A nurse is collecting data from a client who has hepatitis A. Which of the following findings should the nurse expect?

The nurse should include maintaining elbow restraints on the infant in the plan of care following cleft palate repair. This helps to prevent the infant from touching their surgical site and disrupting the healing process.

a) Allowing the infant to have soft foods may be appropriate, but it is not the highest priority. The infant's diet should be determined by the provider and based on the infant's individual needs.

c) Instructing the parents to feed the infant with a spoon may be appropriate, but it is not the highest priority. The infant's feeding method should be determined by the provider and based on the infant's individual needs.

d) Telling the parents to avoid brushing the infant's teeth for two weeks may be appropriate, but it is not the highest priority. The infant's oral care should be determined by the provider and based on the infant's individual needs.

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.