A female client is admitted to psychiatric clinic for treatment of anorexia nervosa. To promote client’s physical health, nurse Tair should plan to:

Correct Answer: C. Monitor vital signs, serum electrolyte levels, and acid-base balance

An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client’s vital signs, serum electrolyte level, and acid-base balance is crucial.

• Option A: Restricting the client’s physical activities may worsen anxiety. Clients with anorexia appear slow, lethargic, and fatigued; they may be emaciated depending on the amount of weight loss; clients with bulimia may be underweight or overweight but are generally close to expected body weight for age and size.
• Option B: This is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. When clients can eat, a diet of 1200 to 1500 calories per day is ordered, with gradual increases in calories until clients are ingesting adequate amounts for height, activity level, and growth needs; the nurse is responsible for monitoring meals and snacks and often initially will sit with a client during eating at a table away from other clients; after each meal or snack, clients may be required to remain in view of staff for 1 to 2 hours to ensure that they do not empty the stomach by vomiting.
• Option D: This would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately. The nurse can help clients begin to recognize emotions such as anxiety or guilt by asking them to describe how they are feeling and allowing adequate time for response.