A patient in the manic phase of bipolar disorder throws a meal tray at lunch. Which of the following are appropriate initial responses? 

"I''d like to figure this out with you."
"Tell me how you''re feeling."
"What happened to upset you?"

Explanation

• Patients in the manic phase of bipolar disorder may have labile moods (rapidly shifting) and can quickly go from very happy to angry.  

• It is important to listen carefully to these patients about how they perceive the situation so the situation can be resolved. Open-ended questions and invitations to share their feelings are appropriate.

• The nurse and patient should work together to seek solutions to the problem. This strengthens the nurse-patient relationship and empowers the patient to problem-solve in a more productive and collaborative way.

• The use of restraints is only indicated if a patient is an immediate threat of harm to him or herself or others and will not agree to safety, and only after less restrictive interventions have been attempted.

• Offering a PRN may be appropriate if it is ordered for agitation, but this should not be the first response. The nurse should first attempt to help the patient problem-solve collaboratively and use other means of coping, and reserve the use of PRN medication as a last resort.

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