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. What is the priority nursing intervention?

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: 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.

Correct Answer: A

Rationale: Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Close-ended questions such as 'Did you feel angry?' ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patient's words, the patient has no way of measuring the understanding.

Correct Answer: D

Rationale: When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurse's personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. 'Why' questions are probing and nontherapeutic.

Correct Answer: B

Rationale: In caring for a patient diagnosed with bipolar disorder in the manic phase, the priority nursing intervention is to select option B, which is to set firm boundaries and limit the patient's ability to make impulsive decisions. This is crucial because individuals in the manic phase of bipolar disorder often lack the ability to control their impulses and may engage in risky behaviors that can be harmful to themselves or others. By setting firm boundaries, the nurse can help maintain a safe environment for the patient and prevent potential negative outcomes. Option A, encouraging the patient to express their feelings and engage in social activities, may not be the priority in this situation as the patient's impulsivity and risk-taking behavior need to be addressed first to ensure safety. Option C, providing medications to control symptoms, is important but may not address the immediate need to manage the impulsive behavior. Option D, offering reassurance and allowing the patient to make their own decisions, could potentially worsen the situation by enabling further impulsive behavior without appropriate limits. Educationally, understanding the priority interventions in managing patients with bipolar disorder is essential for nurses working in behavioral health settings. This scenario highlights the importance of safety and boundary-setting when caring for individuals experiencing manic episodes, emphasizing the need for proactive and structured interventions to promote patient well-being.