A nurse is caring for a client following a suicide attempt.
The client has a history of depression, substance abuse, and anorexia nervosa. Which of the following actions is the nurse's priority?

Choice B rationale:

Male gender is a significant risk factor for suicide. Men are more likely to die by suicide than women, with rates being approximately 3.5 times higher in men than women in the United States.

Several factors contribute to this increased risk:

Men are less likely to seek help for mental health issues. This may be due to societal expectations of masculinity, which often discourage men from expressing emotions or seeking help for emotional distress.

Men are more likely to use more lethal means of suicide. For example, men are more likely to use firearms, which have a higher fatality rate than other methods such as poisoning or cutting.

Men may be more likely to experience social isolation and loneliness. These factors can increase the risk of suicide, as they can lead to feelings of hopelessness and despair.

Men may be more likely to experience substance abuse problems. Substance abuse can increase the risk of suicide, as it can impair judgment and impulse control, and can also lead to feelings of hopelessness and despair.

Choice C rationale:

Recent marriage is not a risk factor for suicide. In fact, some studies have shown that marriage may have a protective effect against suicide.

However, it's important to note that relationship problems, including separation, divorce, or domestic violence, can be significant risk factors for suicide.

Choice D rationale:

Age greater than 55 is a risk factor for suicide. Suicide rates are highest among older adults, particularly among men aged 85 and older.

Several factors contribute to this increased risk:

Older adults are more likely to experience chronic health conditions and pain. These conditions can lead to feelings of hopelessness and despair, and can also make it more difficult to cope with stress.

Older adults are more likely to experience social isolation and loneliness. These factors can increase the risk of suicide, as they can lead to feelings of hopelessness and despair.

Older adults are more likely to experience bereavement and loss. The loss of a spouse, family members, or friends can be a major stressor, and can increase the risk of suicide.

Choice E rationale:

Diagnosis of schizophrenia is a significant risk factor for suicide.

People with schizophrenia are approximately 10 times more likely to die by suicide than the general population. Several factors contribute to this increased risk:

Schizophrenia is a severe mental illness that can cause significant distress and impairment.

People with schizophrenia may experience hallucinations, delusions, and disorganized thinking. These symptoms can be very distressing and can lead to feelings of hopelessness and despair.

People with schizophrenia may also experience social isolation and stigma. These factors can further increase the risk of suicide.

The correct answer/s is:

C. Give positive feedback when the client is assertive with staff or clients.

Rationale for Choice A:

While setting limits is an important aspect of nursing care, it's not specifically targeted towards the core challenges of dependent personality disorder. The primary concern in this case is the client's excessive reliance on others and inability to function independently. Setting limits might be perceived as a rejection or abandonment, potentially exacerbating the client's distress and anxiety. Additionally, focusing on preventing the exploitation of other clients shifts the attention away from the client's individual needs and goals.

Rationale for Choice B:

While self-mutilation is a potential risk in some individuals with dependent personality disorder, it's not a defining characteristic or the most prevalent concern. Continuous close monitoring can be intrusive and undermine the client's sense of autonomy. It's more effective to build trust and establish open communication where the client feels comfortable expressing distress and seeking help before resorting to self-harm.

Rationale for Choice C:

Assertiveness is a key skill to cultivate in individuals with dependent personality disorder. It empowers them to express their needs and desires appropriately, reducing their reliance on others and fostering healthy relationships. Offering positive reinforcement when the client exhibits assertive behavior, even in small steps, strengthens this skill and motivates them to continue their progress. This positive reinforcement approach aligns with therapeutic interventions for dependent personality disorder, which focus on building self-confidence and fostering independent functioning.

Rationale for Choice D:

Discouraging flamboyant or seductive behaviors might seem relevant because some individuals with dependent personality disorder might resort to attention-seeking tactics. However, such an approach risks shaming or judging the client, potentially increasing their feelings of inadequacy and insecurity. It's important to understand the underlying reason behind these behaviors, which could be a desperate attempt to gain approval or validation. Addressing the core issue of low self-esteem and encouraging authentic self-expression are more productive strategies than simply suppressing certain behaviors.

Additional Notes:

In addition to the rationales for each choice, it's important to consider the overall treatment goals for dependent personality disorder. These goals typically include:

Reduced dependence on others: Encouraging the client to take responsibility for their own needs and decisions. Improved assertiveness skills: Enabling the client to express their wishes and opinions confidently.

Enhanced self-esteem: Building the client's confidence and sense of self-worth.

Developing healthy relationships: Fostering interactions based on mutual respect and independence.

When planning care for a client with dependent personality disorder, the nurse should collaborate with other healthcare professionals, such as therapists and social workers, to ensure a comprehensive and coordinated approach.