A nurse is caring for a client who has been diagnosed with end-stage liver cancer. Which of the following responses is an indication the client is in the denial phase of the grief process?

Russell’s sign is a physical symptom that is associated with bulimia nervosa. It refers to the presence of calluses on the knuckles or back of the hand that are caused by repeated self-induced vomiting.

Option a. Very low BMI is not typically associated with bulimia nervosa. People with bulimia nervosa may have a normal or above-normal BMI.

Option b. Decreased size of parotid glands is not associated with bulimia nervosa. In fact, people with bulimia nervosa may have an enlarged parotid gland due to repeated vomiting.

Option d. Fluid and electrolyte overload is not typically associated with bulimia nervosa. People with bulimia nervosa may experience fluid and electrolyte imbalances due to repeated vomiting and laxative abuse.

Borderline personality disorder is a serious mental illness characterized by instability in mood, behaviour, and self-image. Patients with borderline personality disorder are at a high risk of self-harm, suicide, and impulsive behaviours. Therefore, the nurse's priority assessment should be to identify any suicidal or homicidal ideations, as these can be life-threatening emergencies. Once identified, appropriate interventions should be initiated, such as suicide precautions, crisis management, and referral to mental health professionals for further evaluation and treatment.

While sleep patern changes, impulsive behaviours, and support systems are also important aspects to assess in patients with borderline personality disorder, they are not the priority when compared to suicidal or homicidal ideations.