Difficulty: Medium
Average Score: 85%
Simulated
The nurse is attempting to de-escalate a client who is becoming increasingly agitated on the unit. Which of the following interventions would be appropriate for this type of client? (SELECT ALL THAT APPLY)
Correct answer
A,C,D
Rationale
Correct Answer: A, C, D
Rationale:
A: Using a calm voice can help the client feel less threatened and more understood, promoting a sense of safety.
C: Reducing stimuli can help decrease the client's agitation by eliminating potential triggers in the environment.
D: Attempting to redirect the client's focus towards a more positive or neutral topic can help shift their attention away from the source of agitation.
Incorrect Choices:
B: Speaking louder can escalate the situation by increasing the client's agitation and perception of being threatened.
E: Reprimanding the client can further escalate the situation and undermine the client's trust in the nurse, worsening the client's behavior.
Rationale:
A: Using a calm voice can help the client feel less threatened and more understood, promoting a sense of safety.
C: Reducing stimuli can help decrease the client's agitation by eliminating potential triggers in the environment.
D: Attempting to redirect the client's focus towards a more positive or neutral topic can help shift their attention away from the source of agitation.
Incorrect Choices:
B: Speaking louder can escalate the situation by increasing the client's agitation and perception of being threatened.
E: Reprimanding the client can further escalate the situation and undermine the client's trust in the nurse, worsening the client's behavior.