Substance Abuse, Eating Disorders, Impulse Control Disorders no. 5042

Substance Abuse, Eating Disorders, Impulse Control Disorders no. 5042

QUESTION: In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client's husband arrives, shouting that he wants to "finish the job." What is the first priority of the health care worker who witnesses this scene?

✘O a.) Remaining with the client and staying calm
✓O b.) Calling a security guard and another staff member for assistance
✘O c.) Telling the client's husband that he must leave at once
✘O d.) Determining why the husband feels so angry

RATIONALE

RATIONALE: The health care worker who witnesses this scene must take precautions to ensure personal as well as client safety, but shouldn't attempt to manage a physically aggressive person alone. Therefore, the first priority is to call a security guard and another staff member. After doing this, the health care worker should inform the husband what is expected, speaking in concise statements and maintaining a firm but calm demeanor. This approach makes it clear that the health care worker is in control and may diffuse the situation until the security guard arrives. Telling the husband to leave would probably be ineffective because of his agitated and irrational state. Exploring his anger doesn't take precedence over safeguarding the client and staff.
NURSING PROCESS STEP: Planning
CLIENT NEEDS CATEGORY: Safe, effective care environment
CLIENT NEEDS SUBCATEGORY: Safety and infection control
COGNITIVE LEVEL: Application