The nurse is helping to conduct a group therapy session. During the session, a male client threatens to act out physically and states that he will punch another member of the group. Which of the following is the appropriate initial nursing action?
1. Tell the client that he must leave immediately.
2. Call security to come to the session immediately.
3. Tell the client that he can talk about his anger but cannot act on it in during the group session.
4. Tell the client that if he hits another client, he will be restrained and placed in se-clusion.
3
Rationale: If a client threatens to act out physically during a group session, the client should be told that he can talk about his anger but cannot act on it in during the group session. "Tell the client that he must leave immediately," "call security to come to the session immediately," and "tell the client that if he hits another client, he will be restrained and placed in seclusion" are in-appropriate initial nursing actions. Because the client's action was a threat, it is best for the nurse to deal with the behavior. "Call security to come to the session immediately" is a premature ac-tion. Telling the client that he must leave immediately or that if he hits another client he will be restrained and placed in seclusion violates the client's rights, based on the information provided in the question.
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