When working with a client with moderate anxiety, the nurse would expect to see which of the following? Select all that apply.

Choice A reason: Moving far away from the client may reduce immediate risk to the nurse, but it does not address the underlying hostility or prevent escalation. In fact, withdrawing completely can leave the client feeling abandoned, ignored, or misunderstood, which may worsen agitation. Therapeutic intervention requires maintaining safety while still engaging the client in a supportive manner.

Choice B reason: Allowing the client to get their way reinforces maladaptive and potentially manipulative behavior. This approach undermines therapeutic boundaries and fails to teach the client healthier coping strategies. It may provide temporary relief but ultimately perpetuates aggression as a means of control.

Choice C reason: Yelling at the client escalates tension and models aggressive communication. This approach increases the likelihood of physical aggression by challenging the client in a hostile manner. It also violates therapeutic communication principles, which emphasize calm, respectful, and non-confrontational interaction.

Choice D reason: Engaging the hostile client in dialogue is the most effective intervention. Calm, therapeutic communication helps the client verbalize feelings, regain control, and de-escalate before reaching a crisis phase. Dialogue allows the nurse to assess triggers, provide reassurance, and redirect behavior toward safer coping mechanisms. This approach maintains safety while promoting trust and therapeutic rapport.

Choice A reason: Allowing the client to miss group therapy without addressing the underlying issue reinforces avoidance behavior. In psychiatric and therapeutic settings, avoidance can worsen maladaptive coping and hinder progress. While empathy is important, simply excusing the client does not promote therapeutic engagement or accountability.

Choice B reason: This response balances empathy with encouragement. It acknowledges the client’s discomfort while emphasizing the importance of participation in therapy. This approach validates the client’s feelings but also promotes adherence to treatment, which is critical in psychiatric care. It demonstrates therapeutic communication by combining support with gentle redirection toward recovery goals.

Choice C reason: This response is authoritarian and lacks empathy. Telling the client they "have to" attend because of a doctor’s order disregards the client’s autonomy and feelings. Such a directive can increase resistance, foster mistrust, and damage the therapeutic relationship. Effective communication requires collaboration, not coercion.

Choice D reason: Denying the client’s expressed symptoms by stating they are "not really feeling nauseous" invalidates the client’s experience. This response is dismissive and can harm rapport. Even if somatic complaints are part of the illness, the nurse must avoid confrontation or invalidation, as this can exacerbate distress and reduce trust in care providers.