A middle-aged female client is concerned about gaining 10 lb (4.5 kg) over the last 3 months. Which information in the health history should the nurse use to explain the recent weight gain? Select all that apply.

Brief introduction:

Nursing delegation involves the transfer of responsibility for task performance while retaining professional accountability. The Practical Nurse (PN) operates under a defined scope of practice focused on stable patients and standardized procedures, whereas the Registered Nurse (RN) manages complex clinical judgment, initial assessments, and the overarching coordination of specialized patient care plans.

Rationale:

A. Verifying the flow rate of a prescribed intravenous infusion is a technical skill within the PN's competency. This task involves monitoring a stable, established intervention, allowing the PN to ensure the mechanical delivery of fluids remains consistent with the medical orders while the RN focuses on higher-level assessments.

B. Performing the initial sterile dressing change requires an advanced assessment of the surgical site's integrity and healing. The RN must conduct the first inspection to identify early signs of dehiscence or infection, whereas subsequent, routine dressing changes for stable wounds may be delegated to a PN.

C. Developing and initiating a discharge education plan requires complex instructional design and patient evaluation. While a PN can reinforce previously taught information, the initial teaching must be performed by the RN to ensure all physiological and psychological learning needs are addressed before the patient leaves.

D. Analyzing patient data to update or modify a nursing care plan is a core nursing process function. Only the RN has the authority to evaluate patient outcomes and revise the plan of care, as this requires the synthesis of assessment data and clinical judgment beyond the PN’s scope.

Heroin is a highly potent mu-opioid agonist that induces significant neurochemical alterations within the brain's reward and stress systems. Individuals suffering from opioid use disorder (OUD) exhibit a markedly elevated risk for co-occurring psychiatric disturbances and self-harming behaviors compared to the general population. Comprehensive nursing care must prioritize psychosocial stability alongside physical detoxification to address the profound risk of mortality associated with both overdose and intentional self-injury.

Rationale:

A. A family history of schizophrenia provides genetic context but does not represent the most acute threat to the client's current physiological safety. While it suggests a predisposition to psychotic disorders, the immediate planning for a client actively using heroin must focus on survival. Prioritizing family history over active lethal risk is a failure of clinical prioritization.

B. Feelings of disorientation are common during acute intoxication or the early stages of opioid withdrawal syndrome. While requiring monitoring, disorientation is typically a transient symptom that resolves as the substance is metabolized or treated with replacement therapy. It does not carry the same permanent and fatal implications as a history of self-destructive behavior.

C. Social anxiety symptoms are frequently comorbid with substance abuse as a form of maladaptive self-medication for social discomfort. However, diagnosing and treating underlying anxiety is a secondary goal that occurs after the client is stabilized from chemical dependency. Addressing SAD does not mitigate the immediate high-acuity risk identified during the admission assessment.

D. A history of suicide attempts is the most critical factor because heroin use significantly lowers impulse control and increases the lethality of self-harm. Clients transitioning through withdrawal or facing the stressors of admission are at a peak vulnerability for recurring suicidal ideation. Ensuring safety precautions and 1-to-1 observation takes precedence over all other psychosocial assessments.