A nurse is assisting in the care of a client in an outpatient substance use disorder clinic who has been taking naltrexone for the past 30 days. Which of the following client statements indicates an expected response to the treatment?

Rationale:

A. Offer the client fluids and toileting every 15 min: While regular offering of fluids and toileting is essential, the standard protocol is typically every 2 hours not every 15 minutes unless otherwise indicated. Overly frequent checks may not be feasible or necessary unless clinically justified.

B. Obtain a prescription before removing the restraints: Mechanical restraints are considered a restrictive intervention and require a physician's order for both application and removal. This ensures medical oversight and client safety.

C. Ensure the restraints are removed from the client within 6 hr: Time limits for restraints depend on the client’s age. For adults, a new order must be obtained every 4 hours, not 6. For children and adolescents (9-17 years), it's 2 hours, and for children under 9 years, it's 1 hour.

D. Place the client in prone position on a soft mattress: Prone restraint positions are not safe and are strongly discouraged due to risk of asphyxiation or injury. Restraints should always allow for safe positioning, typically with the client in a supine or semi-Fowler’s position.

Rationale:

A. Speech pathologist: A speech pathologist evaluates and treats dysphagia (difficulty swallowing) and communication impairments following a stroke. This referral is essential to assess swallowing safety and prevent aspiration.

B. Respiratory therapist: A respiratory therapist assists with pulmonary care, oxygen therapy, or ventilatory support. Unless the client has respiratory complications, a referral is not typically indicated solely for stroke-related weakness or swallowing difficulty.

C. Occupational therapist: An occupational therapist helps the client regain the ability to perform daily activities (e.g., dressing, grooming) that may be impaired by right-sided weakness. This referral supports independence and rehabilitation.

D. Physical therapist: A physical therapist works to improve mobility, balance, and strength in clients with musculoskeletal impairments after a stroke. Right-sided weakness makes this referral highly appropriate for motor recovery.

E. Pharmacist: A pharmacist ensures appropriate medication management, but a direct referral is not typically required for stroke rehabilitation unless there are specific medication concerns or complexities.