The nurse is providing care for a client diagnosed with a borderline personality disorder who has self-inflicted lacerations on the abdomen. Which approach should the nurse use when changing this client's dressings?

Choice A rationale: A body mass index (BMI) of 21 is within the normal range and does not require immediate notification to the healthcare provider.

Choice B rationale: A blood pressure of 110/70 mm Hg is within the normal range for an adolescent and does not require immediate notification.

Choice C rationale: A potassium level of 2.9 mEq/dL (2.9 mmol/L) is below the normal range (hypokalemia) and requires notification to the healthcare provider due to the potential for adverse effects on cardiac and neuromuscular function.

Choice D rationale: A WBC of 10,000/mm3 (10 x 109/L) falls within the normal range and does not require immediate notification.

A. The client will eat nutritious meals in the hospital cafeteria.
While eating nutritious meals is essential for the physical recovery of the adolescent, improving self-esteem is the highest priority in the treatment of anorexia nervosa. A negative body image and poor self-esteem are central to the disorder, and addressing these underlying psychological factors can foster more effective long-term recovery. Although ensuring the client eats is important, achieving a positive self-image is fundamental for encouraging healthier eating behaviors and overall recovery.

B. The client will verbalize feelings of a positive self-esteem.
This goal is the most appropriate because it targets the core psychological issues that contribute to anorexia nervosa, such as distorted body image and low self-worth. Enhancing the client’s self-esteem can improve their willingness to engage in healthier behaviors, including eating, which directly supports both the physical and emotional aspects of recovery. Verbalizing positive self-esteem is a key step in addressing the psychological distortions that drive the disorder.

C. The family will communicate their love and concern to the client.
While family support is vital to the recovery process, the priority should be on the adolescent’s internal psychological healing. Family communication is important for creating a supportive environment, but it is secondary to addressing the client’s self-esteem and the immediate needs of recovery from anorexia nervosa.

D. The entire family will attend family therapy sessions regularly.
Family therapy is important, but it is not the highest priority in the acute phase of treatment. In the beginning stages of treatment, the focus should be on addressing the adolescent’s psychological and nutritional needs. Family therapy can be integrated later in the treatment plan once the client’s basic physical and emotional health are stabilized.