A client’s medical history reveals long-term use of benzodiazepines for anxiety disorder. The nurse knows that:

Choice A reason: While touch can sometimes convey security, in dissociative identity disorder (DID), touch may trigger traumatic memories or cause distress if not consented to. Therefore, assuming touch will always provide security is unsafe and not therapeutic.

Choice B reason: Touching only when in the client’s line of vision may reduce surprise, but it does not address the fundamental issue of consent. Even if the client sees the nurse, the act of touching without permission can still be intrusive and retraumatizing.

Choice C reason: The best practice is to avoid touching without explicit permission. Clients with DID often have histories of trauma, and unwanted touch can trigger dissociation or flashbacks. Seeking permission respects boundaries, promotes trust, and ensures safety in therapeutic interactions.

Choice D reason: Informing the client that touch is friendly and supportive may help in some contexts, but it still bypasses the client’s autonomy. Without permission, even well-intentioned touch can be harmful. Consent is the critical factor in maintaining therapeutic safety.

Choice A reason: Personality disorders are a recognized risk factor for generalized anxiety disorder (GAD). Clients with maladaptive personality traits such as perfectionism, dependency, or avoidant tendencies are more prone to chronic worry and anxiety. These traits interfere with coping mechanisms and increase vulnerability to persistent anxiety symptoms.

Choice B reason: Anorexia nervosa is an eating disorder characterized by restrictive eating and distorted body image. While anxiety can coexist with anorexia, it is not considered a direct risk factor for GAD. The primary pathology in anorexia is related to eating behaviors and body image rather than generalized worry.

Choice C reason: Schizophrenia is a psychotic disorder involving hallucinations, delusions, and disorganized thinking. It is not a risk factor for GAD. Although anxiety can occur in schizophrenia, the two conditions are distinct and schizophrenia does not predispose someone to generalized anxiety disorder.

Choice D reason: Substance abuse is a major risk factor for GAD. Substances such as alcohol, stimulants, and sedatives can alter brain chemistry, impair coping mechanisms, and trigger or worsen anxiety symptoms. Withdrawal from substances also contributes to heightened anxiety, making substance abuse a strong risk factor.