A nurse is speaking with the parents of a 4-year-old child who has a terminal illness.
The parents tell the nurse they have taken their son's name off the list for little league baseball next season. Which of the following responses should the nurse make?

Choice A rationale:

Obsession over a fictitious defect in physical appearance is characteristic of body dysmorphic disorder, not generalized anxiety disorder (GAD).

Individuals with body dysmorphic disorder become preoccupied with an imagined or slight defect in their appearance, often to the point of significant distress and impairment in functioning.

They may engage in excessive grooming behaviors, repeatedly check their appearance in mirrors, or avoid social situations due to their appearance concerns.

While individuals with GAD may also experience concerns about their physical appearance, these concerns are typically not as severe or pervasive as those seen in body dysmorphic disorder.

Choice B rationale:

Constant worry about the undiagnosed presence of an illness is a hallmark feature of GAD.

Individuals with GAD often experience excessive worry about a variety of things, including health, finances, relationships, and work.

This worry is often accompanied by physical symptoms such as restlessness, fatigue, difficulty concentrating, and muscle tension.

The worry is typically difficult to control and can significantly interfere with daily life.

Choice C rationale:

Sudden unexplained loss of vision without a physical medical explanation is not a common symptom of GAD. It may be indicative of a more serious medical condition, such as a stroke or a neurological disorder.

It is important to rule out any potential medical causes before attributing a symptom like this to GAD.

Choice D rationale:

Prior physical health followed by the need for two surgeries within the last three months may be a stressful life event that could contribute to the development of GAD.

However, it is not a specific symptom of GAD.

Many people experience stressful life events without developing GAD.

The presence of other symptoms, such as excessive worry and physical symptoms, is necessary for a diagnosis of GAD.

Choice A rationale:

This statement is accusatory and blaming, rather than promoting understanding and problem-solving. It focuses on the negative behavior of the sibling and seeks external validation for the speaker's feelings, rather than attempting to address the underlying issue directly with the sibling.

It uses "should" language, which can come across as judgmental and critical, potentially escalating conflict.

It does not express the speaker's own feelings or needs, making it difficult for the other person to understand and respond effectively.

Choice B rationale:

While this statement demonstrates a willingness to take responsibility for actions, it does not directly address the communication between the family members. It focuses on redirecting the father's anger rather than exploring the underlying reasons for the conflict.

It could be interpreted as silencing the children's voices and potentially reinforcing a hierarchical dynamic within the family, where one parent holds authority over the others.

Choice C rationale:

This statement is manipulative and threatening, using a fear of exposure to control the other person's behavior. It undermines trust and safety within the family, making it difficult to have open and honest communication.

It does not address the core issue at hand and instead escalates conflict by using a "tit-for-tat" approach.

Choice D rationale:

This statement effectively demonstrates several key principles of effective communication: It expresses curiosity and a genuine desire to understand the other person's perspective.

It avoids accusations or assumptions, instead inviting open dialogue.

It focuses on specific behaviors and events ("each time you go to the mall") rather than making sweeping generalizations about the person's character.

It uses "I" language to express the speaker's own feelings and concerns, inviting empathy and understanding.

It creates an opportunity for the other person to share their perspective and work towards a resolution together.