A nurse is caring for a client who has borderline personality disorder (BPD). As part of the client's plan of care, the nurse reviews the day's schedule with the client each morning. As the nurse begins to review the schedule with the client, the client says, "Why don't you shut up already? I can read it myself, you know!" Which of the following responses should the nurse give the client?

Rationale:

A) Congenital anomalies: Congenital anomalies, also known as birth defects, are structural or functional abnormalities present at birth. They can affect any part of the body and may cause physical or developmental disabilities, as well as contribute to infant mortality. These anomalies can result from genetic factors, environmental exposures during pregnancy, or a combination of both. Preventive measures such as prenatal care, genetic counseling, and maternal health promotion play crucial roles in reducing the incidence and impact of congenital anomalies.

B) Respiratory distress: While respiratory distress can be a significant concern in newborns, especially those born prematurely or with certain medical conditions, it is not the leading cause of death among infants. Respiratory distress syndrome (RDS) occurs primarily in premature infants due to immature lung development and surfactant deficiency, requiring supportive care and sometimes mechanical ventilation to manage.

C) Sudden infant death syndrome (SIDS): SIDS is the sudden and unexplained death of an otherwise healthy infant, typically occurring during sleep. While SIDS is a devastating tragedy and a major public health concern, it is not the leading cause of death among infants. Strategies to reduce the risk of SIDS include placing infants on their backs to sleep, avoiding soft bedding and overheating, and promoting a safe sleep environment.

D) Low birth weight: Low birth weight, defined as a birth weight of less than 2,500 grams (5.5 pounds), is associated with an increased risk of neonatal complications and long-term health issues. While low birth weight infants may face various health challenges, including respiratory problems and developmental delays, low birth weight itself is not the leading cause of death among infants. Efforts to reduce low birth weight include prenatal care, nutrition support, and management of maternal risk factors such as smoking and substance abuse.

A. "You must be getting better. You look great!": This response could potentially be interpreted as positive reinforcement, but it carries the risk of making assumptions about the client's mental state solely based on their appearance. It implies that the client's improved grooming is solely due to their improvement in depression, which may not necessarily be the case. Additionally, it may inadvertently minimize the client's experience of depression by attributing their grooming to improvement rather than recognizing it as an achievement in itself.

B. "Everyone feels better after showering": This response generalizes the client's experience and minimizes the significance of their actions. It implies that grooming is merely a routine activity that everyone does and that feeling better is solely related to physical cleanliness. It fails to acknowledge the client's effort and positive behavior, which could be significant achievements for someone experiencing depression.

C. "Why are you all dressed up today? Is it a special occasion?": This response might put the client on the spot and make them feel uncomfortable or self-conscious about their appearance. It could also imply that there must be a specific reason for the client to take care of their grooming, rather than recognizing it as a positive step regardless of the reason. Additionally, it doesn't acknowledge the client's effort or provide validation for their behavior.

D. "I see you have done some grooming today.": This response acknowledges the client's effort and positive behavior without making assumptions or judgments about the client's mental state or improvement. It demonstrates observance and recognition of the client's actions, which can help build rapport and trust between the nurse and the client. Additionally, it opens the door for further conversation if the client wishes to discuss their grooming habits or how they are feeling.