✔️ Cardiac status should be addressed first due to the client’s hypokalemia (K⁺ = 2.9 mEq/L), tachycardia (122/min), and weak, thready pulse. These are clear signs of potential cardiac instability, which is the highest priority using the ABC framework (Airway, Breathing, Circulation). Hypokalemia significantly increases the risk of cardiac arrhythmias, which can be life-threatening and require immediate correction. Bulimia nervosa with self-induced vomiting leads to potassium depletion, making cardiac monitoring and electrolyte correction urgent nursing actions.

✔️ Emotional state should be addressed after stabilizing the cardiac condition, as the client reports overwhelming stress, lack of control, tearfulness, trembling, and anxiety. These psychosocial findings suggest the client is in a crisis state, which significantly contributes to the cycle of bingeing and purging. Once physiological safety is ensured, addressing the underlying psychological stressors is essential to begin long-term recovery and reduce disordered eating behaviors.

✔️ Walking with the nurse in the courtyard is the most appropriate activity for a client in the manic phase of bipolar disorder.

✔️ Clients in mania often have excess energy, poor impulse control, and short attention spans, making it difficult for them to focus on structured or group-based activities.

✔️ A noncompetitive, low-stimulation, one-on-one activity such as walking helps the client release excess energy in a safe and calming environment without overstimulating them.

✔️ It also provides an opportunity for therapeutic engagement with the nurse, which can promote trust, safety, and redirection of behavior.

✔️ Dysrhythmias are a known potential adverse effect of haloperidol, particularly when given parenterally (e.g., IM for agitation).

✔️ Haloperidol can cause QT interval prolongation, which increases the risk of torsades de pointes and other life-threatening arrhythmias.

✔️ Clients receiving high doses or with underlying electrolyte disturbances (e.g., hypokalemia or hypomagnesemia) are at greater risk for these cardiac effects.

✔️ Therefore, it is essential to monitor cardiac rhythm, assess for palpitations or syncope, and consider baseline and follow-up ECGs during treatment with haloperidol, especially when given PRN for acute agitation.

✔️ Planning the client’s schedule to allow time for rituals respects the client’s need for control and anxiety reduction, which is a central feature of obsessive-compulsive disorder (OCD).

✔️ Compulsive behaviors are often performed to reduce anxiety caused by intrusive thoughts; abruptly eliminating them can increase distress and trigger agitation or panic.

✔️ By allowing time for rituals initially, the nurse helps to build trust and establish a therapeutic alliance, which is crucial for eventual behavioral interventions.

✔️ Over time, with structured behavioral therapy, the compulsions can be gradually reduced as the client learns healthier coping mechanisms to manage anxiety.

✔️ "You must be very upset about something" is an example of therapeutic communication that acknowledges the client’s feelings without confrontation or judgment.

✔️ This response helps de-escalate the situation by showing empathy and understanding, which is especially important when caring for clients in the manic or agitated phase of bipolar disorder.

✔️ It opens the door for the client to express their concerns more clearly, allowing the nurse to assess whether the issue requires provider notification or can be managed on the unit.

✔️ This approach maintains professional boundaries while still addressing the client’s emotional state, preserving safety and trust in the nurse-client relationship.