A nurse in the Emergency Department is caring for a client with symptoms of depression and admits to thoughts of self-harm with a plan. The client has a history of borderline personality disorder, depression, and substance abuse. Which of the following is the priority action by the nurse?

The correct answer is choice D: Request a mental health consult.

Choice A rationale:

Planning a therapeutic diet for the client is important, but it may not be the first priority in this situation. The client's significant weight loss and distorted body image suggest potential psychological issues that should be addressed before focusing solely on a diet plan.

Choice B rationale:

Providing a structured environment is valuable in promoting stability, but it may not address the underlying psychological concerns that are likely contributing to the client's distorted body image and weight loss.

Choice C rationale:

Assessing the client's nutritional status is certainly important, as the weight loss needs to be understood from a medical perspective. However, given the client's belief that she is fat and the drastic weight loss, there are more urgent mental health concerns to address first.

Choice D rationale:

Requesting a mental health consult is the first priority for this client. The client's weight loss, distorted body image, and belief that she is fat indicate potential body dysmorphic disorder or an eating disorder. This suggests a serious psychological issue that requires immediate attention. A mental health consult can help assess the client's mental and emotional well-being, provide a proper diagnosis, and guide the appropriate interventions to address her distorted perception of her body.

Choice A rationale:

The correct choice. In this situation, the nurse's priority is to gather information and provide emotional support. By asking the spouse to share their concerns, the nurse opens up a channel of communication and shows empathy, creating an opportunity to address the spouse's worries and provide reassurance.

Choice B rationale:

While the sentiment that crying can be cathartic and relieving is true, this response does not directly address the spouse's concern or encourage them to share their feelings. It's important to focus on the spouse's feelings rather than just explaining the benefits of crying.

Choice C rationale:

Assuming that the husband is making progress without knowing the specifics of the situation can come across as dismissive of the spouse's concerns. It's important to validate the spouse's emotions and provide support, rather than making assumptions about the husband's progress.

Choice D rationale:

Asking whether the husband said something to upset the spouse might be relevant, but it does not address the spouse's expressed concern about their husband. This response may not foster open communication and emotional support as effectively as choice A.