A nurse on a mental health unit observes a diagnosed schizophrenic patient on antipsychotics having an impaired gait and uncontrollable tremors. The nurse should recognize that which of the following adverse effects may be occurring?

Choice A rationale:

Other than possible coordination problems, the client's psychomotor skills are not affected. Severe Intellectual Disability (ID) is characterized by significant limitations in intellectual functioning as well as adaptive behaviors. Coordination problems are not a primary characteristic of severe ID. The main focus is on cognitive and adaptive deficits.

Choice B rationale:

The client communicates wants and needs by "acting out behaviors." Severe ID can lead to challenges in effective communication. "Acting out behaviors" such as tantrums, aggression, or other disruptive actions might be the client's way of expressing themselves when they are unable to communicate verbally or effectively due to their cognitive limitations.

Choice C rationale:

The client can perform some self-care activities independently. Severe ID typically involves significant impairments in adaptive functioning, which includes self-care activities. The ability to perform some self-care activities independently is not consistent with the characteristics of severe ID.

Choice D rationale:

The client has advanced speech development. Severe ID is associated with delayed or impaired speech and language development. Advanced speech development would be contradictory to the diagnosis of severe ID, as this condition is characterized by substantial limitations in communication skills.

The correct answer is Choice D

Choice A rationale: Metrorrhagia, or irregular uterine bleeding, is not typically associated with anorexia nervosa. Instead, amenorrhea is more common due to hypothalamic suppression from low body fat and caloric intake. The hypothalamus reduces gonadotropin-releasing hormone (GnRH), leading to decreased luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which suppresses ovulation and menstruation. Estrogen levels fall below normal (typically 30–400 pg/mL), disrupting endometrial stability. Thus, bleeding is less likely than complete menstrual cessation.

Choice B rationale: Tachycardia is not expected in anorexia nervosa; bradycardia is more common due to metabolic adaptation and reduced cardiac workload. The body conserves energy by lowering heart rate, often below 60 bpm. Malnutrition leads to decreased thyroid hormone (T3), reduced sympathetic tone, and myocardial atrophy. Electrolyte imbalances and hypovolemia further depress cardiac output. Tachycardia may occur in refeeding syndrome or acute stress, but chronically, the heart rate is typically slow due to adaptive mechanisms.

Choice C rationale: Hyperkalemia is rare in anorexia nervosa; hypokalemia is far more common due to purging behaviors, vomiting, and diuretic or laxative abuse. Potassium levels often fall below the normal range of 3.5–5.0 mEq/L. Losses through the gastrointestinal tract and renal excretion lead to muscle weakness, arrhythmias, and fatigue. Intracellular shifts during starvation also contribute to low serum potassium. Hyperkalemia may occur transiently during tissue breakdown or renal failure but is not a hallmark finding.

Choice D rationale: Constipation is a frequent finding in anorexia nervosa due to decreased caloric intake, slowed gastrointestinal motility, and reduced fiber consumption. Starvation suppresses parasympathetic activity, leading to delayed colonic transit. Electrolyte imbalances, especially hypokalemia, further impair smooth muscle contraction. Normal bowel frequency ranges from three times per week to three times per day; anorexic clients often fall below this due to systemic hypometabolism. Constipation may also be exacerbated by dehydration and laxative dependence.