A nurse is caring for an adolescent client who has anorexia nervosa. The client asks the nurse, "Have I done any permanent damage to my body?" Which of the following responses should the nurse make?

Choice A reason: Verbalizing difficulty coping reflects ongoing distress rather than adherence. While expressing feelings is important, it does not demonstrate improvement or engagement with treatment goals.

Choice B reason: Frequently seeking reassurance indicates dependence and persistent insecurity. This behavior suggests limited progress in self-efficacy and coping skills, which are essential for adherence.

Choice C reason: Hygiene deficiencies are a hallmark of depressive symptoms and indicate poor functioning. This finding suggests the client is not adhering to treatment or is still severely impaired.

Choice D reason: Increased social engagement is a strong positive indicator of adherence. Clients with major depressive disorder often isolate themselves. Re-engaging socially demonstrates improved mood, motivation, and participation in therapeutic activities, all of which reflect adherence to the treatment plan.

Choice A reason: Encouraging the client to verbalize their feelings about hoarding is the first step because it establishes rapport and allows the nurse to understand the client’s perspective. Hoarding disorder is often associated with deep emotional distress, anxiety, and fear of loss. By exploring feelings first, the nurse builds trust and creates a foundation for further interventions. This therapeutic communication is essential before moving into education or referrals.

Choice B reason: Referring the client to a support group is beneficial but should not be the first action. Without first establishing trust and understanding the client’s feelings, the client may resist external interventions. Support groups are effective later in the care plan once the client is ready to engage with others.

Choice C reason: Discussing health risks is important but should follow after the nurse has explored the client’s feelings. Starting with risks may feel confrontational or judgmental, which could increase resistance. The nurse must first understand the client’s emotional attachment to hoarding before addressing risks.

Choice D reason: Completing the Hoarding Scale Self-Report is a useful assessment tool, but it is not the first action. The client may not be ready to engage in structured assessments until rapport and trust are established.