A nurse is caring for a client on a psychiatric unit.

Exhibits

For each potential action, click to specify if the action is indicated or. contraindicated for the client.

Choice A rationale:

Asking the client directly about the hallucinations is essential in understanding the nature and content of the hallucinations. This information is crucial for the nurse to assess the client's mental state accurately and plan appropriate interventions. Direct communication helps establish trust and rapport with the client, making them more likely to share their experiences.

Choice B rationale:

Avoiding eye contact can create a sense of disconnection and may increase the client's anxiety. Establishing eye contact, on the other hand, communicates empathy and attentiveness, which are essential in therapeutic communication.

Choice C rationale:

Encouraging the client to lie down in a quiet room might not be the most appropriate action, as it does not address the hallucinations directly. It's important to address the hallucinations and help the client cope with them effectively.

Choice D rationale:

Referring to the hallucinations as if they are real might validate the client's experience but can also perpetuate the hallucinations. The nurse should acknowledge the client's feelings without reinforcing the false beliefs. Providing reality-based perspectives and encouraging the client to explore the origin of these hallucinations can be more beneficial.

Choice A rationale:

Soaking in a warm bath every day is not a preventative measure for chronic urinary tract infections. Warm baths might provide temporary relief for discomfort but do not prevent UTIs.

Choice B rationale:

Taking an oral estrogen supplement is not a standard preventative measure for chronic urinary tract infections. Estrogen therapy might be recommended for postmenopausal women with recurrent UTIs, but it's not a general preventive method for all women.

Choice C rationale:

"Drink 2 liters of water per day." This is the correct answer. Staying well-hydrated is essential to prevent urinary tract infections. Drinking an adequate amount of water can help flush out bacteria from the urinary system, reducing the risk of infections. The normal range for daily water intake varies but is generally around 2-3 liters or eight 8-ounce glasses per day.

Choice D rationale:

Emptying the bladder every 6 hours is a good practice, but it might not be sufficient for someone prone to chronic UTIs. Regular and frequent urination can help prevent the buildup of bacteria in the urinary tract. However, specific time intervals might vary from person to person, so a fixed 6-hour rule might not apply to everyone.