Personality and Mood Disorders Q 69
The nurse closely observes the client who has been displaying aggressive behavior. The nurse observes that the client’s anger is escalating. Which approach is least helpful for the client at this time?
A. Acknowledge the client’s behavior.
B. Maintain a safe distance from the client.
C. Assist the client to an area that is quiet.
D. Initiate confinement measures.
Correct Answer: D. Initiate confinement measures
The proper procedure for dealing with harmful behavior is to first try to calm the patient verbally. When verbal and psychopharmacologic interventions are not adequate to handle aggressiveness, seclusion or restraints may be applicable. Alert staff if a potential for seclusion appears imminent. Usual priority of interventions would be firmly setting limits; chemical restraints (tranquilizers); and seclusions.
Option A: Frequently assess client’s behavior for signs of increased agitation and hyperactivity. Early detection and intervention of escalating mania will prevent the possibility of harm to self or others, and decrease the need for seclusions.
Option B: Redirect agitation and potentially violent behaviors with physical outlets in an area of low stimulation (e.g., punching bag). Can help to relieve pent-up hostility and relieve muscle tension.
Option C: Assisting the client in a quiet place an appropriate approach during the escalation phase of aggression. Decrease environmental stimuli (e.g., by providing a calming environment or assigning a private room). Helps decrease escalation of anxiety and manic symptoms.