A nurse is assessing the client for manifestations of anorexia nervosa. Which of the following findings should the nurse expect? Select all that apply.

Choice A reason: Asking “why” places the client on the defensive and implies judgment, which can shut down communication. “Why” questions often elicit rationalizations rather than diagnostic detail, and they are less effective than open, neutral prompts. In anxiety assessment, the nurse should prioritize characterizing onset, duration, triggers, severity, functional impairment, and associated symptoms. A neutral, time-focused question helps establish chronology and guides subsequent targeted assessment without assigning blame.

Choice B reason: This is a labeling and judgmental statement that violates therapeutic communication principles. It risks stigmatizing the client, exacerbating distress, and damaging rapport. Such phrasing can undermine trust and prevent accurate assessment. Therapeutic communication requires empathy, validation, and neutrality to facilitate disclosure of symptoms, stressors, and coping strategies. Judgments impede the nurse’s ability to gather clinically relevant information and formulate a safe, effective plan.

Choice C reason: Focusing on duration opens the door to a clinically useful timeline, clarifying whether symptoms are acute, subacute, or chronic. Duration informs differential diagnosis (e.g., adjustment-related anxiety versus generalized anxiety), helps identify precipitating events, and frames severity and functional impact. It also allows the nurse to explore patterns, exacerbating factors, and any recent changes in sleep, substance use, or stressors. This neutral, open prompt fosters rapport and supports a systematic assessment.

Choice D reason: Redirecting to parents presumes their involvement and may be culturally insensitive or irrelevant for a young adult. It can prematurely shift responsibility away from the nurse’s professional role in assessment and support. The priority is to assess the client’s current symptoms comprehensively and determine safety, impairment, and need for further evaluation. Involving family may be appropriate later, with consent, but it is not the first-line response for establishing a clinical picture.

Choice A reason: Adding an MAOI to citalopram is contraindicated due to risk of serotonin syndrome, which can be fatal. This is not appropriate.

Choice B reason: Changing the medication after only 2 weeks is premature. Antidepressants typically require 4–6 weeks for full effect. Switching too early may prevent therapeutic benefit.

Choice C reason: This is the correct response. Antidepressants often take several weeks to reach full effectiveness. The nurse should provide education and reassurance, helping the client understand the expected timeline.

Choice D reason: A sleep study is not indicated at this stage. The sleep disturbance is likely related to depression and incomplete therapeutic effect of the medication.