The nurse is assessing a 30-month-old child during a well-baby checkup. Which behaviors by the child would lead the nurse to suspect that the child has autism spectrum disorder? Select all that apply.

The Kubler-Ross model identifies five distinct stages of grief. Bargaining involves an internal or external negotiation to delay the inevitable through spiritual appeals or goal-setting. This stage typically manifests when individuals seek more time to reach specific milestones or life events.

Rationale:

A. The client is demonstrating bargaining by attempting to negotiate for more life to witness a specific event. This stage serves as a defense mechanism to maintain hope while acknowledging a terminal prognosis. It often involves making promises to a higher power or setting temporal goals.

B. Depression is characterized by profound sadness, withdrawal, and a sense of great loss. This stage occurs when the individual can no longer deny the inevitability of death and experiences preparatory grief. The client's statement reflects hope and negotiation rather than hopelessness.

C. Acceptance represents a state of being at peace with the reality of the situation. The individual is neither depressed nor angry but has reached a calm expectation of the end. The client's desire to reach a future milestone indicates they have not fully reached this stage.

D. Anger typically involves feelings of resentment, rage, or envy directed toward others or the environment. It is a reaction to the perceived unfairness of the situation or loss of control. The client's plea for a grandchild's birth lacks the hostility associated with this stage.

Therapeutic communication in a psychiatric setting involves validation of the client's subjective experience while maintaining the expectations of the milieu treatment plan. The nurse must address the client's somatic complaints with empathy while gently encouraging behavioral activation and adherence to the therapeutic schedule to prevent isolation.

Rationale:

A. Allowing a client to miss therapy based on a subjective complaint promotes avoidance and hinders the recovery process. This response fails to provide the necessary structure that inpatient psychiatric programs require to help clients develop effective coping mechanisms for stress or discomfort.

B. Telling a client they are not feeling nauseous is invalidating and damaging to the nurse-client relationship. Even if the symptoms are psychosomatic, the physical sensation is real to the client, and denying their reality causes defensiveness and a breakdown in professional trust.

C. This response uses empathy to acknowledge the client's discomfort while clearly stating the therapeutic expectation. By validating the feeling first, the nurse decreases the client's need to protest, making them more receptive to the explanation of why participation is vital for their clinical progress.

D. Using the doctor's authority to coerce a client creates a confrontational power struggle. It shifts the focus from the client's wellness to rigid compliance, which can increase anxiety and result in the client becoming more resistant to the interventions provided by the multidisciplinary team.