The client is struggling with the decision to donate organs after death. The nurse assists the client to list alternatives, examine the "pros" and "cons" and elicits the client's feelings about the decision. The nurse is assisting this client with:

A. Paternalism: Paternalism refers to the healthcare provider making decisions on behalf of the client without their input or consent, typically for the client's perceived benefit. In this scenario, the nurse is not making decisions for the client but rather honoring an agreement to reassess pain after interventions.

B. Confidentiality: Confidentiality refers to maintaining the privacy and security of client information. It does not directly relate to the nurse's commitment to follow through on a verbal contract with the client regarding pain reassessment.

C. Responsibility: Responsibility involves being accountable for one's actions and obligations in providing care to clients. While responsibility is important in nursing practice, it does not specifically address the nurse's commitment to fulfill a verbal contract with the client regarding pain reassessment.

D. Fidelity: Fidelity, also known as loyalty or faithfulness, pertains to the nurse's obligation to uphold commitments made to clients. In this scenario, the nurse is demonstrating fidelity by returning within the agreed-upon time frame to evaluate the effectiveness of pain interventions as promised to the client. This principle emphasizes the importance of keeping promises and honoring agreements made with clients, thereby building trust and promoting ethical practice in nursing.

When a client experiences increased production of antidiuretic hormone (ADH) and aldosterone due to extreme stress, the body's response is aimed at retaining fluid to maintain blood pressure and hydration. As a result, urinary output decreases because the kidneys retain more water, leading to concentrated urine production. This decrease in urinary output helps conserve fluids and contributes to maintaining blood pressure and hydration levels in response to stress.

A. Serum osmolarity: With increased ADH production, serum osmolarity tends to remain stable or may even increase slightly due to the retention of water. ADH acts on the kidneys to increase water reabsorption, which can concentrate the blood and elevate serum osmolarity.

B. Urinary output: Increased production of ADH and aldosterone leads to decreased urinary output as the kidneys retain more water. This response helps conserve fluid volume and maintain hydration during times of stress.

C. Insensible fluid loss: Insensible fluid loss, which includes water lost through respiration and skin evaporation, is not directly affected by ADH and aldosterone. These hormones primarily influence renal water retention rather than insensible fluid loss.

D. Blood pressure: Although aldosterone can indirectly affect blood pressure by increasing sodium retention and therefore influencing fluid balance, its primary role is to regulate sodium and potassium levels. Blood pressure may be influenced by various factors, including stress, hydration status, and cardiovascular health, but it is not directly decreased as a result of increased ADH and aldosterone production.