NCLEX-RN

Bipolar I disorder is characterized by at least one manic episode lasting 7 or more days (or requiring hospitalization). The DSM-5-TR criteria for a manic episode (mnemonic DIG FAST) require elevated, expansive, or irritable mood with increased energy PLUS 3 or more of: Distractibility, Indiscretion/Impulsivity (reckless spending), Grandiosity (inflated self-esteem or delusional beliefs about special powers/importance), Flight of ideas or racing thoughts, Activity increase (goal-directed or psychomotor agitation), Sleep deficit (decreased need without fatigue), Talkativeness (pressured speech). This patient demonstrates: pressured speech (T), decreased sleep (S), grandiose delusions (G), and reckless spending as indiscretion (I), meeting criteria for a manic episode. Nursing priorities include: ensure patient safety (assess suicide risk, which exists in manic states), set firm but therapeutic limits on behavior, provide a calm, low-stimulation environment, monitor nutritional status (patients may be too hyperactive to eat), administer prescribed mood stabilizers (lithium therapeutic level 0.6-1.2 mEq/L, monitor for toxicity >1.5 mEq/L), and monitor for escalation to agitation or psychosis.