A nurse is caring for a 19-year-old client in the emergency department who reports passing out while at school.

The vital signs are as follows: BP 84/48 mm Hg, Pulse rate 48/min, Respiratory rate 16/min, Temperature 36.4° C (97.5 F). A nurse is assessing the client for manifestations of anorexia nervosa.

Which of the following findings should the nurse expect?

Choice A, "Do you think your anxiety is worse than everyone else's?", is invalidating and minimizes the client's experience. Comparing their anxiety to others is unhelpful and could further distress the client.

Choice B, "It doesn't appear as though you are feeling anxious.", is dismissive and ignores the client's self-report. This dismissive response could damage the therapeutic relationship and discourage the client from sharing openly.

Choice D, "I think you should see a therapist and a doctor tomorrow.", is directive and potentially premature. While suggesting mental health resources can be helpful, it's crucial to first understand the client's situation and preferences before making recommendations. Additionally, suggesting both a therapist and a doctor without further assessment might overwhelm the client.

Choice C, "Tell me what has been happening lately.", is an open-ended and validating that encourages the client to share their experiences and concerns. This shows the nurse is actively listening and creates a safe space for the client to explore their anxiety. By understanding the context and potential triggers, the nurse can then provide more tailored support and guidance.

Further rationale for Choice C:

Open-ended s are key tools in therapeutic communication. They promote client engagement, facilitate exploration of thoughts and feelings, and gather valuable information needed for assessment and planning.

Validating the client's experience is crucial in building trust and rapport. Recognizing and acknowledging their anxiety shows the nurse cares and is taking their concerns seriously.

This initial allows the client to guide the conversation, focusing on aspects they feel most comfortable sharing. This empowers the client and promotes autonomy.

Following the client's lead in the conversation also helps the nurse gather specific details about the nature and severity of the anxiety, informing subsequent assessment and intervention strategies.

In conclusion, Choice C, "Tell me what has been happening lately.", is the most appropriate response for a mental health nurse to use when assessing a client who reports an increase in anxiety. It demonstrates active listening, validates the client's experience, encourages engagement, and provides a foundation for further assessment and support.

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.