A nurse and client are engaged in a discussion. The client says, “I feel really close to you. You are my only true friend.” Which response by the nurse would be most therapeutic?

Choice A reason: While behavior acceptability varies across cultures, this statement does not fully define mental health or illness. Cultural norms influence behavior interpretation, but mental health involves emotional and psychological well-being, not just cultural acceptability, making this option incomplete as a definition of mental health or illness.

Choice B reason: Mental health is characterized by emotional, psychological, and social well-being, reflected in adaptive coping strategies like problem-solving or seeking support. This holistic state enables individuals to manage stress and function effectively, making this statement a comprehensive and accurate description of mental health in contrast to mental illness.

Choice C reason: Engaging in fantasies is not inherently indicative of mental illness, as it can be a normal part of creativity or coping. Only when fantasies disrupt functioning or reflect delusions does it suggest illness. This statement is inaccurate, as it overgeneralizes a common behavior as pathological.

Choice D reason: Determining mental health or illness via verbal and nonverbal communication is complex and not always reliable. Cultural, individual, and contextual factors obscure interpretation, and clinical assessment requires comprehensive evaluation beyond communication, making this statement inaccurate as a definitive method for assessing mental health status.

Choice A reason: Renal failure impairs erythropoietin production, a hormone stimulating red blood cell synthesis, leading to anemia, not an increased red blood cell count. Reduced glomerular filtration exacerbates toxin accumulation, further suppressing bone marrow activity, making an elevated red blood cell count unlikely in this condition.

Choice B reason: In renal failure, kidneys fail to excrete potassium, leading to hyperkalemia, not decreased serum potassium. Hyperkalemia can cause cardiac arrhythmias due to altered membrane potentials. A decreased potassium level is more associated with conditions like diuretic use or vomiting, not renal failure.

Choice C reason: Increased serum creatinine is a hallmark of renal failure, as kidneys cannot filter creatinine, a muscle metabolism byproduct. Elevated levels reflect reduced glomerular filtration rate, indicating kidney dysfunction. This is a reliable marker for assessing renal failure severity and progression, making it an expected finding.

Choice D reason: Renal failure typically causes hypocalcemia, not increased serum calcium, due to impaired vitamin D activation and phosphate retention, which binds calcium. Hypercalcemia is rare and may occur in other conditions like hyperparathyroidism, not renal failure, where calcium homeostasis is disrupted by kidney dysfunction.