A nurse is caring for a client who begins yelling and pacing around the room. Which of the following actions should the nurse take? (Select all that apply.)

Choice A reason: Speaking loudly may escalate the situation and increase agitation. A calm, low tone is more effective in de-escalating behavior. Choice B reason: Restraints should only be used as a last resort when the client poses an immediate danger. Premature use can violate patient rights and worsen agitation. Choice C reason: Using short, simple sentences helps the client process information during heightened emotional states. It reduces confusion and promotes clarity. Choice D reason: Identifying stressors helps the nurse understand the root cause of agitation and tailor interventions accordingly. It is a therapeutic and preventive approach. Choice E reason: Standing directly in front of the client may be perceived as confrontational or threatening. Maintaining a safe distance and non-threatening posture is essential for safety.