A nurse is caring for a client in an emergency department (ED).

Exhibits

For each assessment finding, click to specify if the finding is consistent with bulimia nervosa or anorexia nervosa. Each finding may support more than one disease process or none at all. There must be at least 1 selection In every column. There does not need to be a selection in every row. (Note: Each category must have at least 1 response option selected)

Parotid glands

Potassium level

Weight

Sodium level

Hand findings

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A,B"},"C":{"answers":"A"},"D":{"answers":"A,B"},"E":{"answers":"A"}}

Rationale:

Parotid glands: Parotid gland enlargement is a typical finding in clients with bulimia nervosa due to repeated episodes of self-induced vomiting. The recurrent stimulation of salivary glands leads to painless swelling, often bilateral, and may also contribute to facial puffiness or a rounded appearance.
Potassium level: A potassium level of 3.0 mEq/L is low and may result from either bulimia nervosa or anorexia nervosa. In bulimia, this is typically due to purging through vomiting or laxative use; in anorexia, it stems from prolonged restriction, dehydration, and possible diuretic misuse. Both conditions increase the risk of cardiac complications.
Weight: The client’s weight of 61.8 kg with a BMI of 20.7 falls within the normal range and is more consistent with bulimia nervosa. Individuals with anorexia nervosa usually present with a significantly lower body weight and BMI, typically below 18.5, due to extreme caloric restriction and prolonged starvation.
Sodium level: A sodium level of 134 mEq/L is slightly low and can occur in both bulimia nervosa and anorexia nervosa. In bulimia, frequent vomiting may cause sodium loss, while in anorexia, hyponatremia can develop from malnutrition, dehydration, or excessive water intake in attempts to suppress appetite or manipulate weight.
Hand findings: Calluses on the index and middle fingers, known as Russell’s sign, are associated with bulimia nervosa. These result from repeated trauma during induced vomiting episodes, as the hand comes into contact with the teeth. This finding is a classic physical sign of chronic purging behavior.

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Correct Answer is A

Explanation

Rationale:

A. Consult the pharmacist about potential interactions between the client's regular medications and warfarin: Warfarin has numerous drug interactions that can increase bleeding risk or reduce effectiveness. Consulting the pharmacist ensures a thorough review of the client’s medication list for potential harmful interactions before discharge.

B. Tell the client they can continue to drink cranberry juice while taking warfarin: Cranberry juice can potentiate the effects of warfarin and increase bleeding risk by interfering with its metabolism. Clients should be advised to limit or avoid cranberry products.

C. Recommend the client take warfarin at the same time as other medications: Warfarin should be taken at the same time each day, but taking it with other medications may cause interactions. The timing should consider spacing it from medications that might interfere with absorption or potency.

D. Advise the client that over-the-counter medications remain safe to consume as needed: Many OTC medications, especially NSAIDs, can increase bleeding risk when combined with warfarin. Clients need to check with a healthcare provider before taking any new OTC drugs.

A. The client experiences self-doubt when making decisions. B. The client exhibits a flat affect. C. The client can express angry feelings. D. The client looks down when speaking to others.

Correct Answer is C

Explanation

Rationale:

A. The client experiences self-doubt when making decisions: Indecisiveness and self-doubt are common symptoms of major depressive disorder and do not reflect improvement. They typically indicate ongoing low self-esteem and cognitive impairment.

B. The client exhibits a flat affect: A flat or blunted affect is a hallmark of depressive states. Persistence of this symptom suggests the depression is still significantly impacting the client’s emotional expression.

C. The client can express angry feelings: Being able to express emotions such as anger can indicate emotional engagement and increased energy, which are signs of clinical improvement in depression.

D. The client looks down when speaking to others: This behavior suggests ongoing feelings of worthlessness or poor self-confidence, commonly seen in depressive states and not indicative of recovery.

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