The nurse is caring for a group of clients in the mental health outpatient clinic. Which client is most likely to be mandated by a criminal court for outpatient treatment?

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.

Choice A reason: The right to do no harm (nonmaleficence) is an ethical principle, not a specific client right. While premature restraints may cause harm, this option does not directly address the legal right violated, which is the use of least restrictive interventions, making it less precise.

Choice B reason: Informed consent involves agreeing to treatments, not the use of restraints, which is a safety intervention. While clients should be informed, premature restraint use violates the right to least restrictive care, not consent, as restraints are not typically consensual interventions.

Choice C reason: Confidential and respectful care relates to privacy and dignity, not the method of intervention. Premature restraints violate the principle of using less invasive options first, not confidentiality or respect, making this right irrelevant to the specific violation described in the scenario.

Choice D reason: The right to least restrictive treatment requires using non-invasive interventions (e.g., de-escalation) before restraints. Premature restraint use violates this right, as mental health laws mandate the least coercive measures to ensure safety, prioritizing patient autonomy and minimizing harm, making this the correct answer.