A nurse is caring for a client who requires a crisis intervention for acute anxiety. Which of the following actions should be the nurse's highest priority?

The correct answer is choice B.

Choice A rationale:

“Behavioral contract.” While a behavioral contract can be a useful tool in managing certain behaviors, it is not typically the primary intervention used in the discharge planning for a client with borderline personality disorder.

Choice B rationale:

“Dialectical behavior therapy.” This is the correct answer. Dialectical behavior therapy (DBT) is a type of cognitive-behavioral therapy that is specifically designed to help people with borderline personality disorder. It focuses on teaching coping skills to combat destructive urges, encourages mindfulness, improves relationships, and helps with emotional regulation.

Choice C rationale:

“Safety plan.” While a safety plan is important for all clients, it is not the primary intervention for a client with borderline personality disorder. A safety plan is more commonly used for clients who are at risk of self-harm or suicide.

Choice D rationale:

“Bibliotherapy.” Bibliotherapy, the use of books as therapy, can be a useful adjunctive treatment for some individuals. However, it is not typically the primary intervention used in the discharge planning for a client with borderline personality disorder.

Choice A rationale: Brittle and thin hair is a common physical manifestation of anorexia nervosa. This is due to malnutrition, which affects the health and quality of hair.

Choice B rationale: The presence of soft, unpigmented hair on the arms (and other parts of the body) is known as lanugo.

It’s a type of fine hair that the body produces in response to severe malnutrition, often seen in cases of anorexia nervosa.

The body grows lanugo in an attempt to provide insulation and maintain body heat, due to the loss of insulating body fat.

Choice C rationale: Individuals with anorexia nervosa typically have a distorted body image and often perceive themselves as overweight, even when they are underweight.

Therefore, it’s unlikely for them to comment that they are too thin and need to gain weight.

Choice D rationale: Preoccupation with thoughts about food is a common psychological symptom of anorexia nervosa. Individuals with this disorder often spend a lot of time thinking about food, dieting, and body weight.

Choice E rationale: Feeling “too tired” and lacking interest in daily workouts can be a result of the physical exhaustion and weakness caused by severe calorie restriction and malnutrition in anorexia nervosa.

Choice F rationale: The client’s report of consuming around 600 calories per day is not provided in the question. Therefore, it cannot be evaluated.

In conclusion, the nurse should expect to find brittle and thin hair, soft unpigmented hair on the arms, preoccupation with thoughts about food, and lack of energy or interest in daily activities in a client with anorexia nervosa.