A school registered nurse is speaking to the father of a 15-year-old male adolescent. The father has concerns about his son.
Which of the following statements by the mother should indicate to the nurse that the adolescent is at risk for suicide?

Choice A rationale: Brittle and thin hair is a common physical manifestation of anorexia nervosa. This is due to malnutrition, which affects the health and quality of hair.

Choice B rationale: The presence of soft, unpigmented hair on the arms (and other parts of the body) is known as lanugo.

It’s a type of fine hair that the body produces in response to severe malnutrition, often seen in cases of anorexia nervosa.

The body grows lanugo in an attempt to provide insulation and maintain body heat, due to the loss of insulating body fat.

Choice C rationale: Individuals with anorexia nervosa typically have a distorted body image and often perceive themselves as overweight, even when they are underweight.

Therefore, it’s unlikely for them to comment that they are too thin and need to gain weight.

Choice D rationale: Preoccupation with thoughts about food is a common psychological symptom of anorexia nervosa. Individuals with this disorder often spend a lot of time thinking about food, dieting, and body weight.

Choice E rationale: Feeling “too tired” and lacking interest in daily workouts can be a result of the physical exhaustion and weakness caused by severe calorie restriction and malnutrition in anorexia nervosa.

Choice F rationale: The client’s report of consuming around 600 calories per day is not provided in the question. Therefore, it cannot be evaluated.

In conclusion, the nurse should expect to find brittle and thin hair, soft unpigmented hair on the arms, preoccupation with thoughts about food, and lack of energy or interest in daily activities in a client with anorexia nervosa.

Choice A rationale:

Seclusion may be considered for a school-age client who repeatedly bites staff as a method of last resort to ensure the safety of both the client and staff.

It's important to exhaust other interventions first, such as verbal de-escalation, redirection, and medication.

If seclusion is used, it should be implemented under strict guidelines, with close monitoring and frequent reassessment to determine its effectiveness and necessity.

Choice B rationale:

Seclusion may be considered for an older adult client who is manic and agitated due to overstimulation, as it can provide a safe and quiet environment to reduce sensory input and promote calming.

However, it's crucial to carefully assess the client's physical and cognitive status, as seclusion can exacerbate confusion and disorientation in older adults.

Close monitoring and reassessment are essential.

Choice C rationale:

Seclusion may be considered for an adolescent client who throws objects at other clients to maintain safety and prevent harm to others.

It's important to first attempt other interventions, such as verbal de-escalation, redirection, and limit-setting.

If seclusion is used, it should be brief and implemented with therapeutic goals in mind, such as promoting self-regulation and problem-solving skills.

Choice D rationale:

Seclusion is contraindicated for an adult client after an interrupted suicide attempt.

This is because seclusion can increase isolation, hopelessness, and despair, which are significant risk factors for suicide.

It can also hinder close observation and monitoring of the client's mental state, potentially leading to further suicide attempts.

Instead, the focus should be on providing supportive, one-to-one contact, ensuring safety, and establishing therapeutic rapport to address the underlying issues that led to the suicide attempt.