Correct Answer: B

Rationale: Dental caries is not a specific complication commonly associated with heroin use. Dental issues may result from other substances or lifestyle factors. Perforation of the nasal septum is a complication associated with the intranasal use of heroin. Chronic snorting or sniffing of heroin can damage the nasal septum, leading to a perforation. Permanent effects on short-term memory loss are more commonly associated with the use of substances like cannabis or certain hallucinogens. Heroin use is not typically linked to permanent effects on short-term memory. Pancreatitis is not a commonly reported complication of heroin use. Pancreatitis is more commonly associated with alcohol use disorder and gallstone-related issues.

Correct Answer: A,D,E,F,G

Rationale: A. Sodium level: Abnormal sodium levels can have serious consequences, including neurological symptoms. Immediate follow-up is necessary to assess and manage electrolyte imbalances, as severe cases can lead to complications such as seizures. B. Phosphate level: While phosphate levels are important to monitor, they may not require immediate follow-up unless severe abnormalities are present. Severe phosphate imbalances can occur in the context of malnutrition, but they may not necessitate immediate intervention in the ED unless critical. C. Magnesium level: Similar to phosphate, magnesium levels are crucial but may not demand immediate follow-up unless severe abnormalities are detected. While magnesium imbalances can occur in eating disorders, the urgency depends on the extent of the imbalance. D. Respiratory rate: Rapid or abnormal respiratory rates can be indicative of respiratory distress, which may occur in individuals with severe anorexia nervosa. Monitoring and addressing respiratory issues promptly are crucial for the client's respiratory function. E. Capillary refill: Capillary refill is included in the list of findings that require immediate follow-up. Prolonged capillary refill time indicates potential issues with peripheral perfusion and warrants prompt attention to assess and address any circulation concerns. F. Blood pressure: Abnormal blood pressure, especially low blood pressure, can indicate cardiovascular compromise, which is a concern in severe cases of anorexia nervosa. Monitoring and addressing abnormal blood pressure promptly are essential for the client's well-being. G. Glucose level: Anorexia nervosa can lead to hypoglycemia, and low glucose levels can result in various complications, including neurological symptoms. Immediate follow-up is necessary to assess and manage glucose levels for the well-being of the client.

Correct Answer: D

Rationale: Diazepam (Valium) is a benzodiazepine used for anxiety. While benzodiazepines can cause sedation and might carry a risk of dependence, they are not typically associated with an increased risk of suicidal ideation compared to antidepressants. Diphenhydramine (Benadryl) is an antihistamine that might cause drowsiness and sedation. It's not primarily used for anxiety disorders, and it's less associated with increased suicidal risk compared to antidepressants. Propranolol (Inderal) is a beta-blocker used for treating conditions like hypertension and anxiety disorders. It's not typically associated with an increased risk of suicide compared to antidepressants. A client who has obsessive-compulsive disorder and takes fluoxetine (Prozac). Fluoxetine (Prozac) is an antidepressant that belongs to the class of medications called selective serotonin reuptake inhibitors (SSRIs). While it's effective for treating OCD, when initiating or adjusting the dosage of an antidepressant like fluoxetine, there can be an increased risk of suicidal ideation or behavior, especially in younger individuals. This risk is particularly prevalent in the initial weeks of treatment or when there are dosage changes.

Correct Answer: A

Rationale: I should sit on the side of the bed before standing up in the morning.' Amitriptyline is a tricyclic antidepressant that can cause orthostatic hypotension, a sudden drop in blood pressure upon standing.
To minimize the risk of dizziness or fainting, clients taking amitriptyline should be advised to sit on the side of the bed for a few moments before standing up, especially in the morning when orthostatic changes may be more pronounced. 'I may experience an increased libido.' This statement is not related to the common side effects of amitriptyline. Changes in libido are not typically associated with this medication. 'I will avoid drinking caffeinated beverages.' While it's generally a good idea to limit caffeine intake, this statement is not a specific instruction related to amitriptyline. However, reducing caffeine consumption can be beneficial because amitriptyline may enhance the stimulant effects of caffeine. 'I can no longer eat pepperoni pizza.' This statement is not directly related to amitriptyline. There are no specific dietary restrictions associated with amitriptyline use, and the client can continue to eat pepperoni pizza unless there are individual dietary concerns or interactions with other medications.

Correct Answer: C

Rationale: Everyone has trouble sleeping at times' minimizes the client's concerns and may not address the underlying issues contributing to their anxiety. 'Why do you think you are so anxious?' might come across as judgmental or confrontational, and it may not create a supportive environment for the client to open up about their feelings. 'Have you talked to your provider about this yet?' This response encourages the client to seek professional help and addresses the issue of increasing anxiety and difficulty sleeping. It is supportive and guides the client toward discussing their concerns with a healthcare provider who can assess the situation and provide appropriate interventions. 'It sounds like you're having a difficult time' acknowledges the client's distress but does not guide them toward seeking professional help. Encouraging a conversation with a healthcare provider is a more direct and helpful approach.