A nurse is assessing a client who has anorexia nervosa.
Which of the following findings should the nurse expect? (Select all that apply.).

Lanugo.

Bradycardia.

Diarrhea.

Hypotension.

Russell's sign.

Answer and Explanation

Correct Answer : A,B,E

Choice A rationale:

(Statement then rationale) Choice A is one of the correct options. Lanugo, fine hair growth on the body, is a common physical finding in individuals with anorexia nervosa. It occurs as a result of the body's attempt to conserve heat due to a lack of subcutaneous fat and can be considered a clinical sign of severe malnutrition.

Choice B rationale:

(Statement then rationale) Choice B is another correct option. Bradycardia, or a slow heart rate, is often seen in individuals with anorexia nervosa. The body's physiological response to severe malnutrition includes a slowed heart rate to conserve energy. Bradycardia is a result of the reduced metabolic demands and is a common cardiovascular finding in anorexia nervosa.

Choice C rationale:

(Statement then rationale) Choice C is not the correct option. Diarrhea is not typically associated with anorexia nervosa. Instead, individuals with this condition may experience constipation due to a reduced intake of food and fiber. Diarrhea is more commonly associated with other gastrointestinal disorders or conditions.

Choice D rationale:

(Statement then rationale) Choice D is also not the correct option. Hypotension, or low blood pressure, is not a common finding in individuals with anorexia nervosa. In fact, individuals with severe malnutrition may initially have normal or even elevated blood pressure. Hypotension is more commonly associated with conditions like dehydration or certain cardiac issues.

Choice E rationale:

(Statement then rationale) Choice E is the third correct option. Russell's sign is a finding in individuals with anorexia nervosa who engage in self-induced vomiting. It refers to calluses or abrasions on the knuckles or dorsum of the hand, resulting from the repetitive contact with the teeth while inducing vomiting. Recognizing Russell's sign is essential for assessing the severity of purging behaviors in individuals with anorexia nervosa. .

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Correct Answer is C

Explanation

Choice A rationale:

The Generalized Anxiety Disorder 7 (GAD-7) is not the appropriate assessment tool for measuring the severity and impact of depression in a patient with major depressive disorder (MDD). GAD-7 is specifically designed to assess generalized anxiety disorder, not depression. It asks questions related to anxiety symptoms, such as excessive worrying, restlessness, and irritability, which are different from the symptoms of depression.

Choice B rationale:

The Beck Anxiety Inventory (BAI) is not the appropriate assessment tool for measuring the severity and impact of depression. BAI is designed to assess the severity of anxiety symptoms, not depression. It includes questions about symptoms like nervousness, fear, and trembling, which are more related to anxiety rather than depression.

Choice D rationale:

The CAGE questionnaire is not an appropriate tool for assessing the severity and impact of depression. The CAGE questionnaire is primarily used to screen for alcohol use disorder. It consists of questions related to alcohol consumption and is not relevant for evaluating depression in patients with major depressive disorder.

Choice C rationale:

The Patient Health Questionnaire-9 (PHQ-9) is the most suitable assessment tool for measuring the severity and impact of depression in a patient with major depressive disorder (MDD). The PHQ-9 is a self-administered questionnaire that assesses the nine core symptoms of depression. It includes questions related to mood, energy level, concentration, and thoughts of self-harm, making it a comprehensive tool for assessing depression. It is widely used in clinical practice and research to determine the severity of depression and monitor treatment outcomes.

A. Excessive motor activity. B. Failure to recognize familiar objects. C. Altered level of consciousness. D. Rapid mood swings.

Correct Answer is B

Explanation

A nurse is caring for a client who has Alzheimer's disease. Which of the following findings should the nurse expect? The correct answer is choice B: Failure to recognize familiar objects.

Choice A rationale:

Excessive motor activity Individuals with Alzheimer's disease typically exhibit a decline in motor activity rather than excessive motor activity. As the disease progresses, they may become less mobile and experience difficulties with movement due to cognitive and physical impairments.

Choice C rationale:

Altered level of consciousness While individuals with Alzheimer's disease may experience changes in cognitive function, including memory loss and confusion, they do not typically have altered levels of consciousness. They remain conscious and aware of their surroundings, but they struggle with recognizing familiar objects and people.

Choice D rationale:

Rapid mood swings Rapid mood swings are not a prominent feature of Alzheimer's disease. Mood changes are more commonly associated with other psychiatric conditions. In Alzheimer's disease, individuals tend to exhibit personality changes, such as becoming more withdrawn or agitated, but these changes are not rapid mood swings.

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A nurse is assessing a client who has anorexia nervosa.Which of the following findings should the nurse expect? (Select all that apply.).

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Correct Answer is B

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A nurse is assessing a client who has anorexia nervosa.
Which of the following findings should the nurse expect? (Select all that apply.).