A nurse is caring for a young adult client who has major depressive disorder and has been found legally incompetent. The client requires informed consent for abdominal surgery. The nurse should recognize that which of the following people can consent to the surgery?

A. "I'm fearful of how I will look once I heal.": Expressing fear about appearance indicates ongoing anxiety and uncertainty about body image. While this is a normal part of adjustment, it reflects that the client has not yet fully accepted changes to their body.

B. "I can't let my partner see me like this.": Avoidance of intimacy or being seen by a partner demonstrates distress and body image disturbance. This response indicates the client is struggling with self-acceptance and may require emotional support.

C. "I should wear a t-shirt at bedtime.": Planning clothing choices for modesty may reflect concern about appearance or comfort, but it does not necessarily indicate acceptance of the body image changes. It is more a coping strategy than evidence of acceptance.

D. "I'm going to look at myself in the mirror.": Choosing to face one’s reflection demonstrates acknowledgement and acceptance of body changes. This action reflects a willingness to engage with altered body image and is a positive sign of adaptation and self-acceptance.

A. The client talks excessively: Pressured speech is a common manifestation of mania in bipolar disorder. While it requires monitoring, it does not pose an immediate threat to the client’s health.

B. The client dresses in vivid, bright colors: Wearing bright or unusual clothing reflects the euphoric or expansive mood seen in mania. This behavior is not immediately harmful and does not take priority over basic physiological needs.

C. The client refuses to eat: Refusal to eat can lead to malnutrition, dehydration, and electrolyte imbalances, which are life-threatening if not addressed promptly. Maintaining adequate nutrition and hydration is a priority over behavioral or mood-related symptoms.

D. The client sleeps 6 hr at night: Reduced sleep is common during manic episodes but is not immediately life-threatening. Sleep deprivation should be monitored, but the client’s refusal to eat requires more urgent intervention.