A client with a history of generalized anxiety disorder is waiting in a crowded outpatient clinic. The client suddenly becomes highly agitated, clenching their fists, pacing rapidly, and shouting at the clinic staff about the wait time. Which action should the practical nurse (PN) take first?
- AApproach the client to logically explain that the other patients have also been waiting patiently.
- Maintain a safe physical distance and discreetly direct other clients out of the immediate area.Cevap
- CAsk the client directly, "Why are you getting so upset over a minor scheduling delay?"
- DInstruct staff to prepare mechanical restraints to prevent the client from harming others.
Cevap
The practical nurse should prioritize safety by maintaining a safe physical distance and discreetly directing other clients out of the immediate area.
When a client is acutely agitated and exhibiting signs of potential violence (rapid pacing, clenched fists), the primary nursing responsibility is to ensure the physical safety of everyone in the vicinity. Maintaining a safe distance protects the nurse, and clearing the room of bystanders removes an audience, decreases stimulation, and prevents injuries. Once the area is secure, verbal de-escalation techniques can be attempted safely.
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Anahtar Kavram
Crisis De-escalation and Environmental Safety