Joan is a 17 year old who normally weighs 45 kg. She has lost 9 kg over past 3 months and has amenorrhea; Joan expresses an intense fear of gaining weight and is preoccupied with food. She is admitted with a diagnosis of anorexia nervosa. Joan's lunch consists of a small salad, a dinner roll and a bowl of soup and tea. What it is the responsibility of the nurse in order to assess intake?

Choice A reason: Simply removing the tray at the end of the meal does not allow the nurse to observe the patient's eating behaviors. Patients with anorexia nervosa may hide food, crumble it to make the portion look smaller, or dispose of it in napkins to avoid caloric intake. Choice B reason: Direct observation during mealtimes is a standard nursing intervention for patients with anorexia nervosa. It ensures an accurate assessment of actual intake, prevents the disposal of food, and provides the patient with emotional support and structure during a period of high anxiety related to eating. Choice C reason: Periodically returning to check on the patient is insufficient for a patient with a severe eating disorder. This lack of constant supervision provides the patient with opportunities to engage in compensatory behaviors or food avoidance tactics that compromise the nutritional rehabilitation goals of the treatment plan. Choice D reason: Expecting a patient with an intense fear of gaining weight and a preoccupation with food to self-report intake is clinically inappropriate. The cognitive distortions associated with anorexia nervosa make self-reporting highly unreliable, as the patient may underreport intake to satisfy the demands of the disorder.