A nurse is assisting with planning care for a newly admitted 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
A. Encourage the client to gain 2.3 kg (5 lb) per week. This is not appropriate. Weight gain should be gradual in clients with anorexia nervosa, typically around 0.5 to 1 kg (1 to 2 pounds) per week, to prevent refeeding syndrome and support psychological adjustment.
B. Monitor the client for 15 min after meals. This is the correct intervention. Clients with anorexia nervosa may engage in purging behaviors (such as vomiting or excessive exercise) after meals. Monitoring for a period of time after eating helps prevent these behaviors and ensures safety.
C. Weigh the client each morning after voiding. Weighing clients with anorexia nervosa can be distressing and should be done consistently at the same time each day (ideally, before breakfast) but does not need to be after voiding. This may not be the priority intervention compared to monitoring post-meal behavior.
D. Reinforce teaching about healthy eating during meals. While teaching about healthy eating is important, it should not be done during meals, as clients with anorexia nervosa may have difficulty focusing on this information when under stress during eating. Instead, nutrition education should be provided outside of meals.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"B"}}
Explanation
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Potential discharge instruction |
Anticipated |
Contraindicated |
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Take furosemide each night at bedtime. |
✔ |
|
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Record daily weight. |
✔ |
|
|
Adhere to 2 g low-sodium diet. |
✔ |
|
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Maintain bed rest for 1 week following discharge |
✔ |
|
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Restrict fluid intake to 2 L/day |
✔ |
Correct Answer is C
Explanation
A. Airborne precautions are used for diseases transmitted by tiny particles that remain suspended in the air and are inhaled, such as tuberculosis or measles. Mononucleosis is not spread through
the airborne route.
B. Droplet precautions are for diseases transmitted by respiratory droplets, like influenza or pertussis. While mononucleosis can be transmitted through respiratory secretions, it's primarily spread through direct contact with saliva.
C. Contact precautions involve preventing the transmission of pathogens by direct or indirect contact. Given that mononucleosis is transmitted through saliva, contact precautions, including wearing gloves and gowns, are appropriate to prevent its spread.
D. Protective environment precautions are used to protect immunocompromised patients from outside pathogens, such as those recovering from bone marrow transplants. They are not applicable for a client with mononucleosis.
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