A nurse in an acute mental health facility is caring for a client who has major depressive disorder. Since her admission 3 days ago, she has not put on clean clothes, washed her hair, or participated in any of the unit activities. On this day, the nurse observes that she is wearing clean clothes and has combed her hair. Which of the following responses should the nurse make?

A. "Your mood must be lifting because you have on clean clothes and have combed your hair?": This statement assumes a direct correlation between hygiene and mood, which may not be accurate for clients with major depressive disorder. Making assumptions can invalidate the client’s experience and may create pressure to conform to expectations. B. "Why did you wear clean clothes and comb your hair today?": Asking “why” can feel judgmental and may put the client on the defensive. It can inadvertently create anxiety or shame, which is not therapeutic in the context of depression. C. "Oh, I'm so pleased that you finally put on clean clothes.": This conveys approval and reward, which may reinforce dependency on external validation rather than supporting intrinsic motivation. Overpraising can also feel patronizing to the client. D. "I see that you have on clean clothes and have combed your hair": This statement objectively acknowledges the client’s actions without making assumptions or judgments. It validates the behavior, promotes therapeutic rapport, and allows the client to share their own feelings about the accomplishment if they choose.