Question

A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (Select all that apply)

A. Lethargy
B. Defensive responses to questions
C. Disorientation
D. Facial grimacing
E. Agitation

Answer 1

In the preassaultive stage of violence, a nurse would expect to see defensive responses to questions, disorientation, and agitation in the client.

Step-by-step explanation:

In the preassaultive stage of violence, a nurse would expect to see defensive responses to questions, disorientation, and agitation in the client.