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:

: The correct answer/s is Choice/s.

Choice A rationale: Phosphate level is a crucial indicator of the body’s electrolyte balance. In patients with anorexia nervosa, phosphate levels can be significantly affected due to malnutrition and the body’s metabolic response to starvation. Low phosphate levels, known as hypophosphatemia, can lead to serious complications such as muscle weakness, neurological dysfunction, and potentially life-threatening cardiac issues.

Choice B rationale: Capillary refill is a quick test performed on a patient to assess the adequacy of peripheral circulation. The time taken for color to return to an external capillary bed after pressure has been applied to cause blanching signifies the status of the patient’s peripheral blood circulation. Delayed capillary refill time may indicate shock or dehydration, which could be a concern in a patient with anorexia nervosa who may be dehydrated or malnourished.

Choice C rationale: Sodium level is another important electrolyte that needs to be monitored. Patients with anorexia nervosa can have abnormal sodium levels due to various factors such as vomiting, use of diuretics, or not consuming enough dietary sodium. Both high sodium (hypernatremia) and low sodium (hyponatremia) levels can lead to severe neurological symptoms and are considered medical emergencies.

Choice D rationale: Magnesium level is also an important consideration in patients with anorexia nervosa. Low magnesium levels, or hypomagnesemia, can occur due to inadequate dietary intake or excessive loss from the gastrointestinal tract, which can be seen in conditions like anorexia nervosa. Hypomagnesemia can lead to symptoms such as muscle cramps, seizures, and even cardiac arrhythmias.

Choice E rationale: Glucose level is a key indicator of a person’s metabolic state and energy balance. In patients with anorexia nervosa, glucose levels can be low due to inadequate food intake. Hypoglycemia, or low blood sugar, can lead to symptoms such as weakness, tremors, confusion, and in severe cases, it can be life-threatening.

Choice A rationale: Dissociation is a defense mechanism where a person disconnects from reality, memory, identity, or perception. It is often a response to trauma and can result in a detachment from emotional and physical experiences. The client’s behavior does not indicate a disconnection from reality or self.

Choice B rationale: Regression is a defense mechanism where an individual reverts to an earlier stage of development in response to stress or anxiety. In this case, the client’s behavior of wanting someone to take care of them can be seen as a regression to a childlike state of dependency, which is a common response to overwhelming stress or anxiety.

Choice C rationale: Introjection is a defense mechanism where a person internalizes the ideas or voices of other people- often authority figures. This is not evident in the client’s behavior.

Choice D rationale: Repression is a defense mechanism where a person unconsciously blocks out distressing thoughts or feelings. In this scenario, the client is expressing their feelings of stress rather than repressing them.