A nurse in a mental health unit is admitting a female client who has anorexia nervosa.
The admission vital signs are as follows: Heart rate 52/min, Respiratory rate 26/min, Blood pressure 84/50 mm Hg, Temperature 36.1C(97F). The nurse should first address the client's:

Choice A rationale: Bradycardia

Bradycardia, or an abnormally slow heart rate, is a common cardiovascular manifestation in individuals with anorexia nervosa. It is often a result of the body’s adaptive response to conserve energy due to severe malnutrition and reduced caloric intake. This is because the body is trying to conserve as much energy as possible, and one way it does this is by slowing down the heart rate. This can be dangerous, however, as it can lead to fainting, heart failure, or even death if not properly managed.

Choice B rationale: Hyperactive bowel sounds

Hyperactive bowel sounds are not typically associated with anorexia nervosa. Instead, individuals with this disorder often experience constipation and other gastrointestinal issues due to inadequate food intake. The lack of food intake can slow down the digestive process, leading to these symptoms.

Choice C rationale: Dental erosion

Dental erosion can be a consequence of anorexia nervosa, but it is more commonly associated with bulimia nervosa due to the frequent vomiting that characterizes this disorder. The stomach acid that comes into contact with the teeth during vomiting can cause the enamel to erode. However, it’s important to note that not all individuals with anorexia nervosa will experience this symptom.

Choice D rationale: Hypertension

Hypertension, or high blood pressure, is not typically associated with anorexia nervosa. In fact, low blood pressure (hypotension) is more common due to the decreased volume of blood in the body from insufficient nutrition.

Hypertension is more commonly associated with conditions such as obesity and metabolic syndrome.

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.