A nurse is interviewing a client during admission to an alcohol treatment center. Which of the following approaches should the nurse take?

The correct answer is Choice A: Give positive feedback when the client is assertive with staff or clients.

Choice A rationale: Clients with dependent personality disorder exhibit a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior. They often struggle with making decisions, expressing their opinions, and engaging in assertive communication. By providing positive feedback when the client exhibits assertive behavior, the nurse reinforces adaptive coping strategies and encourages the development of healthy interpersonal interactions. This approach fosters independence, self-confidence, and autonomy, ultimately promoting a better quality of life for the client.

Choice B rationale: Although setting limits is crucial in managing manipulative behaviors, it is not the primary focus for clients with dependent personality disorder. These clients tend to prioritize pleasing others and avoiding conflict over exploiting or manipulating other individuals. Instead, nurses should emphasize supportive interventions that foster self-reliance and assertiveness.

Choice C rationale: Close monitoring to prevent self-mutilation is not typically associated with the management of dependent personality disorder. This intervention is more relevant for clients with borderline personality disorder or those with a history of self-harm behaviors. Clients with dependent personality disorder may exhibit passive and avoidant behaviors but are less likely to engage in acts of self-mutilation.

Choice D rationale: Discouraging flamboyant or seductive behaviors is an intervention more suited for clients with histrionic personality disorder, not dependent personality disorder. Histrionic personality disorder is characterized by excessive emotionality and attention-seeking behaviors, whereas dependent personality disorder primarily involves a lack of self-confidence and excessive reliance on others for decision-making and emotional support.

The correct answer is Choice D

Choice A rationale: Metrorrhagia, or irregular uterine bleeding, is not typically associated with anorexia nervosa. Instead, amenorrhea is more common due to hypothalamic suppression from low body fat and caloric intake. The hypothalamus reduces gonadotropin-releasing hormone (GnRH), leading to decreased luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which suppresses ovulation and menstruation. Estrogen levels fall below normal (typically 30–400 pg/mL), disrupting endometrial stability. Thus, bleeding is less likely than complete menstrual cessation.

Choice B rationale: Tachycardia is not expected in anorexia nervosa; bradycardia is more common due to metabolic adaptation and reduced cardiac workload. The body conserves energy by lowering heart rate, often below 60 bpm. Malnutrition leads to decreased thyroid hormone (T3), reduced sympathetic tone, and myocardial atrophy. Electrolyte imbalances and hypovolemia further depress cardiac output. Tachycardia may occur in refeeding syndrome or acute stress, but chronically, the heart rate is typically slow due to adaptive mechanisms.

Choice C rationale: Hyperkalemia is rare in anorexia nervosa; hypokalemia is far more common due to purging behaviors, vomiting, and diuretic or laxative abuse. Potassium levels often fall below the normal range of 3.5–5.0 mEq/L. Losses through the gastrointestinal tract and renal excretion lead to muscle weakness, arrhythmias, and fatigue. Intracellular shifts during starvation also contribute to low serum potassium. Hyperkalemia may occur transiently during tissue breakdown or renal failure but is not a hallmark finding.

Choice D rationale: Constipation is a frequent finding in anorexia nervosa due to decreased caloric intake, slowed gastrointestinal motility, and reduced fiber consumption. Starvation suppresses parasympathetic activity, leading to delayed colonic transit. Electrolyte imbalances, especially hypokalemia, further impair smooth muscle contraction. Normal bowel frequency ranges from three times per week to three times per day; anorexic clients often fall below this due to systemic hypometabolism. Constipation may also be exacerbated by dehydration and laxative dependence.