A client diagnosed with anorexia nervosa is newly admitted to an inpatient psychiatric unit. Which nursing intervention takes priority?

Choice A reason: A ventricular pacemaker stimulates the ventricles, producing a spike on the ECG before each QRS complex, indicating proper pacing and capture. This ensures the ventricles contract in response to the pacemaker’s electrical impulse, maintaining adequate cardiac output in clients with conduction issues.

Choice B reason: Pacemaker spikes after each P wave suggest atrial pacing, not ventricular pacing. Ventricular pacemakers target ventricular contraction, so spikes should precede the QRS complex, not follow the P wave, making this an incorrect indicator of proper ventricular pacemaker function.

Choice C reason: Pacemaker spikes with each T wave are not indicative of proper ventricular pacemaker function. T waves represent ventricular repolarization, and pacing at this phase is ineffective and potentially dangerous, as it does not initiate ventricular contraction, ruling out this option.

Choice D reason: Pacemaker spikes after each QRS complex indicate failure to pace appropriately, as ventricular depolarization has already occurred. Proper ventricular pacing requires spikes before the QRS to initiate contraction, making this an incorrect sign of a functioning ventricular pacemaker.

Choice A reason: Increased sleep may occur with sertraline due to its sedative effects, but it is not the priority assessment. Early in treatment, SSRIs can increase energy before mood improvement, heightening suicide risk, making suicidal ideation a more urgent concern.

Choice B reason: Sertraline, an SSRI, can initially increase energy in severe depression before fully improving mood, potentially increasing suicide risk. Assessing suicidal ideation is the priority to ensure safety, as this risk is highest early in treatment, requiring immediate intervention if present.

Choice C reason: Emotional changes are expected with sertraline as it improves mood over weeks. However, this is less urgent than assessing suicidal ideation, which poses an immediate safety risk, especially in severe depression during the early phase of SSRI treatment.

Choice D reason: Increased socialization may indicate improved depressive symptoms but is a secondary outcome. The priority is assessing suicidal ideation, as SSRIs can paradoxically increase suicide risk early in treatment due to improved energy without full mood stabilization, requiring vigilant monitoring.