A nurse in the emergency department is caring for a 14-year-old who has anorexia nervosa.

• The client was brought to the emergency department by a parent due to fainting at home earlier this evening.
• The parent reports that the client has been worried about their weight and has been refusing to eat.
• The parent also reports the client has been spending several hours at the local gym.
• Vital signs were obtained and labs were drawn as requested by the provider.

Which of the following 5 assessment findings require immediate follow-up?

Choice A rationale: Fear of rejection from staff is not typically a driving factor for the repetitive behaviors seen in OCD. While social anxiety can be a component of many mental health disorders, the compulsions in OCD are usually driven by intrusive thoughts or fears that are specific to the individual, rather than fears about social rejection.

Choice B rationale: Narcissistic Personality Disorder (NPD) is a separate condition from OCD. While individuals with NPD may exhibit certain repetitive behaviors, these are typically driven by a need for admiration and a lack of empathy for others, rather than the intrusive thoughts and fears that drive the compulsions in OCD12.

Choice C rationale: While certain medications can have side effects that might cause unusual behaviors, the repetitive behaviors (compulsions) seen in OCD are not typically a side effect of antidepressant medications. In fact, certain types of antidepressants are often used in the treatment of OCD12.

Choice D rationale: The repetitive behaviors observed in individuals with OCD, such as repeatedly applying, removing, and reapplying makeup, are indeed attempts to reduce anxiety. These individuals experience intrusive thoughts, fears, or images (obsessions) that cause significant anxiety. The repetitive behaviors (compulsions) are performed in an attempt to alleviate the distress caused by these obsessions. Despite the temporary relief, the individual often ends up trapped in a cycle of obsessions and compulsions.

Choice A rationale:

This response is dismissive of the client's concerns and does not acknowledge their feelings. It also implies that the client is not knowledgeable about their own condition. This could make the client feel defensive and less likely to share their concerns in the future.

It focuses on the medical facts of the diagnosis rather than addressing the client's emotional state. It may come across as patronizing or judgmental, further alienating the client.

Choice B rationale:

This response demonstrates active listening and empathy. It acknowledges the client's feelings and validates their concerns. This can help to build trust and rapport with the client.

It encourages the client to express their fears and worries, which can be therapeutic in itself.

It opens the door for further discussion about the client's concerns and provides an opportunity for the nurse to offer support and education.

Choice C rationale:

This response is reassuring, but it does not address the client's underlying concerns. It may also come across as dismissive or patronizing.

It relies solely on the medical chart to make a judgment about the client's concerns, without taking into account the client's own perspective.

It does not provide an opportunity for the client to express their fears and worries.

Choice D rationale:

This response is a deflection and does not provide the client with the support they need in the moment. It may also make the client feel like their concerns are not being taken seriously.

It shifts the responsibility for addressing the client's concerns to the provider, which may not be helpful if the client is already feeling anxious or uncertain.