A nurse in the ER is admitting a client who has experienced a weight loss of 11 kg (25 lb) in the past 3 months. The client weighs 40 kg (88 lb) and believes she is fat. Which of the following aspects of care should the nurse consider the first priority for this client?

The correct answer is choice A: Request a mental health consult.

Choice A rationale:

Requesting a mental health consult is the first priority in this situation. The client's significant weight loss, distorted body image, and belief that she is fat suggest potential body dysmorphic disorder, eating disorder, or other psychological concerns. It's crucial to address these underlying issues before focusing on other aspects of care.

Choice B rationale:

Providing a structured environment can be beneficial, but it might not address the root cause of the client's psychological distress and distorted body image.

Choice C rationale:

Assessing the client's nutritional status is important to understand the physical impact of the weight loss, but the urgent need here is to address the client's psychological well-being and distorted self-perception.

Choice D rationale:

Planning a therapeutic diet for the client is essential, but it should not be the first priority. The client's belief that she is fat and her significant weight loss indicate deeper psychological issues that require immediate attention. Without addressing these psychological concerns, focusing solely on a diet plan might exacerbate her distorted body image and eating behaviors.

Choice A rationale:

Attempting to talk the client down is the priority action in this situation. Agitation can escalate to aggression or violence if not addressed appropriately. Engaging in therapeutic communication can help de-escalate the client's agitation, express understanding, and potentially find out the underlying cause of their distress. This approach prioritizes a non-pharmacological intervention.

Choice B rationale:

Administer a PRN antianxiety medication. While medication might be a consideration for managing agitation, it's generally not the first action to take. Non-pharmacological interventions, like therapeutic communication, should be attempted first to minimize the reliance on medications to manage behaviors.

Choice C rationale:

Place the client in a monitored seclusion room until he is calm. Placing a client in seclusion should be a last resort and should only be done when there's an immediate risk of harm to the client or others. In this scenario, the client's agitation doesn't seem to present an imminent danger, so seclusion would be an excessive and restrictive intervention.

Choice D rationale:

Restrain the client to prevent injury to himself or others. Restraint should be an absolute last resort and only used when there's an imminent risk of harm that cannot be managed in any other way. Restraint can escalate agitation and trauma for the client, as well as pose legal and ethical concerns. Therefore, it should only be used when all other options have been exhausted and safety is a critical concern.