A nurse is creating a plan of care for a client who has anorexia nervosa. Which of the following interventions should the nurse include in the plan?

Prepare the client for electroconvulsive therapy.

Weigh the client twice per day.

Encourage the client to participate in family therapy.

Set a weight gain goal of 2.2 kg (4.9 lb) per week.

Answer and Explanation

The Correct Answer is C

A. Prepare the client for electroconvulsive therapy:
Electroconvulsive therapy (ECT) is not a standard or appropriate treatment for anorexia nervosa. ECT is primarily used for severe depression, bipolar disorder, and certain other mental health conditions. Anorexia nervosa is typically managed through psychotherapy, nutritional counseling, and medical monitoring, often in an outpatient or inpatient setting, depending on the severity of the disorder.

B. Weigh the client twice per day:
Frequent weighing is generally discouraged in the treatment of anorexia nervosa. Individuals with this disorder often have an unhealthy fixation on their weight. Frequent weigh-ins can exacerbate anxiety, foster an unhealthy relationship with food and body image, and reinforce obsessive thoughts about weight and appearance. Healthcare providers should monitor weight and nutritional status regularly, but the frequency should be determined based on the individual's specific needs and in a manner that does not worsen their anxiety.

C. Encourage the client to participate in family therapy:
This is the appropriate choice. Family therapy is often a crucial component of the treatment plan for anorexia nervosa. It helps address family dynamics, communication patterns, and any dysfunctional relationships that might contribute to the eating disorder. Family therapy provides a supportive environment for both the individual with anorexia and their family members, aiding in understanding, coping, and healing.

D. Set a weight gain goal of 2.2 kg (4.9 lb) per week:
Setting specific weight gain goals can be counterproductive and potentially harmful for individuals with anorexia nervosa. Rapid or arbitrary weight gain goals may lead to unhealthy eating behaviors, excessive exercise, or other dangerous practices in an attempt to meet the goal quickly. Instead, healthcare providers focus on a more individualized and gradual approach to weight restoration, ensuring that it is safe, sustainable, and in line with the client's overall health and well-being.

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Correct Answer is C

Explanation

A. Reaction Formation:
Reaction formation is a defense mechanism where an individual expresses feelings or behaviors that are the opposite of their true feelings or impulses. For example, someone who harbors unconscious aggressive feelings might display exaggerated friendliness and kindness. In the given scenario, the behavior of the newly licensed nurse is not contradictory to their true feelings; they are imitating the charge nurse willingly.

B. Suppression:
Suppression is a conscious effort to push down or hide certain thoughts or feelings. Unlike repression (which is unconscious), suppression involves a deliberate choice not to think about or dwell on certain emotions or thoughts. In the scenario, the behavior of the newly licensed nurse is not an example of suppression because they are not consciously trying to hide their actions.

C. Identification:
Identification is a defense mechanism where an individual unconsciously models their behavior, feelings, or attitudes after those of someone else, especially someone they perceive as powerful or significant. In this scenario, the newly licensed nurse is imitating the behaviors of the charge nurse, which is an example of identification.

D. Compensation:
Compensation is a defense mechanism where an individual consciously or unconsciously covers up weaknesses, frustrations, or feelings of inadequacy by emphasizing strengths or seeking to excel in other areas. It involves making up for a perceived lack by putting extra effort into another aspect of life. The scenario does not describe the newly licensed nurse compensating for any perceived weakness; they are simply imitating the charge nurse's behavior.

A. "This medication is given to help with extrapyramidal side effects." B. "Benztropine helps alleviate your hallucinations." C. "This medication is given to help with your depression." D. "Benztropine is used to counteract your tachycardia."

Correct Answer is A

Explanation

A. "This medication is given to help with extrapyramidal side effects."
Benztropine is an anticholinergic medication used to treat the extrapyramidal side effects (EPS) caused by certain psychiatric drugs, particularly antipsychotics. EPS can include symptoms such as muscle stiffness, restlessness, tremors, and other movement disorders. Benztropine helps to alleviate these symptoms, making it an essential medication for individuals experiencing these side effects from antipsychotic medications.

B. "Benztropine helps alleviate your hallucinations."
This statement is incorrect. Benztropine is not primarily used to treat hallucinations; it is used for movement-related side effects as mentioned above.

C. "This medication is given to help with your depression."
This statement is incorrect. Benztropine is not indicated for the treatment of depression.

D. "Benztropine is used to counteract your tachycardia."
This statement is incorrect. Benztropine is not used to treat tachycardia (fast heart rate). It is specifically used for extrapyramidal side effects related to antipsychotic medications.

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A nurse is creating a plan of care for a client who has anorexia nervosa. Which of the following interventions should the nurse include in the plan?

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