A nurse is caring for a client who has anorexia nervosa. Which of the following findings requires immediate intervention by the nurse?

Lanugo covering the body

+2 edema of the lower extremities

BUN 21 mg/dL

Blood pH 7.60

Answer and Explanation

The Correct Answer is D

A blood pH of 7.60 indicates alkalosis, which is a life-threatening condition that can result from vomiting, laxative abuse, or diuretic use in clients who have anorexia nervosa. Alkalosis can cause cardiac arrhythmias, seizures, coma, and death if not corrected promptly. The nurse should notify the provider and prepare to administer IV fluids and electrolytes as ordered. The other findings are also concerning, but they are not as urgent as alkalosis.

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Correct Answer is A

Explanation

Tell me the reasons you think your mother is depressed. This response shows empathy and active listening and invites the daughter to share more information about her mother's condition and behavior. The other responses are dismissive, inaccurate, or minimizing of the daughter's concern.

A. A client who has schizotypal personality disorder B. A client who has a history of alcohol use disorder C. A client who has moderate-stage Alzheimer's disease D. A client who has a history of dependent personality disorder

Correct Answer is C

Explanation

A client who has moderate-stage Alzheimer's disease may experience confusion, memory loss, wandering, agitation, and impaired judgment. Placing this client closest to the nurse's station can facilitate close observation and intervention, as well as reduce environmental stimuli that may trigger anxiety or disorientation.

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A nurse is caring for a client who has anorexia nervosa. Which of the following findings requires immediate intervention by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An older adult client is brought to the mental health clinic by her daughter. The daughter reports that her mother is not eating and seems uninterested in routine activities. The daughter states, "I'm so worried that my mother is depressed." Which of the following responses should the nurse make?

Correct Answer is A

Explanation

A charge nurse is making room assignments for new client admissions. Which of the following clients should the nurse place closest to the nurse's station?

Correct Answer is C

Explanation

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A nurse is caring for a client who has anorexia nervosa. Which of the following findings requires immediate intervention by the nurse?