When working with the family of a client with anorexia nervosa, which issue must be addressed?

Sexual identity

Self-discipline

Control

Codependence

Answer and Explanation

The Correct Answer is C

Family systems theory suggests that anorexia nervosa often develops within a specific homeodynamic environment characterized by enmeshment and overprotection. In these families, the adolescent may feel a lack of autonomy, leading them to use food restriction as a way to exert sovereignty over the only thing they feel they can govern, that is, their own body.

Rationale:

A. Although issues of maturation and the physical changes of puberty are often central to the client's internal struggle, sexual identity is generally not the primary systemic issue addressed in family therapy for anorexia. The focus is more on the transition from childhood to independent adolescence.

B. Clients with anorexia typically possess an extreme, pathological level of self-discipline. The goal of therapy is often to decrease this rigid internal regulation rather than address a lack of it. High self-discipline is a symptom of the disorder's ego-syntonic nature, not the underlying familial conflict.

C. Control is the core psychological issue in the family of a client with anorexia. The family often struggles with allowing the client to develop a separate identity. By controlling their caloric intake to a life-threatening degree, the client is making a bid for individualization in a system that feels suffocatingly restrictive.

D. Codependence is a term more frequently associated with substance use disorders and "enabling" behaviors. The family of an anorexic client is often enmeshed, but the clinical priority is addressing the power struggles and the need for personal agency rather than the rescue-victim cycles typical of codependency.

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Correct Answer is A

Explanation

Crisis management for the acutely aggressive patient prioritizes environmental safety and the containment of physical violence. When a patient exhibits active destructive behavior, they have moved beyond the stage of verbal escalation into physical aggression, characterized by a loss of impulse control and potential for injury. The primary clinical objective shifts from therapeutic communication to rapid stabilization and the protection of both the client and others within the psychiatric milieu.

Rationale:

A. Calling for an emergency response ensures sufficient trained personnel are available to manage the situation safely. When a client is actively throwing furniture, they pose an immediate threat to physical safety. Utilizing a team approach is the most effective way to implement necessary restrictive interventions, such as seclusion or restraint, while minimizing the risk of injury to everyone involved.

B. Attempting to use problem-solving techniques is inappropriate during the crisis phase of aggression. A client who is physically violent is experiencing significant cognitive impairment due to extreme emotional arousal and cannot engage in complex executive functions. These behavioral strategies are only effective during the pre-escalation or post-crisis phases once the client has regained emotional and physiological baseline.

C. Encouraging verbal expression while the client is actively throwing objects is a dangerous intervention. Calmly speaking to an out-of-control client may be perceived as a challenge or simply ignored due to the client's high sympathetic arousal. At this stage of the assault cycle, verbal de-escalation is no longer a sufficient or safe primary intervention to prevent imminent physical harm.

D. Approaching an aggressive client to give a firm command increases the risk of physical assault on the nurse. Direct confrontation during active violence can trigger further escalation or result in the nurse being struck by the object. Maintaining a safe distance and awaiting the arrival of the emergency response team is the standard protocol for managing active physical destructiveness.

A. Social skills training for chronic schizophrenics B. Self-esteem building with a local after-school program C. Depression screening in an assisted living facility D. Parenthood classes at a local community center

Correct Answer is C

Explanation

In the public health model of psychiatric nursing, secondary prevention focuses on early identification and prompt intervention. The goal is to shorten the duration of the illness or minimize its severity by catching symptoms as soon as they appear. This differs from primary prevention (prevention before it starts) and tertiary prevention (rehab for chronic issues).

Rationale:

A. Social skills training for those with chronic schizophrenia is an example of tertiary prevention. At this stage, the disease is already established, and the goal of the nurse is to provide rehabilitation, reduce disability, and help the client achieve their highest possible level of functioning.

B. Building self-esteem in an after-school program is primary prevention. The goal here is to bolster resilience and insulate a healthy population against the future development of mental health disorders. It is a proactive, educational approach for people who are currently asymptomatic.

C. Depression screening is the hallmark of secondary prevention. Screening programs, whether for depression in the elderly, developmental delays in toddlers, or PTSD in veterans, are designed for early case-finding. By identifying depression in an assisted living facility early, the nurse can initiate treatment before the condition leads to more severe complications like malnutrition, isolation, or suicide.

D. Parenthood classes are another example of primary prevention. These classes aim to reduce the stress of a major life transition and provide parents with tools to foster healthy environments for their children, thereby preventing potential mental health issues from arising in the first place.

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When working with the family of a client with anorexia nervosa, which issue must be addressed?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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