A nurse is planning care for a client who has a prescription for a bowel-training program following a spinal cord injury.

Which of the following actions should the nurse include in the plan of care?

The correct answer is choice D. Positioning both hands on the grips with his elbows slightly flexed.

Choice A rationale:

Moving both crutches with the stronger leg forward first is not correct because in a three-point gait, the two crutches and the affected leg move together, followed by the stronger leg.

Choice B rationale:

Supporting body weight while leaning on the axillary crutch pads is incorrect as this can cause nerve damage under the arms. Weight should be supported by the hands while using crutches.

Choice C rationale:

Stepping with the affected leg first when going up stairs is incorrect. When ascending stairs, the unaffected (stronger) leg should be moved first, followed by the affected leg and crutches.

Choice D rationale:

Positioning both hands on the grips with elbows slightly flexed is correct as it allows for proper weight distribution through the arms and hands, which is essential for balance and safety while using crutches.

This is the priority question for the nurse to ask the client because it assesses the client’s risk for suicide, which is a serious and potentially life-threatening complication of conduct disorder. The nurse should use a direct and nonjudgmental approach when asking about suicidal ideation and plan.

Choice A is wrong because it is not the most urgent question to ask the client.

While it is important to assess the client’s social relationships and possible peer rejection, this can be done after addressing the client’s safety and mental status.

Choice B is wrong because it is not relevant to the client’s current condition and might make the client feel defensive or stigmatized.

The nurse should avoid asking questions that imply blame or judgment and focus on the client’s strengths and coping skills.

Choice D is wrong because it is not appropriate for the nurse to ask the client in an emergency department setting.

This question might imply that the client is responsible for their conduct disorder, which is a complex and multifactorial mental health condition. The nurse should collaborate with the client and their family to develop a behavior management plan that involves positive reinforcement, limit setting, and consistent consequences.

Normal ranges: According to the DSM-5, conduct disorder is characterized by a persistent pattern of behavior that violates the rights of others or societal norms.

The symptoms of conduct disorder include aggression, deceitfulness, destruction of property, serious rule violations, and lack of remorse.

Conduct disorder can cause significant impairment in social, academic, or occupational functioning. The prevalence of conduct disorder is estimated to be 4% among children and adolescents.

The risk factors for conduct disorder include genetic factors, neurobiological factors, environmental factors, and psychological factors.