A nurse is caring for a client who has bipolar disorder and suddenly begins yelling at staff and other clients. Which of the following actions should the nurse take first?

Introduction: Acute agitation in bipolar disorder involves excessive psychomotor activity and verbal aggression. The nurse must utilize the least restrictive intervention first to maintain safety while respecting the client's autonomy, progressing to more restrictive measures only if the client's behavior escalates to provide an immediate threat. A. Administering an intramuscular (IM) benzodiazepine like lorazepam is a chemical restraint. While effective for severe agitation that does not respond to verbal intervention, it should not be the first action taken for a client who is yelling but not yet physically violent or posing an immediate danger. B. Placing a client in physical restraints is the most restrictive intervention possible and is reserved for situations where the client is an immediate physical danger to self or others. Using restraints before attempting verbal de-escalation is a violation of the client’s rights and nursing ethical standards. C. Verbal de-escalation is the priority action. By using a calm, low voice and maintaining a non-threatening posture, the nurse may help the client regain emotional control. This "least restrictive" approach is the standard of care for managing behavioral outbursts before escalating to pharmacological or physical interventions. D. Seclusion is a restrictive intervention that involves involuntary confinement. It is used to manage behavior that poses a safety risk to others when less restrictive methods have failed. Starting with seclusion for verbal yelling without trying to talk to the client first is premature and non-therapeutic.