A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to “end it all.” The client decides they want to leave against medical advice. Which of the following would be the most appropriate action by the nursing staff?

Choice A reason: Hypoglycemia involves low blood glucose, causing symptoms like shakiness or confusion, not muscle weakness or arrhythmias. Hypertonic glucose and insulin would worsen hypoglycemia by increasing glucose uptake, and sodium bicarbonate is irrelevant. These symptoms and treatments align with hyperkalemia, not low glucose levels, in renal failure.

Choice B reason: Hyperkalemia, common in acute renal failure due to impaired potassium excretion, causes muscle weakness and cardiac arrhythmias by altering membrane potentials. Hypertonic glucose and insulin drive potassium into cells, while sodium bicarbonate corrects acidosis, stabilizing cardiac membranes, making this the targeted complication for the prescribed treatment.

Choice C reason: Hypernatremia (high sodium) causes neurological symptoms like confusion, not muscle weakness or arrhythmias. The prescribed treatments do not address sodium levels; insulin and glucose manage potassium, and bicarbonate corrects acidosis. Hypernatremia is not a primary concern in acute renal failure with these symptoms.

Choice D reason: Hypokalemia (low potassium) causes muscle weakness and arrhythmias but is rare in acute renal failure, where hyperkalemia is typical due to reduced excretion. The prescribed treatments aim to lower potassium, not increase it, making hypokalemia an incorrect target for this therapy in the context of renal failure.

Choice A reason: This response reinforces professional boundaries while therapeutically redirecting the client to explore external social support, addressing potential dependency. It validates the client’s feelings without personalizing the relationship, promoting healthy coping and social integration, which are critical for mental health recovery and maintaining therapeutic integrity.

Choice B reason: Bluntly denying friendship dismisses the client’s feelings, potentially damaging trust and therapeutic rapport. This approach risks alienating the client, who may feel rejected, hindering open communication and progress in addressing underlying emotional needs, making it non-therapeutic in a mental health context.

Choice C reason: Suggesting other friends without exploration dismisses the client’s expressed feelings, potentially invalidating their emotional experience. The assumption about existing friends may not apply, and the response lacks therapeutic engagement, failing to address the client’s dependency or need for social connection, making it less effective.

Choice D reason: Affirming the client’s view of friendship blurs professional boundaries, fostering dependency and compromising therapeutic objectivity. While validating feelings is important, reinforcing a personal connection risks hindering the client’s ability to develop external support systems, making this response non-therapeutic for mental health progress.