A nurse is assisting in the care of a client. Nurses' Notes 2000:

Client presents to emergency department and states, "I have been assaulted." Client was immediately placed in a treatment room.

2015:

"Client states they were out with friends this evening and had "a little too much to drink." Client states that they fell asleep at their friend's house and when they woke up all of their clothes were off and their genitals were sore. The client states, "I think someone had sex with me, but I don't remember anything." Client reports history of depression. Client is a full-time college student who lives with roommates. Client admits to drinking socially but denies illicit drug use and tobacco use.

Which of the following interventions should the nurse plan to implement?

Select all that apply.

Stopping dialysis is a significant decision made by the client, and it is important for the nurse to respect and support the client's autonomy and right to make decisions about their own healthcare. The nurse should provide emotional support, validate the client's feelings and concerns, and ensure that the client has access to appropriate resources and support systems. It is not the nurse's role to persuade or encourage the client to continue or reconsider the decision.

The other options are incorrect:

Tell the client she should discuss this decision with her family: While family involvement and support are important, the decision to stop dialysis ultimately rests with the client. It is the client's decision to make, and the nurse should respect the client's autonomy.

Discuss alternative treatment methods with the client: If the client has made an informed decision to stop dialysis, it is not appropriate for the nurse to discuss alternative treatment methods at this point. The focus should be on supporting the client in their decision and providing comfort and care.

Ask the facility chaplain to visit the client: Spiritual and emotional support can be valuable for clients facing end-of-life decisions, but it should be based on the client's preferences and requests. The nurse can offer spiritual support if desired but should not assume that it is necessary or appropriate in every case.

Headaches are a common side effect of isosorbide dinitrate, especially when initially starting the medication. However, they often improve as the body adjusts to the medication. It is important to reassure the client that the headaches should decrease over time. If the headaches persist or worsen, the client should inform their healthcare provider for further evaluation and possible adjustment of the medication regimen.

The statement about taking the medication on an empty stomach is not relevant to preventing headaches associated with isosorbide dinitrate.

The statement about swallowing the tablet whole does not address the issue of headaches. Chewable isosorbide dinitrate is designed to be chewed or dissolved in the mouth, and swallowing it whole may not provide the intended therapeutic effect.

Discontinuing the medication until the headache goes away is not recommended without consulting the healthcare provider. Abruptly stopping or changing the dose of isosorbide dinitrate can have serious consequences and should only be done under medical supervision.