An older adult male client, recently diagnosed with Type 2 diabetes, refuses to allow the practical nurse (PN) to stick his finger to obtain a blood glucose assessment, and states, "My fingers are sore and it's useless anyway. How should the PN document the refusal in the client's electronic medical record?

A. Maintain sterile technique during specimen collection: Sterile technique is required for urine cultures, not for 24-hour urine collections. For a timed urine collection, clean collection techniques are sufficient to accurately measure excretion over a full day.
B. Assist the client to cleanse the perineal area prior to voiding: While perineal hygiene is important, it is not the primary step when starting a 24-hour urine collection. The critical action is ensuring that the first void is discarded to properly begin timing the collection period.
C. Instruct the client to discard the first voided specimen: The first void is discarded to ensure the collection accurately measures substances excreted during the full 24-hour period. Timing officially starts after discarding the initial urine, and every subsequent void must be collected.
D. Insert an indwelling urinary catheter: Inserting an indwelling catheter is unnecessary unless the client is unable to void independently. Most 24-hour urine collections are performed using normal voiding and collection into a clean container.

A. Provide a PRN hypnotic medication: Administering a hypnotic should not be the first response without first assessing the underlying cause of the sleep difficulty. Non-pharmacological approaches are safer, especially for older adults who are more sensitive to sedative side effects.
B. Reassure the client that it is still early: Simply reassuring the client does not address the immediate concern of why the client cannot sleep. Dismissing the complaint without assessment may lead to prolonged distress and unresolved sleep disturbances.
C. Evaluate the room environment: Assessing the room for factors like noise, lighting, temperature, and comfort is a priority because environmental factors often contribute significantly to insomnia. Addressing modifiable conditions can promote natural sleep without immediately resorting to medications.
D. Close the door to the client's room: While closing the door might reduce noise, it is a single action that may not fully address all potential environmental issues affecting sleep. A complete evaluation of the environment is necessary first to identify and correct all possible disruptions.