Correct Answer: B

Rationale: Reacting to the nurse as though she were his mother is indicative of transference where the client projects feelings or attitudes from past relationships onto the nurse.

Correct Answer: C

Rationale: Post-meal monitoring prevents binge episodes addressing core behaviors of the disorder.

Correct Answer: D

Rationale: Sore throat is a priority finding for the nurse to report to the provider. Sore throat is a sign of infection,inflammation or irritation of the throat which can be caused by various factors such as viruses bacteria allergens or irritants. However,in a client who is taking clozapine sore throat can also indicate a serious and potentially fatal adverse effect of the medication: severe neutropenia. Neutropenia is a condition in which the number of neutrophils a type of white blood cell that fights infection is abnormally low. This increases the risk of developing serious and life-threatening infections especially in the mouth throat and respiratory tract. Clozapine can cause neutropenia in some patients especially during the first 18 weeks of treatment and it is the most common reason for discontinuing the medication.
Therefore any client who is taking clozapine and develops a sore throat should be evaluated by the provider as soon as possible to rule out neutropenia and initiate appropriate treatment if needed. The nurse should also educate the client on the importance of regular blood tests to monitor the absolute neutrophil count (AN
C) and the signs and symptoms of infection such as fever chills weakness or sore throat. The nurse should also instruct the client to avoid contact with people who are sick practice good hygiene and report any signs of infection immediately.

Correct Answer: C

Rationale: Sudden onset is a hallmark of delirium distinguishing it from other conditions like dementia.

Correct Answer: A

Rationale: Numbness indicates anhedonia a core symptom of clinical depression requiring provider evaluation.