The nurse is caring for a client whose BMI is 35 kg/m². Which condition(s) is/are the client at greatest risk of developing? Select all that apply.

• Chest pain: Blood clot embolism, especially pulmonary embolism, typically causes sudden chest pain due to obstruction of the pulmonary arteries. Fat embolism rarely causes chest pain as the primary symptom, though hypoxia may lead to discomfort. Chest pain is therefore more indicative of thrombotic embolism.

• Petechiae: Petechiae on the neck, upper chest, and conjunctiva are hallmark signs of fat embolism. They result from occlusion of dermal capillaries by fat globules and platelet aggregation. Blood clot embolism does not usually cause petechiae.

• Origin typically long bone fracture: Fat emboli commonly originate from fractures of long bones such as the femur, tibia, or pelvis. Trauma forces fat from the bone marrow into the bloodstream, creating emboli. Blood clot emboli generally do not arise from bone fractures.

• Altered mental status: Fat embolism can impair cerebral oxygenation, leading to confusion, lethargy, or agitation. This neurological involvement is a distinguishing feature of fat embolism. Blood clot embolism rarely affects mental status unless there is severe hypoxia.

• Dyspnea: Dyspnea occurs in both fat and blood clot embolism due to impaired oxygen exchange in the lungs. In fat embolism, hypoxia may develop gradually, while blood clot embolism often causes sudden shortness of breath. Both conditions require prompt respiratory support.

• Origin typically deep vein thrombosis: Blood clot emboli usually originate from deep veins in the legs or pelvis and travel to the lungs. Fat emboli are not associated with venous thrombi. Identifying the source helps differentiate between the two embolism types.

• Tachycardia: Tachycardia is a compensatory response to hypoxia or stress in both fat and blood clot embolism. It helps maintain oxygen delivery to vital organs. While nonspecific, its presence supports the need for urgent intervention in either condition.

A. Noncompliance with treatment regimen: While noncompliance can affect recovery, it is secondary to the immediate physiological risks posed by malnutrition. Addressing noncompliance becomes relevant after stabilizing the client’s health.

B. Disturbed Body Image: Distorted body image is a core psychological issue in anorexia nervosa, but it does not pose an immediate threat to the client’s life. Interventions targeting body image are important but not the first priority.

C. Interrupted Family Processes: Family dynamics may influence the client’s condition and recovery, yet they are not life-threatening. Family interventions are supportive and adjunctive to stabilizing the client’s nutritional status.

D. Imbalanced Nutrition: less than body requirements: Malnutrition directly threatens the adolescent’s physiological stability, affecting cardiovascular, gastrointestinal, and endocrine function. Correcting nutritional deficits and preventing complications such as electrolyte imbalance or organ failure is the highest priority in care planning.