A nurse at a mental health clinic is caring for a client.

The client reports they have been overeating since they were 14 years old. The nurse is reviewing the client's medical record.

Based on the information, which of the following actions should the nurse take? For each potential action, specify if the potential action is anticipated or contraindicated for the client.

The correct answer/s is:

C. Give positive feedback when the client is assertive with staff or clients.

Rationale for Choice A:

While setting limits is an important aspect of nursing care, it's not specifically targeted towards the core challenges of dependent personality disorder. The primary concern in this case is the client's excessive reliance on others and inability to function independently. Setting limits might be perceived as a rejection or abandonment, potentially exacerbating the client's distress and anxiety. Additionally, focusing on preventing the exploitation of other clients shifts the attention away from the client's individual needs and goals.

Rationale for Choice B:

While self-mutilation is a potential risk in some individuals with dependent personality disorder, it's not a defining characteristic or the most prevalent concern. Continuous close monitoring can be intrusive and undermine the client's sense of autonomy. It's more effective to build trust and establish open communication where the client feels comfortable expressing distress and seeking help before resorting to self-harm.

Rationale for Choice C:

Assertiveness is a key skill to cultivate in individuals with dependent personality disorder. It empowers them to express their needs and desires appropriately, reducing their reliance on others and fostering healthy relationships. Offering positive reinforcement when the client exhibits assertive behavior, even in small steps, strengthens this skill and motivates them to continue their progress. This positive reinforcement approach aligns with therapeutic interventions for dependent personality disorder, which focus on building self-confidence and fostering independent functioning.

Rationale for Choice D:

Discouraging flamboyant or seductive behaviors might seem relevant because some individuals with dependent personality disorder might resort to attention-seeking tactics. However, such an approach risks shaming or judging the client, potentially increasing their feelings of inadequacy and insecurity. It's important to understand the underlying reason behind these behaviors, which could be a desperate attempt to gain approval or validation. Addressing the core issue of low self-esteem and encouraging authentic self-expression are more productive strategies than simply suppressing certain behaviors.

Additional Notes:

In addition to the rationales for each choice, it's important to consider the overall treatment goals for dependent personality disorder. These goals typically include:

Reduced dependence on others: Encouraging the client to take responsibility for their own needs and decisions. Improved assertiveness skills: Enabling the client to express their wishes and opinions confidently.

Enhanced self-esteem: Building the client's confidence and sense of self-worth.

Developing healthy relationships: Fostering interactions based on mutual respect and independence.

When planning care for a client with dependent personality disorder, the nurse should collaborate with other healthcare professionals, such as therapists and social workers, to ensure a comprehensive and coordinated approach.

Rationale:

Choice A is incorrect. Alprazolam does not have any known dietary interactions with aged cheeses. This information is specific to monoamine oxidase inhibitors (MAOIs), not benzodiazepines like alprazolam.

Choice B is incorrect. While some benzodiazepines can have side effects like drowsiness or dizziness that might indirectly affect blood pressure, alprazolam itself is not known to directly cause an increase in blood pressure.

Choice D is incorrect. Doubling the next dose of medication if a dose is missed is dangerous and can lead to overdose and increased risk of serious side effects. The client should be instructed to contact their doctor if they miss a dose.

Choice C is correct. Alprazolam is a pregnancy category D medication, meaning it has positive evidence of fetal risk. Studies have shown an increased risk of birth defects, including cleft lip and palate, in babies exposed to alprazolam during pregnancy. Therefore, it is crucial for women of childbearing age to use a reliable form of contraception while taking alprazolam to prevent unintended pregnancy and potential harm to the fetus.

Additional teaching points for the nurse:

The nurse should inform the client about the specific risks associated with alprazolam during pregnancy and the importance of discussing alternative treatment options if pregnancy is desired.

The nurse should emphasize the importance of using a reliable form of contraception that is effective both during and after treatment with alprazolam, as the medication can remain in the system for some time after the last dose.

The nurse should provide the client with resources on contraception and reproductive health, and encourage her to talk to her doctor about any s or concerns she may have.