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Exam NCLEX-RN topic 6 question 84 discussion

Actual exam question from Test Prep's NCLEX-RN
Question #: 84
Topic #: 6
[All NCLEX-RN Questions]

A client who has been diagnosed with anorexia nervosa refuses to eat lunch. The most therapeutic response by the nurse to her refusal is:

  • A. "Okay, missing one meal won’t hurt."
  • B. "You’ll have to eat lunch, or we’ll force-feed you."
  • C. "It’s not appropriate for you to try to manipulate the staff into granting your wishes."
  • D. "We will not allow you to starve yourself. You may choose to eat voluntarily or be fed."
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Suggested Answer: D 🗳️
(A) This response reinforces the clients maladaptive behavior, thereby contributing to the clients risk. (B) Ultimatums are not therapeutic. (C) This comment invites an argument because it puts the client on the defensive and stabs at her self-esteem, which is already compromised. (D) Setting limits assures the client that staff has genuine concern for her safety and well-being. Giving her an actual choice will give the client an increased sense of control over her life and avoid an argument or power struggle.

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