Which nursing intervention has the highest priority for a patient who is diagnosed with anorexia nervosa and has begun to gain weight?

Observe for adverse effects of refeeding.

Communicate empathy for the patient's feelings.

Help the patient balance energy expenditures with caloric intake.

Assess for depression and anxiety.

Answer and Explanation

The Correct Answer is A

A. The highest priority is monitoring for refeeding syndrome, a potentially fatal complication when nutrition is reintroduced after prolonged starvation. It causes severe electrolyte shifts (especially hypophosphatemia, hypokalemia, and hypomagnesemia) and cardiac/respiratory complications.

B. Important, but not priority. Therapeutic communication builds trust, but physiological safety is the first concern.

C. Help the patient balance energy expenditures with caloric intake. – Useful long-term. This supports recovery but is not immediately life-saving.

D. Assess for depression and anxiety. – Necessary, but secondary. Mental health evaluation is part of holistic care, but immediate physical safety takes precedence.

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Correct Answer is B

Explanation

A. While laboratory tests are important for assessing electrolyte imbalances and liver function, they are not the immediate priority in acute alcohol withdrawal.

B. Acute alcohol withdrawal can rapidly lead to seizures and delirium tremens, which are life-threatening. Patient safety and prevention of injury are the priority.

C. Neurological assessment is important, but first ensuring the client’s safety from potential seizures takes precedence.

D. IV access is necessary for fluid or medication administration, but it follows implementing immediate safety measures.

A. bleeding B. pancreatitis C. dysrhythmias D. cataracts

Correct Answer is C

Explanation

A. Haloperidol is not commonly associated with bleeding; this is more relevant to anticoagulants or antiplatelet therapy.

B. Pancreatitis is more commonly associated with certain antipsychotics like clozapine or valproate, not haloperidol.

C. Haloperidol, a typical antipsychotic, can prolong the QT interval and cause cardiac dysrhythmias, especially in higher doses or IV administration. Monitoring ECG and cardiac status is important.

D. Cataract formation is a potential adverse effect of long-term use of atypical antipsychotics such as quetiapine or olanzapine, not haloperidol.

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Which nursing intervention has the highest priority for a patient who is diagnosed with anorexia nervosa and has begun to gain weight?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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