A nurse on a mental health unit is assisting with the care of a client. The nurse is continuing to assist with the care of the client. Select the four actions the nurse should take.

Ask the provider for a PRN prescription for restraints.

Establish clear limits for expected behaviors.

Place the client in a room near the nurse's station.

Determine if the client is experiencing command hallucinations.

Administer diazepam when the client exhibits anxiousness.