A nurse is preparing for an interprofessional team meeting regarding a newly admitted client who has major depressive disorder. Which of the following findings obtained during the initial assessment is the priority to report to other disciplines?
Significant weight loss
Markedly neglected hygiene
Psychomotor retardation
Poor problem-solving skills
The Correct Answer is A
Choice A reason:
Significant weight loss in a patient with major depressive disorder is a red flag for clinicians. It can signify a high risk of complications, including malnutrition, electrolyte imbalance, and weakened immunity. In the context of depression, it may also reflect a lack of self-care or even suicidal tendencies, which require immediate attention.
Choice B reason:
While markedly neglected hygiene is concerning and indicative of a patient's inability to perform daily self-care activities, it is not typically considered an immediate life-threatening issue. However, it does warrant intervention to prevent potential secondary infections or complications.
Choice C reason:
Psychomotor retardation is a symptom that can manifest in major depressive disorder, characterized by slowed physical movements and cognitive processing. Although it impacts the quality of life and daily functioning, it is not usually a direct indicator of an acute life-threatening condition.
Choice D reason:
Poor problem-solving skills are part of the cognitive symptoms of depression, affecting a patient's ability to manage daily tasks and make decisions. While this can significantly impact a patient's life, it is not as urgent as significant weight loss, which can have immediate physical health consequences.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Clozapine is an antipsychotic medication that can cause agranulocytosis, a potentially life-threatening condition that reduces the number of white blood cells and increases the risk of infection. A sore throat is a sign of infection and should be reported immediately. The other clients are not in immediate danger and can be seen later.
Correct Answer is B
Explanation
The correct answer is B. Allow the client unlimited time for the grieving process.
Choice A reason:
Changing the subject when the client becomes upset may prevent the client from expressing their feelings and could hinder their emotional processing. This is not a recommended approach as it may lead to unresolved grief and emotional distress.
Choice B reason:
Allowing the client unlimited time for the grieving process aligns with the principles of palliative care, which focuses on enhancing a patient's quality of life and providing relief from the symptoms and stress of serious illness. It's important to give the client the time and space they need to process their emotions.
Choice C reason:
Discouraging the client from forming new relationships could lead to social isolation and negatively impact their emotional well-being. It's important for the client to have a support system during this difficult time.
Choice D reason:
Offering advice about various treatment choices is not the nurse's role. The nurse should provide information and support, but the decision-making should be patient-centered. It's important to respect the client's autonomy and decisions regarding their care.
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