A nurse is caring for a client who has a history of aggression and is threatening to harm the staff on the unit.
Which of the following actions should the nurse take first?

Choice A rationale

Asking "Do you feel like your anger is becoming more manageable?" directly assesses the client's subjective experience of their anger levels. This is a crucial indicator of the treatment's effectiveness as it reflects the client's internal perception of change in their emotional regulation. While objective measures are also important, the client's self-report provides valuable insight into the practical impact of therapy on their daily life.

Choice B rationale

Asking "What do you do when something makes you angry?" explores the client's behavioral responses to anger-provoking situations. While this provides information about their coping mechanisms, it doesn't directly evaluate whether their anger is becoming more manageable overall. The client might still be engaging in maladaptive behaviors even if they are learning new strategies.

Choice C rationale

Asking "Did you learn any coping strategies from your counselor?" assesses the client's acquisition of new skills taught in therapy. While learning coping strategies is a goal of anger management, it doesn't necessarily indicate that the client is effectively applying these strategies or experiencing a reduction in the intensity or frequency of their anger.

Choice D rationale

Asking "Have you been attending your anger management group?" evaluates the client's adherence to the treatment plan. While attendance is important for progress, it doesn't directly measure the effectiveness of the therapy itself. A client may attend sessions without actively engaging or experiencing a reduction in their anger.

Choice A rationale

A client repeatedly requesting anxiety medication should be assessed, but their behavior does not indicate an immediate safety risk to themselves or others. While their anxiety needs attention, other clients may have more urgent needs. The nurse should acknowledge their request and address it in a timely manner, but not necessarily as the absolute first priority.

Choice B rationale

A client yelling obscenities and throwing clothes is exhibiting escalating and potentially aggressive behavior. This situation poses an immediate risk to the client's safety and the safety of others on the unit. The nurse must intervene promptly to de-escalate the situation, ensure the client's well-being, and prevent potential harm to themselves or others. This behavior indicates a loss of control and requires immediate attention.

Choice C rationale

A client with bipolar disorder who is continuously pacing is displaying psychomotor agitation, which is characteristic of a manic episode. While this behavior warrants assessment and intervention, it does not present the same level of immediate risk as the client who is actively yelling and throwing objects. The pacing client should be monitored and offered interventions to help manage their agitation, but they are not the highest priority in this scenario.

Choice D rationale

A client screaming at other clients in the dayroom is exhibiting aggressive verbal behavior that is disruptive and potentially threatening to others. This situation requires the nurse's intervention to de-escalate the situation, ensure the safety and comfort of the other clients, and address the yelling client's behavior. However, the client actively throwing objects in their room poses a more immediate and direct safety risk.