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Question

Difficulty: MediumBehavioral Interventions

An adolescent client in a residential eating disorder facility refuses to sit at the table during a scheduled meal. The client stands in the dining room doorway, shouting profanities at the staff and physically blocking the exit. Which action should the practical nurse take first?

  1. A
    Initiate a physical hold to carefully move the client away from the exit.
  2. B
    Discuss the nutritional goals of the treatment plan to encourage the client to participate.
  3. Direct the other clients in the dining area to move to the opposite side of the room.Answer
  4. D
    Ask the client why they are feeling so angry about the current meal.

Answer

The priority action is to ensure the immediate physical safety of everyone in the milieu by directing the other clients away from the escalating individual.
When a client is acutely agitated and physically blocking an exit, the immediate priority is to protect the other clients in the area. Directing them to the opposite side of the room increases physical distance and ensures safety while staff prepare to manage the escalating behavior.

Step-by-Step Solution

1
Identify the immediate safety threat in the clinical scenario.
The client is highly agitated and physically blocking an exit, posing a direct risk to the safety of the other clients in the room.
Recognizing the primary hazard dictates the sequence of nursing interventions.
2
Determine the priority intervention based on the hierarchy of behavioral emergencies.
Milieu safety and protecting vulnerable bystanders takes precedence over verbally engaging the agitated client.
Nurses must secure the environment before attempting focused de-escalation techniques on an out-of-control individual.
3
Select the least restrictive and most immediate action.
Directing the other clients away from the danger zone secures their safety without immediately resorting to physical force against the agitated client.
This adheres to safety priorities while respecting the requirement to avoid premature physical interventions.

Key Concept

During an acute behavioral escalation, the nurse's first priority is the physical safety of the milieu, which involves removing bystanders from potential harm before attempting verbal de-escalation or applying physical interventions.
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Topics

Behavioral Interventions

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