A client is brought to the emergency department after a motorcycle accident.

The client is alert, responsive, and diagnosed with a broken leg.

The client's vital signs are pulse 72 and respiration 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected?

Choice A rationale

While nutrition is important for overall health, it is not the most critical factor for the success of a scheduled medication injection plan. The primary issue addressed is medication nonadherence, which is directly related to the client receiving the prescribed dose. Access to food, while a social determinant of health, does not directly impact the client's ability to get to the clinic for the specific purpose of receiving their injection on time.

Choice B rationale

A trusting relationship between the client and nurse is crucial for effective care and communication. However, for a long-acting injection administered every three weeks, the most immediate and practical barrier to success is not the interpersonal dynamic but the logistical challenge of physically getting to the clinic. Without reliable transportation, trust alone cannot ensure the client receives the medication as scheduled.

Choice C rationale

The attitudes of significant others can influence a client's motivation and support system, which can be beneficial for treatment adherence. However, the attitudes of others do not directly resolve the practical problem of attending a scheduled clinic appointment. Even with a supportive family, if the client cannot physically get to the clinic for their injection, the plan will ultimately fail due to the lack of a reliable means of transportation.

Choice D rationale

The availability of transportation is the most critical factor because the entire treatment plan hinges on the client's ability to consistently travel to the clinic every three weeks. Without reliable transportation, the client cannot receive the long-acting injection, which directly leads to medication nonadherence. This logistical barrier is a fundamental and practical requirement that must be met for the plan to be successful in addressing the client's history of nonadherence.

Choice A rationale

Countertransference is a phenomenon where the nurse unconsciously redirects feelings from a past relationship onto the client. In this case, the client's behavior or appearance triggers unresolved emotions and memories related to a past abusive boyfriend. This is an unconscious process that can interfere with the nurse's ability to provide objective, therapeutic care, as the nurse's emotional response is not about the client, but rather an echo of a past experience.

Choice B rationale

Blurred boundaries occur when the professional relationship between a nurse and client becomes less defined or crosses into personal or social territory. This can involve sharing excessive personal information, inappropriate physical contact, or becoming overly involved in the client's life. While a nurse's feelings could lead to blurred boundaries, the initial experience of struggling with a client due to a past relationship is specifically countertransference.

Choice C rationale

Experiencing strong, unhelpful emotional reactions to a client is not considered a normal finding in a therapeutic relationship. While nurses are human and have personal histories, the professional expectation is to recognize and manage these feelings to ensure that care remains client-focused and therapeutic. If the nurse is struggling with providing care, it indicates a professional challenge that needs to be addressed, not a normal state of affairs.

Choice D rationale

Transference is the opposite phenomenon, where the client unconsciously projects feelings and attitudes from a past relationship onto the nurse. For example, if a client sees the nurse as a parental figure, they may act out a dependent relationship with the nurse. In this scenario, the nurse is the one having the emotional reaction based on their past, not the client, making this an example of countertransference.