A nurse is preparing to transfer a client who has had a stroke to a rehabilitation facility. The client's family tells the nurse they are concerned about the level of care the client will receive.

Which of the following actions should the nurse take?

Use a reward system to modify the child's behavior.

Rationale:

• A. Incorrect. Maintaining a flexible daily schedule for the child may increase their anxiety and confusion, as they may have difficulty adapting to changes in routine and expectations. The nurse should advise the parents to establish a consistent and structured schedule for the child, with clear rules and boundaries.
• B. Correct. Using a reward system to modify the child's behavior is an effective strategy to reinforce positive behaviors and reduce negative ones. The nurse should help the parents identify specific and measurable goals for the child, and provide them with praise, tokens, or privileges when they achieve them.
• C. Incorrect. Providing a variety of family members to care for the child may overwhelm them and impair their social skills development, as they may have difficulty forming attachments and communicating with different people. The nurse should encourage the parents to select one or two primary caregivers for the child, who can provide them with consistent and supportive interactions.
• D. Incorrect. Administering alprazolam as needed to reduce the child's anxiety is not recommended, as it may cause adverse effects such as sedation, dependence, or withdrawal symptoms. The nurse should educate the parents about nonpharmacological interventions for anxiety, such as relaxation techniques, cognitive behavioral therapy, or social skills training.

- A. Diarrhea is not an adverse effect of amitriptyline, which is a tricyclic antidepressant (TCA). Diarrhea may be caused by other factors, such as infection, food intolerance, or stress. Therefore, this choice is incorrect.

- B. Frequent urination is not an adverse effect of amitriptyline either. Frequent urination may be a sign of diabetes, urinary tract infection, or other conditions that affect the kidneys or bladder. Therefore, this choice is also incorrect.

- C. Excessive salivation is not an adverse effect of amitriptyline as well. Excessive salivation may be due to increased production of saliva, difficulty swallowing, or mouth irritation. Therefore, this choice is incorrect too.

- D. Blurred vision is an adverse effect of amitriptyline and other TCAs. Amitriptyline can cause anticholinergic effects, such as dry mouth, constipation, urinary retention, and blurred vision. These effects are more pronounced in older adults and can impair their daily functioning and quality of life. Therefore, this choice is correct and the nurse should identify it as an adverse effect of the medication.