Which assessment finding for a client diagnosed with an eating disorder meets a criterion for
hospitalization? Select one:
Pulse rate: 55 beats/min
Serum potassium: 3.5 mEq/L
Systolic blood pressure: 62 mm Hg
urine output: 90 ml/3 hr.
The Correct Answer is C
A systolic blood pressure of 62 mm Hg indicates severe hypotension and is a medical emergency. This is a life-threatening situation that requires immediate hospitalization for stabilization and treatment. Clients with eating disorders are at risk of electrolyte imbalances, cardiac complications, and other medical complications due to malnutrition and dehydration. While the other options are also abnormal findings, they are not as severe as the critically low blood pressure measurement. Therefore, the priority for hospitalization would be the client with severe hypotension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This response acknowledges the client's distress and opens the opportunity for the client to express their feelings and concerns. It also demonstrates empathy and a willingness to listen, which can help deescalate the situation and build trust between the nurse and client.
Option a ("Others are being distracted; Please, quiet down and go to your room") is dismissive of the client's feelings and may further escalate the situation.
Option c ("Please go to your room to get control of yourself") is directive and may be perceived as confrontational, potentially increasing the client's agitation.
Option d ("What's going on? Be quiet") is insensitive and dismissive of the client's distress and may further agitate the client.
Correct Answer is A
Explanation
Clonazepam is a benzodiazepine medication that acts quickly to reduce anxiety and promote relaxation. It is commonly used as a PRN medication for acute anxiety episodes.
Amitriptyline (Elavil) is a tricyclic antidepressant that is not typically used as an as-needed anxiolytic medication due to its slow onset of action and potential for side effects.
Olanzapine (Zyprexa) is an atypical antipsychotic medication that can be used to treat anxiety in certain cases, but it is not typically used as a PRN medication for acute anxiety episodes.
Escitalopram (Lexapro) is a selective serotonin reuptake inhibitor (SSRI) antidepressant that is not typically used as an as-needed anxiolytic medication due to its slow onset of action. It is usually taken on a daily basis to provide ongoing anxiety relief.
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