Question

A nurse in a mental health facility is caring for a young adult client.

Answer 1

Correct Answers:

Experience with legal system since teenage years.
Relationship with family.
Acceptance of responsibility.
Substance use.

Rationale :

Experience with legal system since teenage years

🧠ASPD requires evidence of conduct problems before age 15 and a persistent pattern of rule-breaking into adulthood.

🧠A history of shoplifting, auto theft, and juvenile detention demonstrates early-onset conduct disorder, which is the developmental precursor to ASPD.

🧠Repeated arrests reflect disregard for social norms and laws, a core diagnostic theme.

🧠Continuing legal trouble in adulthood shows the pervasive and persistent nature of the behavior rather than isolated incidents.

🧠These features collectively align with DSM-5 criteria for ASPD.

Relationship with family

🧠Marked estrangement and inability to maintain stable, caring relationships are common in ASPD due to lack of empathy, exploitation, and manipulative interpersonal style.

🧠Distancing from family often stems from a pattern of violating others’ rights, hostility, and callousness, which undermine trust and attachment.

🧠Chronic conflictual interactions and limited remorse contribute to relational breakdowns that persist across settings.

🧠The social history here illustrates impaired attachment consistent with the disorder’s interpersonal domain.

🧠These relational deficits are not episodic; they are enduring traits central to ASPD.

Acceptance of responsibility

🧠Failure to accept responsibility and externalization of blame (e.g., “the judge has it out for me”) reflect lack of remorse and rationalization—signature cognitive patterns in ASPD.

🧠Such statements minimize harm and justify antisocial acts, supporting a pattern of deceitfulness and accountability avoidance.

🧠This cognitive style often coexists with aggression, irritability, and disregard for consequences, perpetuating legal and social problems.

🧠Persistent denial impedes therapeutic alliance and reduces engagement with treatment or rehabilitation efforts.

🧠These features are diagnostically salient for ASPD.

Substance use

🧠 Substance misuse (alcohol, cannabis) frequently co-occurs with ASPD, amplifying impulsivity, risk-taking, and aggressive behavior.

🧠Intoxication lowers inhibition, facilitating rule violations and criminal acts, which are already more likely in ASPD.

🧠Substance use can also serve as a maladaptive coping strategy in individuals with low frustration tolerance and sensation-seeking traits.

🧠The pattern strengthens the clinical impression of a pervasive, cross-situational dysfunction rather than isolated behaviors.

🧠While not diagnostic alone, in this context it supports the ASPD profile.

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Answer 2

Correct Answers:

Weight
Sodium level
Respiratory assessment
Temperature
Creatinine level

Rationale :

Weight:

➡️ The client’s weight increased from 34.5 kg (BMI 13) to 37.2 kg (BMI 14.1), showing gradual nutritional restoration — a hallmark of positive treatment response in anorexia nervosa.

➡️This weight gain indicates improved caloric intake, better metabolic balance, and adherence to the refeeding plan.

➡️Weight restoration helps reverse cardiovascular instability and multi-organ effects caused by chronic starvation.

➡️In anorexia care, safe and steady gain (0.5–1 kg/week) confirms therapeutic progress without refeeding complications.

Sodium level:

➡️ Serum sodium improved from 128 mEq/L to 130 mEq/L, reflecting better hydration and electrolyte correction.

➡️Hyponatremia in anorexia results from malnutrition, excessive water intake, or renal dysfunction.

➡️The rise demonstrates restored fluid-electrolyte homeostasis and effective nutritional and medical management.

➡️Maintenance of sodium within or trending toward normal range supports cellular integrity and neurological stability.

Respiratory assessment:

➡️ Respiratory findings improved from labored breathing to even, unlabored respirations with clear lung sounds, suggesting improved muscular strength, oxygen delivery, and metabolic recovery.

➡️In malnutrition, weakened respiratory muscles and decreased energy stores can impair ventilation.

➡️The current assessment indicates restored respiratory effort and tissue perfusion, key clinical outcomes in recovery.

Temperature:

➡️ The client’s body temperature increased from 35.6°C (96°F) to 36°C (97°F), reflecting improvement in metabolic rate and circulatory function.

➡️Hypothermia is common in anorexia due to loss of subcutaneous fat, low metabolism, and bradycardia.

➡️A stabilized temperature signals enhanced thermoregulation and nutritional rehabilitation.

➡️It also indicates improved perfusion to peripheral tissues.

Creatinine level:

➡️Creatinine decreased from 1.2 mg/dL to 0.9 mg/dL, indicating better renal perfusion and hydration as nutrition and circulatory volume normalize.

➡️Elevated creatinine initially reflected dehydration and catabolism of muscle protein.

➡️Normalization confirms improved renal function, fluid balance, and reduced metabolic stress.

➡️This biochemical progress complements clinical recovery indicators.

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Answer 3

Correct Answers:

Comorbidities in childhood
Treatment of animals
School history
Parental history

Rationale :

Comorbidities in childhood:

✔️The client’s prior diagnoses of ADHD at age 6 and conduct disorder (CD) at age 9 are strong predictors of antisocial personality disorder (ASPD) in adulthood.

✔️Early-onset behavioral disorders involving impulsivity, aggression, and defiance often evolve into chronic patterns of rule-breaking and disregard for social norms.

✔️These early comorbidities reflect neurobehavioral dysregulation and poor impulse control, foundational traits in ASPD.

✔️Identifying such patterns early is essential for preventive behavioral interventions and long-term management.

Treatment of animals:

✔️A history of animal cruelty is one of the cardinal diagnostic criteria for conduct disorder.

✔️It demonstrates a callous disregard for the suffering of others and an absence of empathy—core features that later manifest as interpersonal exploitation and aggression in antisocial personality disorder.

✔️This behavior signifies an early moral and emotional detachment, which escalates if untreated.

✔️ The client’s documented animal cruelty provides a clear developmental link between CD and ASPD.

School history:

✔️ Being expelled for possession of a weapon on school grounds indicates serious rule violations and disregard for authority, consistent with conduct disorder diagnostic features.

✔️Such behavior often includes aggression toward peers, truancy, and property destruction, all of which foreshadow the criminality, impulsivity, and hostility typical of ASPD.

✔️Early disciplinary action for violent conduct is a reliable red flag for later antisocial development.

Parental history:

✔️A family history of bipolar disorder, conduct disorder, and substance use disorder increases genetic and environmental vulnerability to behavioral dysregulation and antisocial traits.

✔️Parental neglect and unstable caregiving contribute to insecure attachment, poor emotional regulation, and learned maladaptive coping behaviors.

✔️This background fosters the developmental trajectory from conduct disorder in youth to antisocial personality disorder in adulthood, as seen in this client’s case.

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Answer 4

Correct Answers:

Frequent mood changes

Rationale :

🦋Hyperthyroidism increases circulating thyroid hormones (T3/T4), which stimulate the sympathetic nervous system and heighten metabolic and neuropsychiatric activity.

🦋Clients commonly exhibit mood lability, anxiety, irritability, and restlessness due to adrenergic overactivity.

🦋Sleep disturbance and poor concentration further amplify emotional volatility.

🦋Weight typically decreases despite increased appetite, and clients often have heat intolerance rather than cold sensitivity.

🦋Recognizing frequent mood changes helps the nurse monitor for worsening thyrotoxicosis and tailor low-stimulus care.

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Answer 5

Correct Answers:

Urine albumin increasing

Rationale :

🩺In progressing chronic kidney disease (CKD), there is ongoing glomerular damage, which increases albumin leakage into the urine (albuminuria/micro- to macro-albuminuria).

🩺Rising urine albumin is a key early marker of CKD progression and correlates with worse renal and cardiovascular outcomes.

🩺As CKD advances, GFR declines while serum creatinine and BUN rise—trends that align with increased protein loss in urine.

🩺Detecting increasing albuminuria prompts tighter blood pressure, glycemic, and RAAS blockade management to slow progression.

🩺Routine urine ACR (albumin-to-creatinine ratio) trending is recommended to risk-stratify and adjust therapy.

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Answer 6

Correct Answers:

Dehydration

Rationale :

💧Low urine volume from dehydration causes urinary solutes (e.g., calcium, oxalate, uric acid) to become supersaturated, greatly increasing crystal nucleation and stone growth.

💧Adequate hydration maintains urine output ≥2–2.5 L/day, which dilutes lithogenic substances and lowers stone recurrence.

💧Dehydration is a universal risk across major stone types (calcium oxalate, uric acid, cystine), making it the single most modifiable factor.

💧Counseling emphasizes consistent fluid intake throughout the day and extra fluids with heat/exertion to prevent concentrated urine.

💧Nurses reinforce urine color targets (pale yellow) and 24-hr urine goals as practical markers of adequate hydration.

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Answer 7

Correct Answers:

Spending time sitting with the client

Rationale :

🧠In severe depression, clients often have low energy, psychomotor retardation, and impaired decision-making, so simple, presence-based support is therapeutic.

🧠Sitting quietly communicates acceptance, safety, and unconditional positive regard, reducing isolation without demanding engagement.

🧠This approach aligns with Milieu therapy and therapeutic communication, allowing trust to build before introducing more active interventions.

🧠It avoids overwhelming choices and supports gradual activation consistent with the client’s cognitive and energy limits.

🧠Regular, predictable nurse presence can lower anxiety, improve affect regulation, and foster rapport essential for treatment adherence.

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Answer 8

Correct Answers:

Hyperpigmentation

Rationale :

🟤Primary Addison’s disease features low cortisol and aldosterone with elevated ACTH; pro-opiomelanocortin cleavage increases melanocyte-stimulating hormone, causing diffuse hyperpigmentation.

🟤Darkening appears on sun-exposed areas, palmar creases, scars, mucous membranes, and pressure points—an important diagnostic clue.

🟤Additional findings include hypotension, hyponatremia, hyperkalemia, and weight loss due to mineralocorticoid and glucocorticoid deficiency.

🟤Recognizing hyperpigmentation helps differentiate primary adrenal insufficiency from secondary causes (which lack this sign).

🟤Early identification supports prompt steroid replacement and stress-dose planning to prevent adrenal crisis.

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Answer 9

Correct Answers:

Provide a quiet ,low-stimulus environment.

Rationale :

🔥Clients with hyperthyroidism are vulnerable to thyroid storm, precipitated by stress, infection, surgery, or excessive stimulation.

🔥A quiet, low-stimulus environment reduces adrenergic drive, helping stabilize heart rate, temperature, and CNS excitability.

🔥Environmental control complements beta-blockade, antithyroid therapy, and temperature management to limit decompensation.

🔥Minimizing noise, bright lights, frequent interruptions, and emotional triggers decreases the risk of catecholamine surge.

🔥This non-pharmacologic step is a core nursing prevention strategy while definitive therapy is optimized.

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Answer 10

Correct Answers:

Moist, clammy skin.
Blurred vision.
Tachycardia.

Rationale :

Moist, clammy skin

🍬Neuroglycopenia and adrenergic counter-regulation in hypoglycemia trigger sweating and a cold, clammy feel as epinephrine rises.

🍬The sudden sympathetic discharge is a hallmark of acute low blood glucose, signaling the body to mobilize fuel.

🍬Nurses teach the cue “cold and clammy, need some candy” to promote rapid recognition and treatment.

🍬Skin changes often precede confusion, offering an early intervention window.

🍬Prompt 15–20 g fast carbs typically reverses autonomic symptoms quickly.

Blurred vision

🍬Retinal and cortical function require steady glucose; hypoglycemia impairs visual processing, producing blurred or double vision.

🍬Visual symptoms may co-occur with dizziness and headache, reflecting neuroglycopenia.

🍬Recognizing visual changes as hypoglycemia red flags helps prevent injury and progression to seizures.

🍬Resolution after glucose intake supports the diagnosis at the bedside.

🍬Educating clients to self-monitor when vision blurs can prevent severe episodes.

Tachycardia

🍬Epinephrine release during hypoglycemia causes palpitations and tachycardia, a classic autonomic warning sign.

🍬Heart rate rise accompanies tremor, anxiety, and sweating, forming the adrenergic symptom cluster.

🍬Early identification allows immediate carbohydrate treatment and re-check in 15 minutes per sick-day rules.

🍬Persistent tachycardia warrants continued monitoring and evaluation for recurrent hypoglycemia.

🍬Teaching clients to link rapid pulse with potential low glucose supports timely self-care.

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Custom NUR212 Final Assessment Fall 1 2025

No.

1 :
A nurse in a mental health facility is caring for a young adult client.

Answer Options

2 :
A nurse on an inpatient eating disorder unit is caring for a client who has anorexia nervosa.

Answer Options

3 :
A nurse is caring for a young adult client who is being evaluated for antisocial personality disorder.

Answer Options

4 :
A nurse is assessing a client who has hyperthyroidism. The nurse should expect the client to report which of the following manifestations?

5 :
A nurse is caring for a client who has progressing chronic kidney disease (CKD). Which of the following laboratory results would the nurse expect to find in the client's electronic health record?

6 :
A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk for renal calculi?

7 :
A nurse is caring for a client who is hospitalized for the treatment of severe depression. Which of the following nursing approaches is therapeutic to include in the client's plan of care?

8 :
A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?

10 :
A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.)

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Custom NUR212 Final Assessment Fall 1 2025

No.

1 : A nurse in a mental health facility is caring for a young adult client.

Answer Options

2 : A nurse on an inpatient eating disorder unit is caring for a client who has anorexia nervosa.

Answer Options

3 : A nurse is caring for a young adult client who is being evaluated for antisocial personality disorder.

Answer Options

4 : A nurse is assessing a client who has hyperthyroidism. The nurse should expect the client to report which of the following manifestations?

5 : A nurse is caring for a client who has progressing chronic kidney disease (CKD). Which of the following laboratory results would the nurse expect to find in the client's electronic health record?

6 : A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk for renal calculi?

7 : A nurse is caring for a client who is hospitalized for the treatment of severe depression. Which of the following nursing approaches is therapeutic to include in the client's plan of care?

8 : A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?

10 : A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.)

1 :
A nurse in a mental health facility is caring for a young adult client.

2 :
A nurse on an inpatient eating disorder unit is caring for a client who has anorexia nervosa.

3 :
A nurse is caring for a young adult client who is being evaluated for antisocial personality disorder.

4 :
A nurse is assessing a client who has hyperthyroidism. The nurse should expect the client to report which of the following manifestations?

5 :
A nurse is caring for a client who has progressing chronic kidney disease (CKD). Which of the following laboratory results would the nurse expect to find in the client's electronic health record?

6 :
A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk for renal calculi?

7 :
A nurse is caring for a client who is hospitalized for the treatment of severe depression. Which of the following nursing approaches is therapeutic to include in the client's plan of care?

8 :
A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?

10 :
A nurse is providing teaching to a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia? (Select all that apply.)