A mental health nurse on an inpatient eating disorders unit is caring for a client who has anorexia nervosa and has a body mass index of 16.7. Which of the following actions should the nurse take? (Select all that apply.)

Choice A rationale:

Repression: This statement suggests that the client is unconsciously blocking out memories of the tragedy as a way to cope with the anxiety. While repression can be a defense mechanism, it's not considered an adaptive use of sublimation.

Sublimation involves channeling anxiety into a productive or socially acceptable activity.

Denial of anxiety: The client's denial of anxiety, despite outward signs of distress, indicates a lack of awareness or acceptance of their emotional state. This can hinder effective coping and processing of the trauma.

Potential for delayed or prolonged distress: Repressed memories can resurface later, often in unexpected or disruptive ways, potentially leading to prolonged or intensified distress.

Choice B rationale:

Hopelessness and helplessness: The client's statement reflects a sense of defeat and a belief that they are incapable of overcoming the trauma. This can lead to feelings of despair, isolation, and withdrawal.

Lack of adaptive coping mechanisms: The client's inability to envision a future beyond the tragedy suggests a lack of healthy coping strategies to manage their anxiety and move forward.

Risk of prolonged distress and potential for depression: Persistent feelings of hopelessness and helplessness can increase the risk of developing depression or other mental health conditions.

Choice C rationale:

Denial of anxiety and potential lack of insight: The client's denial of anxiety, despite the nurse's observation, suggests a lack of awareness or acceptance of their emotional state. This can impede effective coping and processing of the trauma.

Potential resistance to support: The client's defensiveness may make it challenging for them to receive support or engage in therapeutic interventions.

Risk of delayed or unmanaged distress: If the client continues to deny their anxiety, they may not seek appropriate help, potentially leading to prolonged or intensified distress.

Choice D rationale:

Sublimation: This statement demonstrates the client's ability to channel their anxiety into a constructive and healthy outlet. Physical activity can provide a release for pent-up emotions, reduce stress, and improve overall well-being.

Adaptive coping mechanism: The client's choice to engage in physical activity as a way to manage their emotions indicates a positive coping strategy that can promote resilience and recovery.

Potential for improved mental and physical health: Regular exercise has numerous benefits for both mental and physical health, which can support the client's overall well-being and recovery process.

Rationale:

Choice A: While offering hope and highlighting potential positives can be important in supporting someone with depression, this statement feels dismissive of the client's current experience and minimizes the intensity of their feelings. It could inadvertently make them feel unheard and misunderstood.

Choice B: While acknowledging the commonality of these feelings in depression is important for normalization, it can feel impersonal and fail to address the individual's specific struggles. It focuses on the diagnosis rather than the person's unique experience.

Choice D: Asking "why" can feel interrogative and put pressure on the client to explain their complex emotions. The focus should be on actively listening and validating their feelings rather than seeking justifications.

Choice C: This response demonstrates active listening and reflects back the client's core feeling (lack of meaning) without judgment. It shows empathy and opens the door for further exploration of their thoughts and emotions. It encourages the client to elaborate on their experience and potentially identify areas where meaning can be rediscovered.

Elaboration:

Suicide ideation and attempts are often linked to feelings of hopelessness and a perceived lack of value or purpose in life. When caring for someone with major depressive disorder who has expressed these thoughts, the primary goal is to establish safety and create a space for open communication.

Using therapeutic communication techniques like reflection, validation, and open-ended s allows the nurse to build trust and rapport with the client. Reflecting their feelings, as in Choice C, demonstrates understanding and helps the client feel heard and accepted. This can be a crucial step in reducing their distress and fostering a sense of hope and possibility.

By creating a safe and supportive environment, the nurse can encourage the client to explore their thoughts and feelings about their life and identify potential sources of meaning and hope. This can be a vital step in their journey towards recovery and well-being.