A charge nurse in the emergency department is reviewing the data of four young children who are receiving treatment. Which of the following should alert the charge nurse to the possibility of child maltreatment?

Choice A reason: Encouraging a client to gain 2.3 kg (5 lb) per week is unrealistic and unsafe. Gradual weight gain of about 0.5 to 1 kg per week is recommended to avoid complications such as refeeding syndrome and to promote sustainable recovery.

Choice B reason: Weighing the client once per week is insufficient. Clients with anorexia nervosa require close monitoring, typically daily weights, to assess progress and detect rapid changes. Weekly weighing could miss dangerous fluctuations.

Choice C reason: Monitoring the client for 1 hr after meals is correct because clients with anorexia nervosa may attempt to purge or exercise excessively after eating. Post-meal monitoring ensures food intake is retained and helps prevent compensatory behaviors. This intervention supports nutritional rehabilitation and safety.

Choice D reason: Allowing the client to choose meal times is inappropriate because it gives them control that may reinforce disordered eating patterns. Structured meal times are necessary to normalize eating habits and reduce avoidance behaviors.

Choice A reason: Muscle weakness is a sign of hypokalemia, which can predispose the client to digoxin toxicity. Educating the client to report muscle weakness ensures early detection of electrolyte imbalance and prevents complications such as arrhythmias. This teaching is directly related to digoxin safety and is essential for client self-monitoring.

Choice B reason: Reporting weight gain is important in heart failure management, but the threshold is typically 2 pounds in a day or 5 pounds in a week, not one-half pound. A small daily fluctuation is normal and does not necessarily indicate fluid overload. Therefore, this teaching is inaccurate and could lead to unnecessary concern.

Choice C reason: Digoxin does not increase blood pressure. Its primary effects are to increase myocardial contractility (positive inotrope) and slow conduction through the AV node (negative chronotrope). Teaching the client to expect increased blood pressure would be misleading and incorrect.

Choice D reason: Not all clients prescribed digoxin require a diuretic. Diuretics may be used in heart failure to manage fluid overload, but they are not universally prescribed alongside digoxin. Furthermore, diuretics can increase the risk of hypokalemia, which complicates digoxin therapy. Therefore, this statement is inaccurate as a blanket teaching.