A nurse in an emergency department is performing an assessment on a client who reports being sexually assaulted. Which of the following actions should the nurse take first?

Choice A rationale:

An anxiety reaction is the most appropriate explanation for the toddler's behavior of sitting quietly in the corner of the crib, sucking her thumb, and turning away from the nurse. These behaviors suggest that the toddler is experiencing anxiety due to the absence of her mother. Sucking the thumb is a common self-soothing mechanism in young children, and the behavior of turning away from the nurse can be seen as an attempt to cope with the separation.

Choice B rationale:

Resentment toward the mother is less likely in this context, as the toddler's behavior is more indicative of distress and anxiety related to separation from her mother rather than directed resentment.

Choice C rationale:

Developing autonomy is not the primary explanation for these behaviors. While developing autonomy is an important developmental milestone for toddlers, the described behavior is more suggestive of anxiety and coping with separation rather than a deliberate expression of autonomy.

Choice D rationale:

Regression refers to reverting to an earlier developmental stage in response to stress or difficulty. While regression can occur in response to hospitalization and separation from caregivers, the toddler's behavior of sitting quietly and sucking her thumb is better explained by anxiety than by regression to an earlier developmental stage.

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.