A nurse is caring for a client who has a chronic illness. In which phase of the therapeutic relationship should the nurse help the client develop problem-solving skills?

A. Turning off the lights in the client's room at bedtime: Keeping the room well-lit at night can help prevent disorientation and reduce the risk of falls for clients with dementia. Turning off lights may increase confusion and make wandering more dangerous, so this is not an appropriate intervention.

B. Limiting the client's physical activity during the day: Reducing daytime activity can increase restlessness and nighttime wandering. Encouraging safe physical activity during the day helps expend energy and may improve sleep patterns, making limitation counterproductive.

C. Having the client wear incontinence briefs after dinner: While incontinence briefs can prevent accidents, they do not address the underlying cause of nighttime wandering and may contribute to agitation or discomfort if used inappropriately.

D. Labeling the client's bathroom door: Clear visual cues, such as labeled doors, help clients with dementia navigate their environment independently and safely. This intervention reduces confusion, supports orientation, and can decrease wandering behaviors.

A. Initiate NPO status: The child is already unable to tolerate oral intake due to vomiting, but routine NPO status is not always necessary unless prescribed. With mild to moderate dehydration, oral rehydration may be attempted if tolerated, and withholding all fluids could worsen fluid deficit.

B. Maintain IV fluids: The child demonstrates signs of moderate dehydration, including weight loss, sunken eyes, delayed skin turgor, and reduced urine output. IV fluid therapy is necessary to restore intravascular volume, correct electrolyte imbalances, and prevent progression to hypovolemic shock.

C. Maintain strict intake and output: Accurate monitoring of fluid intake and urine/stool output is critical to assess hydration status and guide IV fluid replacement. The child’s ongoing diarrhea and low urine output indicate the need for close tracking to prevent further fluid deficit.

D. Weigh the child daily: Daily weight measurement is an objective and sensitive indicator of hydration status in pediatric clients. The child’s 0.5 kg (1 lb) weight loss over 24 hours reflects significant fluid loss and helps guide ongoing fluid management.

E. Instruct the guardian about proper hand hygiene: The child has a confirmed Escherichia coli infection, which is highly transmissible via the fecal–oral route. Educating the guardian about proper handwashing helps prevent spread to others and reinforces infection control practices.

F. Check the child's temperature rectally: Rectal temperature measurement is invasive and may increase discomfort or risk of injury, especially in a drowsy or irritable toddler. Oral or axillary methods are safer and sufficient for routine monitoring.

G. Monitor laboratory values: Electrolytes, BUN, creatinine, and other relevant labs are crucial to assess the severity of dehydration, renal perfusion, and metabolic disturbances. Trends in these values guide fluid and electrolyte replacement and indicate improvement or deterioration.