Correct Answer: C,D

Rationale: C. Hypochondriasis can strain interpersonal relationships due to excessive preoccupation with health concerns, frequent doctor visits, and seeking reassurance from others. D. Hypochondriasis often follows a chronic course with periods of intense anxiety about health alternating with periods of relative calm. Despite reassurances and negative medical tests, individuals with hypochondriasis may continue to worry about their health. A. Hypochondriasis typically develops in adulthood rather than childhood. It involves persistent anxiety about health and the interpretation of normal bodily sensations as signs of serious illness. Childhood is less commonly associated with the onset of hypochondriasis. B. While stress can exacerbate symptoms of hypochondriasis, it is not typically diagnosed immediately following a specific stressor. The disorder often develops gradually over time due to a combination of factors, including anxiety, personality traits, and past experiences with illness. E. There is no consistent evidence suggesting that exposure to serious illness in childhood predisposes individuals to hypochondriasis. The disorder is more associated with individual psychological factors, cognitive biases, and anxiety sensitivity rather than childhood illness exposure.

Correct Answer: A

Rationale: Anxiety is characterized by feelings of worry, fear, and apprehension about future events or uncertain outcomes. In this situation, the client's concerns about her husband's chronic illness diagnosis, his treatment, and financial implications (due to his inability to work) indicate that she is experiencing anxiety. These worries are typical responses to stressful life events and uncertainties. Shock is a sudden and intense emotional reaction typically experienced immediately after a traumatic or unexpected event. While the client may initially experience shock upon hearing her husband's diagnosis, ongoing worry about treatment and financial concerns suggests a more prolonged state of anxiety rather than acute shock. Withdrawal refers to a disengagement or retreat from social interactions or activities. There is no indication in the scenario that the client is withdrawing from social interactions. Rather, she is actively expressing concerns and seeking support, which is inconsistent with withdrawal. Anger involves feelings of hostility, frustration, or resentment towards others or situations. While anger could potentially arise in response to the stressors described, the primary emotion expressed by the client in this scenario is worry and concern, which aligns more closely with anxiety than anger.

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.

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: D

Rationale: While this is an important goal for improving self-esteem and mood, it may not be the highest priority when the client's safety is at risk. This goal focuses on future planning and motivation, which is important for recovery but may not be as urgent as ensuring immediate safety. Understanding one's grief process is important for emotional healing, but it is not typically as critical as ensuring safety in the immediate term. This goal addresses the immediate safety and well-being of the client. Depression, especially severe depression, can increase the risk of suicidal ideation and behaviors. It is crucial to ensure the client's safety and have measures in place for her to reach out for help if she feels overwhelmed or unsafe.