A nurse is caring for a client who was admitted to the mental health unit for treatment. The client states, "I am a nurse on the medical-surgical unit, and I don't want my coworkers to know." Which of the following actions should the nurse take?

Choice A reason: Explaining a legal obligation to share information is not accurate in this context.

Choice B reason: Advising the client that her supervisor will be informed is not necessary or appropriate.

Choice C reason: Telling the client her coworkers' opinions should not matter does not address the confidentiality concern.

Choice D reason: The correct answer is d) because informing the client that the information will be shared with the treatment team addresses the need for confidentiality while ensuring the team has the necessary information for treatment.

Choice A reason: Hypotension and venous pooling in the extremities are not typical of autonomic dysreflexia. Autonomic dysreflexia usually results in hypertension due to an exaggerated autonomic response to a stimulus such as a full bladder. This condition is characterized by severe, uncontrolled hypertension rather than hypotension.

Choice B reason: While pain and a burning sensation upon urination and hematuria can be related to a urinary tract infection or bladder issue, they are not specific to autonomic dysreflexia. Autonomic dysreflexia presents with symptoms that result from the body's exaggerated response to the stimulus, such as severe headache and sweating.

Choice C reason: The correct answer is c) because profuse diaphoresis (sweating) and a severe, pounding headache are hallmark signs of autonomic dysreflexia. This condition occurs in individuals with spinal cord injuries at or above the T6 level and is triggered by stimuli like a full bladder, causing a dangerous rise in blood pressure and severe autonomic responses.

Choice D reason: Reports of chest pain and shortness of breath are not typical signs of autonomic dysreflexia. While these symptoms may be concerning, they are not the primary indicators of this specific condition. The severe headache and sweating are more indicative of autonomic dysreflexia.