A client who has uncontrollable urges to overeat gives a series of presentations in her workplace about nutrition guidelines for a healthy lifestyle. The nurse counseling this client should identify that the client is displaying which of the following defense mechanisms?

A. Place the client in restraints:Restraints are a last-resort intervention and should only be used when the client poses an immediate danger to self or others and less restrictive methods have failed. Initiating restraints first violates the client’s rights and can escalate agitation.

B. Escort the client to a place of seclusion:Seclusion, like restraints, is a restrictive intervention that should only be used after less invasive strategies have been attempted. Removing a client without consent may also worsen their aggression or fear.

C. Offer the client PRN medication:While medication may be helpful in calming the client, it should not be the first step unless the client is in imminent danger or past strategies have failed. Attempting non-pharmacologic interventions first respects the client’s autonomy.

D. Offer the client choices for a diversionary activity:This is the least restrictive intervention and a therapeutic first approach. Providing the client with options promotes autonomy, can redirect aggression, and helps prevent escalation through calming, client-centered communication.

Rationale:

• Encourage the client to talk: Talking can strain the airway and worsen laryngeal edema or stridor. Airway obstruction is developing, and preserving respiratory function is critical. Silence reduces laryngeal movement and decreases airway irritation.
• Notify the rapid response team: The client is showing signs of acute airway compromise: stridor, dysphagia, increasing temperature, and tachycardia. Immediate medical intervention is required to maintain oxygenation and prevent respiratory failure.
• Assist client to high-Fowler's position: Sitting the client upright improves lung expansion and reduces pressure on the neck. This position facilitates breathing and airway patency, especially important during potential obstruction or edema.
• Place emergency tracheostomy equipment in the client's room: Due to the risk of airway obstruction from laryngeal edema post-thyroidectomy, emergency airway access may be needed. Having tracheostomy equipment ready ensures rapid response if intubation becomes impossible.