A nurse is caring for a client who has bulimia nervosa.
The client is at risk for developing
The Correct Answer is {"dropdown-group-1":"D","dropdown-group-2":"D"}
Cardiovascular abnormalities are a serious risk in clients with bulimia nervosa due to electrolyte imbalances, especially hypokalemia, which can lead to arrhythmias, weakened heart muscles, and potential heart failure. Hyponatremia (low sodium levels) can occur due to excessive vomiting, which leads to the loss of fluids and electrolytes, including sodium. Incorrect responses: Group 1: Hypoglycemia: Bulimia nervosa primarily causes electrolyte imbalances and acid-base disturbances due to vomiting, not significant alterations in blood sugar levels. Metabolic Acidosis: Vomiting leads to the loss of gastric acid, causing metabolic alkalosis. Hypotension: Hypotension could occur if the client experiences significant dehydration from vomiting. Hypotension would be a consequence of severe dehydration rather than a primary risk at this stage. Hyperglycemia: Hyperglycemia is not typically associated with bulimia nervosa or vomiting. It would be more relevant in conditions like diabetes. Group 2: Hyperkalemia: Hyperkalemia (high potassium) is unlikely in bulimia nervosa, where frequent vomiting usually leads to hypokalemia due to the loss of potassium in gastric secretions. Metabolic Acidosis: As mentioned before, vomiting leads to metabolic alkalosis, not acidosis, because of the loss of hydrochloric acid. Hypochloremia: Hypochloremia (low chloride levels) can occur with vomiting due to the loss of stomach acid, which contains chloride. While it is a possible outcome, metabolic alkalosis better captures the overall acid-base disturbance in the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Natural loss of deciduous teeth is incorrect. Natural loss of deciduous teeth, also known as baby teeth, usually begins around the age of 5 or 6 years. At the age of 2, a toddler would still have their baby teeth.
Choice B reason:
This is a normal finding in toddlers. It is common for toddlers to have a protruding abdomen due to their body composition and the normal development of their abdominal muscles.
Choice C reason:
Head circumference exceeds chest circumference: In a typical 2-year-old toddler, the head circumference should be less than the chest circumference. The head grows rapidly during infancy and slows down as the child grows older, leading to a cage in the head-to-chest ratio.
Choice D reason:
The fontanels, or soft spots on the skull, usually close by the end of the first year. By age 2, the fontanels should be closed or very close to being closed, and they would not typically be palpable.
Correct Answer is A
Explanation
A. Correct. A 6-month-old infant who has croup and an O2 saturation of 92% on room air is at risk of respiratory distress and hypoxia. Croup causes inflammation and narrowing of the upper airway, which can compromise breathing. An O2 saturation of 92% is below the normal range of 95% to 100% and indicates inadequate oxygenation. This child needs immediate assessment and intervention to prevent further deterioration.
B. Incorrect. A 15-year-old adolescent who is 2 hr postoperative following an open reduction and internal fixation of the left ankle and is requesting pain medication has a priority need for pain management, but not as urgent as a child with respiratory compromise. The nurse should assess the adolescent's pain level, administer the prescribed analgesic, and monitor the effectiveness of the medication.
C. Incorrect. A 3-year-old toddler who has gastroenteritis, moderate dehydration, and had two loose bowel movements over the past 24 hr has a potential risk for fluid and electrolyte imbalance, but not as acute as a child with respiratory compromise. The nurse should monitor the toddler's intake and output, vital signs, weight, and skin turgor, and administer oral or intravenous fluids as prescribed.
D. Incorrect. A 10-year-old child who is awaiting surgery for an appendectomy and experienced sudden relief from pain may have a perforated appendix, which can lead to peritonitis and sepsis. However, this child is not as unstable as a child with respiratory compromise. The nurse should notify the surgeon of the change in pain status, monitor the child's vital signs, abdominal assessment, and laboratory results, and prepare the child for surgery.
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