A nurse is assessing a client who complains of left shoulder pain after a recent fall.
Which additional symptoms would support the nurse's suspicion of a splenic injury? Select all that apply.

Management of esophageal varices requires reducing the pressure gradient within the portal venous system. This scenario necessitates applying knowledge of splanchnic vasoconstriction and hemodynamic stability to prevent life-threatening hemorrhage and manage portal hypertension through pharmacological intervention and nursing surveillance.

Choice A rationale

Lactulose is a synthetic disaccharide that lowers blood ammonia levels by acidifying colonic contents and promoting excretion. While used in hepatic encephalopathy, it does not directly reduce portal hypertension or stop acute variceal bleeding.

Choice B rationale

Propranolol is a nonselective beta-blocker that reduces portal pressure by decreasing cardiac output and causing splanchnic vasoconstriction. It is the gold standard for preventing further variceal bleeding by lowering the hepatic venous pressure gradient.

Choice C rationale

Omeprazole is a proton pump inhibitor that reduces gastric acid secretion by inhibiting the hydrogen-potassium ATPase pump. While it prevents stress ulcers and treats gastritis, it has no direct hemodynamic effect on portal venous pressure.

Choice D rationale

Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the loop of Henle. It is used to manage ascites or edema but does not effectively target the portal hypertension causing varices.

This scenario requires the application of therapeutic communication principles, specifically validation. Validating feelings involves acknowledging the client's emotional state without dismissing it. Nurses must distinguish between open-ended exploration, false reassurance, and self-disclosure to effectively support patients experiencing acute psychological distress.

Choice A rationale

Validation occurs when the nurse acknowledges the client's subjective experience. Myocardial infarction triggers significant anxiety regarding mortality. Acknowledging that the situation is frightening provides empathy and validates the client's feelings without being dismissive or providing false reassurance.

Choice B rationale

Asking why is often perceived as accusatory and may put the client on the defensive. It requires the client to analyze their emotions logically during a crisis, which can block further therapeutic communication and effective emotional expression.

Choice C rationale

This statement provides false reassurance. In a clinical setting, nurses cannot guarantee specific outcomes. This approach shuts down the client's expression of fear by shifting the focus to clinical actions rather than acknowledging the emotional reality.

Choice D rationale

This is an example of self-disclosure. By focusing on the nurse's own hypothetical feelings, the conversation shifts away from the client. Therapeutic communication must remain client-centered rather than focusing on the nurse's personal perspectives or reactions.