A nurse is assessing an adolescent client who has anorexia nervosa. Which of the following client statements is a sign of cognitive distortion?

"I really need to get into shape."

"If I eat one piece of candy, I may as well eat ten."

"I can't afford to gain weight."

"I like to cut my food into small pieces."

Answer and Explanation

The Correct Answer is B

A.   It reflects a desire to improve physical fitness, which is a common and generally positive goal. However, if this statement were accompanied by an excessive focus on weight loss or extreme measures to achieve fitness, it could indicate a problem, but on its own, this statement is not clearly indicative of cognitive distortion.
B.   It reflects "all-or-nothing thinking," a common cognitive distortion in eating disorders. This pattern of thinking involves seeing things in black and white, where a small lapse in diet is perceived as a complete failure, leading to excessive and irrational behavior, such as consuming more than intended.
C.   It shows a strong fear of gaining weight, which is typical in anorexia nervosa. However, it is more a sign of extreme concern about body image rather than a specific cognitive distortion pattern. Cognitive distortions often involve faulty logic or irrational beliefs, and this statement is more about an emotional response to weight gain.
D.   Cutting food into small pieces can be a behavioral characteristic or ritual for someone with anorexia nervosa, but it does not necessarily reflect a cognitive distortion on its own. It might be a way to control portions or prolong the eating process, but it is not a direct example of distorted thinking.

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Correct Answer is A

Explanation

A. The supine position increases the risk of aspiration, where food or liquid could enter the airway and potentially cause aspiration pneumonia. To minimize this risk, the client should be positioned in a semi- Fowler’s position (head of the bed elevated at 30-45 degrees) during feedings.
B. Aspirating gastric residual volumes is a standard practice to check for proper digestion and tolerance of the feeding. Generally, a residual of up to 250-500 mL can be acceptable depending on institutional policy and client condition. This action does not necessarily require intervention unless specific guidelines indicate otherwise.
C. Irrigating the NG tube with tap water is a common practice to ensure the tube remains patent and to help clear any residual feeding material from the tube. Tap water is generally considered acceptable for this purpose, though some facilities may use sterile or distilled water to avoid any potential infections.
D. Administering the feeding through a syringe barrel by gravity is a standard method for intermittent tube feedings. This technique allows the feeding to flow slowly into the stomach without excessive pressure, which can help prevent complications such as nausea or cramping.

A. Allow room for some air inside the bag. B. Place the bag directly on the skin. C. Apply the bag for 30 min at a time. D. Reapply the bag 30 min after removing it.

Correct Answer is A

Explanation

A. Allowing a small amount of air inside the bag can prevent the formation of ice crystals that could lead to frostbite or skin damage. Air space allows the ice to conform better to the shape of the injury and can help distribute the cold more evenly. However, the bag should not be too full to ensure effective cooling.
B. Placing an ice bag directly on the skin can lead to skin damage or frostbite. To prevent this, a thin cloth or towel should be placed between the ice bag and the skin. This barrier helps protect the skin from the intense cold and reduces the risk of injury.
C. Applying an ice bag for 30 minutes at a time can be too long and may risk skin damage or frostbite. Typically, ice should be applied for 15-20 minutes at a time, followed by a break to allow the skin to warm up before reapplication.
D. After applying an ice bag for 15-20 minutes, it is usually recommended to remove it and allow the skin to return to normal temperature before reapplying. Waiting about 30 minutes before reapplying allows the skin to recover and helps avoid potential complications like frostbite or cold burns.

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A nurse is assessing an adolescent client who has anorexia nervosa. Which of the following client statements is a sign of cognitive distortion?

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Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is A

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