After an Angry outburst, a client quickly appears calmer and receptive to input from the nurse. Which is the most helpful response to the client at this time?

"We will have to talk about this later."

"what happened that got you so upset?"

"You really scared me. I'm glad you are okay."

"Your behavior is unacceptable and will not be tolerated

Answer and Explanation

The Correct Answer is B

When a client has an angry outburst and then quickly appears calmer and receptive to input from the nurse, it is important for the nurse to address the underlying cause of the outburst and explore the client's feelings and emotions. By asking, "What happened that got you so upset?", the nurse is inviting the client to express their feelings and share what triggered their anger. This can help the nurse understand the client's perspective, provide appropriate support, and potentially de-escalate any remaining tension or frustration.

The other options are inappropriate because:

A- "We will have to talk about this later." This response may make the client feel dismissed or that their feelings are not being heard or understood.

C- "You really scared me. I'm glad you are okay." While this response acknowledges the client's emotional state, it centers the focus on the nurse's feelings rather than exploring the client's perspective or emotions.

D- "Your behavior is unacceptable and will not be tolerated." This response is confrontational and judgmental, which can escalate the situation and potentially trigger further defensive reactions from the client.

Overall, a non-judgmental and empathetic approach that focuses on understanding the client's feelings and experiences is more likely to foster open communication and provide the client with a safe space to express themselves.

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Correct Answer is C

Explanation

The client's observed behavior of pacing the hall with clenched fists and swearing at others indicates that they are in the escalation phase of the aggression cycle. During this phase, the individual's anger and agitation increase, and their behavior becomes more intense and aggressive. If not addressed promptly and effectively, the situation can escalate further and potentially lead to a crisis or violent outburst.

By intervening immediately and calmly, the nurse aims to prevent the situation from escalating further and moving into the crisis phase, where the risk of harm to the client and others is highest. Effective de-escalation techniques, such as using a calm and non-threatening demeanor, active listening, and providing clear and respectful communication, can help the client regain control and reduce their agitation.

Option A - Recovery: The recovery phase comes after the aggressive incident, during which the individual may feel remorse or embarrassment about their behavior.

Option B - Crisis: The crisis phase is the point where the individual's anger and agitation reach a peak, and there is a high risk of violence or harmful actions.

Option D - Triggering: The triggering phase is the initial phase of the aggression cycle, where the individual's anger begins to build, and certain triggers may set off their aggressive behavior.

A. Use brief statements and questions to obtain information. B. Provide close contact to increase the client's sense of safety. C. Have a sense of humor to show a lack of fear. D. Use open-ended questions so the client can elaborate.

Correct Answer is A

Explanation

Explanation: When dealing with a client who has been physically aggressive and is in distress, the best approach for the nurse is to use brief statements and questions to obtain essential information. This approach helps to keep the communication clear, focused, and non-threatening. The nurse should maintain a calm and assertive demeanor while avoiding lengthy discussions that may escalate the client's agitation.

Options not appropriate in this situation:

B. Providing close contact to increase the client's sense of safety may not be safe for the nurse or the client, especially when dealing with someone who has been physically aggressive. It is essential to maintain a safe distance and ensure the safety of everyone involved.

C. Having a sense of humor to show a lack of fear can be misinterpreted by the client and may not be appropriate or therapeutic in this context. The focus should be on establishing a professional and respectful rapport with the client, prioritizing their needs and safety.

Option D may not be the best approach because open-ended questions could lead to lengthy responses, which may not be suitable for a client who is in distress and potentially aggressive. The nurse should aim for concise and clear communication to ensure safety and facilitate a psychiatric assessment efficiently.

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After an Angry outburst, a client quickly appears calmer and receptive to input from the nurse. Which is the most helpful response to the client at this time?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is observed pacing the hall with clenched fists and swearing at others. The nurse intervenes immediately in a calm manner to prevent the client from moving to which phase of the aggression cycle?

Correct Answer is C

Explanation

A client who has been physically aggressive arrives at the emergency department for a psychiatric assessment. Which approach would be best for the nurse to use?

Correct Answer is A

Explanation

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After an Angry outburst, a client quickly appears calmer and receptive to input from the nurse. Which is the most helpful response to the client at this time?