A nurse is reviewing the medical record of a 50-year-old male client who has schizophrenia in an inpatient mental health facility

Exhibits

Which of the following findings should the nurse report to the provider? (Select all that apply.)

Choice A rationale

Asking "Do you feel like your anger is becoming more manageable?" directly assesses the client's subjective experience of their anger levels. This is a crucial indicator of the treatment's effectiveness as it reflects the client's internal perception of change in their emotional regulation. While objective measures are also important, the client's self-report provides valuable insight into the practical impact of therapy on their daily life.

Choice B rationale

Asking "What do you do when something makes you angry?" explores the client's behavioral responses to anger-provoking situations. While this provides information about their coping mechanisms, it doesn't directly evaluate whether their anger is becoming more manageable overall. The client might still be engaging in maladaptive behaviors even if they are learning new strategies.

Choice C rationale

Asking "Did you learn any coping strategies from your counselor?" assesses the client's acquisition of new skills taught in therapy. While learning coping strategies is a goal of anger management, it doesn't necessarily indicate that the client is effectively applying these strategies or experiencing a reduction in the intensity or frequency of their anger.

Choice D rationale

Asking "Have you been attending your anger management group?" evaluates the client's adherence to the treatment plan. While attendance is important for progress, it doesn't directly measure the effectiveness of the therapy itself. A client may attend sessions without actively engaging or experiencing a reduction in their anger.

Choice A rationale

Tooth erosion occurs in clients with anorexia nervosa due to the frequent vomiting associated with bulimic behaviors, which can be present in some individuals with anorexia. Gastric acid erodes tooth enamel over time, leading to sensitivity, discoloration, and decay. This is a direct physiological consequence of repeated exposure to stomach acid.

Choice B rationale

Hypotension, or low blood pressure, is a common finding in anorexia nervosa. Reduced food intake leads to decreased body mass and lowered metabolic rate. This can result in decreased cardiac output and peripheral vasodilation, causing systolic blood pressure below the normal range of 90-120 mmHg and diastolic blood pressure below 60-80 mmHg.

Choice C rationale

Diarrhea is not a typical finding in anorexia nervosa. Constipation is more common due to decreased food intake and slowed gastrointestinal motility. While laxative abuse can cause diarrhea, it is not a primary expectation in anorexia nervosa itself.

Choice D rationale

Cold extremities are often present in clients with anorexia nervosa due to poor circulation and a decreased metabolic rate. The body conserves energy by reducing blood flow to the periphery, leading to cold hands and feet. This is a physiological adaptation to conserve core body temperature in the face of inadequate caloric intake.

Choice E rationale

Lanugo, a fine, downy hair, can develop on the face and body of individuals with anorexia nervosa. This is a physiological response to significant weight loss and decreased body fat, as the body attempts to conserve heat. It is similar to the hair seen on newborns and is a sign of the body trying to insulate itself.