Which of the following actions should the nurse take first when performing an assessment on a client who reports being sexually assaulted?

Choice A Reason:
"I understand that you feel like you don't need it; however, the provider thinks it will help." This response acknowledges the client's feelings but immediately contradicts them by emphasizing the provider's opinion. This can make the client feel invalidated and less likely to engage in therapy. A therapeutic response should validate the client's feelings and encourage open communication without imposing the provider's perspective.

Choice B Reason:
"You don't feel like group therapy is for you. Tell me more about what you know about group therapy." This response is therapeutic because it validates the client's feelings and invites them to share their thoughts and knowledge about group therapy. It opens up a dialogue, allowing the nurse to understand the client's perspective better and address any misconceptions or fears they may have. This approach fosters a collaborative and empathetic relationship, which is crucial in therapeutic settings.

Choice C Reason:
"I am not saying that you need therapy, but I am sure it will help you." This response attempts to reassure the client but can come across as dismissive of their feelings. It implies that the nurse knows better than the client, which can create a power imbalance and hinder the therapeutic relationship. Effective therapeutic communication should empower the client and respect their autonomy.

Choice D Reason:
"You don't have to be afraid to go. Our therapists are very understanding." While this response aims to reassure the client, it assumes that fear is the primary reason for their reluctance. It does not validate the client's expressed feelings or invite further discussion. Therapeutic communication should be based on active listening and addressing the client's specific concerns.

Choice A Reason:

Monitoring the client closely to prevent self-mutilation is crucial for clients with certain personality disorders, such as borderline personality disorder, where self-harm is more prevalent. However, dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior. Self-mutilation is not a primary concern for this disorder.

Choice B Reason:

Setting limits to prevent exploitation of other clients is important in managing clients with antisocial personality disorder, who may manipulate or exploit others. Clients with dependent personality disorder are more likely to be overly reliant on others rather than exploit them. Therefore, this action is not the highest priority for this specific disorder.

Choice C Reason:

Giving positive feedback when the client is assertive with staff or clients is the most appropriate action. Clients with dependent personality disorder often struggle with making decisions and expressing their own needs due to their excessive reliance on others. Encouraging and reinforcing assertive behavior helps them develop independence and self-confidence, which are crucial for their treatment and overall well-being.

Choice D Reason:

Discouraging flamboyant or seductive behaviors is more relevant for clients with histrionic personality disorder, where attention-seeking and dramatic behaviors are common. Clients with dependent personality disorder do not typically exhibit these behaviors, so this action is not the highest priority.