ATI RN
Age Specific Care Questions
Question 1 of 5
A patient has anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is 2.7 mg/dL. Which nursing diagnosis applies?
Correct Answer: D
Rationale: The correct answer is D: Imbalanced nutrition: less than body requirements related to refusal to eat, as evidenced by loss of 25% of body weight and hypokalemia. Rationale: 1. Anorexia nervosa involves severe restriction of food intake, leading to significant weight loss and malnutrition. 2. The patient's history of virtually stopping eating and losing 25% of body weight aligns with the nursing diagnosis of imbalanced nutrition. 3. Hypokalemia (low serum potassium level) is common in patients with anorexia nervosa due to inadequate intake or purging behaviors. 4. The other choices are incorrect because they do not match the patient's specific presentation of anorexia nervosa and hypokalemia.
Question 2 of 5
A client with an eating disorder that has resulted in weight loss to a point 15% below normal weight tells the nurse, 'I don't need to be hospitalized. I can control myself.' The nurse continues to prepare the client for hospitalization because the vicious cycle of eating disorder behavior is fueled by:
Correct Answer: A
Rationale: The correct answer is A: feelings of power and control resulting from weight loss. In clients with eating disorders, the behavior is often driven by a sense of control and power gained through weight loss. This reinforces the cycle of the disorder as the individual feels empowered by their ability to restrict food intake. This false sense of control becomes a driving force in the continuation of the disorder. Incorrect answers: B: Dysfunctional family dynamics may contribute to the development of an eating disorder, but in this scenario, the client's refusal for hospitalization is more related to their own sense of control rather than family dynamics. C: Faulty use of the defense mechanism projection is not the primary reason for the client's resistance to hospitalization in this case. D: Lack of superego constraints on behavior is not the main factor driving the client's refusal for hospitalization.
Question 3 of 5
Children should undergo further evaluation when their weight is % above their height.
Correct Answer: C
Rationale: The correct answer is C (20%). This is because a weight that is 20% above a child's height can indicate potential health issues such as obesity. Excess weight can lead to various health problems in children. Choices A, B, and D are incorrect as they represent lower percentages, which may not be as concerning in terms of potential health risks. It is important to consider a higher percentage threshold for further evaluation to ensure early detection and intervention for any weight-related issues.
Question 4 of 5
A nurse has completed the assessment for a patient who has a maladaptive response to eating regulation. Findings include the following: height, 5 feet 3 inches; current weight, 80 pounds with weight loss of 30% of body weight over the past 3 months; T, 96.6m F; BP, 68/40; P, 40; R, 20; poor skin turgor; lanugo; amenorrhea of 6 months' duration; admits to restricting intake to 350 calories daily; dissatisfied with eating pattern as evidenced by patient statement, 'I need to lose another 10 pounds to be at an ideal weight.' These assessment findings are most consistent with the medical diagnosis of:
Correct Answer: B
Rationale: The correct answer is B: Anorexia nervosa. The assessment findings align with the diagnostic criteria for anorexia nervosa, including significant weight loss, restrictive eating patterns, distorted body image, amenorrhea, and physical signs like poor skin turgor and lanugo. The patient's extreme weight loss, restrictive calorie intake, dissatisfaction with weight despite being underweight, and other physical and psychological symptoms are classic indicators of anorexia nervosa. Incorrect Choices: A: Bulimia nervosa involves binge eating followed by compensatory behaviors, which are not evident in this case. C: Binge-eating disorder involves recurrent episodes of binge eating without compensatory behaviors, which are not present here. D: Disturbed body image may be present in anorexia nervosa, but the key features of weight loss, restrictive eating, and amenorrhea are more indicative of anorexia nervosa.
Question 5 of 5
When should a child be assessed for a possible attention disorder as the primary condition?
Correct Answer: A
Rationale: In this scenario, the correct answer is A) A 7-year-old who speaks well and reads fluently but struggles to complete assignments on time and forgets to hand them in. This child displays symptoms commonly associated with attention disorders, such as difficulties with organization, time management, and completing tasks. It is important to assess this child for a possible attention disorder because these issues can significantly impact academic performance and social interactions. Option B) describes a 4-year-old who is exhibiting developmental delays in fine motor skills and attention span, which are more indicative of developmental delays rather than an attention disorder. Option C) depicts a 5-year-old who shows signs of possible autism spectrum disorder with social communication challenges, rather than symptoms specific to an attention disorder. Option D) describes a 6-year-old struggling with dyslexia-related difficulties, like letter reversals, which do not directly point to an attention disorder. Educationally, understanding the specific behaviors and symptoms associated with attention disorders in different age groups is crucial for early identification and intervention to support children's academic and social success. By recognizing these signs early on, educators and healthcare professionals can collaborate to provide appropriate strategies and resources to help children thrive in their learning environments.