A nurse is caring for a patient with bipolar disorder who is in a manic phase and refuses to attend a scheduled group therapy session. Which response by the nurse best promotes therapeutic engagement?

Choice A reason: Direct questions like "Did you feel angry?" may elicit specific information but can feel confrontational, limiting open dialogue. They focus on the nurse’s agenda rather than signaling attentive listening, which is critical for therapeutic communication in mental health, making this choice less effective.

Choice B reason: Asking "Why did you do that?" can seem judgmental, causing defensiveness and hindering open communication. It shifts focus to justification rather than fostering a safe space for the patient to share feelings, making it non-therapeutic and incorrect for showing listening interest.

Choice C reason: Maintaining eye contact and nodding are nonverbal cues that demonstrate active listening and empathy, encouraging patients to share openly. These align with therapeutic communication principles in psychiatric nursing, creating a supportive environment and fostering trust, making this the correct choice for showing interest.

Choice D reason: Offering advice based on personal experience shifts focus to the nurse, undermining the patient’s perspective. It risks blurring professional boundaries and is non-therapeutic, as it does not prioritize the patient’s feelings or encourage open dialogue, making this choice incorrect.

Choice A reason: Suggesting the adolescent share with the psychiatrist avoids the nurse’s duty to report imminent threats. Ethical and legal standards require immediate action for safety, making this response inadequate, as it delays intervention in a potential crisis.

Choice B reason: Reporting a threat to harm others is a legal and ethical duty in psychiatric nursing, as it indicates imminent danger. Sharing with the team ensures safety interventions, aligning with mandatory reporting laws, making this the correct response.

Choice C reason: Discussing feelings is therapeutic but does not address the immediate safety risk of a threat. Prioritizing exploration over reporting violates ethical standards for managing dangerous behaviors, making this response incorrect in this context.

Choice D reason: Promising confidentiality in the face of a threat violates nursing ethics and legal mandates to report harm risks. This undermines patient and public safety, making it a non-therapeutic and incorrect response to a serious threat.