A 20-year-old client is at 18 weeks gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used cocaine.
The nurse should recognize that the client is at increased risk for which condition(s)? (Select all that apply.)

Choice A rationale

This statement indicates an appropriate understanding of the disease process because early reporting of inflammatory symptoms like puffiness or pain allows for timely pharmacological intervention. Juvenile idiopathic arthritis involves chronic synovial inflammation that can lead to joint erosion if not managed. Recognizing these subjective and objective signs of a flare ensures that the healthcare team can adjust the treatment plan to prevent long term joint damage and preserve functional mobility.

Choice B rationale

This statement indicates a need for further education because children with juvenile idiopathic arthritis should be encouraged to attend school and remain active despite mild discomfort. Prolonged inactivity and school absenteeism can lead to social isolation and increased joint stiffness. Physical therapy and regular movement are therapeutic components that help maintain muscle strength and joint range of motion. Keeping the child home unnecessarily reinforces a sick role and hinders developmental progress.

Choice C rationale

Swimming is a highly recommended low impact aerobic exercise for patients with juvenile idiopathic arthritis because the buoyancy of the water reduces the gravitational stress on inflamed weight bearing joints. Utilizing a heated pool during winter months helps maintain muscle tone and cardiovascular health without exacerbating joint pain. This proactive approach to staying active supports long term physical functioning and helps prevent the secondary complications of a sedentary lifestyle in pediatric patients.

Choice D rationale

Adherence to prescribed medication regimens is critical in managing the systemic and localized inflammation associated with juvenile idiopathic arthritis. Medications such as nonsteroidal anti inflammatory drugs, disease modifying antirheumatic drugs, or biologics work to suppress the immune response and prevent irreversible joint destruction. Understanding the importance of compliance indicates that the family recognizes the chronic nature of the condition and the necessity of pharmacological control to achieve and maintain clinical remission.

Choice A rationale

This response is inconsistent with anorexia nervosa because individuals with this disorder rarely express satisfaction or tolerance of their weight. The diagnostic criteria include an intense fear of gaining weight and a significant disturbance in the way one's body weight or shape is experienced. If a client suggests they can live with being overweight, it indicates a level of body acceptance that is typically absent in those suffering from the restrictive and distorted perceptions inherent in this condition.

Choice B rationale

While a client may be defensive or guarded during an interview, this statement is a general expression of privacy rather than a symptom of the eating disorder itself. Anorexia nervosa is characterized by specific cognitive distortions regarding body image. A deflective answer does not provide clinical insight into the core psychopathology of the illness, which involves the delusional perception of being overweight despite objective evidence of severe emaciation and a body mass index well below normal limits.

Choice C rationale

Although this statement acknowledges being underweight, it lacks the characteristic cognitive distortion of body dysmorphia found in anorexia nervosa. Most clients with this diagnosis do not perceive themselves as underweight; instead, they see specific body parts as being too large even when they are skin and bone. Acknowledging that one is "grossly underweight" suggests a degree of insight that is often missing during the acute phase of the illness, where the perception of fatness remains dominant regardless of reality.

Choice D rationale

This response is the most consistent with the diagnosis because it reflects the profound body image distortion and low self-esteem central to anorexia nervosa. Even when severely emaciated, these clients often perceive themselves as "fat" and experience intense self-loathing regarding their appearance. This cognitive appraisal drives the continued restrictive eating behaviors and excessive weight loss. The statement highlights the lack of objective reality in the client's self-perception, which is a hallmark psychological feature of the restrictive type.