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A nurse is caring for a client who refuses a prescribed influenza immunization. Which of the following actions should the nurse take first?

A nurse is caring for a 45-year-old female client in a clinic setting. The client has returned for a follow-up visit after experiencing insomnia, anxiety, and weight loss despite an increased appetite over the past several weeks. Below are the exhibits that detail the client’s condition and clinical findings.

Select the 4 findings that indicate an improvement in the client's condition.

Exhibit 1: Nurses' Notes

5 weeks ago:

The client reports experiencing persistent insomnia and anxiety. She has been feeling increasingly restless and has lost weight despite having an increased appetite. Her skin is warm and moist. Speech is rapid, and she seems anxious and fidgety during the assessment. She denies any abdominal discomfort or issues with digestion. Lung sounds are clear to auscultation, and her abdomen is soft with normoactive bowel sounds. The client was instructed to undergo lab work and return for follow-up in 4 weeks.

Today:

The client reports some improvement but still experiences occasional anxiety. She states she has been sleeping better for the past week and her appetite remains unchanged. The nurse notes her skin is warm but now dry. Her lung sounds are clear, and her abdomen remains soft and non-tender with normoactive bowel sounds. The client expresses that she still feels anxious at times but believes her symptoms are improving.

Exhibit 2: History and Physical

The client has a history of heart failure but denies experiencing any new cardiac symptoms in the past several weeks. She presents with increased anxiety, difficulty sleeping, and unintentional weight loss. She reports no changes in her diet or physical activity that could explain the weight loss. Her primary health care provider previously prescribed medication for her anxiety, and she is following the treatment plan as instructed. There is no history of thyroid disorders or gastrointestinal conditions, and no recent history of infections.

Exhibit 3: Vital Signs

5 weeks ago:

• Heart rate: 120/min
• Respiratory rate: 18/min
• Blood pressure: 118/85 mm Hg
• Temperature: 37.8°C (100°F)
• Oxygen saturation: 98% on room air
• Weight: 53 kg (117 lb)

Today:

• Heart rate: 95/min
• Respiratory rate: 16/min
• Blood pressure: 115/82 mm Hg
• Temperature: 37.2°C (99°F)
• Oxygen saturation: 98% on room air
• Weight: 55 kg (121 lb)

Exhibit 4: Physical Examination Results

During the physical examination today, the client appears less anxious and more composed compared to her last visit. Her skin is warm but dry, and her speech is noticeably slower and more controlled. The lung fields are clear to auscultation bilaterally, and no respiratory distress is noted. The abdomen is soft and non-tender with normoactive bowel sounds. The client has gained weight since her last visit, and there are no signs of edema or other abnormal physical findings. She expresses optimism about her recovery and reports better sleep.

Question: Select the 4 findings that indicate an improvement in the client's condition.

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