A nurse is caring for a client who has anorexia nervosa.

The client was admitted for medical stabilization due to a deteriorating condition that requires supervised refeeding. The client's weight is currently at 73% of ideal body weight.

Exhibits

Select the three findings that require immediate follow-up:

Magnesium level

Chloride level

Phosphate level

Potassium level.

Answer and Explanation

Correct Answer : A,C,D

Choice A rationale: The client’s magnesium level is 1.7 mg/dL, which is below the normal range of 1.8 to 2.4 mg/dL. Hypomagnesemia can cause neuromuscular irritability, muscle weakness, tremors, and even seizures or cardiac arrhythmias in severe cases.

It’s often associated with other electrolyte imbalances such as hypokalemia and hypocalcemia.

In the context of anorexia nervosa, this could be due to inadequate dietary intake, malabsorption, or excessive losses from the gastrointestinal tract.

Choice B rationale: The client’s chloride level is 98 mmol/L, which falls within the normal range of 96 to 106 mmol/L. Chloride is an important electrolyte that helps maintain acid-base balance, fluid balance, and is a component of gastric juice as hydrochloric acid.

There’s no immediate concern regarding the client’s chloride level.

Choice C rationale: The client’s phosphate level is 2.5 mg/dL, which is below the normal range of 2.8 to 4.5 mg/dL. Hypophosphatemia can lead to muscle weakness, bone pain, mental changes, and potentially life-threatening complications such as respiratory failure and heart failure.

In the context of anorexia nervosa, hypophosphatemia is a common complication during refeeding due to shifts in electrolytes.

Choice D rationale: The client’s potassium level is 3.5 mmol/L, which is at the lower end of the normal range of 3.5 to

5.0 mmol/L. Hypokalemia can cause muscle weakness, cramps, arrhythmias, and in severe cases, it can be life- threatening.

In the context of anorexia nervosa, this could be due to inadequate dietary intake, excessive losses due to vomiting or laxative abuse, or shifts in electrolytes during refeeding.

In conclusion, the nurse should follow up on the client’s magnesium, phosphate, and potassium levels due to their potential implications on the client’s health, especially considering the client’s current health status and the process of refeeding.

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Correct Answer is C

Explanation

The correct answer/s is C

Choice A rationale: Hyperkalemia, or high potassium levels in the blood, is not typically associated with anorexia nervosa. In fact, individuals with anorexia nervosa are more likely to experience hypokalemia, or low potassium levels, due to inadequate dietary intake and excessive loss of potassium through vomiting or use of diuretics1.

Choice B rationale: Metrorrhagia, or irregular menstrual bleeding between periods, can occur in females with anorexia nervosa due to hormonal imbalances caused by extreme weight loss and malnutrition. However, amenorrhea, or the absence of menstruation, is more commonly observed1.

Choice C rationale: Lanugo, which is fine, soft hair that grows on the face and body, is a common finding in individuals with anorexia nervosa. It is the body’s response to severe weight loss and starvation as an attempt to provide insulation and maintain body temperature1.

Choice D rationale: Tachycardia, or a rapid heart rate, is not typically associated with anorexia nervosa. Instead, individuals with anorexia nervosa often experience bradycardia, or a slower than normal heart rate, as the body’s response to starvation1.

A. "The ritualistic behavior temporarily relieves anxiety." B. "The ritualistic behavior provides sexual satisfaction." C. "The client performs ritualistic behavior to decrease feelings of shame." D. "The client performs ritualistic behavior to boost self-esteem." .

Correct Answer is A

Explanation

Choice A rationale:

Anxiety reduction is the core motivation for ritualistic behaviors in OCD. Individuals with OCD experience intrusive, distressing thoughts (obsessions) that trigger intense anxiety. To neutralize this anxiety, they engage in repetitive behaviors (compulsions) that provide temporary relief.

The relief is often short-lived, leading to a cycle of obsessions and compulsions. This cycle can become debilitating and significantly impair daily functioning.

Research supports the anxiety-reduction model of OCD. Studies have shown that engaging in compulsions reduces anxiety in individuals with OCD, both subjectively and physiologically.

Neuroimaging studies have also demonstrated that ritualistic behaviors activate brain regions involved in anxiety and fear processing. This suggests that compulsions have a direct effect on the brain's anxiety circuitry.

Choice B rationale:

Sexual satisfaction is not a typical motivation for ritualistic behaviors in OCD. While some compulsions may have a sexual component (e.g., checking for arousal), the primary goal is to reduce anxiety, not to achieve sexual gratification.

Choice C rationale:

Feelings of shame may be associated with OCD, but they are not the primary driving force behind ritualistic behaviors. Shame often arises from the content of obsessions (e.g., thoughts about contamination, harm, or taboo subjects) or the perceived social stigma of OCD. However, the urge to perform compulsions stems from the need to alleviate anxiety, not to decrease shame.

Choice D rationale:

Boosting self-esteem is not a common motivation for ritualistic behaviors in OCD. In fact, many individuals with OCD experience low self-esteem due to the impact of the disorder on their lives. Compulsions may provide a temporary sense of control or mastery, but they do not typically lead to lasting improvements in self-esteem.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing an adolescent female client who has anorexia nervosa. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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