A nurse is reinforcing teaching with a client on measures to promote their sleep. Which of the following instructions should the nurse include in the teaching?

• emotional lability: The client’s sudden and intense shifts in mood, such as calling the nurse "horrible" and then later saying the nurse is "the best," are classic signs of emotional lability. This rapid mood instability is a hallmark feature of borderline personality disorder and reflects difficulties regulating emotions.
• increased heart rate: An increased heart rate is a physiological response often linked to anxiety, panic, or substance use but is not a defining characteristic of borderline personality disorder. It does not directly represent a core emotional or relational disturbance seen in this disorder.
• elevated body temperature: Elevated body temperature is a physical finding associated with infection, inflammation, or drug reactions. It is not a behavioral or psychological symptom related to borderline personality disorder.
• tactile hallucinations: Tactile hallucinations, such as feeling sensations that are not there, are associated with psychotic disorders or substance intoxication rather than borderline personality disorder. They are not characteristic features of this condition.
• fear of abandonment: Individuals with borderline personality disorder have a profound fear of abandonment, whether real or perceived. This fear often leads to intense emotional reactions and unstable interpersonal relationships, as seen in the client’s extreme reactions toward the nurse.

A. Suggest the client exercise before going to bed: While exercise is beneficial for depression, vigorous activity before bedtime can interfere with sleep. It is generally better to recommend exercise earlier in the day to promote better rest and regulate mood.

B. Offer the client low-protein snacks throughout the day: Clients with major depressive disorder may experience changes in appetite, but offering low-protein snacks is not a specific therapeutic intervention. Balanced meals and snacks are more appropriate to support overall nutrition.

C. Encourage the client to use positive self-talk: Positive self-talk can help challenge and change negative thought patterns that are common in major depressive disorder. Encouraging cognitive restructuring strategies like positive affirmations supports emotional healing and coping.

D. Recommend the client spend time alone in his room: Isolation can worsen depressive symptoms by increasing feelings of loneliness and hopelessness. Encouraging social interaction and structured activities is more helpful in managing depression.