A client is having vivid hallucinations and does not turn to face the nurse when called by name. The client is trembling and appears frightened and agitated. What should the nurse do at this time?
A) Take the client's vital signs.
B) Tell the client that his fear is unrealistic.
C) Take the client to watch television in the day room.
D) Explore the content of the hallucinations.
Question 2
Following a violent outburst in the unit, all of the clients are sent to their rooms while the staff restrains and secludes a client. The client's psychiatrist is notified and the order for restraints is written.
The milieu appears to be quiet once more. What should the nurse do next? A) Return to the nursing station and document the event according to hospital policy.
B) Make rounds to see how the other clients are responding to the situation.
C) Find a peer and debrief about the event.
D) Set up a time for the staff to engage in a critical incident review.
Cougar - Close-up front face
Nurse-patient interaction; nonveral communication
Face
Structure of a b turn
Nurse administering enteral nutrition through a feeding tube.