The nurse is caring for an acutely ill client. Which assessment finding should prompt the nurse to inform the healthcare provider that the client may be exhibiting signs of acute kidney injury (AKI)?

Choice A reason: Informing the client about potential nurse reprimands is coercive and inappropriate, as it prioritizes the nurse’s interests over patient autonomy. This approach fails to explore the client’s reasons for refusal, which may involve side effects or mistrust, and does not support therapeutic communication or ethical care.

Choice B reason: Documenting refusal is necessary but not the first action. Exploring the reason for refusal allows the nurse to address concerns, potentially resolving issues like misunderstanding or side effects. Documentation follows after attempts to understand and educate, ensuring a therapeutic approach before recording the refusal.

Choice C reason: Asking the reason for refusal respects autonomy and initiates therapeutic communication. It identifies barriers like side effect fears or lack of understanding, enabling education or alternative solutions. This approach aligns with patient-centered care, addressing underlying issues to promote adherence while respecting the client’s rights.

Choice D reason: Stating that refusal is not permitted is coercive and violates autonomy. Clients have the right to refuse medication unless under involuntary treatment orders. This approach damages trust, escalates resistance, and contradicts ethical principles, making it an inappropriate initial response to medication refusal.

Choice A reason: Silence allows the client to process trauma at their own pace, creating a safe, non-pressurized environment. Fearful clients may need time to feel secure before speaking. This technique fosters trust, encourages emotional expression, and is particularly effective in trauma, where verbalization can be challenging due to psychological distress.

Choice B reason: Giving information provides facts but may overwhelm a fearful client, who may not be ready to process details post-trauma. This technique is less effective for engagement, as it does not address emotional barriers or encourage self-expression, which are critical for therapeutic interaction in trauma recovery.

Choice C reason: Focusing directs the conversation to specific topics, which can feel intrusive for a traumatized client. It assumes readiness to discuss, potentially increasing anxiety or withdrawal. This technique is less effective than silence, which allows the client to initiate dialogue when emotionally prepared, fostering trust.

Choice D reason: Broad opening encourages the client to choose topics but may be too vague for a fearful, traumatized client, who may feel overwhelmed by the lack of structure. Silence is more effective, as it provides space for emotional processing without pressuring the client to verbalize prematurely.