Ms. C(an adolescent admitted for diagnostic evaluation and nutritional support related to anorexia nervosa)'s self-esteem and weight have gradually improved, but she continues to refer to herself as "fatty." She is able to appropriately verbalize an appropriate diet and exercise plan. What is the priority nursing diagnosis?

Correct Answer: C

Rationale: Even though Ms. C's self-esteem and weight have improved, her continued negative self-talk and use of derogatory terms like "fatty" indicate a distorted perception of her body image. This distortion needs to be addressed and corrected for her overall long-term psychological well-being. By focusing on addressing the disturbed body image, the nursing team can help Ms. C develop a more positive self-perception and maintain the progress she has made towards recovery from anorexia nervosa. It is important to prioritize interventions that promote a healthier and more realistic body image in order to support her ongoing recovery journey.

Correct Answer: D

Rationale: Arterial blood gases (ABGs) do not directly assess the client's electrolyte and fluid balance. ABGs primarily evaluate the client's acid-base balance and oxygenation status by measuring levels of pH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3) in the arterial blood. While ABGs can provide some information about blood parameters, such as oxygen saturation, they do not comprehensively assess electrolyte levels or fluid balance. To specifically assess electrolytes and fluid balance, additional tests like basic metabolic panels or comprehensive metabolic panels would be required.

Correct Answer: B

Rationale: In Stage I of Hodgkin's disease, the most commonly seen early symptom is usually unexplained fever and night sweats. Other common symptoms at this stage may include unexplained weight loss, itching, and enlarged lymph nodes in the neck, underarms, or groin. Chest and back pains, subnormal body temperature, and swelling of extremities are not typically early indicators of Stage I Hodgkin's disease.

Correct Answer: C

Rationale: Nurse Gina has to consider that most of the elderly are dependent on others financially. This is an important factor to take into account when planning and providing care for elderly patients. Many elderly individuals rely on financial assistance from family members, government programs, or retirement funds. Understanding the financial status of elderly patients helps nurses like Gina provide adequate care and support to meet their needs effectively. This can involve coordinating with social services or financial assistance programs to ensure that the patients' financial concerns are addressed along with their healthcare needs.

Correct Answer: B

Rationale: To assess the strengths and weaknesses of the organization, the nurse should employ a strategic plan. A strategic plan involves setting overall goals, objectives, and strategies for the organization. It provides a comprehensive framework for evaluating the current state of the organization, identifying areas of improvement, and aligning resources to achieve long-term success. By using a strategic plan, the nurse can conduct a thorough analysis of the organization's internal and external factors, including its strengths and weaknesses, to determine the most effective course of action for the future.