The psychiatric-mental health nurse is performing the admission assessment of a client who is being admitted for depression and anxiety. The client reports a long history of excessive alcohol use and the recent loss of her job. When the nurse asks whether she has a religious preference or affiliation, the client states. "I used to believe in God, but I do not anymore. I do not understand how God can allow terrible things to keep happening to me.' Which nursing diagnoses will the nurse include in the client’s care plan?

Explanation: SMART is an acronym for Specific, Measurable, Achievable, Relevant, and Time-bound. A SMART goal should be specific, clear, well-defined, measurable, attainable or achievable, relevant, and time-bound.

Option (a) is not specific, measurable, or achievable. It does not provide a clear target or timeline for the client's improvement, and it may not be attainable for some clients to feel less depressed after only one day of admission.

Option (b) is specific and measurable, but it may not be achievable or relevant for all clients. Increases in energy are not always a direct indicator of improved depressive symptoms.

Option (c) is specific, measurable, achievable, and relevant. A 10% reduction in the self-rating of the depression scale is a clear and well-defined goal that can be easily measured. It is also achievable and relevant as it directly addresses the client's depressive symptoms.

Option (d) is specific, measurable, achievable, and relevant. However, it is not time-bound, which means there is no clear timeline for the client's improvement. It is also not as direct or measurable as option (c).

Confidentiality is a critical aspect of the nurse-patient relationship. However, there are specific circumstances where confidentiality must be breached to ensure the patient's safety and well-being. For instance, if a patient is expressing suicidal ideation or harm to others, the nurse has an ethical and legal obligation to report it to the treatment team to prevent harm. It is essential to explain this to the client to establish trust and clarify the limitations of confidentiality.

Option (a) is incorrect because not all information can remain confidential.

Option (b) is incorrect because not all information requires the client's approval to share.

Option (d) is incorrect because the nurse has the responsibility to disclose certain information to other healthcare professionals for the patient's benefit.