A 16-year-old female client is admitted to the psychiatric unit and states that she is depressed and anxious. The client appears frail and is wearing baggy clothes. When it is time for lunch, the client states, "I can't eat, I'm already overweight." What is the best response by the nurse?
"You may think you are fat, but you look thin to me."
"There are consequences for not eating."
"Explain how you feel when it is time to eat."
"You must eat or you will become very sick."
The Correct Answer is C
Choice A rationale: "You may think you are fat, but you look thin to me" is dismissive and may invalidate the client's feelings. It is essential to explore the client's emotions rather than providing a judgmental response.
Choice B rationale: "There are consequences for not eating" is confrontational and may increase the client's anxiety. A more therapeutic approach involves exploring the client's feelings and concerns about eating.
Choice C rationale: "Explain how you feel when it is time to eat" is an open-ended and non-judgmental response. It encourages the client to express her emotions, providing valuable information for further assessment and care planning.
Choice D rationale: "You must eat or you will become very sick" is directive and may increase resistance. It is essential to explore the client's feelings and collaborate on a plan rather than issuing directives.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale: "If your partner is abusing you, I need to ask these questions" may be too direct and could potentially make the client feel pressured or uncomfortable. The nurse should emphasize the routine nature of the screening.
Choice B rationale: "The healthcare provider needs to know if you are experiencing any domestic abuse" is correct but may sound directive. Emphasizing the routine nature of the screening helps to normalize the process.
Choice C rationale: "All clients are screened for domestic abuse because it is common in our society" is the best choice. It normalizes the screening process, reducing stigma and encouraging disclosure.
Choice D rationale: "State law mandates that I ask if you are a victim of domestic violence" may make the client feel compelled to answer due to legal reasons, potentially affecting the validity of the response. Emphasizing routine screening is a more patient centered approach.
Correct Answer is D
Explanation
A: While eating nutritious meals is important for recovery, it is not the highest priority because it addresses a physical need without directly addressing the underlying psychological issues.
B: Positive self-esteem is crucial for the recovery from anorexia nervosa. It addresses the core psychological challenges of the disorder, helping the client to develop a healthier self-image and relationship with food.
C: Communication of love and concern by the family is supportive, but it does not directly facilitate the client's personal development of self-esteem and self-worth, which are essential for long-term recovery.
D: Family therapy is beneficial for systemic healing and support, but the individual's self-esteem needs to be established as a priority to empower personal change and recovery.
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