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    RN Ati Capstone mental health assessment proctored exam
    Select All That Apply

    The nurse continues to care for the client. Exhibits The nurse is discussing the plan of care with the client. Select the 3 statements the nurse should make.

    Explanation & Rationale

    A. "We will explore your thoughts that trigger you to participate in a rigorous exercise regimen.": Cognitive-behavioral therapy (CBT) focuses on identifying and modifying distorted thoughts and behaviors related to body image and exercise. Exploring these triggers helps the client develop healthier coping mechanisms and insight into maladaptive patterns. B. "We will create an exercise plan once you reach your target weight.": Exercise is often restricted initially in clients with anorexia nervosa due to the risk of further weight loss and cardiac complications. Once nutritional and medical stability are achieved, a structured exercise plan can safely be reintroduced to support recovery. C. "We would like you to eat independently to limit distractions during mealtime.": Clients with anorexia often require supervision during meals to prevent food avoidance, hiding food, or purging behaviors. Independent eating is not appropriate until consistent eating habits and trust are established. D. "We will monitor your blood pressure every other day until it is stable.": Given the client’s hypotension and bradycardia, daily monitoring of vital signs is essential to promptly detect cardiac instability or worsening malnutrition. Every-other-day monitoring would be insufficient in the acute phase. E. "We will set a goal for you to gain 2 to 3 pounds per week.": A gradual weight gain of 2–3 pounds per week is a realistic and safe goal for clients in recovery from anorexia nervosa. This approach minimizes the risk of refeeding syndrome and supports long-term stabilization. F. "We will weigh you every evening to monitor your progress.": Weight should be measured once daily, ideally in the morning after voiding and before eating, to maintain consistency. Evening weights are influenced by fluid and food intake, leading to inaccurate assessments.

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