Comprehensive exams for Mental Health Q 162
Kathleen is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client’s physical health, the nurse should plan to:
A. Severely restrict the client's physical activities.
B. Weigh the client daily, after the evening meal.
C. Monitor vital signs, serum electrolyte levels, and acid-base balance.
D. Instruct the client to keep an accurate record of food and fluid intake.
Correct Answer: C. Monitor vital signs, serum electrolyte levels, and acid-base balance.
An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client’s vital signs, serum electrolyte level, and acid-base balance is crucial. Work-up includes a thorough medical history (comprehensive review of systems, family and social history, medications including non-prescribed, past medical and psychiatric history, prior abuse) and physical exam (looking for complications above).
Option A: This may worsen anxiety. Treatment for anorexia nervosa is centered on nutrition rehabilitation and psychotherapy. Outpatient treatment includes intensive therapy (2 to 3 hours per weekday) and partial hospitalization (6 hours per day). Pediatric patients benefit from family-based psychotherapy to explore underlying dynamics and restructure the home environment.
Option B: This is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Diagnose by history, physical, and lab work that rules out other conditions that can make people lose weight. Treatment includes gaining weight (sometimes in a hospital if severe), therapy to address body image, and management of complications from malnourishment.
Option D: This would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately. Patient and family education is key to preventing high morbidity. The dietitian should educate the family on the importance of nutrition and limiting exercise. The mental health nurse should educate the patient on changes in behavior, easing stress, and overcoming any emotional issues.