A nurse is caring for a patient diagnosed with bipolar disorder who is in the manic phase. The patient is exhibiting rapid speech, racing thoughts, and impulsive behavior. Which of the following interventions should the nurse implement first?

Correct Answer: B

Rationale: In caring for a patient with bipolar disorder in the manic phase, providing a calm environment to reduce external stimulation (option B) should be implemented first. This intervention is crucial as it helps decrease the patient's agitation and can prevent escalating behavior. Encouraging social activities (option A) may exacerbate the symptoms due to increased stimulation. Offering medication (option C) is important but may not have an immediate effect in managing acute manic symptoms. Setting firm limits (option D) may agitate the patient further and should be used cautiously. Educationally, understanding the importance of environment in managing acute behavioral health crises is key. Nurses need to prioritize interventions that promote a safe and calming atmosphere to support patients in regaining control during manic episodes. This rationale highlights the significance of tailored care strategies in psychiatric nursing practice.

Correct Answer: D

Rationale: The most appropriate nursing diagnosis for the patient described is option D) Hopelessness. In major depressive disorder, feelings of hopelessness are common and can significantly impact a patient's mental well-being. By selecting this diagnosis, the nurse acknowledges the patient's emotional state and initiates appropriate interventions to address these feelings of despair and helplessness. Option A) Impaired social interaction may not fully capture the depth of the patient's emotional distress and does not address the core issue of hopelessness. Option B) Risk for suicide is a serious concern in major depressive disorder, but the patient's statement does not indicate immediate suicidal intent. Option C) Ineffective coping may be relevant, but it does not specifically address the patient's profound sense of hopelessness as expressed in the statement. Educationally, understanding how to accurately assess and diagnose mental health conditions is crucial for nurses working in behavioral health settings. By selecting the most appropriate nursing diagnosis, nurses can tailor interventions to support patients effectively in managing their mental health challenges. In this case, identifying hopelessness as the primary issue allows for targeted and holistic care planning to address the patient's emotional needs.

Correct Answer: A

Rationale: In caring for a patient with bipolar disorder in the manic phase, the priority nursing intervention is to provide a quiet environment and limit stimulation (Option A). This is essential because individuals in a manic state are often overwhelmed by their own racing thoughts and heightened energy levels. Creating a calm and quiet space can help reduce external stimuli that may exacerbate their symptoms and promote a sense of grounding for the patient. Encouraging the patient to engage in social activities (Option B) may further escalate their symptoms due to the already heightened energy levels and impulsivity present during mania. Administering sedatives (Option C) should not be the initial approach as it may not address the underlying causes of the manic behavior and can have potential side effects. Offering medications to address the manic symptoms (Option D) is important, but creating a safe and calming environment is the immediate priority to ensure the patient's well-being and safety. From an educational perspective, understanding the principles of therapeutic communication, environmental management, and prioritization of care in mental health nursing is crucial for nurses caring for patients with bipolar disorder or other psychiatric conditions. By prioritizing non-pharmacological interventions like providing a quiet environment, nurses can help promote patient comfort, safety, and overall therapeutic outcomes.

Correct Answer: B

Rationale: The correct answer is B) Countertransference. Countertransference occurs when a healthcare provider projects their own feelings, attitudes, or unresolved issues onto a patient. In this scenario, the nurse is experiencing sadness and making a personal connection to the patient, which indicates countertransference. Option A) Transference involves the patient projecting feelings onto the nurse based on their past experiences. This is not occurring in the scenario provided. Option C) Catastrophic reaction involves an extreme response to stress or trauma, which is not evident in the nurse's feelings of sadness. Option D) Defensive coping reaction refers to strategies individuals use to protect themselves from unpleasant emotions or situations, which is not the case in the given scenario. In an educational context, understanding countertransference is crucial for healthcare providers, especially in behavioral health settings where emotional connections with patients are common. Recognizing and managing countertransference can help nurses maintain professional boundaries and provide effective care without letting personal emotions interfere with their judgment or care delivery. This scenario highlights the importance of self-awareness and emotional regulation in nursing practice.

Correct Answer: B

Rationale: In this scenario, the priority nursing action is option B) Ask the patient if they are having thoughts of suicide or self-harm. This is the correct answer because the patient's statement indicates a high risk for self-harm or suicide, which requires immediate assessment and intervention to ensure the patient's safety. Option A is incorrect because while encouraging the patient to talk about their feelings is important, assessing for suicidal ideation takes precedence in this situation. Option C is incorrect as providing reassurance without addressing the risk of self-harm may overlook the seriousness of the patient's statement. Option D is incorrect as engaging in physical activities may not address the immediate risk of self-harm that the patient is expressing. In an educational context, this question highlights the critical importance of recognizing and responding to suicide risk in patients with mental health disorders. Nurses must be trained to assess and address suicidal ideation promptly and effectively to ensure patient safety and provide appropriate care in behavioral health settings.