What is the best response for the nurse to make to an adolescent who states, "I am very sad.
I wish I wasn't alive.”.

Choice A rationale

Administering furosemide, a loop diuretic, is often utilized in the management of patent ductus arteriosus (PDA) to decrease pulmonary congestion. This medication works by inhibiting sodium and chloride reabsorption in the ascending limb of the loop of Henle, which promotes diuresis and reduces the fluid volume overload contributing to respiratory distress, but it is not the primary mechanism to close the defect. The newborn's vital signs, especially the tachypnea and mild desaturation, suggest significant pulmonary overflow that needs corrective intervention.

Choice B rationale

Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is a prostaglandin synthesis inhibitor which is the primary pharmacological treatment for closing a hemodynamically significant PDA in a premature infant. Prostaglandins, particularly PGE_2, maintain ductal patency, so blocking their production allows the ductus arteriosus to constrict and eventually close. The elevated pulse and respiratory rate in this newborn indicate a large left-to-right shunt requiring this specific closure therapy.

Choice C rationale

Initiating intravenous access is a necessary procedural step for administering medications like indomethacin or furosemide, but it is not the therapeutic "order" that directly addresses the pathophysiology of the PDA. Securing IV access is a prerequisite action for treatment, but Choice B represents the most critical therapeutic order to question for a patient presenting with symptomatic PDA and signs of pulmonary overcirculation.

Choice D rationale

While newborns with PDA often have increased caloric needs due to the work of breathing and potential heart failure, feeding a high-calorie formula every two hours is a supportive measure, not the urgent primary treatment. Furthermore, frequent, large feeds may exacerbate respiratory distress or necrotizing enterocolitis due to gut hypoperfusion in a severely compromised infant. The priority is to close the PDA and stabilize the cardiorespiratory status.

Choice A rationale

This statement reflects a classic symptom of anorexia nervosa known as body image disturbance or distortion. Individuals with this condition have a profound fear of gaining weight and perceive themselves as being overweight or fat, even when they are severely underweight. This distorted self-perception drives the restrictive eating and weight-loss behaviors.

Choice B rationale

Stating a desire to gain weight but being unable to is more consistent with a medical cause for weight loss or a chronic illness with resulting cachexia, or possibly a lack of nutritional knowledge. A key feature of anorexia nervosa is the intense fear of weight gain and a refusal to maintain a minimally normal weight, not an inability to gain weight.

Choice C rationale

While interest in modeling may be a motivation for some to maintain a certain physique, it is not a core diagnostic feature of anorexia nervosa. The central psychopathology of anorexia is the fear of gaining weight, body image distortion, and behaviors to prevent weight gain, not merely a career aspiration.

Choice D rationale

This statement, which expresses a fear of being poisoned, is a symptom of delusional thinking and is more consistent with a severe mental illness such as paranoid schizophrenia. While comorbid conditions can occur, intense fear of poisoning is not a defining or consistent diagnostic criterion for anorexia nervosa.