A nurse is assisting with the care of an 18-year-old client who was recently admitted.

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Rationale for correct choices:

• Anorexia nervosa: The client has a significantly low BMI, prolonged weight loss, refusal to eat, fear of weight gain, and distorted body image. Physical findings such as lanugo, bradycardia, hypotension, amenorrhea, and electrolyte abnormalities strongly support this diagnosis. The client’s restrictive eating patterns and compensatory behaviors further align with anorexia nervosa.

• Provide a structured meal environment: A structured meal plan reduces anxiety, discourages food manipulation, and promotes consistent nutritional intake. Supervised meals help prevent hiding, discarding food, or engaging in compensatory behaviors. Consistency also supports gradual weight restoration. This intervention is a core component of treatment for anorexia nervosa.

• Focus on the client’s underlying feelings of dysphoria and lack of control: Anorexia nervosa is often associated with emotional distress, low self-worth, and a need for control. Addressing these feelings helps the client develop healthier coping mechanisms beyond food restriction. Emotional support is essential alongside nutritional rehabilitation.

• Weight on a daily basis
Daily weight monitoring evaluates nutritional rehabilitation and treatment effectiveness. Gradual, consistent weight gain is a primary goal in anorexia nervosa management. Sudden changes may indicate dehydration, food restriction, or manipulation. Tracking weight trends guides care planning and risk assessment.

• Cardiac function with ECG: The client has sinus bradycardia and severe hypokalemia, both of which significantly increase the risk of arrhythmias and cardiac arrest. Continuous or frequent ECG monitoring is essential to detect potentially life-threatening conduction abnormalities early.

Rationale for incorrect choices:

• Bulimia nervosa: Bulimia nervosa is characterized by binge eating followed by compensatory behaviors while maintaining normal or near-normal weight. This client demonstrates severe underweight status and primarily restrictive eating. The clinical presentation does not include recurrent binge episodes.

• Avoidant/restrictive food intake disorder: This disorder lacks body image distortion or fear of weight gain. In contrast, the client expresses feeling “fat” and avoids food due to weight concerns. The presence of body dissatisfaction and intentional restriction supports anorexia nervosa instead.

• Binge eating disorder: Binge eating disorder involves recurrent binge episodes without compensatory behaviors and typically results in overweight or obesity. The client is underweight and restricts intake rather than bingeing. No loss-of-control eating episodes are described.

• Encourage the client to limit fasting: While reducing fasting is important, this intervention is too vague and does not address the need for structured, supervised nutrition. Clients with anorexia often require clear expectations rather than general encouragement. Without structure, the client may continue restrictive behaviors.

• Accept the client’s belief about “forbidden” foods: Accepting food-related distortions reinforces maladaptive beliefs and perpetuates restriction. Treatment focuses on challenging rigid food rules rather than validating them. Supporting these beliefs can worsen anxiety and nutritional deficits.

• Provide the client with foods that have a variety of textures: Texture variety may be useful later in recovery but is not a priority during acute stabilization. Early treatment emphasizes caloric adequacy and meal completion rather than sensory exploration. Introducing multiple textures may increase anxiety and refusal. Structured consistency is more effective initially.

• Calcium level: The client’s calcium level is within normal limits and does not currently indicate acute risk. Other parameters such as potassium, magnesium, and cardiac status are more clinically significant. Calcium monitoring does not best reflect short-term progress.

• Vital signs every 8 hrs: Although vital signs are important, this frequency does not specifically measure recovery progress. More targeted parameters such as weight trends and post-meal behaviors provide clearer indicators of improvement. Vital signs alone may remain stable despite ongoing disordered behaviors. They are supportive but not primary indicators.

• Behavior 15 min after meals: Although useful in detecting purging behaviors, this is not as critical as cardiac monitoring in the context of severe bradycardia and hypokalemia. Behavioral monitoring remains important but secondary to life-threatening risk.