One liter of normal saline is to infuse over 8 hours. At what rate will the nurse set the infusion pump?

d. Emesis from purging corrodes the tooth enamel

Explanation of Choices

Choice A Reason: Food is Rapidly Ingested Without Proper Chewing

While individuals with bulimia nervosa may engage in rapid eating during binge episodes, this behavior alone does not directly cause dental deterioration. Rapid ingestion of food can lead to other gastrointestinal issues, but it is not the primary cause of dental problems seen in bulimia nervosa. The main dental issues arise from the purging behavior that follows binge eating.

Choice B Reason: Poor Dental and Oral Hygiene Leads to Dental Caries

Poor dental and oral hygiene can indeed lead to dental caries (cavities), but this is not the primary issue in bulimia nervosa. The dental deterioration observed in bulimia nervosa is more specifically related to the effects of repeated vomiting, which introduces stomach acid into the mouth. While maintaining good oral hygiene is important, it does not fully address the unique dental challenges posed by bulimia.

Choice C Reason: Purging Causes the Depletion of Dietary Calcium

Purging can lead to various nutritional deficiencies, including calcium, but the depletion of dietary calcium is not the main cause of dental deterioration in bulimia nervosa. The primary issue is the direct effect of stomach acid on the teeth. Calcium depletion can contribute to overall bone health issues, but it is not the specific cause of the dental erosion seen in bulimia.

Choice D Reason: Emesis from Purging Corrodes the Tooth Enamel

Emesis (vomiting) from purging is the primary cause of dental deterioration in bulimia nervosa. When individuals with bulimia vomit, stomach acid comes into contact with the teeth, leading to enamel erosion. This acid is highly corrosive and can wear away the protective enamel layer, resulting in increased tooth sensitivity, cavities, and other dental issues. This repeated exposure to stomach acid is the most significant factor in the dental deterioration observed in bulimia nervosa.

The correct answer is a. The client’s behavioral change is expected after the time period of medication.

Choice A Reason:

This choice is correct because fluoxetine, a selective serotonin reuptake inhibitor (SSRI), typically takes about 4 to 6 weeks to start showing its full effects. The client’s statement, “I feel like a great weight is off my chest,” indicates a positive response to the medication, which aligns with the expected timeline for SSRIs to improve mood and alleviate symptoms of depression. This behavioral change suggests that the medication is working as intended, helping to lift the depressive symptoms.

Choice B Reason:

This choice is incorrect and concerning. While it is true that some individuals may experience a temporary increase in energy before their mood improves, which could potentially increase the risk of suicide, the client’s positive statement does not necessarily indicate suicidal planning. It is important for healthcare providers to continuously monitor for any signs of suicidal ideation, but in this context, the client’s statement more likely reflects an improvement in their depressive symptoms.

Choice C Reason:

This choice is incorrect because there is no indication that the medication dosage should be decreased or that a mood stabilizer should be added. Fluoxetine is generally well-tolerated, and the client’s positive response suggests that the current dosage is effective. Mood stabilizers are typically used in the treatment of bipolar disorder, not major depressive disorder, unless there is a specific indication for their use.

Choice D Reason:

This choice is incorrect and indicates a misunderstanding of serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonin activity in the brain, often due to drug interactions or overdose. Symptoms include agitation, confusion, rapid heart rate, and high blood pressure4. The client’s statement of feeling relieved does not align with the symptoms of serotonin syndrome, which are generally severe and require immediate medical attention.