A nurse is caring for a client who has anorexia nervosa. Which of the following findings requires immediate intervention by the nurse?
Lanugo covering the body
+2 edema of the lower extremities
BUN 21 mg/dL
Blood pH 7.60
The Correct Answer is D
A blood pH of 7.60 indicates alkalosis, which is a life-threatening condition that can result from vomiting, laxative abuse, or diuretic use in clients who have anorexia nervosa. Alkalosis can cause cardiac arrhythmias, seizures, coma, and death if not corrected promptly. The nurse should notify the provider and prepare to administer IV fluids and electrolytes as ordered. The other findings are also concerning, but they are not as urgent as alkalosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Tell me the reasons you think your mother is depressed. This response shows empathy and active listening and invites the daughter to share more information about her mother's condition and behavior. The other responses are dismissive, inaccurate, or minimizing of the daughter's concern.
Correct Answer is B
Explanation
The nurse's priority is to ensure that the child is safe and protected from further harm. A spiral fracture is a type of fracture that occurs when a bone is twisted, and it is often associated with child abuse. The nurse should assess if there are any other signs of abuse, such as bruises, burns, or cuts, and if there are any threats to the child's well-being at home or elsewhere. The nurse should also provide emotional support and comfort to thechild. The other options are important steps to take, but they are not as urgent as ensuring safety.
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