A nurse in an eating disorders treatment center is reviewing the medical record of a newly admitted client. Which of the following findings should the nurse identify as a risk factor for anorexia nervosa?

Rationale:

A. Seeking clarification: Seeking clarification involves asking the client to explain something they have already said to ensure mutual understanding. It usually occurs in response to ambiguous or unclear statements, not as an initial, open-ended invitation to speak.

B. Reflecting: Reflecting is a technique in which the nurse restates the client’s feelings or thoughts to encourage deeper exploration. The nurse in this case is not restating anything but is instead prompting the client to share independently.

C. Focusing: Focusing involves guiding the conversation toward a specific topic or detail the client has already brought up. Since the nurse is initiating a broad and open-ended question, focusing is not the technique being used here.

D. Giving broad openings: This technique encourages the client to take the lead in the conversation by expressing themselves freely. Asking this question invites open communication and helps build rapport, which is characteristic of broad opening statements.

Rationale:

• Ask the client for a list of close contacts: The client exhibits classic symptoms of active tuberculosis (TB), including weight loss, night sweats, hemoptysis (bloody cough), and chest tightness. Identifying close contacts is crucial for contact tracing and limiting disease spread.
• Obtain a sputum culture: A sputum culture is essential for diagnosing pulmonary TB. This test confirms the presence of Mycobacterium tuberculosis and guides further treatment decisions.
• Place the client in a negative-pressure room: Clients suspected of having TB should be placed in a negative-pressure isolation room to prevent airborne transmission to others, especially in healthcare settings.
• Use airborne precautions: Airborne precautions, including the use of an N95 respirator, are required for suspected or confirmed TB due to its airborne transmission risk.
• Obtain blood cultures: Blood cultures are not the priority in TB diagnosis unless sepsis is suspected. TB is primarily diagnosed through respiratory samples, not blood.
• Recommend ABGs be drawn: Arterial blood gases (ABGs) are typically unnecessary in TB unless there is respiratory compromise requiring ventilatory support or oxygenation monitoring, which is not indicated here.
• Request a glucocorticoid prescription from the provider: Glucocorticoids are not standard treatment for TB and may suppress immune response. They may be used in specific TB complications like meningitis or pericarditis, but not in general pulmonary TB management.