A nurse is assisting with planning care for a newly admited client who has anorexia nervosa. Which of the following interventions should the nurse recommend to include in the plan of care?
Encourage the client to gain 2.3 kg (5 lb) per week.
Monitor the client for 15 min after meals
Weigh the client each morning after voiding
Reinforce teaching about healthy eating during meals
The Correct Answer is B
b. Monitor the client for 15 min after meals.
Explanation:
The correct answer is b. Monitor the client for 15 min after meals.
Anorexia nervosa is a serious eating disorder characterized by self-imposed starvation and a distorted body image. When planning care for a client with anorexia nervosa, it is important to focus on interventions that promote safety, nutritional rehabilitation, and psychological support.
Option a is not the correct answer. Encouraging the client to gain 2.3 kg (5 lb) per week is not a realistic or healthy goal for weight gain in the context of anorexia nervosa. Rapid weight gain can be physically and psychologically overwhelming for the client and may reinforce disordered eating behaviors.
Option c is not the correct answer. Weighing the client each morning after voiding may contribute to obsessive monitoring of weight, which is a common feature of anorexia nervosa. Frequent weigh-ins can exacerbate anxiety and fixation on numbers, which are detrimental to the client's recovery.
Option d is not the correct answer. Reinforcing teaching about healthy eating during meals is not an appropriate intervention for a client with anorexia nervosa. Anorexia nervosa involves a distorted perception of body weight and shape, as well as deeply ingrained beliefs and fears related to food. Focusing on teaching about healthy eating during meals may trigger anxiety and reinforce disordered thoughts and behaviors.
By recommending the intervention to monitor the client for 15 minutes after meals, the nurse ensures close observation during a critical time when the client may engage in compensatory behaviors such as purging or exercising excessively. This intervention allows for immediate identification of any concerning behaviors and provides an opportunity for therapeutic intervention, support, and redirection.
It is crucial to approach care for clients with anorexia nervosa with sensitivity and an understanding of the complex psychological and physiological challenges they face. The chosen intervention focuses on the immediate post-meal period and aims to promote safety and support the client in their recovery journey.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
b. Keep suction equipment at the client's bedside.
The nurse should plan to include keeping suction equipment at the client's bedside as an intervention for a client with Parkinson's disease. Parkinson's disease can cause dysphagia (difficulty swallowing) and an increased risk of aspiration. Having suction equipment readily available allows for prompt intervention in case of choking or aspiration episodes, ensuring the client's safety.
Explanation for the other options:
a. Restrict the client's fluid intake: Restricting the client's fluid intake is not typically indicated in the care of a client with Parkinson's disease. Adequate hydration is important for overall health and well-being. However, specific fluid restrictions may be necessary in certain situations, such as if the client has coexisting conditions like heart failure or kidney disease, which should be assessed and determined by the healthcare provider.
c. Instruct the client to look down when ambulating: In Parkinson's disease, individuals often experience a forward-flexed posture and a shuffling gait. Instructing the client to look down when ambulating is not an appropriate intervention. Instead, the nurse should encourage the client to maintain an upright posture, take smaller steps, and focus on taking deliberate and controlled movements to promote stability and reduce the risk of falls.
d. Position the client supine after eating: Positioning the client supine after eating is not recommended for a client with Parkinson's disease. This position can increase the risk of aspiration, as it may promote reflux and regurgitation of stomach contents. Instead, the nurse should advise the client to maintain an upright position, such as sitting in a chair or using a recliner with appropriate head support, to aid digestion and reduce the risk of aspiration.
Correct Answer is A
Explanation
After a patient dies, postmortem care includes preparing them for family viewing. The nurse should place the body in the supine position, with the arms at the sides and the head on a pillow. Then elevate the head of the bed 30 degrees to prevent discoloration from blood settling in the face .
The other options are not correct because:
b) The nurse should cleanse the client's body while wearing appropriate personal protective equipment (PPE) based on indications for isolation precautions, not necessarily sterile gloves.
c) If the patient wore dentures and your facility’s policy permits, gently insert them; then close the mouth
d) The nurse should close the eyes by gently pressing on the lids with their fingertips. If they don’t stay closed, place moist coton balls on the eyelids for a few minutes, and then try again to close them. Surgical tape is not mentioned as necessary .
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