A nurse in an inpatient mental health facility is reviewing the medical record of a client who has bipolar disorder. When planning to establish a nurse-client relationship with the client, which of the following actions should the nurse plan to take first?

Choice A reason: Assertiveness training is typically used to help individuals communicate more effectively and assert their needs and rights while respecting others. However, for someone with narcissistic personality disorder (NPD), this approach may not address the core issues of grandiosity and lack of empathy.

Choice B reason: Response prevention therapy is often used in the treatment of obsessive-compulsive disorder to help prevent the individual from engaging in compulsive behaviors. It is not typically indicated for NPD, as it does not address the underlying issues of self-esteem and empathy.

Choice C reason: Schema-focused therapy is designed to help individuals with NPD by identifying and changing deeply ingrained patterns of thinking and behavior, known as schemas, that are often maladaptive. This therapy can help address the root causes of NPD, such as feelings of inadequacy and the need for admiration, making it a suitable recommendation for someone with NPD³.

Choice D reason: Cognitive behavioral therapy (CBT) can be effective for a range of mental health disorders by helping individuals recognize and change negative thought patterns. While CBT can be beneficial for someone with NPD, schema-focused therapy is often preferred because it goes deeper into the personality structure and addresses the specific challenges of NPD³.

Choice A reason: Encouraging the client to internalize their feelings related to the loss is not advisable. Grief is a personal experience, and expressing emotions is a healthy part of the grieving process. Internalizing feelings can lead to unresolved grief and potential mental health issues.

Choice B reason: Changing the subject when the client expresses anger about their situation is not supportive. Anger is a natural stage of the grieving process, and it's important for the nurse to acknowledge the client's feelings and provide a safe space for them to express their emotions.

Choice C reason: Allowing the client to be alone during times of spiritual inadequacy may not be beneficial. While respecting the client's need for solitude is important, it's also crucial to offer support and presence, as isolation can exacerbate feelings of loneliness and despair.

Choice D reason: Offering to contact the client's spiritual advisor is a supportive action that can help meet the client's spiritual needs. Spiritual care is an integral part of holistic nursing care, and connecting the client with their spiritual support system can provide comfort and aid in the grieving process.