A patient admitted with an acute coronary syndrome (ACS) is receiving eptifibatide, a glycoprotein (GP) IIb IIIa inhibitor.
Which assessment finding poses the greatest risk to the patient?

Choice A rationale

Roast pork is a protein source and does not contribute to fiber content. However, fresh strawberries are high in fiber and may not be suitable for a low-fiber diet.

Choice B rationale

Roasted turkey is a good source of protein and does not contribute to fiber content. Canned vegetables are typically lower in fiber than their fresh or frozen counterparts because the canning process tends to degrade some of the fiber. Therefore, this food selection indicates that the patient understands the prescribed low-fiber diet.

Choice C rationale

Both baked potatoes with skin and raw carrots are high in fiber. The skin of the potato and raw carrots contain insoluble fiber, which may not be suitable for a patient with ulcerative colitis on a low-fiber diet.

Choice D rationale

Pancakes made from refined flour can be part of a low-fiber diet. However, whole-grain cereals are high in fiber and may not be suitable for a patient with ulcerative colitis on a low-fiber diet.

Based on the information provided, the client is most likely experiencinganorexia nervosa.This is suggested by her significant weight loss, bradycardia, hypothermia, lanugo-type hair, and her expressed fear of gaining weight despite being underweight. However, this is a preliminary assessment and a definitive diagnosis should be made by a healthcare professional.

Actions the nurse should take to address this condition include:

• Acknowledge anxious feelings: It’s important to validate the client’s feelings and fears about food and weight gain.This can help build trust and facilitate further discussion about her health.
• Provide emotional support: Emotional support is crucial in managing eating disorders.The nurse can provide reassurance, listen empathetically, and encourage the client to express her feelings.

Parameters the nurse should monitor to assess the client’s progress include:

• Nutritional intake: Monitoring the client’s food and fluid intake can help assess her nutritional status and response to treatment.
• Weight and BMI: Regular monitoring of the client’s weight and BMI can provide objective measures of her nutritional status and response to treatment.