A nurse observes the caregiver of a client who has Alzheimer's disease throwing magazines on the floor and crying. Which of the following actions should the case manager take first?

Choice A reason:
Responding with "All of your letters come sealed, so that seems unlikely" dismisses the client's feelings and does not address their distress. Clients with delusions need validation of their emotions rather than logical arguments that contradict their beliefs.

Choice B reason:
Telling the client "You know that's not true, because it is against the law for others to read your mail" also dismisses their feelings and may increase their distress. Clients with delusions often hold their beliefs strongly, and simply stating that their belief is false does not help in managing their anxiety or fear.

Choice C reason:
Saying "It must be frightening to think that someone is reading your mail" validates the client's feelings and shows empathy. This response acknowledges the client's fear and opens the door for further discussion about their concerns. It is important to build trust and provide emotional support to clients experiencing delusions.

Choice D reason:
Asking "Why do you think the government wants to read your mail?" can reinforce the delusion by encouraging the client to elaborate on their false beliefs. This approach is not helpful in managing delusions and can lead to further distress.

Choice A reason:
The client's best friend moving away can significantly impact their emotional well-being and stress levels. Emotional support is crucial during recovery from major surgery like coronary artery bypass. The absence of a close friend can lead to feelings of loneliness and increased stress, which can negatively affect the healing process. Stress can elevate cortisol levels, which may impair immune function and slow down recovery. Therefore, the nurse should recognize this factor as a potential interference with the client's recovery.

Choice B reason:
Walking the dog daily is generally beneficial for recovery. Physical activity, such as walking, can improve cardiovascular health, enhance mood, and reduce stress. It helps in maintaining mobility and preventing complications like blood clots. Therefore, this activity is unlikely to interfere with the client's recovery and may actually support it.

Choice C reason:
Stopping coffee consumption can have mixed effects. While reducing caffeine intake might be beneficial for some individuals, abrupt cessation can lead to withdrawal symptoms such as headaches, irritability, and fatigue. These symptoms can add to the client's stress and discomfort during recovery. However, this is generally a temporary issue and not as significant as the emotional impact of losing a close friend.

Choice D reason:
Exercising in the morning is typically a positive habit for recovery. Regular exercise can improve circulation, reduce stress, and enhance overall physical health. It can also help in maintaining a routine and providing a sense of normalcy. Therefore, morning exercise is unlikely to interfere with recovery and is usually encouraged.