Nurse is developing a plan of care for a female client with anorexia nervosa. Which action should the nurse i… - SJH Nursing Officer - 2019

SJH Nursing Officer - 2019

Mental Health Nursing

Medium

Appeared in: SJH Nursing Officer - 2019

Explanation

The cornerstone of inpatient treatment for anorexia nervosa is nutritional rehabilitation, which requires a highly structured approach.
A strict eating plan removes the burden of food choice from the client, which can be a source of extreme anxiety, and ensures a predictable, adequate caloric intake.
This structured environment helps re-establish normal eating patterns and promotes steady weight gain (e.g., 0.5-1 lb/week) in a controlled manner.
All patients with anorexia nervosa benefit from a daily structure for healthy eating that includes three meals and at least one snack a day, distributed evenly.

Option A: Providing privacy during meals is contraindicated because it creates an opportunity for the client to hide food, discard it, or engage in purging behaviors. Supervision is a key safety measure.
Option C: Encouraging exercise is dangerous for a client with anorexia nervosa. These clients often have compulsive exercise habits and are medically unstable due to malnutrition. Exercise would burn needed calories and strain a compromised cardiovascular system.
Option D: Restricting family visits is generally not therapeutic. Family involvement and therapy (like the Maudsley approach) are often critical for long-term success. Isolating the client can increase feelings of hopelessness.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing care plan for anorexia nervosa to guide bedside assessment, documentation, and the next nursing action.
Nurses play a pivotal role in creating a therapeutic and safe environment for clients with anorexia nervosa. This involves a balance of firm boundaries and empathetic support.
A primary patient safety concern is Refeeding Syndrome, a potentially fatal shift in fluids and electrolytes that can occur in malnourished patients receiving artificial refeeding. Nurses must monitor vital signs, intake/output, and lab values (phosphate, potassium, magnesium) vigilantly.
What if? If a client with anorexia nervosa refuses to eat despite the structured plan, the nurse must enforce the plan consistently, communicate with the treatment team, and prepare for potential interventions like nasogastric tube feeding if medically necessary.

How to Approach the Question

First, identify the client's diagnosis: anorexia nervosa. Recall the core psychopathology: an intense fear of gaining weight, distorted body image, and restrictive eating/compensatory behaviors.
Analyze the goal of the question: identify a correct nursing action within a plan of care.
Evaluate each option based on the principles of treating anorexia nervosa: structure, safety, and supervision.
Option A (privacy) violates supervision. Option C (exercise) violates safety and structure. Option D (restricting family) violates the principle of using support systems.
Option B (strict eating plan) directly addresses the need for structure and is a foundational element of treatment. Therefore, it is the most appropriate action.

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 318-320

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1518-1520