A nurse is preparing to administer a measles, mumps, and rubella (MMR) immunization. Which of the following client characteristics is a contraindication to administration?

Rationale:

A. Paranoid personality disorder: This disorder is marked by distrust and suspicion of others, but it is not closely associated with the development of anorexia nervosa. It does not typically involve the rigid control over food and body image seen in eating disorders.

B. Schizotypal personality disorder: While schizotypal personality disorder involves social anxiety and eccentric behaviors, it is more aligned with psychotic spectrum disorders than with the rigid and perfectionistic traits commonly seen in anorexia nervosa.

C. History of attention deficit hyperactivity disorder: ADHD may be more associated with impulsive eating behaviors and a higher risk for binge eating or bulimia nervosa, rather than the restrictive and perfectionistic traits seen in anorexia nervosa.

D. History of obsessive-compulsive disorder: OCD is a significant risk factor for anorexia nervosa due to the overlap in obsessive thoughts and compulsive behaviors. Individuals with OCD often display rigid routines, perfectionism, and intrusive thoughts about food, body image, and control—all of which are common features in anorexia.

Rationale:

A. "Controlled substances are kept in the bottom drawer of the medication cart.": Controlled substances are stored in locked, secure medication dispensing systems or locked drawers—not casually in the bottom drawer. Security measures are in place to prevent diversion and ensure accurate tracking.

B. "I should verify the number of controlled substances at the end of the shift. The provider is responsible for inventory of controlled substances.": While end-of-shift counts are standard practice, the nurse not the provider is responsible for verifying inventory at shift change. Accountability for handling and documenting controlled substances lies with nursing staff.

C. "If a controlled substance requires a waste, a second nurse must witness the waste.":
This is a correct and essential safety protocol. When wasting part of a controlled substance dose, a second licensed nurse must witness and document the waste to prevent diversion and ensure accurate medication tracking.

D. "Computer controlled substance inventory is reported to the Drug Enforcement Administration every 10 years.": Facilities are required to maintain records and conduct regular audits, and the DEA mandates inventory at least every 2 years not every 10. Reporting frequency and requirements are more stringent.