A nurse is admitting a client who is to undergo paracentesis for removal of ascitic fluid. Which of the following actions should the nurse take?

A. Avoid eye contact with the client: Avoiding eye contact can convey disinterest or disengagement, which may increase the client’s sense of isolation. Therapeutic engagement requires maintaining appropriate eye contact to promote trust and effective communication.

B. Encourage the client to lie down in a quiet room: Isolating the client in a quiet room may intensify auditory hallucinations, as there are fewer environmental stimuli to help the client reality-test. Structured interaction and distraction techniques are generally more effective.

C. Ask the client directly what they are hearing: Engaging the client in a nonjudgmental discussion about their hallucinations helps the nurse understand the content, assess risk, and provide support. This approach promotes reality orientation, therapeutic rapport, and early identification of command hallucinations that may pose safety risks.

D. Refer to the hallucinations as if they are real: Validating hallucinations as real can reinforce psychotic thinking and perpetuate the hallucinations. The nurse should acknowledge the client’s experience without confirming the reality of the voices.

A. Esophagitis: Esophagitis is not a typical manifestation of systemic lupus erythematosus (SLE). While SLE can affect multiple organ systems, gastrointestinal involvement usually presents as abdominal pain, nausea, or pancreatitis, rather than inflammation of the esophagus.

B. Fever: Fever is a common systemic manifestation during an acute SLE exacerbation due to immune system activation and widespread inflammation. It reflects the inflammatory response and cytokine release associated with disease flare-ups.

C. Diplopia: Diplopia (double vision) is not a common feature of SLE exacerbations. Neurologic involvement in SLE more frequently presents as headache, seizures, cognitive dysfunction, or peripheral neuropathy rather than isolated visual disturbances.

D. Bradykinesia: Bradykinesia, or slowness of movement, is characteristic of Parkinson’s disease and other movement disorders, not SLE. Musculoskeletal manifestations of SLE typically include joint pain, stiffness, and swelling without the motor deficits seen in bradykinesia.