A nurse is caring for a client who has borderline personality disorder (BPD). As part of the client's plan of care, the nurse reviews the day's schedule with the client each morning.
As the nurse begins to review the schedule with the client, the client says, "Why don't you shut up already? I can read it myself, you know!" Which of the following responses should the nurse give the client?

Choice A rationale: The nurse should ask the client to agree to talk to a nurse whenever she feels the urge to exercise. This is because the client with anorexia nervosa who overexercises is using exercise as a means to control her weight and shape, which is a characteristic of this disorder. By asking the client to talk to a nurse when she feels the urge to exercise, the nurse is providing a safe and supportive environment for the client to express her feelings and fears related to her body image and weight. This intervention also helps the client to develop healthier coping mechanisms and reduces the risk of physical harm due to excessive exercise.

Choice B rationale: Praise the client for looking at herself in a mirror may not be the most effective nursing action. While it’s important to encourage positive body image, simply praising the client for looking at herself in a mirror may not address the underlying issues related to her body dissatisfaction and fear of weight gain. It’s crucial to understand that anorexia nervosa is not just about body image, but also about control, perfectionism, and fear of maturity. Therefore, interventions should be comprehensive and target all aspects of the disorder.

Choice C rationale: Restricting the client from being weighed may not be beneficial. While it’s true that clients with anorexia nervosa can become obsessed with their weight, weighing is a necessary part of monitoring their health status. Instead of restricting the client from being weighed, the nurse should provide education about the importance of regular weight checks and involve the client in the process. This can help to reduce anxiety and promote a sense of control.

Choice D rationale: Reprimanding the client about the potential damage that has occurred due to overexercising her body is not therapeutic. It’s important to remember that clients with anorexia nervosa are often in denial about the seriousness of their condition. Therefore, reprimanding or confronting the client may lead to resistance and defensiveness. Instead, the nurse should use a supportive and understanding approach, providing education about the risks of excessive exercise and the benefits of a balanced lifestyle.

Choice A rationale:

Avoids addressing the client's behavior: This response does not directly address the client's disrespectful tone of voice. It simply gives the client the schedule and expects them to comply. This could reinforce the client's belief that they can act out without consequences.

Misses an opportunity to set boundaries: Setting boundaries is essential when working with clients with BPD. This response does not establish a clear boundary regarding acceptable communication.

Does not promote therapeutic communication: This response does not encourage the client to share their feelings or explore the reasons behind their outburst. It shuts down communication rather than opening it up.

Choice B rationale:

Directly addresses the inappropriate behavior: This response assertively communicates to the client that their tone of voice is unacceptable. It sets a clear boundary regarding respectful communication.

Models appropriate communication: The nurse models respectful communication by using a calm and assertive tone of voice. This can help the client learn to communicate more effectively.

Promotes self-awareness: This response may prompt the client to reflect on their behavior and the impact it has on others. It can help them develop better self-awareness and emotional regulation skills.

Choice C rationale:

Focuses on the nurse's feelings: This response shifts the focus away from the client's behavior and onto the nurse's feelings. It can make the client feel defensive and less likely to engage in productive communication.

May escalate the situation: Asking "why" s can sometimes put clients on the defensive and lead to further conflict. It's generally more helpful to focus on the present behavior and its impact.

Choice D rationale:

Condescending and challenging: This response comes across as condescending and challenging. It's likely to make the client feel defensive and resentful.

Not therapeutic: This response does not promote a sense of trust or rapport between the nurse and the client. It's unlikely to lead to productive communication or behavior change.