Substance Abuse and Abuse Q 59
A teenage female is admitted with the diagnosis of anorexia nervosa. Upon admission, the nurse finds a bottle of assorted pills in the client’s drawer. The client tells the nurse that they are antacids for stomach pains. The best response by the nurse would be:
A. "These pills aren’t antacids since they are all different."
B. "Some teenagers use pills to lose weight."
C. "Tell me about your week prior to being admitted."
D. "Are you taking pills to change your weight?"
Correct Answer: C. “Tell me about your week prior to being admitted.”
This is an open-ended question which is non-judgemental and allows for further discussion. The topic is also non-threatening yet will give the nurse insight into the client’s view of events leading up to admission. It is the only option that is client-centered. The other options focus on the pills. Encourage personal development program, preferably in a group setting. Provide information about the proper application of makeup and grooming. Learning about methods to enhance personal appearance may be helpful to a long-range sense of self-esteem and image. Feedback from others can promote feelings of self-worth.
Option A: Establish a therapeutic nurse-patient relationship. Within a helping relationship, the patient can begin to trust and try out new thinking and behaviors. Promote self-concept without moral judgment. Patient sees herself as weak-willed, even though part of a person may feel a sense of power and control (dieting, weight loss).
Option B: Be aware of your own reaction to a patient’s behavior. Avoid arguing. Feelings of disgust, hostility, and infuriation are not uncommon when caring for these patients. Prognosis often remains poor even with a gain in weight because other problems may remain. Many patients continue to see themselves as fat, and there is also a high incidence of affective disorders, social phobias, obsessive-compulsive symptoms, drug abuse, and psychosexual dysfunction. The nurse needs to deal with own response and feelings so they do not interfere with the care of the patient.
Option D: Respond (confront) with reality when a patient makes unrealistic statements. The patient may be denying the psychological aspects of their own situation and are often expressing a sense of inadequacy and depression. Help a patient formulate goals for herself (not related to eating) and create a manageable plan to reach those goals, one at a time, progressing from simple to more complex. The patient needs to recognize the ability to control other areas in life and may need to learn problem-solving skills to achieve this control. Setting realistic goals fosters success.