The nurse is caring for a pregnant client with a positive urine drug screen. When questioned about substance abuse, the client begins to throw objects at the nurse and yells, "I'm leaving this hospital right now before you call the police on me!" What is the best response by the nurse?

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Violence (eg, offensive language, physical aggression) may be precipitated by substance abuse, emotional stress, mental instability, or altered mentation from medical conditions. To de-escalate a violent situation and ensure the safety of the client and others, the nurse should: Remove other clients from the area. Keep a safe distance from the client with a clear path to safety. Maintain a calm demeanor, keeping the hands visible. Use clear, nonthreatening communication focusing on mutual goals (Option D). (Option A) During periods of extreme anxiety and stress, clients are prone to irrational thinking. The nurse should avoid reasoning (eg, explaining the dangers of refusing treatment) until the situation has been de-escalated and the client is no longer in crisis. (Option B) Bargaining with the client by providing false reassurance (eg, promising not to involve authorities) is nontherapeutic and may cause the client to lose trust in the nurse. (Option C) The client with impaired thinking from substance abuse is legally incompetent to leave the hospital against medical advice. Educational objective: To de-escalate a violent situation involving a client with irrational thinking (eg, from substance use), the nurse should ensure the safety of the client and others and use calm, clear, nonthreatening communication focusing on mutual goals. The nurse should avoid attempting to reason with the client or providing false reassurance.

The Nurse Is Caring for a Pregnant Client with a Positive