ATI RN
Age Specific Populations Questions
Question 1 of 5
A patient admitted to the eating disorders unit has yellow skin, the extremities are cold, and the heart rate is 42 bpm. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient is quiet during the assessment, saying only, 'I will not eat until I lose enough weight to look thin.' Select the best initial nursing diagnosis.
Correct Answer: D
Rationale: Rationale for Correct Answer (D): None of the above is the best initial nursing diagnosis because the patient's symptoms suggest a severe medical condition rather than psychological issues. The yellow skin, cold extremities, low heart rate, extreme low weight, and refusal to eat indicate severe malnutrition and possible organ failure. Therefore, the priority is to address the patient's immediate medical needs, such as restoring electrolyte balance and preventing further complications. Psychological assessments and diagnoses can follow once the patient's physical health is stabilized. Summary of Other Choices: A: Anxiety related to fear of weight gain - This choice focuses on psychological factors, but the patient's symptoms indicate severe physical malnutrition rather than anxiety. B: Disturbed body image related to weight loss - While body image issues may be present, the patient's critical medical condition takes precedence over psychological concerns. C: Ineffective coping related to lack of conflict resolution skills - This choice does not address the urgency of the patient's physical symptoms and is not the most
Question 2 of 5
What is the primary nursing intervention for a patient with anorexia nervosa who is refusing to eat?
Correct Answer: B
Rationale: The correct answer is B because providing firm encouragement and offering small, frequent meals is a supportive approach to help the patient with anorexia nervosa overcome their fear of eating. It helps in gradually reintroducing food, building trust, and establishing a healthier eating pattern. Offering rewards (A) may reinforce unhealthy eating behaviors. Enforcing strict diet control (C) can exacerbate control issues and worsen the patient's condition. Allowing the patient to skip meals (D) can perpetuate malnutrition and reinforce avoidance behaviors.
Question 3 of 5
The nurse is assessing a patient with anorexia nervosa. What is the most important physical examination finding to monitor?
Correct Answer: B
Rationale: The correct answer is B: Height and weight changes. In anorexia nervosa, monitoring height and weight changes is crucial as it reflects the patient's nutritional status and overall health. Weight loss and changes in height can indicate severe malnutrition and potential complications. Blood pressure and heart rate (choice A) can be affected by various factors in anorexia nervosa but may not directly reflect the patient's nutritional status. Skin turgor and hydration status (choice C) are important indicators of hydration levels but may not provide a comprehensive assessment of the patient's nutritional status. Respiratory rate and lung function (choice D) are important, but they may not be the most critical physical examination findings to monitor in anorexia nervosa.
Question 4 of 5
When planning nursing care for a client with a dependent personality disorder, the nurse recognizes which of the following as characteristic behavior for someone with this disorder? The client:
Correct Answer: B
Rationale: The correct answer is B because individuals with dependent personality disorder typically believe they cannot function without the help of others. This is a key characteristic of the disorder as they rely heavily on others for decision-making and day-to-day tasks. This behavior stems from an intense fear of separation and abandonment. Choice A (perceiving behavior as embarrassing) is incorrect as it is more aligned with social anxiety disorder rather than dependent personality disorder. Choice C (exaggerating dangers) is incorrect as it is more characteristic of individuals with anxiety disorders. Choice D (demanding excessive attention) is incorrect as it is more typical of individuals with histrionic personality disorder.
Question 5 of 5
A client with borderline disorder tells the nurse, 'It's hard to figure out who I am. Sometimes I'm sexually attracted to women and sometimes to men.' The nurse using Freudian concepts can analyze this as a developmental problem related to:
Correct Answer: C
Rationale: The correct answer is C: Impaired development of sexual identity during the phallic stage. According to Freudian theory, the phallic stage occurs around ages 3 to 6 and is when children become aware of their genitals. This stage is crucial for the development of sexual identity. In this case, the client's confusion about their sexual attraction to both men and women suggests a difficulty in establishing a clear sexual identity during this stage. This can lead to ongoing struggles with sexual orientation and identity. Choice A (Lack of separation-individuation) is incorrect because this concept is related to the development of individuality and autonomy, not sexual identity. Choice B (Isolation of affect during latency) is incorrect as it refers to a defense mechanism where emotions are separated from their associated ideas or events during the latency stage, not related to sexual identity development. Choice D (Overdevelopment of latency stage traits related to control issues) is incorrect because it focuses on traits related to the