A home health nurse is caring for a client who has terminal cancer. The client tells the nurse they wish to stop their chemotherapy treatments. Which of the following statements should the nurse make?

Rationale:

• "We should notify the provider if the cast becomes loose over time.": A loose cast can fail to immobilize the fracture properly, risking displacement or delayed healing. Recognizing this and contacting the provider demonstrates proper understanding of cast care.

• "We should expect the swelling and tingling to worsen before it gets better.": While mild swelling and tingling may occur, increasing or worsening neurovascular symptoms can indicate complications such as compartment syndrome. The parent needs reinforcement that any worsening sensation or cold fingers should prompt immediate provider notification rather than being expected.

• "We need to be very careful about how we handle the cast for the first 2 days while it dries.": Handling a wet cast improperly can deform it and compromise fracture stabilization. Awareness of this indicates correct knowledge of initial cast care.

• "It is important that our child avoids placing anything inside the cast.": Inserting objects into the cast can cause skin irritation, pressure ulcers, or infection. Avoiding this demonstrates understanding of safe cast management.

• "We should prop the casted arm on pillows for the next 24 hours.": Elevation of the casted limb reduces swelling and promotes comfort. This reflects correct knowledge of post-cast care.

Rationale:
A. Reassure the client that their injuries are not life threatening: While reassurance may seem supportive, minimizing the client’s experience or focusing on injury severity too early may invalidate their emotional trauma and hinder trust-building.

B. Limit the number of staff members providing care for the client: Limiting staff exposure promotes a sense of safety and control for the client, who may feel vulnerable and traumatized. Consistency in caregivers helps reduce anxiety and supports trauma-informed care principles by minimizing re-traumatization and promoting trust.

C. Ask the client for details about the assault: The nurse should not probe for specific details because repeated questioning can intensify trauma and emotional distress. Instead, the nurse should allow the client to share voluntarily when ready and defer detailed questioning to a trained sexual assault nurse examiner (SANE).

D. Instruct the client to shower and change their clothes: The client should not bathe, change, or wash clothing before evidence collection. The nurse should explain the importance of preserving evidence and provide clean clothing after the forensic examination is complete.