A nurse on an inpatient eating disorders unit is caring for a client who has anorexia nervosa and has a body mass index of 17.2. Which of the following actions should the nurse take? (Select all that apply.).

The correct answer is Choice A: Give positive feedback when the client is assertive with staff or clients.

Choice A rationale: Clients with dependent personality disorder exhibit a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior. They often struggle with making decisions, expressing their opinions, and engaging in assertive communication. By providing positive feedback when the client exhibits assertive behavior, the nurse reinforces adaptive coping strategies and encourages the development of healthy interpersonal interactions. This approach fosters independence, self-confidence, and autonomy, ultimately promoting a better quality of life for the client.

Choice B rationale: Although setting limits is crucial in managing manipulative behaviors, it is not the primary focus for clients with dependent personality disorder. These clients tend to prioritize pleasing others and avoiding conflict over exploiting or manipulating other individuals. Instead, nurses should emphasize supportive interventions that foster self-reliance and assertiveness.

Choice C rationale: Close monitoring to prevent self-mutilation is not typically associated with the management of dependent personality disorder. This intervention is more relevant for clients with borderline personality disorder or those with a history of self-harm behaviors. Clients with dependent personality disorder may exhibit passive and avoidant behaviors but are less likely to engage in acts of self-mutilation.

Choice D rationale: Discouraging flamboyant or seductive behaviors is an intervention more suited for clients with histrionic personality disorder, not dependent personality disorder. Histrionic personality disorder is characterized by excessive emotionality and attention-seeking behaviors, whereas dependent personality disorder primarily involves a lack of self-confidence and excessive reliance on others for decision-making and emotional support.

Choice A rationale:

Reality orientation is a technique commonly used in dementia care to help individuals be aware of time, place, and person. It is not directly related to the statement made by the client in the scenario about loving the daughter as much as the son based on academic performance.

Choice B rationale:

The correct choice. According to Eric Berne's theory of Transactional Analysis and Eric Erikson's psychosocial development stages, unconditional love is essential for fostering a positive sense of self-esteem. The statement made by the client to the daughter, linking love with better school performance, creates conditional love, implying that the daughter's worthiness of love is tied to her academic achievements. This can hinder the development of positive self-esteem.

Choice C rationale:

A sense of survival refers to basic human instincts related to self-preservation. It is not directly connected to the client's statement or the development of positive self-esteem in the context of parenting.

Choice D rationale:

A sense of responsibility involves understanding and fulfilling one's obligations. While it is important for parenting, the client's statement is more closely related to the concept of conditional love, which directly impacts self-esteem, as explained in choice B.