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1. A nurse in an outpatient clinic is reviewing the medical record of a clientwho has
anorexia nervosa.
Click to highlight the information in the client's medical record that indicatethe client's
,condition is deteriorating. To deselect information, click on the information again.
-QT prolongation
-Exercise regimen
-Hematemesis
-Temperature
-Laxative use
-BMI: QT prolongation is correct. The finding of QT prolongation in the client's ECG during
the second visit reveals cardiac complications of anorexia nervosa. Changes in electrolyte
levels can shorten or prolong the QT interval. This is an indication that the client's
condition is deteriorating.
Exercise regimen is correct. The client's purchase of exercise equipment and work- ing out
twice a day is a new manifestation of anorexia nervosa. This is an indication that the
client's condition is deteriorating.
Hematemesis is correct. New onset of hematemesis might be caused by esophagealirritation
or ulceration due to the increase in the frequency of induction of vom- iting. Continued
induction of vomiting can cause esophageal rupture. Therefore, hematemesis is an
,indication that the client's condition is deteriorating.
Temperature is incorrect. The client's temperature has remained within the expected
reference range. A decrease in body temperature with cool skin is an indication that the
client's condition is deteriorating.
Laxative use is incorrect. The client's cessation of the use of laxatives is an indicationthat the
client's condition is improving.
BMI is correct. The client's BMI decreased between visits, which indicates the client is
continuing to lose weight. This is an indication that the client's condition isdeteriorating.
2. A nurse is caring for an older adult client who has dementia and has wandered into
the day room looking for their deceased partner. Which of thefollowing actions should
the nurse take?
, a. Move the client to a room near the nurses' station.
b. Limit visitors until the client is oriented to the environment.
c. Tell the client that their partner is deceased.
d. Talk with the client about activities they enjoyed with their partner.: Ans- d. Talkwith
the client about activities they enjoyed with their partner.
Talking about positive experiences can help distract the client from their disorienta-tion
3. A nurse is caring for a client who has alcohol use disorder.Complete
the following sentence by using the list of options.
The client is at greatest risk for as evidenced by the client's .
Dropdown 1:
-Ineffective coping
-Dehydration
-Violent behavior
Dropdown 2:
-Agitation
-Loss of appetite