Correct Answer: B

Rationale: This option is not the first priority because while addressing anorexia nervosa is important, safety concerns related to the suicide attempt and potential substance abuse take precedence. Making a weight gain contract requires the client's cooperation and readiness, which may not be feasible immediately upon admission. This is the most appropriate initial action. One-to-one observation ensures constant monitoring of the client's safety and prevents further harm, such as another suicide attempt or self-harm. Given the client's history of depression and recent suicide attempt, ensuring their safety is paramount. While assessing the severity of depression is crucial, it is secondary to ensuring immediate safety in this context. The client's safety must be established first through continuous observation and intervention. While important to understand the substances involved in the suicide attempt, this action is secondary to ensuring ongoing safety through direct observation.
Toxicology results can guide subsequent treatment decisions but are not as urgent as immediate safety measures.

Correct Answer: A

Rationale: ECT is often considered for severe major depression that has not responded to other treatments, especially when there is a risk of suicide. ECT can provide rapid relief of symptoms, which is crucial in cases where immediate intervention is needed to prevent harm to the patient. While ECT is generally safe for individuals with medical conditions, including heart disease, special precautions might be needed. However, the presence of heart disease alone would not necessarily preclude ECT if the benefits outweigh the risks and if the client's cardiac status is stable. Dysthymic disorder, characterized by persistent depressive symptoms that are less severe than major depression, typically does not warrant ECT. ECT is usually reserved for more severe forms of depression that significantly impair daily functioning or pose a risk to the patient's safety. ECT may be contraindicated or require careful consideration in clients with brain metastasis due to potential risks related to increased intracranial pressure or neurological complications. Alternative treatments may be preferred in such cases.

Correct Answer: D

Rationale: Dissociative amnesia is characterized by significant memory loss that cannot be explained by ordinary forgetfulness. If a client experiences sudden travel and cannot remember how they arrived at a distant location, it could indicate dissociative amnesia. Hospitalization is not absolutely necessary. Dissociative disorders are primarily treated with psychotherapy rather than medication adjustments. However, if medication adjustments are necessary for co-occurring conditions or to manage symptoms like anxiety or depression, hospitalization is not necessary. Monitoring of identities is typically done on an outpatient basis, unless there are additional complications or risks identified by a healthcare professional. Dissociative disorders, particularly post-traumatic stress disorder (PTS
D) and acute stress disorder, can involve the reliving of traumatic events through flashbacks, nightmares, or intrusive memories. Hospitalization may be required if the client experiences severe distress, is at risk of self-harm or harm to others during flashbacks.

Correct Answer: D

Rationale: Major depressive disorder is characterized by persistent feelings of sadness and loss of interest or pleasure in activities. It does not involve manic or hypomanic episodes, which are essential for diagnosing bipolar disorder. Dysthymic disorder involves chronic, low-grade depression that lasts for at least two years. It does not typically present with episodes of mania or hypomania. Personality disorders involve enduring patterns of behavior, cognition, and inner experience that deviate markedly from the expectations of the individual's culture. While some personality disorders can present with mood instability, the description of severe and sudden mood swings from mania to depression is not characteristic of personality disorders in general. Bipolar disorder is characterized by episodes of mania or hypomania (elevated, expansive, or irritable mood, increased energy, racing thoughts) alternating with episodes of depression (sadness, loss of interest, low energy). The mood swings can be severe, and the transition between mood states can occur suddenly.

Correct Answer: C

Rationale: Dysthymia is a type of persistent depressive disorder characterized by a depressed mood that lasts for at least two years. It typically involves emotional and behavioral symptoms rather than physical symptoms without clinical findings. Body dysmorphic disorder involves a preoccupation with perceived defects or flaws in physical appearance that are not observable or appear slight to others. While it involves body image concerns, it does not manifest as physical symptoms in the absence of objective findings. Somatoform disorders are characterized by physical symptoms that suggest a medical condition but cannot be fully explained by a general medical condition, another mental disorder, or substance use. Individuals with somatoform disorders often experience distress or impairment due to these symptoms despite medical reassurance that no physical cause can be found. Major depressive disorder primarily involves mood disturbances such as sadness, loss of interest or pleasure, and changes in appetite or sleep. While physical symptoms like fatigue and changes in weight can occur, they are not typically reported persistently without objective clinical findings as seen in somatoform disorders.