A nurse in an inpatient psychiatric unit is setting short-term goals for a client who was admitted for treatment of anorexia nervosa. Which of the following is an appropriate short-term goal the nurse should set?
The client will reach an appropriate body weight.
The client will gain 2 to 3 lb weekly.
The client will verbalize a realistic body image.
The client will develop a personalized meal plan.
The Correct Answer is B
Choice A reason: Reaching an appropriate body weight is a long-term goal, not a short-term one. Clients with anorexia nervosa require gradual weight restoration to avoid complications such as refeeding syndrome. Setting this as a short-term goal is unrealistic and potentially unsafe.
Choice B reason: Gaining 2 to 3 lb weekly is the correct short-term goal because it is measurable, realistic, and safe. This gradual increase helps stabilize the client’s nutritional status while minimizing medical risks. It also provides a tangible benchmark for progress during inpatient treatment.
Choice C reason: Verbalizing a realistic body image is important but represents a long-term psychosocial goal. Distorted body image is a core feature of anorexia nervosa and requires extended therapy and counseling. It cannot be expected as a short-term outcome during initial hospitalization.
Choice D reason: Developing a personalized meal plan is a collaborative long-term strategy involving dietitians and therapists. While important, it is not the immediate short-term focus. The priority is safe, gradual weight gain.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: While it is true that many clients can resume usual activities while on hemodialysis, this statement does not address the client’s uncertainty. It provides reassurance but does not encourage exploration of the client’s feelings or concerns, which is essential in therapeutic communication.
Choice B reason: Asking “Why are you unsure?” can sound confrontational and may make the client defensive. It does not promote open dialogue in a supportive manner.
Choice C reason: Asking the client to clarify what makes them unsure is therapeutic. It invites the client to share their concerns in a nonjudgmental way, allowing the nurse to better understand their perspective and provide individualized support. This is the correct answer because it fosters communication and client-centered care.
Choice D reason: Recommending that the client talk to their family shifts responsibility away from the nurse-client relationship. While family support is important, the nurse’s role is to explore the client’s feelings and provide education, not to delegate the decision-making process.
Correct Answer is C
Explanation
Choice A reason: Celiac disease is an autoimmune condition triggered by gluten ingestion. It affects nutrient absorption but does not directly increase aspiration risk during enteral feedings.
Choice B reason: Increased gastric motility actually reduces aspiration risk because food moves more quickly through the stomach. Delayed gastric emptying, not increased motility, is associated with aspiration.
Choice C reason: Parkinson’s disease is the correct answer because it impairs swallowing and gag reflexes due to neuromuscular dysfunction. Clients with Parkinson’s are at high risk for aspiration when receiving enteral feedings, as they may not adequately protect their airway.
Choice D reason: Systemic lupus erythematosus affects multiple organ systems but does not directly impair swallowing or airway protection. It is not a primary risk factor for aspiration during tube feedings.
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