Nurses' Notes
Client ate 80% of lunch with encouragement. Mild edema to hands, feet, and ankles. Client states, "It feels like my heart is jumping in my chest."
Graphic Results
BP 100/64 mm Hg
Pulse rate 58/min
Respiratory rate 16/min
Temperature 36.4° C (97.5° F)
SaO2 96%
BMI 16
A nurse is reviewing the medical record of a client who has anorexia nervosa. Which of the following findings should the nurse report to the provider?
Edema
Heart rhythm
Temperature
Intake
The Correct Answer is B
A client who has anorexia nervosa is at risk for cardiac arrhythmias due to electrolyte imbalances, dehydration, and malnutrition. The client's statement of feeling their heart jumping in their chest indicates a possible irregular heartbeat that should be reported to the provider. Edema, temperature, and intake are not as urgent as heart rhythm in this case.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Referring the client to a self-help group, such as Alcoholics Anonymous (AA), is an effective strategy to promote sobriety and prevent relapse after discharge. Self-help groups provide peer support, education, and coping skills for clients who have alcohol use disorder. Systematic desensitization is a behavioral therapy technique that is used to treat phobias, not alcohol use disorder. Contacting a close relative of the client may be helpful, but it is not a recommendation that the nurse can make without the client's consent and involvement. Buprenorphine is a medication that is used to treat opioid use disorder, not alcohol use disorder.
Correct Answer is ["A","D","E"]
Explanation
Positive symptoms of schizophrenia are those that add something to the normal experience, such as hallucinations, delusions, disorganized speech, and abnormal motor behavior. Flight of ideas is a type of disorganized speech that involves rapid switching from one topic to another. Delusions of grandeur are false beliefs of having superior power or status. Auditory hallucinations are hearing voices or sounds that are not real. Negative symptoms of schizophrenia are those that take something away from the normal experience, such as decreased motivation, impaired memory, flat affect, and social withdrawal.
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