A nurse is caring for an older adult client diagnosed with a cerebrovascular accident and has right-sided paralysis and aphasia. The client's son tells the nurse it is his fault because he did not insist that his mother live with him. Which of the following responses should the nurse make?

The correct answer is choice A: "You may experience dizziness upon standing while taking this medication."

Choice A rationale:

This choice is the correct answer because haloperidol, an antipsychotic medication, can cause orthostatic hypotension, which leads to dizziness upon standing. Antipsychotic medications often affect blood pressure regulation and can result in a sudden drop in blood pressure when transitioning from sitting or lying down to standing. This explanation provides essential information to the client to help them understand potential side effects and take necessary precautions.

Choice B rationale:

This choice is incorrect. Haloperidol is not indicated for treating symptoms of obsessive-compulsive disorder (OCD). It is primarily used to manage symptoms of schizophrenia and other psychotic disorders. Providing false information about its indications is not appropriate and may lead to confusion.

Choice C rationale:

This choice is incorrect. Clients should never stop taking antipsychotic medications abruptly without consulting their healthcare provider. Discontinuing such medications can lead to withdrawal effects and a worsening of symptoms. Encouraging the client to stop the medication if side effects are bothersome is not appropriate and could potentially jeopardize their well-being.

Choice D rationale:

This choice is partially correct but not the best answer. While haloperidol can cause excessive salivation (sialorrhea) as a side effect, the primary concern in this situation should be related to orthostatic hypotension and dizziness upon standing. Mentioning excessive salivation would be helpful, but it's secondary to the risk of falls associated with orthostatic hypotension.

The correct answer is choice B: Maintain a nonjudgmental attitude.

Choice A rationale:

Verbalize disapproval of the client's substance abuse. Expressing disapproval can create a negative environment and hinder the therapeutic relationship. Judgmental attitudes can make clients feel defensive and less likely to open up about their struggles.

Choice B rationale:

Maintain a nonjudgmental attitude. Maintaining a nonjudgmental attitude is crucial in building trust and rapport with clients. It creates an environment where clients feel safe discussing their issues without fear of criticism. A nonjudgmental attitude encourages open communication and helps the nurse gather relevant information to provide appropriate care.

Choice C rationale:

Offer sympathetic support. While offering support is important, sympathy might inadvertently convey pity or enable the client's behavior. Empathy, where the nurse understands and shares the client's feelings without judgment, is more effective in building a therapeutic relationship.

Choice D rationale:

Avoid displaying an emotional response. While it's important for the nurse to maintain professionalism, avoiding any emotional response might come across as cold or detached. Expressing appropriate empathy and emotions can actually enhance the therapeutic relationship.