A nurse is providing discharge teaching to the parents of a toddler who has cystic fibrosis.

Which of the following instructions should the nurse include?

Choice A reason

Act as a spokesperson to provide information to the media in inappropriate. During a disaster, the nurse manager or designated hospital spokesperson usually handles communication with the media. The unit nurse's primary focus is on patient care and ensuring the safety and well-being of the clients on their unit.

Choice B reason

Recommending to the provider a list of clients for early discharge is the action that should be taken by the nurse. During a disaster, the responsibility of the unit nurse includes recommending to the healthcare provider a list of clients who may be considered for early discharge. This decision is based on the nurse's assessment of the clients' conditions and the need to create additional capacity for incoming patients who require urgent medical attention.

Choice C reason:

Determining the need for additional providers is inappropriate. The determination of the need for additional providers during a disaster is usually made at a higher level, such as by the nursing supervisor, nurse manager, or hospital administration. The unit nurse may collaborate with the nursing leadership to assess staffing needs and provide input, but the final decision is typically made at a higher level.

Choice D reason

Deciding which clients should be transported for a higher level of care is not the responsibility of the nurse. Decisions about transferring clients for a higher level of care during a disaster are usually made collaboratively among the healthcare team, including the healthcare providers and nursing leadership. The unit nurse may provide valuable input about the clients' conditions, but the decision is not solely the responsibility of the unit nurse.

The correct answer is choice C: “Do you have thoughts of harming yourself?”.

This is the priority question for the nurse to ask the client because it assesses the client’s risk for suicide, which is a serious and potentially life-threatening complication of conduct disorder. The nurse should use a direct and nonjudgmental approach when asking about suicidal ideation and plan.

Choice A: “How do you get along with your peers at school?” is wrong because it is not the most urgent question to ask the client.

While it is important to assess the client’s social relationships and possible peer rejection, this can be done after addressing the client’s safety and mental status.

Choice B: “Do you have a criminal record?” is wrong because it is not relevant to the client’s current condition and might make the client feel defensive or stigmatized.

The nurse should avoid asking questions that imply blame or judgment and focus on the client’s strengths and coping skills.

Choice D: “How do you manage your behavior?” is wrong because it is not appropriate for the nurse to ask the client in an emergency department setting.

This question might imply that the client is responsible for their conduct disorder, which is a complex and multifactorial mental health condition. The nurse should collaborate with the client and their family to develop a behavior management plan that involves positive reinforcement, limit setting, and consistent consequences.

Normal ranges: According to the DSM-5, conduct disorder is characterized by a persistent pattern of behavior that violates the rights of others or societal norms.

The symptoms of conduct disorder include aggression, deceitfulness, destruction of property, serious rule violations, and lack of remorse.

Conduct disorder can cause significant impairment in social, academic, or occupational functioning. The prevalence of conduct disorder is estimated to be 4% among children and adolescents.

The risk factors for conduct disorder include genetic factors, neurobiological factors, environmental factors, and psychological factors.