The nurse walks in and finds the patient who is not able to sleep because they are having a mastectomy surgery in the morning. Which therapeutic response is most appropriate?

Choice A reason: This response dismisses the patient’s anxiety by offering superficial reassurance without addressing their emotional state. Preoperative anxiety activates the sympathetic nervous system, increasing cortisol and adrenaline, which disrupt sleep by elevating heart rate and alertness. This approach fails to validate emotions, potentially worsening stress responses and hindering psychological coping, making it non-therapeutic for addressing the patient’s distress.

Choice B reason: Questioning the patient’s insomnia and implying they should feel reassured invalidates their feelings. Anxiety triggers the hypothalamic-pituitary-adrenal axis, releasing stress hormones that disrupt REM sleep cycles. This response lacks empathy, failing to address the limbic system’s role in emotional distress, which is critical for therapeutic communication to reduce preoperative anxiety and promote emotional stability.

Choice C reason: Minimizing the patient’s concerns and focusing on pharmacological intervention ignores emotional needs. Sedatives may depress the central nervous system to induce sleep, but they don’t address anxiety-driven amygdala activation, which elevates cortisol. A therapeutic response should validate feelings and offer emotional support to mitigate stress responses, making this option inadequate for addressing the patient’s psychological state.

Choice D reason: This empathetic response acknowledges the patient’s uncertainty and invites dialogue, aligning with therapeutic communication principles. Preoperative anxiety, driven by fear of unknown surgical outcomes, activates the limbic system, increasing heart rate and cortisol. By validating emotions and offering support, this response fosters trust, reduces stress hormone release, and supports psychological coping, making it the most appropriate choice.

Choice A reason: Assisting to the bedside commode is impractical if the patient cannot hold the enema, as it risks spillage and discomfort. Enemas stimulate bowel evacuation by distending the colon, triggering peristalsis. Administering in a commode for an elderly patient with retention concerns increases fall risk and is not the priority action.

Choice B reason: Inserting a rectal plug is not standard practice and risks discomfort or injury in an elderly patient. Enemas work by stimulating peristalsis via fluid volume, requiring retention for efficacy. A plug is not a recognized medical device for this purpose, making positioning on a bedpan the safer, more practical priority.

Choice C reason: Right-lying Sims’ position aids enema administration but does not address the patient’s inability to retain fluid. The position facilitates fluid flow but is secondary to ensuring containment. Elderly patients have weaker sphincter control, making dorsal recumbent on a bedpan the priority to manage potential leakage and maintain dignity.

Choice D reason: Positioning in dorsal recumbent on a bedpan is the priority, as it allows enema administration while containing potential leakage in an elderly patient with retention concerns. This position supports sphincter relaxation and fluid delivery while minimizing mess, ensuring comfort and dignity. It addresses the patient’s concern effectively, aligning with safe practice.