Help Understanding Test Question

kermitlady · Jul 8, 2009

I'd say C b/c the underlying problem is that the patient perceives normal boday weight/shape as fat.

greeniebean · Jul 8, 2009

I would also say C. If this girl percieves herself as fat she isn't going to consume enough calories to maintain a normal weight. If you tackle the psychological problem first, then you can get her eating more.

Daytonite, BSN, RN · Jul 8, 2009

a client's disturbance of body image is evidenced by her claims of feeling "fat" even though she is emaciated. the outcome criterion for this target behavior would be:

a) consuming enough calories to sustain normal body weight.

b)ceasing a strenuous exercise program

c)

perceiving standard body weight and shape as normal

d) demonstrating an absence of preoccupation with food

this is an application type question that is testing your knowledge of not only the eating disorder, but of the nursing process and the specific nursing diagnoses. the definition of disturbed body image, the nursing diagnosis, is confusion in the mental picture of one's physical self (page 197, nanda international nursing diagnoses: definitions and classifications 2009-2011). you need to recognize that the patient stating something like, "i feel fat", would be a subjective cue or symptom (a defining characteristic) of that nursing diagnosis. emaciation would be an objective cue or symptom of the eating disorder itself. if you were developing a care plan for this patient for disturbed body image there would be many nursing interventions put in place for the patient statement of feeling "fat". outcomes are going to be what you predict will happen as a result of your nursing interventions. outcome statements can be written to include assessment criteria (how you will measurement or determine success) that are opposite to the abnormal assessment information initially obtained in arriving at the nursing diagnosis. all nursing diagnoses are based upon abnormal assessment criteria. therefore, it is logical that outcome criteria be normal. so, for this diagnosis, specifically, "c" perceiving standard body weight and shape as normal, is the measurement by which you will know that nursing interventions that targeted the statements about feeling fat have been successful and outcomes achieved.

it is important to know what the definitions and defining characteristics are for the various nursing diagnoses. not eating enough in order to reach the point of emaciation would be impaired nutrition: less than body requirements. consuming enough calories to sustain normal body weight is an outcome that would belong with a problem like impaired nutrition: less than body requirements.

llg, PhD, RN · Jul 8, 2009

I'm not so sure, Daytonite. Her body weight and shape are NOT normal as stated in the question. Therefore, if she were to perceive her current body weight and shape to be normal ... that would indicated a distorted sense of what is normal. "Emaciated" is not "normal" ... and that is how she was described in the question.

I believe that a very strong case can be made AGAINST answer "C."

I would chose "A" because it is a good, measurable, patient outcome goal. Something solid and concrete that can be tracked easily.

I would be tempted by "D" but reject it because the question did not say say she was pre-occupied with food (though we all know she probably is.)

I would reject "C" because her body weight and shape is NOT normal and therefore it would be inappropriate for her to think so.

I would reject "B" because the question made no reference to exercise (though we know she is probably trying to exercise as much as possible.)

That leaves me with no good reason to reject "A" ... and it would be a measurable thing to track to indicate that the patient was now engaging in appropriate behaviors.

Daytonite, BSN, RN · Jul 8, 2009

i believe that a very strong case can be made against answer "c."
i would chose "a" because it is a good, measurable, patient outcome goal. something solid and concrete that can be tracked easily. it would be a measurable thing to track to indicate that the patient was now engaging in appropriate behaviors.

i looked at all the answer choices and thought about a care plan that would be designed for this patient. consuming enough calories (a) has to do with impaired nutrition: less than body requirements. a strenuous exercise program (b) and preoccupation with food (d) are coping mechanisms and have to do with defensive coping or ineffective coping.

the question is very clear in saying a client's disturbance of body image is evidenced by her claims of feeling "fat"which would indicate that they are telling the student that the patient has already been diagnosed with disturbed body image, a nursing diagnosis, supported by the defining characteristic of feeling fat. clearly, they want to student to extrapolate that the nursing diagnosis here is disturbed body image r/t (misconception of appearance probably secondary to anorexia nervosa) aeb patient statement of feeling "fat". it asks what outcome criterion for this target behavior would be. the target behavior is feeling "fat". criterion means the standard, or measure, by which we will judge the outcome. the question is asking how we are to judge that something has been done successfully for the patient's symptom of feeling "fat". disturbed body image is a psychosocial diagnosis supported by psychosocial evidence (feeling "fat"). interventions and outcomes need to be psychosocial in nature as well. if the patient feels fat, consuming enough calories isn't going affect their feelings. you want interventions that are going to affect and change how the patient feels and thinks. the only answer choice that does that is c) perceiving standard body weight and shape as normal.

llg, PhD, RN · Jul 8, 2009

Oops. My mistake. I misread the question.

SolaireSolstice, BSN, RN · Jul 8, 2009

C is correct because the answer states : C) Perceiving standard body weight and shape as normal

STANDARD is the operative word. Not her CURRENT body weight.

ZanatuBelmont · Jul 8, 2009

I understand your reasoning, Daytonite ... I just think that it is not the best way to approach the question. "C" would be an inappropriate goal because it would indicate that the patient's body image was still distorted. To "convert" the patient from having one wrong body image to another equally wrong body image is not a good outcome. It's simply exchanging one body image distortion with another.
If the patient were to have a correct body image, she would see that she was emaciated (as stated in the question.) She would not see herself as "normal." Seeing that she was emaciated, she would see the need for more nourishment.
I believe the question is a poor one because the direct reasoning focused on the choice of diagnosis that you used leads the student (and you, an expert) astray -- to a stated goal based on equating "emaciated" with "normal." I believe that even a lot of faculty members would follow the same reasoning that you did and come up with the same problematic answer. To arrive at the "A" answer, you have to look at a 2-stage recovery process -- first, the establishment of a correct body image of emaciated -- then to the establishment of a health behavior, eating to maintain a healthy weight. That's a 2-step recovery and perhaps too complicated to include in such questions.

I agree with both of you. I agree with you because in real life, you would obviousy begin initiation of nutritional intervention first. I agree with Daytonite because in the NCLEX hospital - for test taking purposes - the question is asking about body image, not nutritional deficit. The NCLEX questions are geared as they are for a reason, to make sure we can comprehend the situation given to us and what we would do to resolve it. Learning to read "between the lines" is a big part of mastering NCLEX-style questions I've found.

vmoh18 · Jul 8, 2009

Thanks for all your help. The correct answer was C. So many in the class missed that one that the instructor may end up accepting A and C. She said she was going to look at again.

morte, LPN, LVN · Jul 8, 2009

Thanks for all your help. The correct answer was C. So many in the class missed that one that the instructor may end up accepting A and C. She said she was going to look at again.

i dont think she should, the question was about preception of body image....so you need to address that in the answer....consuming sufficient calories to maintain a normal wt, is one thing she is going to need to do to get there...

Daytonite, BSN, RN · Jul 9, 2009

I think this may go back to terminology and definition of the word "outcome", a discussion that has come up many times before here on the student forums. How do your instructors define the word outcome? Some programs make a clear distinction between goals and outcomes. Others do not and use the terms interchangeably.