A nurse is weighing a client who was recently admitted into the eating disorder program. Which of the following actions should the nurse take?

Demand that the client remove hidden objects from their clothing prior to being weighed.

Invite the client to predict their weight beforehand.

Monitor for any extra fluids the client may have consumed prior to being weighed.

Weigh the client each day after their evening meal.

Answer and Explanation

The Correct Answer is B

A. Demand that the client remove hidden objects from their clothing prior to being weighed. While it is important to ensure accurate weight measurement, demanding removal of hidden objects may create a confrontational atmosphere and increase anxiety for the client. A more supportive approach is beneficial in this setting.
B. Invite the client to predict their weight beforehand. Encouraging clients to predict their weight can help engage them in the process and promote a sense of control. This approach may also facilitate a therapeutic conversation about their feelings regarding weight and body image.
C. Monitor for any extra fluids the client may have consumed prior to being weighed. While monitoring fluid intake is important in the overall care of clients with eating disorders, it is not a standard practice to monitor this immediately before weighing unless there is a specific concern about fluid retention or overhydration.
D. Weigh the client each day after their evening meal. Weighing clients daily can contribute to anxiety and unhealthy focus on weight. It is generally more effective to establish a consistent weighing schedule that minimizes distress, such as weekly or bi-weekly measurements, rather than immediately following meals.

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Correct Answer is D

Explanation

A. Insist the client report the incident. While reporting the incident may be important, it is not appropriate to insist that the client do so, as this can create additional pressure and may lead to feelings of coercion. The client should be allowed to make their own choices regarding reporting.
B. Touch the client for reassurance. Touching the client without their consent can be intrusive and may not be welcome, especially after a trauma. It's essential to respect the client's personal space and boundaries.
C. Ask the client a series of questions about who assaulted them. While gathering information may be necessary, bombarding the client with questions immediately after a traumatic event can be overwhelming. It’s better to allow the client to share information at their own pace.
D. Allow the client to control the conversation. Empowering the client to control the discussion fosters a sense of safety and autonomy. It allows them to share their feelings and experiences when they feel ready, which is crucial for their emotional healing after an assault.

A. Employment assistance B. Psychiatrist C. Social worker D. Spiritual advisor

Correct Answer is C

Explanation

A. Employment assistance. While employment support is valuable for clients with schizophrenia, housing stability should be prioritized first. A client without a place to live may struggle to maintain a job, making housing support the more immediate concern.
B. Psychiatrist. A psychiatrist plays a crucial role in managing schizophrenia through medication and therapy. However, the client’s immediate need is housing, which falls outside the psychiatrist’s primary role and is better addressed by a social worker.
C. Social worker. A social worker can assist with housing placement, financial aid, and community resources for individuals experiencing homelessness. They are the most appropriate referral to help the client secure stable living arrangements.
D. Spiritual advisor. While spiritual guidance may provide emotional support, it does not directly address the client’s urgent need for housing. The primary intervention should focus on securing a safe and stable place to live.

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