An extremely thin preadolescent is being assessed by the nurse.
Which client statement should the nurse identify as being consistent with that of a person with anorexia nervosa?
I feel chubby no matter what I wear.
I would like to gain weight but I just cannot.
I would like to grow up to be a model.
I am afraid that someone is poisoning my food.
The Correct Answer is A
Choice A rationale
This statement reflects a classic symptom of anorexia nervosa known as body image disturbance or distortion. Individuals with this condition have a profound fear of gaining weight and perceive themselves as being overweight or fat, even when they are severely underweight. This distorted self-perception drives the restrictive eating and weight-loss behaviors.
Choice B rationale
Stating a desire to gain weight but being unable to is more consistent with a medical cause for weight loss or a chronic illness with resulting cachexia, or possibly a lack of nutritional knowledge. A key feature of anorexia nervosa is the intense fear of weight gain and a refusal to maintain a minimally normal weight, not an inability to gain weight.
Choice C rationale
While interest in modeling may be a motivation for some to maintain a certain physique, it is not a core diagnostic feature of anorexia nervosa. The central psychopathology of anorexia is the fear of gaining weight, body image distortion, and behaviors to prevent weight gain, not merely a career aspiration.
Choice D rationale
This statement, which expresses a fear of being poisoned, is a symptom of delusional thinking and is more consistent with a severe mental illness such as paranoid schizophrenia. While comorbid conditions can occur, intense fear of poisoning is not a defining or consistent diagnostic criterion for anorexia nervosa.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
A preference for certain toys is a common, non-pathological finding in toddlers as they develop individual interests and preferences. While extreme rigidity in play or an inability to shift focus may be concerning, simple preference alone does not typically indicate a significant developmental delay in a 30-month-old child, but rather a normal expression of autonomy. Further assessment would involve observing the quality and functional use of play.
Choice B rationale
Food selectivity or "picky eating" is a very frequent and normal developmental phase during toddlerhood, often peaking around age two to five years, and is not usually indicative of a neurological or pervasive developmental disorder. A child's refusal to frequently try new foods, especially in the absence of weight loss or growth failure, is not an immediate alarm for developmental delay.
Choice C rationale
Restlessness in a structured public setting like a restaurant with a waiting period is an expected behavior for a 30-month-old toddler due to their limited attention span and developmental need for gross motor activity and immediate gratification. This is a common age-appropriate reaction to boredom and constraint, not a sign of major developmental pathology.
Choice D rationale
At 30 months old, a child's expressive language milestone should significantly exceed "one or two words" and grunting. The expected milestone for this age is a vocabulary of 50 or more words and the ability to combine two to three words into short phrases or sentences (e.g., "Mommy go"). This finding strongly suggests a language delay warranting immediate comprehensive developmental evaluation.
Correct Answer is A
Explanation
Step 1 is: Calculate the minimum safe dose for 24 hours. 5 mcg/kg/24 hr × 16.1 kg = 80.5 mcg/24 hr.
Step 2 is: Calculate the maximum safe dose for 24 hours. 6 mcg/kg/24 hr × 16.1 kg = 96.6 mcg/24 hr.
Step 3 is: Compare the ordered dose to the safe range. The ordered dose is 150 mcg. The safe dose range is 80.5 mcg to 96.6 mcg. The ordered dose (150 mcg) is higher than the maximum safe dose (96.6 mcg). The ordered dose is NOT safe, so the initial answer is B. However, the question choices are A. Yes, B. No, C. The dose is too low for the client's weight, D. The safe dose range is too narrow to determine. Since the ordered dose is too high, the most accurate choice indicating it is NOT safe is "No".
Choice A rationale
The statement "Yes" is incorrect because the ordered dose of 150 mcg is significantly above the calculated safe range maximum of 96.6 mcg/24 hr. Administering an overdose of levothyroxine can lead to hyperthyroidism symptoms like tachycardia, heat intolerance, and anxiety, which is not a safe practice.
Choice B rationale
The statement "No" is correct because the ordered dose of 150 mcg is not within the therapeutic and safe range of 80.5 mcg to 96.6 mcg for a 16.1 kg child. Dosing levothyroxine accurately is crucial as it has a narrow therapeutic index, and excess dosage carries risks of serious cardiac side effects.
Choice C rationale
The statement "The dose is too low for the client's weight" is incorrect. The maximum safe dose is 96.6 mcg, and the ordered dose is 150 mcg, which makes the ordered dose too high, not too low. Giving an excessively high dose can cause adverse effects due to drug toxicity or an induced hypermetabolic state in the body systems.
Choice D rationale
The statement "The safe dose range is too narrow to determine" is incorrect. The safe dose range is clearly defined by the provided parameters as 80.5 mcg to 96.6 mcg/24 hr. The calculation provides a precise and sufficient range to determine that the ordered dose of 150 mcg is clearly unsafe and should be questioned by the nurse.
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