A nurse is assessing a preschool-aged child during a routine check-up. Which nursing action should the nurse prioritize to support the child’s growth and development?

Choice A reason: Suggesting that lack of bonding or feeding methods cause ASD is inaccurate and perpetuates stigma. Research has consistently shown that parenting styles or feeding practices do not cause autism. This response would increase guilt and distress for the mother.

Choice B reason: Stating that the mother plays a greater role than the father in ASD development is misleading and harmful. It reinforces blame and is not supported by scientific evidence. Autism is linked to neurodevelopmental abnormalities, not parental roles.

Choice C reason: While the etiology of ASD is not fully understood, linking it to fetal alcohol syndrome is speculative and not evidence-based. This response could confuse the mother and increase unnecessary guilt.

Choice D reason: This is the most appropriate reply because it reassures the mother that her parenting did not cause autism. It provides accurate information that ASD is associated with brain structure and function abnormalities, emphasizing that it is beyond parental control. This reduces guilt and supports emotional coping.

Choice A reason: Automatic thoughts are the immediate, often unconscious responses that individuals have to situations. In depression, these thoughts are frequently negative and distorted. Identifying them is a cornerstone of cognitive behavior therapy because it allows the client to recognize patterns that contribute to their mood disturbances. By recording these thoughts daily, the nurse helps the client become aware of triggers and maladaptive responses.

Choice B reason: Monitoring thoughts related to self-esteem is appropriate because depression often involves pervasive feelings of worthlessness and low self-worth. Keeping a record allows the client to see how frequently these thoughts occur and how they influence emotions and behaviors. This monitoring provides data for the therapist and client to challenge and restructure these negative self-perceptions.

Choice C reason: Eliminating irrational beliefs is not the direct purpose of the DRDT exercise. While CBT does aim to challenge irrational beliefs, the exercise focuses more on identifying and restructuring thoughts rather than outright elimination. The process is gradual and involves replacing distorted cognitions with healthier alternatives, not simply erasing them.

Choice D reason: Identifying rational alternatives is a key goal of CBT. Once dysfunctional thoughts are recognized, clients are guided to generate more balanced, rational interpretations of events. This helps reduce emotional distress and promotes adaptive coping strategies. The DRDT provides the raw material for this restructuring process.

Choice E reason: Modifying cognitive errors is central to CBT. Cognitive errors such as overgeneralization, catastrophizing, or personalization are common in depression. By recording daily thoughts, clients and nurses can pinpoint these distortions and work to correct them. This modification reduces depressive symptoms and improves functioning.