A nurse is caring for a client in the manic phase of bipolar disorder. Which behavior is MOST characteristic of mania?

MANIA (in bipolar I disorder) is characterized by a DISTINCT PERIOD of abnormally elevated, expansive, or irritable mood plus increased goal-directed activity or energy lasting at least 7 days, causing marked impairment. DSM-5 CRITERIA — three or more of (DIGFAST mnemonic): DISTRACTIBILITY; IMPULSIVITY/INDISCRETION (risky behaviors: spending sprees, sexual indiscretions, unwise business decisions); GRANDIOSITY (inflated self-esteem, belief in special powers, feeling one is on a special mission); FLIGHT OF IDEAS (rapidly shifting thoughts); ACTIVITY INCREASED (goal-directed — many projects started, excessive socializing, irritable); SLEEP DECREASED (needs only 2-3 hours, doesn't feel tired); TALKATIVENESS (PRESSURED SPEECH — talks rapidly, hard to interrupt).

Clinical features: the client often does NOT recognize they are ill and may feel better than ever; may be euphoric, energetic, charming at first — then irritable, hostile when limits are set; poor judgment leads to dangerous behaviors; insight is usually impaired during acute mania.

Hypomania: less severe than mania; does not cause marked impairment; lasts 4+ days; characteristic of bipolar II. NURSING CARE in mania: SAFETY FIRST (the client's impulsivity and poor judgment create safety risks).

Environment: low stimulation, structured, consistent.

Medications: mood stabilizers (lithium is first-line — monitor levels, renal function, thyroid; therapeutic range 0.8-1.2 mEq/L; signs of toxicity: tremors, confusion, nausea, decreased urine output); anticonvulsants (valproate, lamotrigine, carbamazepine); atypical antipsychotics (for acute mania); monitor nutrition and hydration (manic clients may not eat/drink); DOCUMENT behavior; limit setting in a calm, non-punitive way.