A nurse is contributing to the plan of care for a client who has a gambling disorder. Which of the following nursing interventions should the nurse include in the plan of care?

Rationale:

A. Urinary frequency: As death approaches, urinary output typically decreases due to reduced kidney perfusion. Urinary frequency is not a common sign of impending death and may suggest other unrelated conditions.

B. Difficulty swallowing: Difficulty swallowing is a common manifestation of impending death. As muscle tone declines, the child may struggle to manage secretions or food, increasing the risk of aspiration and signaling the body is shutting down.

C. Decreased sleep: Clients nearing death often exhibit increased sleep or lethargy, not decreased sleep. Diminished responsiveness and longer periods of unresponsiveness are expected in the final stages of life.

D. Increased senses: Sensory function generally declines as death nears. Vision, hearing, taste, and touch may all diminish, and the child may become less responsive to external stimuli. Increased senses are not expected at this stage

Rationale:

A. "My anxiety has been getting a little easier to deal with every day." Naltrexone is not primarily used to treat anxiety. While improvement in anxiety may occur secondarily as alcohol use decreases, this statement does not directly reflect the intended therapeutic effect of naltrexone in substance use treatment.

B. "I have not had any cravings to drink since my visit last week." Naltrexone works by blocking opioid receptors involved in the brain’s reward system, reducing cravings and the pleasurable effects of alcohol. Decreased alcohol craving is a direct and expected response to naltrexone therapy in clients with alcohol use disorder.

C. "When I had one drink last week. I had extreme nausea and vomited several times."
This describes the effect of disulfiram, not naltrexone. Disulfiram causes an aversive reaction to alcohol, while naltrexone does not produce sickness when alcohol is consumed; it simply reduces the reward response.

D. “Since I quit drinking. I have not had any hallucinations." Hallucinations are associated with alcohol withdrawal, not the effect of naltrexone. Naltrexone does not prevent withdrawal symptoms or hallucinations; it is used after detox to help maintain abstinence and reduce relapse.