A school-aged patient with attention-deficit/hyperactivity disorder is entering day treatment. During the initial office visit, the mental health nurse anticipates the patient will exhibit which of the following behaviors? Select all that apply.

A: The patient who is superficial in group therapy may not be engaging deeply with the therapeutic process, which can hinder their progress. However, this behavior does not pose an immediate threat to the safety of others or the therapeutic environment. It is important for the nurse to address this issue to encourage more meaningful participation, but it is not the most urgent concern.

B: The patient who threatens other patients presents an immediate risk to the safety and well-being of others in the unit. Threatening behavior can escalate to physical violence, causing harm to patients and staff. Addressing this behavior first is crucial to maintaining a safe and therapeutic environment. The nurse must intervene promptly to de-escalate the situation, ensure the safety of all individuals, and implement appropriate measures to prevent further threats.

C: The patient who is lying to others in the group can disrupt the trust and cohesion within the therapeutic setting. While honesty is important for effective therapy, this behavior does not pose an immediate danger. The nurse should address this issue to maintain the integrity of the group therapy process, but it is not as urgent as addressing threats of violence.

D: The patient who makes sexual jokes may be engaging in inappropriate behavior that can make others uncomfortable and disrupt the therapeutic environment. While this behavior needs to be addressed to maintain a respectful and professional atmosphere, it does not pose an immediate threat to safety. The nurse should intervene to correct this behavior, but it is not the highest priority compared to threats of violence.

The correct answer is:

A. Stabilize fluid, electrolyte levels, address dysrhythmia

B. Initiate adequate calories for age, height and metabolic need

C. Develop more effective coping skills to deal with anxiety

D. Verbalizes body shape and weight as normal and acceptable

Stabilize fluid, electrolyte levels, address dysrhythmia: This is the most urgent priority because imbalances in fluids and electrolytes, as well as dysrhythmias, can be life-threatening. Immediate medical intervention is necessary to stabilize the patient’s condition and prevent serious complications.

Initiate adequate calories for age, height and metabolic need: Once the patient’s immediate medical needs are addressed, the next priority is to ensure they receive adequate nutrition. This step is crucial for weight restoration and overall health improvement, which are essential for recovery from anorexia nervosa.

Develop more effective coping skills to deal with anxiety: After addressing the physical health concerns, the focus can shift to psychological aspects. Developing coping skills to manage anxiety is important for long-term recovery and preventing relapse. Anxiety often underlies eating disorders, so addressing it is key to comprehensive treatment.

Verbalizes body shape and weight as normal and acceptable: This outcome is important for the patient’s self-perception and long-term recovery. However, it is the least urgent compared to the immediate medical and nutritional needs. It can be addressed once the patient is medically stable and has begun to develop coping mechanisms.