A nurse is assessing a group of clients at risk of developing a pressure injury. The nurse should identify that which of the following clients is at the greatest risk?

Rationale for correct choices:

• Electrolyte imbalance: The client’s potassium level of 3.0 mEq/L is critically low, contributing to premature ventricular contractions and orthostatic hypotension. These abnormalities place the client at immediate risk for cardiac dysrhythmias and require urgent correction to prevent life-threatening complications.
• View of body: The client voices fear of gaining weight and fixates on food, which are indicators of distorted self-perception. This impaired view of the body is a central feature of bulimia nervosa and needs to be addressed during psychotherapy once the client is medically stabilized.

Rationale for incorrect choices:

• Impaired body image: While body image concerns are common in eating disorders, this option is more general. “View of body” better captures the client’s psychological distortion and allows for more precise therapeutic interventions that address the cognitive roots of the disorder.
• Impaired coping: The client engages in maladaptive coping strategies like bingeing and purging. However, these behaviors are secondary to deeper distortions in self-image and medical instability. Coping can be addressed later in the treatment process once safety is ensured.
• History of anxiety: Anxiety is part of the client's long-standing history but is not causing the immediate physical risk. Addressing acute electrolyte disturbances and body image distortion takes precedence over chronic anxiety in this clinical setting.
• Obsession with food: Although the client’s persistent thoughts about food are important, they are symptoms driven by distorted body perception. Treating the underlying belief system about body image is more foundational and effective in resolving food-related obsessions.

Rationale:

A. Drinks 3 cups of 1% milk per day: This intake is appropriate for an 8-year-old child. It supports bone development by providing sufficient calcium and vitamin D, aligning with dietary guidelines for school-age children.

B. Weight has increased by 5 kg (11 lb): A weight gain of about 2–3 kg (4.4–6.6 lb) per year is typical for children between ages 6 and 12. A 5 kg increase over one year is within normal limits and does not require provider notification unless accompanied by other concerns.

C. Height has increased by 3.8 cm (1.5 in): This is below the expected annual growth rate for an 8-year-old, which is typically 5 to 6.5 cm (2 to 2.5 in) per year. Slowed linear growth can indicate underlying medical or nutritional issues and should be reported for evaluation.

D. Consumes three meals and two snacks per day: This is a healthy and age-appropriate eating pattern for a school-age child, promoting stable energy levels and supporting growth and development.