A nurse is caring for a client who has a substance use disorder. The client states, "The state took my child away after my overdose. I don't want to go on living without them." Which of the following therapeutic responses should the nurse make?

Choice A Reason: Vital signs are a critical indicator of a patient’s health status. Normal ranges for vital signs in a resting adult include a body temperature of 97.8°F to 99.1°F (36.5°C to 37.3°C), blood pressure between 90/60 mmHg and 120/80 mmHg, a pulse rate of 60 to 100 beats per minute, and a respiratory rate of 12 to 18 breaths per minute. The client’s vital signs have stabilized from the initial erratic readings to within normal ranges by hospital day 5, indicating a positive response to the treatment plan.
Choice B Reason: Movement through the stages of grief is essential for emotional recovery, especially in the context of alcohol use disorder where the grief may have triggered the relapse. The stages of grief include denial, anger, bargaining, depression, and acceptance. Progress in these stages can be a sign of emotional healing and a successful coping mechanism in the recovery process.
Choice D Reason: Participation in group therapy is a key component of substance use disorder treatment. It provides social support, reduces isolation, and helps develop effective communication and interpersonal skills3. Active participation in group therapy sessions indicates the client’s engagement with the treatment process and their commitment to recovery.
Choice E Reason: Appetite changes are common during recovery from alcohol use disorder. Initially, there may be a loss of appetite due to the effects of alcohol on the gastrointestinal system and overall health. However, as recovery progresses, appetite usually returns, and the individual may even overeat5. An improvement in appetite suggests that the client’s physical health is improving and that they are regaining a normal relationship with food.

Choice C Reason: Cognition refers to the mental processes involved in gaining knowledge and comprehension, including thinking, knowing, remembering, judging, and problem-solving. These are higher-level functions of the brain and encompass language, imagination, perception, and planning. A person’s cognitive ability can be affected by alcohol use disorder, as alcohol can impair cognitive functions and damage brain structures. However, recovery from alcohol abuse can lead to improvements in cognitive functions. Research indicates that most noticeable improvement in cognitive function begins after one year of abstinence from alcohol. Therefore, if the client shows signs of improved cognition, such as better memory, clearer thinking, or improved problem-solving, it would indicate progress in their recovery.
Choice F Reason: The client’s resolve to limit alcohol consumption is a significant indicator of their commitment to long-term recovery. Setting limits on alcohol intake is a crucial step in the process of recovery and can help prevent relapse. For men, moderate drinking is defined as up to two drinks per day and for women, up to one drink per day3. If the client expresses a desire to limit their alcohol consumption to within these guidelines, or better yet, abstains from alcohol completely, it would demonstrate a positive change in behavior and mindset towards their health and recovery.

Choice A reason: This response is appropriate because it respects the client's autonomy and comfort level. It is essential to acknowledge the client's feelings and preferences, especially when dealing with mental health issues like panic disorder. Massage therapy, while beneficial for some, may not be suitable for everyone, particularly if the idea of being touched exacerbates the client's anxiety. By offering to communicate the client's concerns to the provider, the nurse acts as an advocate for the client's well-being and ensures that the treatment plan is tailored to the client's specific needs and comfort.

Choice B reason: While this option might seem like a compromise, it does not address the client's fundamental discomfort with being touched. Wearing gloves may not alleviate the distress associated with physical contact for someone with panic disorder. It is crucial to consider the client's psychological state and the potential for gloves to serve as a reminder of the unwanted touch, possibly leading to increased anxiety rather than relief.

Choice C reason: Asking the client to explain their discomfort could be seen as dismissive of the client's stated boundaries and may put them in an uncomfortable position to justify their feelings. It is important for healthcare professionals to create a safe and supportive environment where clients do not feel pressured to defend their preferences or feelings, especially when they are already experiencing distress.

Choice D reason: This choice minimizes the client's concerns and could be perceived as invalidating their feelings. Telling a client not to worry about their anxiety, particularly in the context of a panic disorder, overlooks the complexity of the condition. Anxiety disorders can significantly impact a person's life, and reassurances like this may not be helpful and could potentially worsen the client's anxiety.