A nurse is admitting an older adult client to the unit who has a suspected cognitive disorder. Which of the following inventories should be included as part of the admission assessment?

The correct answer is Choice D

Choice A rationale: Metrorrhagia, or irregular uterine bleeding, is not typically associated with anorexia nervosa. Instead, amenorrhea is more common due to hypothalamic suppression from low body fat and caloric intake. The hypothalamus reduces gonadotropin-releasing hormone (GnRH), leading to decreased luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which suppresses ovulation and menstruation. Estrogen levels fall below normal (typically 30–400 pg/mL), disrupting endometrial stability. Thus, bleeding is less likely than complete menstrual cessation.

Choice B rationale: Tachycardia is not expected in anorexia nervosa; bradycardia is more common due to metabolic adaptation and reduced cardiac workload. The body conserves energy by lowering heart rate, often below 60 bpm. Malnutrition leads to decreased thyroid hormone (T3), reduced sympathetic tone, and myocardial atrophy. Electrolyte imbalances and hypovolemia further depress cardiac output. Tachycardia may occur in refeeding syndrome or acute stress, but chronically, the heart rate is typically slow due to adaptive mechanisms.

Choice C rationale: Hyperkalemia is rare in anorexia nervosa; hypokalemia is far more common due to purging behaviors, vomiting, and diuretic or laxative abuse. Potassium levels often fall below the normal range of 3.5–5.0 mEq/L. Losses through the gastrointestinal tract and renal excretion lead to muscle weakness, arrhythmias, and fatigue. Intracellular shifts during starvation also contribute to low serum potassium. Hyperkalemia may occur transiently during tissue breakdown or renal failure but is not a hallmark finding.

Choice D rationale: Constipation is a frequent finding in anorexia nervosa due to decreased caloric intake, slowed gastrointestinal motility, and reduced fiber consumption. Starvation suppresses parasympathetic activity, leading to delayed colonic transit. Electrolyte imbalances, especially hypokalemia, further impair smooth muscle contraction. Normal bowel frequency ranges from three times per week to three times per day; anorexic clients often fall below this due to systemic hypometabolism. Constipation may also be exacerbated by dehydration and laxative dependence.

Choice A rationale:

Joining a bowling league 2 months ago indicates that the client is actively seeking social interactions and engaging in activities. While grief can manifest in various ways, joining a social activity does not necessarily indicate maladaptive grief. It's important for individuals to find ways to connect with others and continue living their lives after the loss of a loved one.

Choice B rationale:

Meeting his daughter for dinner every week demonstrates ongoing communication and emotional connection with family. This behavior suggests a healthy attempt at maintaining relationships and coping with the loss. Regular interactions with family members can be supportive during the grieving process.

Choice C rationale:

Keeping his partner's closet untouched since her death is a sign of maladaptive grief. This behavior suggests an inability to let go of personal belongings and move forward after a significant period of time. In healthy grieving, individuals usually work through their emotions and gradually start reorganizing their living spaces and personal items.

Choice D rationale:

Exercising at a local health facility 3 days each week indicates that the client is engaging in self-care and maintaining physical health. While exercise can be a coping mechanism, this behavior alone does not provide enough evidence to determine whether the client is experiencing maladaptive grief.