On an inpatient unit, a client with bipolar disorder behaves disruptively. Which action should the nurse take?

• A. Initiate sodium restrictions
• B. Engage the client in a group activity
• C. Withhold the next dose of aripiprazole
• D. Accompany the client to a private area

Answer: (D)

Prioritizing safety through de-escalation in an acutely agitated state is the key idea. When a client with bipolar disorder is disruptive on an inpatient unit, the first step is to reduce stimulation and create a safer, calmer space. Accompanying the client to a private area provides a quieter environment where the nurse can use a calm, nonthreatening approach, observe cues, assess what’s triggering the distress, and begin de-escalation and rapport-building. In this setting, the nurse can speak more directly yet gently, set boundaries, and determine immediate needs, while maintaining safety for the client and others.

Sodium restrictions don’t address the immediate behavior and could be harmful if not medically indicated. Engaging the client in a group activity while they’re disrupted is likely to escalate agitation and pose safety risks. Withholding the next dose of aripiprazole without assessment could worsen symptoms and endanger safety. The private-area approach is the most appropriate initial step to calm the situation and guide appropriate next actions.