A patient was admitted two weeks ago with depression and suicidal ideation. As the nurse monitoring the patient, what are some "covert" statements that would cause you concern?

"While I am here perhaps I could speak with the social worker to help me with my resume"

"I wont be a problem much longer"

"I am feeling so much better"

"I wish I were dead"

Answer and Explanation

The Correct Answer is B

Choice A reason: This statement is an overt sign of future-oriented thinking and a desire for rehabilitation. It indicates that the patient is engaging with the treatment team and planning for life after discharge, which is generally considered a positive prognostic sign in the recovery from a major depressive episode.

Choice B reason: This is a classic "covert" or indirect suicidal statement. It suggests that the patient has reached a decision or formulated a plan to end their life, thereby "resolving" their problems and the perceived burden they place on others, without explicitly stating the intent to commit self-harm.

Choice C reason: While a sudden improvement in mood can sometimes be a warning sign that a patient has made a firm decision to complete suicide, on its own, it is a clinical observation of affect rather than a "statement" of intent. It requires further investigation but lacks the specific veiled meaning of choice B.

Choice D reason: This is an "overt" or direct statement of suicidal ideation. The patient is clearly expressing a death wish. The question specifically asks for a "covert" statement, which refers to hidden or disguised meanings that require clinical intuition to identify the underlying risk of self-harm.

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Correct Answer is C

Explanation

Choice A reason: While some studies have suggested a statistical link between creativity and bipolar disorder, this observation does not provide scientific evidence for "genetic transmission." It reflects a possible correlation in phenotype or behavior rather than demonstrating a clear hereditary or genotypic pattern of inheritance for the disorder.

Choice B reason: Exaggerated responses to stress (emotional reactivity) may be a temperamental trait, but it is not specific evidence for the genetic transmission of bipolar disorder. Genetic evidence must specifically link the occurrence of the clinical diagnosis itself across generations within a family tree to be considered valid evidence.

Choice C reason: This statement accurately reflects findings from family, twin, and adoption studies. The risk for bipolar disorder is significantly higher among first-degree relatives of affected individuals compared to the general population. This familial aggregation is the primary clinical evidence supporting a strong hereditary and genetic component for the disorder.

Choice D reason: Socioeconomic and educational backgrounds are environmental and social factors. While early research once suggested a link between higher socioeconomic status and bipolar disorder, these findings have largely been debunked and do not contribute to the scientific understanding of the biological and genetic roots of the illness.

A. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia B. Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia C. Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss D. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia

Correct Answer is A

Explanation

Choice A reason: This diagnosis accurately reflects the patient’s clinical status. A 25% weight loss over 5 months indicates a severe nutritional deficit. The serum potassium level of 2.7 mg/dL confirms hypokalemia (normal range is 3.5 to 5.0 mg/dL), which is a common and dangerous complication of restricted intake and malnutrition in anorexia nervosa.

Choice B reason: This choice is incorrect because the patient’s potassium level of 2.7 mg/dL indicates hypokalemia, not hyperkalemia (high potassium). Additionally, while swollen parotid glands occur in purging-type anorexia, the question focuses on the "stopped eating" aspect and the resulting low potassium, making "imbalanced nutrition" the primary diagnostic focus.

Choice C reason: "Adult failure to thrive" is a multi-systemic decline often seen in the elderly, characterized by weight loss, decreased appetite, and social withdrawal. While this patient has weight loss, the specific psychiatric diagnosis of anorexia nervosa and the acute electrolyte crisis make "imbalanced nutrition" a more precise and clinically appropriate nursing diagnosis.

Choice D reason: "Disturbed energy field" is a nursing diagnosis related to the body's energy flow and is not grounded in the physiological data provided. Furthermore, this choice incorrectly labels the potassium level as hyperkalemia. The medical priority in this scenario is the physiological instability caused by starvation and severe hypokalemia.

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A patient was admitted two weeks ago with depression and suicidal ideation. As the nurse monitoring the patient, what are some "covert" statements that would cause you concern?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which response should the nurse provide?

Correct Answer is C

Explanation

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?

Correct Answer is A

Explanation

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