Exhibits A nurse is planning care for a client who has been readmitted to an acute mental health unit. Which of the following actions should the nurse take? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

A. Use verbal intervention to assess the client's behavior. The first step in managing aggressive behavior is verbal de-escalation. Speaking calmly, using open-ended questions, and acknowledging the client’s emotions can help prevent further escalation and reduce agitation. Since the client has a history of aggression and medication nonadherence, early intervention is key to maintaining safety. B. Stand in front of the patient while acknowledging their behavior. Standing directly in front of an aggressive client can be perceived as confrontational and threatening, which may provoke further aggression. Instead, the nurse should stand at an angle and maintain a safe distance while maintaining a calm, non-threatening posture. C. Ignore the client's escalating behavior. Ignoring escalating aggression can put staff and other clients at risk. While not reinforcing negative behaviors is important in some cases, failing to intervene can lead to physical outbursts and loss of control. D. Approach the client with security. While security may be needed if the client becomes physically violent, the first step in de-escalation should always be verbal intervention. Using security too soon can increase agitation and make the client feel threatened or cornered, escalating the situation unnecessarily.