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A healthcare professional is assessing a client diagnosed with anorexia nervosa. Which of the following findings should the healthcare professional expect? Select one that doesn't apply.
- A. Amenorrhea
- B. Lanugo
- C. Hypotension
- D. Hyperkalemia
Correct Answer: D
Rationale: Findings in a client diagnosed with anorexia nervosa include amenorrhea, lanugo, hypotension, and bradycardia. Hyperkalemia is not typically associated with anorexia nervosa. In anorexia nervosa, electrolyte imbalances often lead to hypokalemia, which is low potassium levels, due to malnutrition and potential purging behaviors. Hyperkalemia, high potassium levels, is not a common finding in individuals with anorexia nervosa.
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A client with bipolar disorder is experiencing a depressive episode. Which of the following interventions should the nurse not implement?
- A. Agree with the client's delusions to avoid confrontation.
- B. Monitor for signs of suicidal ideation
- C. Promote a regular sleep schedule
- D. Discourage the expression of negative feelings
Correct Answer: A
Rationale: During a depressive episode in bipolar disorder, it is crucial not to agree with the client's delusions to avoid reinforcing false beliefs. Monitoring for signs of suicidal ideation is essential for safety. Promoting a regular sleep schedule can help stabilize mood. Discouraging the expression of negative feelings is not recommended as it is important to allow clients to express their emotions and feel heard.
A client is experiencing occasional feelings of sadness due to the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors?
- A. The client's behaviors demonstrate mental illness in the form of depression.
- B. The client's behaviors are extensive, indicating the presence of mental illness.
- C. The client's behaviors are not congruent with cultural norms.
- D. The client's behaviors demonstrate no functional impairment, indicating no mental illness.
Correct Answer: D
Rationale: In this scenario, the nurse should interpret the client's behaviors as not indicative of mental illness. The client is experiencing normal feelings of sadness following the loss of a pet, and the fact that the client's appetite, sleep patterns, and daily routine remain unchanged suggests no functional impairment. It is essential to recognize that experiencing occasional feelings of sadness in response to a significant life event, such as the death of a pet, does not necessarily signify mental illness, especially when there is no significant impairment in daily functioning. Choices A, B, and C are incorrect because they incorrectly suggest that the client's behaviors indicate mental illness, which is not the case in this context.
During an assessment of a client with suspected substance use disorder, which of the following findings should the nurse expect? Select one that doesn't apply.
- A. Feelings of hopelessness
- B. Increased tolerance to the substance
- C. Withdrawal symptoms when not using the substance
- D. Unsuccessful attempts to cut down or control use
Correct Answer: A
Rationale: In clients with substance use disorder, common findings include increased tolerance to the substance, withdrawal symptoms when not using it, and unsuccessful attempts to cut down or control use. Feelings of hopelessness are not typically a direct manifestation of substance use disorder. Instead, feelings of hopelessness may be associated with other mental health conditions or situational factors. Therefore, the correct answer is A. Choices B, C, and D are all expected findings in clients with substance use disorder.
When interviewing a distressed client who was fired after 15 years of loyal employment, which of the following questions would best assist the nurse in determining the client's appraisal of the situation? Select the one that does not apply.
- A. What coping resources have you used previously in stressful situations?
- B. Have you ever faced a similar stressful situation before?
- C. Who do you think is to blame for this situation?
- D. What do you believe led to your termination from your job?
Correct Answer: C
Rationale: In this scenario, it is crucial for the nurse to help the client assess their coping mechanisms and perspective on the situation. Questions A and B focus on exploring the client's coping resources and past experiences to guide them towards effective stress management. Asking who is to blame (choice C) is not conducive to evaluating coping abilities; instead, it might elicit a blame-focused response, which can impede progress. Choice D, inquiring about the reason for being fired, is a nontherapeutic approach that does not promote a constructive appraisal of the situation.
A healthcare professional is conducting education on anxiety and stress management. Which of the following should be identified as the most important initial step in learning how to manage anxiety?
- A. Diagnostic blood tests
- B. Awareness of factors creating stress
- C. Relaxation exercises
- D. Identifying support systems
Correct Answer: B
Rationale: The correct answer is B: Awareness of factors creating stress. In managing anxiety, the first crucial step is recognizing and being aware of the factors that contribute to stress. Without this awareness, it becomes challenging to effectively address and manage anxiety. Diagnostic blood tests are not typically the initial step in managing anxiety; they may be used to rule out other medical conditions but are not the primary focus. While relaxation exercises can be helpful in managing anxiety, understanding the root causes of stress takes precedence. Identifying support systems is important but comes after recognizing the stress factors to develop a comprehensive management plan.