A nurse is reviewing the medical record of a male client who has schizophrenia and is taking clozapine. Which of the following findings should the nurse identify as a contraindication to the administration of clozapine?

A. Assessing pain requires clinical judgment and should be done by the nurse.
B. Checking pedal pulses is a nursing task that requires assessment of circulation and requires nursing expertise.
C. Observing the positioning of the weight is a task that requires an LPN or RN as it involves assessing the traction’s effectiveness.
D. Reminding the client to use the incentive spirometer is a task that can be delegated to an assistive personnel (AP) to help prevent respiratory complications.

Potential Condition: Anorexia nervosa Actions to Take:

• Focus on the client's underlying feelings of dysphoria and lack of control.
• Provide a structured meal environment. Parameters to Monitor:
• Weight on a daily basis.
• Cardiac function with ECG. Rationale

Potential Condition:

Anorexia Nervosa

The client is presenting with significant weight loss (weighing 37.2 kg or 82 lb and having a BMI of 15, which is extremely low), refusal to eat, and anxiety around meals. These are hallmark signs of anorexia nervosa, a psychological disorder characterized by a distorted body image and an intense fear of gaining weight, leading to restrictive eating behaviors. The anxiety during mealtime and the refusal to eat or very limited intake (10% of the meal) are also consistent with this condition.

Actions to Take:

• Focus on the client's underlying feelings of dysphoria and lack of control

Anorexia nervosa often involves underlying psychological issues, including dysphoria, anxiety, and a lack of control over the disorder. Addressing the psychological aspects of the disorder is crucial in helping the client work through their fear of eating and regain control over their behaviors in a healthier way.

• Provide a structured meal environment

Anorexic patients often feel out of control and overwhelmed during meals, leading to avoidance and anxiety. A structured meal environment where the patient is encouraged to eat in a controlled, supportive manner is critical. A structured approach, along with meal monitoring (observing eating behaviors), helps ensure adequate nutrition and reduces anxiety around eating.

Parameters to Monitor:

• Weight on a daily basis

Monitoring weight daily is essential for tracking the client’s progress in terms of nutrition and weight restoration, which is a key treatment goal in anorexia nervosa. Daily weight checks provide feedback on how well the client is accepting nutrition and managing their eating disorder.

• Cardiac function with ECG

Severe weight loss in anorexia nervosa can lead to electrolyte imbalances, which, in turn, can affect cardiac function and lead to arrhythmias. The low BMI and nutritional deficiencies (such as low potassium or magnesium levels) increase the risk of cardiac complications, including bradycardia and hypotension.

Rationale for other conditions;

Avoidant Restrictive Food Intake Disorder (ARFID) is not the most likely condition because the client's symptoms are more consistent with anorexia nervosa, particularly the preoccupation with weight and body image. ARFID typically involves food aversion and eating difficulties without the same concerns about body weight or a distorted body image.

Bulimia Nervosa is ruled out because the client does not exhibit behaviors such as binge eating followed by compensatory purging (e.g., vomiting, excessive exercise, or laxative use). Instead, the client is actively refusing food and experiencing anxiety around eating, which fits better with anorexia nervosa.

Binge Eating Disorder does not fit the client's behavior either, as this disorder is characterized by episodes of overeating without compensatory behaviors, and the client is not exhibiting such patterns. The client is avoiding food and struggling with restriction, which aligns with anorexia nervosa.