A client with chronic renal failure is admited with a heart rate of 122 beats/minute; a respiratory rate of 32 breaths/minute, a blood pressure of 190/110 mm Hg, neck vein distention, and bibasilar crackles. Which nursing diagnosis takes highest priority for this client? Select one answer

Choice A reason: “I hear frustration or perhaps anger in your voice. Could you tell me more about how you are feeling right now?” is a therapeutic response, not a non-therapeutic one. This response shows active listening, which is a communication skill that involves hearing, understanding, and responding to the client’s verbal and nonverbal messages. It also shows empathy, which is the ability to understand and share the feelings of another person. It acknowledges and validates the client’s emotions, and invites them to express their concerns or fears. Therefore, this choice is incorrect.

Choice B reason: “It sounds as though you are nervous about going home, but the wound care nurse who will see you also uses excellent technique I am sure your wound will continue to heal.” is a non-therapeutic response, not a therapeutic one. This response shows false reassurance, which is a communication technique that involves minimizing or dismissing the other person’s feelings or situation. It also shows assumption, which is a communication barrier that involves making judgments or guesses about what the other person thinks or feels. It does not address the client’s emotions or needs, and may sound vague or insincere. Therefore, this choice is correct.

Choice C reason: “Do you have any concerns about what will happen after discharge that you would like to talk about?” is a therapeutic response, not a non-therapeutic one. This response shows open-ended questioning, which is a communication technique that involves asking questions that require more than a yes or no answer. It also shows support, which is a communication technique that involves providing emotional or practical assistance to the client, and helping them cope with their situation or problem. It encourages the client to share their thoughts and feelings, and shows that the nurse is interested, supportive, and empathetic. Therefore, this choice is incorrect.

Choice D reason: “Many people who have been in the hospital for an extended period have mixed feelings about going home. Can you tell me how you are feeling about discharge?” is a therapeutic response, not a non-therapeutic one. This response shows generalization, which is a communication technique that involves using statements that apply to most people in similar situations. It also shows reflection, which is a communication technique that involves restating or paraphrasing what the client has said to show understanding and clarify meaning. It helps the client to feel less alone or isolated, and to explore their own feelings or thoughts. Therefore, this choice is incorrect.

Choice A reason: Providing open-ended questions and silence is a communication technique that can encourage the client to eat dinner. Open-ended questions can invite the client to share their thoughts and feelings about food and eating, and can help the nurse to explore the client’s perception of reality and identify any distorted thinking. Silence can give the client time to process and respond, and can show respect and acceptance. Therefore, this choice is correct.

Choice B reason: Focusing on self-disclosure of own food preferences is not a communication technique that can encourage the client to eat dinner. Self-disclosure can be appropriate in some situations, but it should be used sparingly and only when it benefits the client. Focusing on the nurse’s own food preferences can be irrelevant, distracting, or imposing, and it can shift the atention away from the client’s needs and concerns. Therefore, this choice is incorrect.

Choice C reason: Atempting to show empathy by suggesting reasons why the client may not want to eat is not a communication technique that can encourage the client to eat dinner. Empathy is a valuable skill, but it should be based on understanding and reflecting the client’s feelings, not on assuming or guessing them. Suggesting reasons why the client may not want to eat can be inaccurate, patronizing, or discouraging, and it can reinforce the client’s resistance or mistrust. Therefore, this choice is incorrect.

Choice D reason: Telling the client of the importance of eating is not a communication technique that can encourage the client to eat dinner. Telling or lecturing the client can be perceived as authoritative, judgmental, or condescending, and it can increase the client’s defensiveness or anxiety. It can also ignore the client’s perspective or experience, and fail to address the underlying causes of their disordered thinking. Therefore, this choice is incorrect.