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.
Select the three findings that require immediate follow-up:
Magnesium level
Chloride level
Phosphate level
Potassium level.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Avoids addressing the client's behavior: This response does not directly address the client's disrespectful tone of voice. It simply gives the client the schedule and expects them to comply. This could reinforce the client's belief that they can act out without consequences.
Misses an opportunity to set boundaries: Setting boundaries is essential when working with clients with BPD. This response does not establish a clear boundary regarding acceptable communication.
Does not promote therapeutic communication: This response does not encourage the client to share their feelings or explore the reasons behind their outburst. It shuts down communication rather than opening it up.
Choice B rationale:
Directly addresses the inappropriate behavior: This response assertively communicates to the client that their tone of voice is unacceptable. It sets a clear boundary regarding respectful communication.
Models appropriate communication: The nurse models respectful communication by using a calm and assertive tone of voice. This can help the client learn to communicate more effectively.
Promotes self-awareness: This response may prompt the client to reflect on their behavior and the impact it has on others. It can help them develop better self-awareness and emotional regulation skills.
Choice C rationale:
Focuses on the nurse's feelings: This response shifts the focus away from the client's behavior and onto the nurse's feelings. It can make the client feel defensive and less likely to engage in productive communication.
May escalate the situation: Asking "why" s can sometimes put clients on the defensive and lead to further conflict. It's generally more helpful to focus on the present behavior and its impact.
Choice D rationale:
Condescending and challenging: This response comes across as condescending and challenging. It's likely to make the client feel defensive and resentful.
Not therapeutic: This response does not promote a sense of trust or rapport between the nurse and the client. It's unlikely to lead to productive communication or behavior change.
Correct Answer is ["B","C","D","F"]
Explanation
Choice B rationale:
Schizophrenia is a severe mental illness that is characterized by disturbances in thought, perception, emotion, and behavior. It is associated with an increased risk of suicide, with estimates suggesting that up to 10% of individuals with schizophrenia will die by suicide.
Several factors contribute to the increased risk of suicide in individuals with schizophrenia, including:
Hopelessness and despair: Individuals with schizophrenia often experience profound feelings of hopelessness and despair, which can lead to suicidal thoughts and behaviors.
Psychotic symptoms: Psychotic symptoms, such as delusions and hallucinations, can also contribute to suicide risk. For example, an individual with schizophrenia may experience auditory hallucinations that command them to harm themselves.
Impaired judgment: Schizophrenia can impair an individual's judgment and decision-making abilities, which can make it more difficult for them to resist suicidal urges.
Social isolation: Individuals with schizophrenia often experience social isolation, which can further increase their risk of suicide.
Comorbidity with other mental disorders: Schizophrenia is often comorbid with other mental disorders, such as depression and anxiety, which can also increase suicide risk.
Substance abuse: Substance abuse is a common problem among individuals with schizophrenia, and it can further increase suicide risk.
Choice C rationale:
Alcohol use disorder is a chronic, relapsing brain disease characterized by compulsive alcohol use, despite harmful consequences. It is a significant risk factor for suicide, with studies suggesting that individuals with alcohol use disorder are 10-14 times more likely to die by suicide than the general population.
Several factors contribute to the increased risk of suicide in individuals with alcohol use disorder, including: Depression: Alcohol use disorder is often comorbid with depression, which is a major risk factor for suicide. Impulsivity: Alcohol can impair judgment and increase impulsivity, which can lead to suicidal behaviors.
Social isolation: Alcohol use disorder can lead to social isolation, which can increase suicide risk.
Access to lethal means: Individuals with alcohol use disorder may have access to lethal means, such as firearms, which can increase the risk of suicide completion.
Choice D rationale:
Substance use disorder is a chronic, relapsing brain disease characterized by compulsive drug use, despite harmful consequences. It is a significant risk factor for suicide, with studies suggesting that individuals with substance use disorder are 6-12 times more likely to die by suicide than the general population.
Several factors contribute to the increased risk of suicide in individuals with substance use disorder, including: Depression: Substance use disorder is often comorbid with depression, which is a major risk factor for suicide. Impulsivity: Substance use can impair judgment and increase impulsivity, which can lead to suicidal behaviors.
Hopelessness: Individuals with substance use disorder may experience feelings of hopelessness and despair, which can increase suicide risk.
Social isolation: Substance use disorder can lead to social isolation, which can increase suicide risk.
Access to lethal means: Individuals with substance use disorder may have access to lethal means, such as firearms, which can increase the risk of suicide completion.
Choice F rationale:
Age greater than 65 years old is a risk factor for suicide. Suicide rates are highest among older adults, particularly white men over the age of 85.
Several factors contribute to the increased risk of suicide in older adults, including:
Chronic health conditions: Older adults are more likely to experience chronic health conditions, such as pain, disability, and cognitive decline, which can increase suicide risk.
Social isolation: Older adults are more likely to experience social isolation due to factors such as retirement, loss of loved ones, and decreased mobility.
Loss of independence: Older adults may experience a loss of independence due to physical and cognitive decline, which can contribute to suicide risk.
Access to lethal means: Older adults may have access to lethal means, such as firearms or medications, which can increase the risk of suicide completion.
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