A nurse is caring for a client who reports a history of frequent alcohol consumption. Which of the following questions should the nurse ask when screening for alcohol use disorder?

A. "Have you thought about taking a sleeping pill?”: While this response acknowledges the client's report of feeling tired, it immediately jumps to suggesting a specific solution without exploring the underlying reasons for the fatigue. It also assumes that medication is the appropriate intervention without further assessment.

B. "Your fatigue will pass, and everything will be just fine.”: This response minimizes the client's concerns and feelings by dismissing them with a vague reassurance. It does not validate the client's experience or offer practical support.

C. "Do you have a family member who can assist you?”: This response acknowledges the client's difficulty with grocery shopping and offers a practical solution by asking about available support from family members. It encourages the client to explore their support system and potential resources.

D. "Let's discuss how to get you the help you need.”: This response demonstrates empathy, validation, and a willingness to collaborate with the client to address their needs. It acknowledges the client's concerns and offers to explore solutions together, empowering the client to be actively involved in their care.

A. Keep the client hospitalized until there is no longer a threat

Nurses do not have the authority to unilaterally detain clients in a hospital. This decision is typically made by a physician or a legal authority, especially in the context of a medical-surgical unit where mental health professionals may need to be involved.Keeping a client hospitalized without proper legal procedures and mental health evaluation could lead to legal repercussions for unlawful detainment.

B. Ensure the client's ex-partner is notified of the threat

This option involves notifying the potential victim about the threat made by the client. While it's important to ensure the safety of others, the nurse's legal duty primarily lies with protecting the confidentiality of the client's information. Without consent from the client or a legal obligation, such as mandatory reporting laws for imminent harm, the nurse cannot disclose the threat to the ex-partner.

C. Ask a friend or family member to monitor the client

While involving family or friends might provide support, it is not a sufficient or appropriate response to a threat of harm. It does not address the immediate risk posed to the ex-partner and may not comply with legal obligations.

D. Transfer the client to a mental health facility

Transferring the client to a mental health facility for further evaluation and treatment might be necessary, but it must be done through appropriate medical and legal channels. It addresses the need for a thorough mental health assessment and ensures that the client receives the necessary care.