A nurse in an acute care mental health facility is participating in a medication education group. The leader of the group uses a laissez-faire leadership style. Which of the following actions should the nurse expect from the leader during the session?

A. Restrict the client's sodium intake
One of the common complications of cirrhosis and liver disease is ascites (fluid accumulation in the abdomen), and hyponatremia (low sodium) may develop due to the body's altered fluid balance. Sodium restriction is a key part of managing ascites and preventing further fluid buildup.
B. Provide frequent rest periods for the client
Fatigue and weakness are common symptoms of liver disease and cirrhosis. The client is likely experiencing decreased energy levels due to liver dysfunction, so it is important to provide frequent rest periods to help prevent further fatigue and promote overall well-being.
C. Assess the client's level of orientation
Disorientation to time and changes in mental status are common in clients with liver disease, particularly due to the development of hepatic encephalopathy, a condition where toxins (like ammonia) accumulate in the blood and affect brain function.
D. Instruct the client to avoid blowing their nose forcefully
This action is typically suggested for clients at risk for bleeding (e.g., those with low platelet counts or clotting disorders). Although the client does have thrombocytopenia (low platelet count), there is no evidence in the provided data that the client is at immediate risk for epistaxis (nosebleeds).
E. Place the client on a low-carbohydrate diet
Clients with liver disease typically benefit from a high-calorie, high-protein diet to support healing and provide energy. A low-carbohydrate diet is not indicated unless there are other factors like diabetes or fatty liver disease, which is not suggested by the information provided.
F. Place the client under contact isolation
Contact isolation is generally used to prevent the spread of infectious diseases that are transmitted through direct contact with the patient or their environment (e.g., MRSA, C. difficile). There is no
indication that this client has a contagious infection that would require isolation. The client’s symptoms are more indicative of liver disease and complications of cirrhosis, rather than an infectious condition that would require isolation.
G. Advise the client to avoid the use of soap and alcohol-based lotions
Clients with liver disease often experience dry skin and pruritus (itching), which can be aggravated by harsh soaps and alcohol-based lotions. The yellowing of the sclera (jaundice) and itching (pruritus) are symptoms commonly seen in liver dysfunction, and using gentle skin care products without harsh chemicals will help minimize irritation and soothe the skin.

Rationale
A. Review the need for the indwelling urinary catheter daily.
One of the most effective strategies to prevent UTIs is avoiding unnecessary catheterization. The nurse should regularly assess whether the catheter is still necessary and remove it as soon as possible. Keeping a catheter in place longer than needed increases the risk of infection.
B. Encourage the client to drink 3000 mL of fluid daily.
Increasing fluid intake is generally a good measure to help flush the urinary tract, reducing the concentration of bacteria and preventing infections. However, for clients with heart failure, excessive fluid intake can exacerbate fluid overload, leading to pulmonary edema and worsened symptoms of heart failure. Therefore, the nurse should consult the healthcare provider before recommending a specific amount of fluid intake (such as 3000 mL). The nurse should ensure that the client’s fluid intake is balanced with their heart failure management plan.
C. Place the drainage bag on the bed when transporting the client.
The drainage bag should always be kept below the level of the bladder to prevent urine from flowing back into the bladder, which can lead to infections. Placing the drainage bag on the bed when transporting the client would increase the risk of urine reflux, potentially leading to a UTI. The bag should be secured properly and kept off the bed or floor during transport.
D. Empty the drainage bag when it is half-full.
The drainage bag should be emptied when it is full (typically around 2/3 to 3/4 full) to prevent overfilling, which can increase the risk of backflow or spillage. Emptying the bag when it is half-full may lead to unnecessary handling of the catheter and increases the risk of contamination. It’s important to empty the bag regularly, but not excessively often.
E. Change the indwelling urinary catheter tubing every 3 days.
There is no need to change the indwelling catheter tubing on a regular basis unless there is a specific indication (e.g., blockage or infection). Frequent changes of the catheter tubing increase the risk of introducing bacteria. According to best practice guidelines, the catheter should be changed only when necessary, not routinely every 3 days.
F. Use soap and water to provide perineal care.
Regular and gentle perineal care with soap and water is crucial for reducing the risk of UTIs. The perineal area should be cleaned daily and after any incontinence episodes to minimize bacterial contamination of the catheter and urinary tract. It’s important to avoid harsh chemicals, which could irritate the skin and urinary tract.