The nurse is evaluating nutritional outcomes for an elderly client with anorexia nervosa. Which data best indicates that the plan of care is effective?

1. A

   The client selects a balanced diet from the menu

2. B

   The client's hematocrit improves

3. C

   The client's tissue turgor improves

4. D

   The client gains weight

Appeared in: DHS 2018 shift 1st

Explanation

• The core problem in anorexia nervosa is severe underweight from extreme caloric restriction; therefore, weight gain is the primary goal and the most direct measure of treatment success.
• Weight gain is an objective, measurable outcome that confirms the client is consuming and utilizing more calories than they are expending.
• Unlike other measures which can be influenced by hydration or behavior, weight gain provides concrete evidence of nutritional rehabilitation.
• Treatment plans for anorexia nervosa explicitly set weight gain goals (e.g., 1-3 lbs per week) and use this metric to evaluate progress.

Why Other Options Were Wrong

• Option A: This reflects a positive behavioral change and cognitive understanding, but it does not confirm actual food consumption or caloric absorption, which are common challenges in treating anorexia nervosa.
• Option B: Hematocrit is primarily an indicator of red blood cell concentration and can be misleading. In anorexia, it is often elevated due to dehydration (hemoconcentration). An improvement may simply reflect rehydration rather than improved nutritional status.
• Option C: Improved tissue turgor is a direct indicator of hydration status. While important, it does not reflect the client's caloric intake or overall nutritional recovery, which is the central issue in anorexia nervosa.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Evaluation of nutritional therapy effectiveness in anorexia nervosa to guide bedside assessment, documentation, and the next nursing action.
• In managing eating disorders, nurses must prioritize objective physiological data (like weight) over subjective reports or behavioral intentions, as there can be a significant discrepancy.
• The elderly population with anorexia presents unique challenges, including comorbidities, polypharmacy, and age-related changes in metabolism, making careful monitoring essential.
• What if... the client gains 5 lbs (2.3 kg) in the first week? This rapid weight gain is a major red flag for refeeding syndrome, a potentially fatal condition caused by rapid shifts in fluid and electrolytes. The nurse must immediately notify the provider, monitor vital signs, and check electrolyte levels (especially phosphate, potassium, and magnesium).

How to Approach the Question

• First, identify the core clinical problem presented in the question: anorexia nervosa, a disorder defined by severe underweight.
• Next, understand what the question is asking: to find the 'best' indicator of an effective care plan. This requires you to prioritize outcomes.
• Evaluate each option against the primary goal of treatment for anorexia nervosa, which is nutritional rehabilitation and weight restoration.
• Eliminate options that are secondary or indirect measures. Improved tissue turgor and hematocrit are primarily related to hydration.
• Eliminate options that reflect intent rather than a physiological outcome. Selecting a balanced diet is a good intention but doesn't prove consumption.
• Select the option that directly and objectively measures the reversal of the core problem. Weight gain is the most direct measure of successful nutritional rehabilitation.

Concept Tested & Keywords

• Concept Tested: Evaluation of nutritional therapy effectiveness in anorexia nervosa.
• Stem keywords: nutritional outcomes, elderly client, anorexia nervosa, plan of care, effective
• Lead-in keywords: best indicates
• Clinical cues: The diagnosis of anorexia nervosa is the key cue, as its primary feature is significant low weight.

Question ID

Qs4Z7MviE6ISyiDWgqCvX8

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 5 pp. 197-199, 210-212

E6 Pharmacology Nursing Lilley 11e Part 3 p. 234-236