The nurse recognizes that the difference between a voluntary and an involuntary commitment is what?

Choice A reason: Taking blood pressure in the left arm with an AV fistula risks compressing the fistula, potentially causing thrombosis or damage. This can impair dialysis access, leading to inadequate treatment and complications like uremia or fluid overload. Blood pressure should be measured in the opposite arm to protect the fistula.

Choice B reason: Keeping the AV fistula site dry is important to prevent infection, as moisture can promote bacterial growth. However, it is not the priority over ensuring fistula patency, which is critical for effective dialysis. Infection prevention is secondary to confirming the fistula’s functionality to avoid life-threatening dialysis interruptions.

Choice C reason: Wrapping the AV fistula in gauze is not standard practice unless post-surgical or infected. Excessive wrapping may obscure the site, hindering patency assessments, and could increase infection risk if not changed properly. This action is less critical than ensuring the fistula’s functionality for dialysis.

Choice D reason: Assessing the AV fistula for bruit (whooshing sound) and thrill (vibration) confirms patency, ensuring it is functional for dialysis. A non-patent fistula prevents effective toxin and fluid removal, leading to uremia, hyperkalemia, or fluid overload. This assessment is the priority to ensure life-sustaining dialysis can proceed without complications.

Choice A reason: Apologizing for the question may imply it was inappropriate, undermining the therapeutic intent to explore emotions. Homelessness is a valid topic in mental health care, and apologizing could discourage further discussion, disrupting trust and the client’s ability to process and express difficult emotions.

Choice B reason: Encouraging a list of concerns shifts focus to problem-solving prematurely, potentially overwhelming the client who is processing emotions. This action disregards the client’s need for reflection, which is critical in therapeutic communication to facilitate emotional expression and address underlying psychological distress effectively.

Choice C reason: Diverting the subject avoids the client’s emotional response, missing a therapeutic opportunity to explore feelings about homelessness. This can signal discomfort with the topic, reducing trust and hindering the client’s ability to process trauma, which is essential for mental health recovery and coping.

Choice D reason: Sitting quietly allows the client time to process complex emotions about homelessness, fostering a safe therapeutic environment. Silence supports reflection, enabling the client to articulate feelings at their pace, which enhances trust and facilitates deeper emotional exploration, making it the most therapeutic response in this context.