A client with acute respiratory distress syndrome (ARDS) has fine crackles at lung bases and the respirations are shallow at a rate of 28 breaths/minute. The client is restless and anxious. In addition to monitoring the arterial blood gas results, the nurse should anticipate doing which of the following? Select all that apply.

A. Safetyis a top priority because clients admitted from correctional facilities may present risks to themselves, staff, or othersdue to stress, aggression, or underlying medical or psychiatric conditions. Ensuring a safe environment involves constant assessment, monitoring, and awarenessof the client’s behavior and potential triggers. Safety measures protect both the client and healthcare team, and are essential in the emergency setting where acute and unpredictable situations are common.

B. Human dignitymust be maintained because every client, regardless of incarceration status, is entitled to ethical, respectful care. Preserving dignity involves addressing the client by name, respecting privacy, explaining procedures, and avoiding stigmatizing or judgmental behavior. Upholding dignity encourages client cooperation, reduces agitation, and supports positive healthcare outcomes, even in a secure setting.

C. Ambulatory careis not a priority in this scenario. Ambulatory care refers to outpatient or non-urgent care for clients who are mobile and can self-manage certain aspects of their care. In an emergency department, especially for a client coming from a correctional facility, the focus is on immediate safety, assessment, and stabilization, not outpatient care.

D. Compassionate careis essential because incarcerated clients may experience stress, fear, or mistrustin healthcare environments. Providing compassionate care involves listening, validating concerns, showing empathy, and responding to needswhile maintaining professional boundaries. Compassionate care improves compliance, reduces anxiety, and promotes therapeutic rapport, which is critical for effective treatment and assessment.

E. Secure environmentis crucial when caring for clients from penitentiaries. This includes ensuring that the client is monitored, potentially restrained if necessary, and kept in a controlled areato prevent escape or harm to staff and other patients. Security protocols must be integrated with nursing care to maintain safety without compromising ethical treatment or human dignity.

A. Assess the client for a physiologic reason for his agitationis correct because agitation in an intubated, mechanically ventilated patient can indicate hypoxia, hypercapnia, pain, airway obstruction, or other acute physiologic problems. High-pressure alarms are often triggered by secretions, bronchospasm, coughing, or patient-ventilator dyssynchrony, and these causes must be identified and corrected immediatelybefore implementing sedation or restraints. Assessment is always the first step in the nursing process.

B. Administer a bolus dose of IV antianxiolyticis incorrect because giving medication without first determining the underlying causecould mask important signs of deterioration, such as hypoxia or ventilator obstruction. Sedation is secondary to addressing the primary physiologic problem.

C. Obtain a stat ABGis incorrect as the first action because while ABGs provide important data about oxygenation and ventilation, the immediate cause of agitation and high ventilator pressures needs to be addressed first, such as suctioning secretions or checking tubing. ABGs can follow after rapid assessment and interventions.

D. Apply soft wrist restraintsis incorrect because restraints do not treat the underlying cause of agitationand may worsen anxiety or increase oxygen demand. Restraints are considered only if the patient poses a risk of self-harm or removing the endotracheal tube after addressing physiologic needs.