On a mental health unit, which client should the nurse attend to first?

• A. A client who is repeatedly approaching the nurses' station to request medication for his anxiety
• B. A client in the dayroom who is screaming at other clients about what is on the television
• C. A client who is standing in her room, yelling obscenities, and throwing her clothes
• D. A client who has bipolar disorder and is continuously pacing at the end of the hall

Answer: (D)

When multiple clients are showing distress, safety takes priority, and you must assess who is at the highest immediate risk for harm to self or others. The patient who is continuously pacing at the end of the hall represents escalating psychomotor agitation typical of a manic state. This type of agitation can quickly progress to impulsive actions, wandering off the unit, or potential aggression, which poses a direct and imminent safety threat to themselves and others. Attending to this client first allows you to intervene early with de-escalation, ensure safe supervision, and implement necessary precautions before the situation worsens.

The other scenarios, while concerning, do not present the same immediate level of danger. A client repeatedly asking for anti-anxiety medication is seeking relief but is not currently displaying a behavior that risks harm. A client in the dayroom screaming at others is disruptive and can be managed with de-escalation, redirection, and reducing stimulation. A client yelling obscenities and throwing clothes in their room is aggressive, but if the behavior is contained, it can be addressed with calming approaches and safety measures without the same immediate risk of harming others or eloping.

In practice, you’d approach the pacing patient with calm, nonthreatening communication, ensure safety around the area, and use de-escalation techniques, while preparing to involve the treatment team as needed.