A patient with antisocial personality disorder tells Nurse A, 'You're a much better nurse than Nurse B said you were.' The patient tells Nurse B, 'Nurse A's upset with you for some reason.' To Nurse C the patient states, 'You'd like to think you're perfect, but I've seen three of your mistakes this morning.' These comments can best be assessed as:

Correct Answer: D

Rationale: The correct answer is D: manipulative. The patient is using different strategies to manipulate each nurse's emotions and behavior for personal gain. In the first scenario, the patient is attempting to create a divide between Nurse A and Nurse B by praising Nurse A and implying Nurse B's incompetence. In the second scenario, the patient is trying to instigate conflict between Nurse A and Nurse B by falsely suggesting Nurse A's negative feelings towards Nurse B. In the third scenario, the patient is employing a manipulative tactic by undermining Nurse C's confidence and competence. These behaviors demonstrate a pattern of manipulation aimed at controlling and influencing the nurses' perceptions and actions. Choices A, B, and C do not accurately capture the manipulative intent behind the patient's actions.

Correct Answer: A

Rationale: The correct answer is A: Monitor for signs of electrolyte imbalances and dehydration. This is the priority assessment for a patient with bulimia nervosa who is experiencing frequent purging behaviors because purging can lead to electrolyte imbalances and dehydration, which can result in serious health complications such as cardiac arrhythmias and renal issues. Monitoring electrolyte levels and hydration status is crucial for the patient's safety and well-being. Summary: - Choice B is incorrect because focusing on weight gain and exercise habits is not the priority when dealing with the immediate health risks of electrolyte imbalances and dehydration. - Choice C is incorrect as expressing feelings about food and body image is important for therapy but not the priority in this acute situation. - Choice D is incorrect as monitoring for compulsive eating behaviors and binge episodes is more relevant for patients with binge eating disorder rather than bulimia nervosa with frequent purging behaviors.

Correct Answer: B

Rationale: The correct answer is B. Monitoring the patient's heart rate and electrolyte levels closely is crucial in managing electrolyte imbalances in patients with bulimia nervosa. Electrolyte imbalances, often caused by purging behaviors, can lead to serious complications like cardiac arrhythmias. Close monitoring allows for timely interventions such as electrolyte replacement therapy to prevent cardiac issues. A: Encouraging the patient to drink fluids and increase food intake is not the priority when dealing with electrolyte imbalances as it may worsen the imbalance. C: Providing high-protein foods may be beneficial for overall nutrition but does not address the immediate need to correct electrolyte imbalances. D: Instructing the patient to avoid physical exercise is not directly related to managing electrolyte imbalances and may not address the underlying issue effectively.

Correct Answer: B

Rationale: The correct answer is B because promoting gradual weight gain and nutritional rehabilitation is essential in treating anorexia nervosa. Rapid weight gain can lead to medical complications and mental distress. Providing a low-calorie diet (C) contradicts the goal of weight gain. Focusing on weight maintenance without discussing food intake (D) neglects the importance of nutrition in recovery.

Correct Answer: B

Rationale: The correct answer is B: To provide a structured meal plan and monitor food intake. This is crucial in the treatment of bulimia nervosa as it helps establish regular eating patterns, prevent binge episodes, and promote healthy nutrition. Providing structure and monitoring food intake also helps in addressing underlying psychological issues related to disordered eating. Encouraging purging behaviors (choice A) can worsen the condition and lead to serious health complications. Focusing solely on weight loss (choice C) may reinforce unhealthy behaviors and neglect the holistic approach needed for recovery. Offering therapy focused only on body image (choice D) overlooks the critical component of addressing eating behaviors and nutritional needs.