The client states, “I understand that in order to leave, I must sign a request to withdraw from treatment.” What is the client’s legal status?

Choice A reason: Implementing interventions addresses specific needs but is not the primary goal of therapeutic communication during admission. Interventions follow after building trust, as depression and anxiety require a strong therapeutic alliance to ensure effective treatment engagement, making this a secondary priority at this stage.

Choice B reason: Teaching self-care skills is important for long-term management but not the initial communication goal. Clients with depression and anxiety need trust and emotional safety first to engage in learning, making skill-building secondary to establishing a therapeutic relationship during the admission assessment.

Choice C reason: Facilitating emotional expression is a key component of therapeutic communication but depends on a trusting relationship. Without a strong nurse-client bond, clients with depression and anxiety may resist sharing emotions, making this goal important but secondary to establishing rapport during the initial assessment.

Choice D reason: Establishing a therapeutic nurse-client relationship is the priority during admission, as it builds trust and safety, critical for clients with depression and anxiety. This foundation enables emotional expression, engagement in interventions, and skill-building, ensuring effective communication and treatment adherence, making it the primary goal in this context.

Choice A reason: Hypertension and obesity (BMI 30) are major risk factors for ESRD. Chronic hypertension damages renal vasculature, reducing glomerular filtration over time. Obesity exacerbates hypertension and promotes glomerulosclerosis, leading to progressive kidney damage. This combination significantly increases the risk of developing ESRD through sustained renal injury.

Choice B reason: Vascular disorders, such as atherosclerosis, impair renal blood flow, causing ischemic nephropathy. Chronic reduced perfusion damages nephrons, leading to progressive renal failure. Vascular diseases also contribute to hypertension, further stressing kidneys. This client’s history indicates a high risk for ESRD due to ongoing vascular compromise affecting renal function.

Choice C reason: Poorly controlled diabetes mellitus causes diabetic nephropathy, a leading cause of ESRD. Chronic hyperglycemia damages glomerular capillaries, leading to proteinuria and declining kidney function. Sustained high glucose levels accelerate nephron loss, making this client at high risk for ESRD due to irreversible renal damage from diabetes.

Choice D reason: Chronic obstructive pulmonary disease (COPD) primarily affects the lungs, not the kidneys. While hypoxia or medications like corticosteroids may indirectly stress kidneys, COPD is not a direct risk factor for ESRD. Renal damage requires specific insults like hypertension or diabetes, making this client less likely to develop ESRD.

Choice E reason: A recent dehydration episode from gastroenteritis can cause acute kidney injury but is reversible with treatment. It is not a chronic condition leading to ESRD unless recurrent or combined with other risk factors like diabetes or hypertension. This isolated event poses a lower risk for ESRD development.