A nurse in an outpatient setting is caring for a client.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

Potential Condition

Bulimia nervosa: The client has a BMI of 18.5, which is on the lower end of normal, indicating possible weight issues, but not the severe underweight typical of anorexia nervosa. The client describes cycles of binge eating followed by compensatory behaviors such as purging (using laxatives), which are characteristic of bulimia nervosa. The client expresses a preoccupation with food and body weight, and feelings of embarrassment about their eating habits, which align with bulimia nervosa.

Actions to Take

1. Assess binging and purging patterns: It's crucial to understand the frequency, triggers, and methods of binging and purging to tailor interventions effectively and to monitor the severity and progression of bulimia.

2. Encourage client to identify triggers for overeating: Identifying triggers for binging can help the client develop healthier coping mechanisms and reduce the occurrence of binge eating episodes.

Parameters to Monitor

1. Electrolyte levels: Frequent use of laxatives and purging behaviors can lead to electrolyte imbalances, which are potentially life-threatening and must be monitored regularly.

2. Frequency of compensatory behaviors: Tracking the frequency of purging behaviors (such as laxative use) helps assess the effectiveness of interventions and the client’s progress in reducing harmful behaviors.

Incorrect answers:

Actions to Take:

Assess for and discourage provocative or seductive behaviour: This is more relevant to histrionic personality disorder, not bulimia nervosa.
Weigh daily for the first week: While weighing the client can be part of the monitoring process, daily weigh-ins can increase anxiety and may not directly address the core issues of bulimia.
Assess for consumption of right food items: While dietary intake is important, focusing solely on food items without addressing the psychological aspects may not be effective for treating bulimia.

Parameters to Monitor:

Attention-seeking behaviours: More relevant to histrionic personality disorder than bulimia nervosa.
Signs of infection: Not directly relevant unless there is evidence of a related health issue or a compromised immune system, which is not indicated in the provided information.
Presence of lanugo: Lanugo is more commonly associated with anorexia nervosa due to severe malnutrition, not bulimia.

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Correct Answer is B

Explanation

A. Ensuring that the client takes care of their ADLs to prevent dependence: While maintaining independence in activities of daily living (ADLs) is important, safety takes precedence because the client may not have the cognitive ability to perform ADLs safely.

B. Ensuring that the client environment is safe to prevent injury. Safety is the priority for clients with Alzheimer's disease due to their risk of confusion, disorientation, and falls. Creating a safe environment helps prevent accidents and injuries.

C. Ensuring that the client receives food they like to prevent anxiety: Providing familiar food can help reduce anxiety, but this is secondary to ensuring safety. The primary concern is to prevent injury in a client who may be disoriented or confused.

D. Ensuring that the client meets the other patients to prevent social isolation. While social interaction is beneficial, it is not the priority in the acute care setting for someone with Alzheimer's disease. The focus should first be on the client’s immediate safety and well-being.

A. Promoting social skills and communication development B. Administering medications to manage symptoms C. Implementing strict routines and schedules D. Providing sensory stimulation to reduce hyperactivity

Correct Answer is A

Explanation

A. Promoting social skills and communication development: This is a priority because individuals with Asperger's disorder often struggle with social interactions and communication. Interventions focus on improving these skills to enhance their quality of life and ability to function in society.

B. Administering medications to manage symptoms: While medications may be prescribed for co-occurring conditions (e.g., anxiety, ADHD), they are not typically the primary intervention for core symptoms of Asperger's disorder.

C. Implementing strict routines and schedules: Routine and structure can be beneficial for individuals with Asperger's disorder but are not the primary focus compared to social and communication skills.

D. Providing sensory stimulation to reduce hyperactivity: Sensory issues can be part of Asperger's disorder, but it is not the priority over social and communication development.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who is being admitted to the hospital with a neurocognitive disease due to Alzheimer's disease. Which action by the nurse is the priority?

Correct Answer is B

Explanation

A nurse is caring for a client in an adolescent unit. What is the nurse's priority when caring for a client with Asperger's disorder?

Correct Answer is A

Explanation

A nurse is caring for a client with an eating disorder. Which safety considerations should the nurse prioritize for a client with Binge eating disorder? (Select All that Apply.)

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A new student nurse is learning about Mental health. Which of the following should be stated as representation of a nursing intervention at the tertiary level of prevention in mental health?

A nurse is caring for an adolescent who is experiencing depression. Which of the following findings should the nurse expect? (Select all that apply.)

The nurse is preparing to discharge a client home from a mental health institution. The nurse should recognize that in order for a mental health client to receive home-bound health care, which of the following criteria must be met?

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A new nurse is teaching a nursing student in the mental health unit. The nurse explains that an example of a treatable (reversible) form of Neurocognitive disorder is caused by which of the following? (Select all that apply)