The nurse is setting up the room for an admission who is being admitted for alcohol withdrawal. Which of the following should the nurse place at bedside to initiate seizure precautions? (Select all that apply)

Choice A reason: Instructing the client to sit down and stop pacing may escalate anxiety, as pacing is a physical outlet for heightened amygdala activity and cortisol release in generalized anxiety disorder. Forcing cessation dismisses the client’s emotional state, potentially worsening distress and hindering therapeutic engagement.

Choice B reason: Escorting the client to her room isolates her and may increase anxiety by removing a coping mechanism (pacing) without addressing the underlying neurochemical imbalance, such as excessive norepinephrine. This approach risks escalation rather than de-escalation, as it does not engage the client therapeutically.

Choice C reason: Walking with the client at a gradually slower pace is therapeutic, as it validates the client’s anxiety-driven pacing while gently reducing arousal. This mirrors the client’s energy, calming the overactive amygdala and lowering cortisol levels, promoting de-escalation and trust in a non-confrontational, supportive manner.

Choice D reason: Allowing the client to pace alone until tired risks physical exhaustion and does not address the underlying anxiety driven by neurochemical imbalances, such as excessive norepinephrine or GABA dysfunction. Unsupervised pacing may reinforce anxiety without therapeutic intervention, making it less effective than guided de-escalation.

Choice A reason: Assessing cranial nerves is important for neurological evaluation but is not the priority after droplet precautions in suspected meningococcal meningitis. Nuchal rigidity and petechial rash suggest bacterial infection, and reducing stimuli prevents worsening neurological irritation, as meningitis inflames meninges, increasing brain sensitivity to external stressors.

Choice B reason: Decreasing environmental stimuli is the priority, as meningococcal meningitis causes meningeal inflammation, increasing intracranial pressure and sensitivity to light, noise, or movement. Minimizing stimuli reduces neurological irritation, preventing seizures or discomfort, critical in stabilizing the client before further assessments or treatments are initiated.

Choice C reason: Completing a vascular assessment is less urgent, as the petechial rash already suggests meningococcal septicemia, a hallmark of the disease. While vascular status is relevant, reducing stimuli takes precedence to prevent neurological complications like seizures, which are exacerbated by meningeal inflammation in meningitis.

Choice D reason: Administering an antipyretic addresses fever, common in meningococcal meningitis, but is not the priority over reducing stimuli. Fever is secondary to meningeal irritation, which increases seizure risk and discomfort. Decreasing stimuli stabilizes the client’s neurological status before symptomatic treatments like antipyretics are considered.