A nurse is collecting data from a client who has anorexia nervosa. Which of the following findings should the nurse expect? (Select all that apply.)
Lanugo
Cold extremities
Hypotension
Tooth erosion
Diarrhea
Correct Answer : A,B,C,D,E
A. Lanugo refers to fine, soft hair that can develop on the face, back, and other parts of the body in response to malnutrition and low body fat. It is a compensatory mechanism to help regulate body temperature in individuals with severe weight loss, including those with anorexia nervosa. Therefore, the nurse should expect to find lanugo in a client with anorexia nervosa.
B. Cold extremities are a common finding in individuals with anorexia nervosa due to reduced body fat and poor circulation. The body's natural response to conserve heat is impaired when body fat is extremely low. Therefore, cold extremities are expected in clients with anorexia nervosa.
C. Hypotension, or low blood pressure, can occur in individuals with anorexia nervosa due to dehydration, electrolyte imbalances (such as low potassium levels), and reduced cardiac output. These conditions are often associated with severe malnutrition and can lead to cardiovascular complications. Therefore, hypotension is a potential finding in clients with anorexia nervosa.
D. Tooth erosion can result from frequent vomiting, which is a behavior sometimes seen in individuals with anorexia nervosa, particularly those with purging subtype (anorexia nervosa binge-eating/purging type). Stomach acid from vomiting can damage tooth enamel over time, leading to tooth erosion. Therefore, the nurse should expect to find tooth erosion in clients who engage in purging behaviors.
E. Diarrhea is less commonly associated with anorexia nervosa. Individuals with anorexia nervosa typically have reduced food intake, which can lead to constipation rather than diarrhea. However, in some cases, diarrhea can occur due to malnutrition-related changes in bowel function. It is not a consistent finding but can occasionally be observed.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Tinnitus, or ringing in the ears, is not a common side effect of haloperidol. Therefore, this statement does not indicate an accurate understanding of the medication's potential side effects.
B. Urinary incontinence is also not typically associated with haloperidol. Therefore, this statement does not reflect correct knowledge about the medication.
C. Haloperidol can indeed make individuals more sensitive to sunlight, and patients are often advised to avoid prolonged exposure to the sun and to use sunscreen when outdoors.
D. Haloperidol is not associated with any form of dygeusia
Correct Answer is D
Explanation
A. Lithium can affect sodium and potassium balance in the body, but it does not specifically require a decrease in dietary potassium. Instead, sodium intake should be kept consistent because lithium excretion is influenced by sodium levels. Therefore, decreasing dietary potassium is not a recommended intervention.
B. Lithium can sometimes cause weight gain as a side effect. Increasing daily caloric intake is not a standard intervention when starting lithium. Clients should be encouraged to maintain a balanced diet and regular exercise regimen to manage potential weight changes.
C. Hypoglycemia is not a common side effect of lithium. Therefore, monitoring for hypoglycemia is not necessary when a client is taking lithium.
D. Administering lithium with meals can help reduce gastrointestinal side effects, such as nausea and upset stomach, which are common when starting the medication. It also helps with consistent absorption and reduces the peak serum concentration of lithium, which can minimize side effects and stabilize blood levels.
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