A nurse is caring for a client who has a chronic illness. In which phase of the therapeutic relationship should the nurse help the client develop problem-solving skills?

A. Avoiding actions that can cause harm to the client: This action demonstrates the ethical principle of nonmaleficence, which focuses on preventing harm, rather than veracity. While important in nursing practice, it does not relate specifically to truthfulness.

B. Prioritizing interventions that benefit the client: This reflects the principle of beneficence, which emphasizes doing good and promoting the client’s well-being. It does not directly involve honesty or truthful communication with the client.

C. Allowing the client to function independently: Supporting autonomy involves respecting the client’s ability to make decisions and perform activities independently. While ethically important, it is not the same as veracity.

D. Being honest with the client: Veracity refers to truthfulness and providing accurate, complete information to clients. Being honest about diagnoses, treatments, and care plans ensures informed decision-making and builds trust between the nurse and client.

A. Bowel elimination: The child has had six watery stools in 24 hours with confirmed Escherichia coli infection, indicating ongoing significant gastrointestinal fluid losses. Continued diarrhea increases the risk of worsening dehydration, electrolyte imbalance, and hypovolemia, especially in a 2-year-old with limited physiologic reserves.

B. Oxygenation: Oxygen saturation has remained between 95% and 98% on room air, which is within acceptable limits for a toddler. There is no evidence of respiratory distress or hypoxemia requiring urgent intervention based on the data provided.

C. Respiratory rate: A respiratory rate of 25–30/min falls within the upper expected range for a 2-year-old, particularly in the presence of fever. There is no indication of severe tachypnea or respiratory compromise requiring immediate follow-up.

D. Temperature: The child’s temperature increased to 38.8°C (101.8°F) on Day 2, indicating persistent or worsening infection. Ongoing fever in the setting of confirmed E. coli and dehydration increases metabolic demand and fluid loss, requiring prompt reassessment and management.

E. Hgb: Hemoglobin of 16 g/dL is elevated for age and suggests hemoconcentration secondary to dehydration. Fluid loss from vomiting and diarrhea reduces plasma volume, artificially elevating hemoglobin concentration, which signals significant intravascular volume depletion.

F. Sodium: Sodium level of 136 mEq/L falls within the normal reference range. There is no current laboratory evidence of hypo- or hypernatremia requiring urgent correction.

G. Blood pressure: Blood pressure readings of 95/56–98/62 mm Hg in a toddler with ongoing fluid loss raise concern for evolving hypovolemia. Although not profoundly hypotensive, the combination of tachycardia, dehydration signs, and weight loss suggests risk for progression to hypovolemic shock.

H. Skin turgor: Delayed skin turgor and sunken eyes are classic clinical signs of moderate to severe dehydration in pediatric clients. These findings reflect decreased interstitial fluid volume and require immediate intervention to prevent further hemodynamic instability.

I. Creatinine: Creatinine of 0.8 mg/dL is elevated for a 2-year-old, indicating possible decreased renal perfusion due to dehydration. Reduced intravascular volume can impair glomerular filtration rate, placing the child at risk for acute kidney injury.