017). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (3rd ed.). Elsevier. The chapter on Bipolar Spectrum Disorders outlines interventions for a patient in acute mania, stating, "Offer frequent high-calorie protein drinks and finger foods... The patient can 'eat on the run'." (Chapter 13, Bipolar Spectrum Disorders, p. 231, Table 13-3).

3. Halter, M. J. (2022). Varcarolis' foundations of psychiatric-mental health nursing: A clinical approach (9th ed.). Elsevier. In the chapter discussing care for patients with bipolar disorder, a key intervention for severe mania is to "Provide foods that are easy to eat on the go (finger foods)... to ensure adequate nutrition." (Chapter 13, Bipolar and Related Disorders, p. 226, Nursing Care Plan).