A nurse in an outpatient mental health clinic is treating a client who has bulimia nervosa.
A nurse is assessing the client during a follow-up visit. Select the 4 assessments that indicate a therapeutic response to the treatment plan.
Potassium level
ECG report
BUN level
Laxative usage
overeating cycle/purging
Coping skills
Correct Answer : A,D,E,F
Choice A: Potassium Level
Reason: Monitoring potassium levels is crucial in clients with bulimia nervosa due to the risk of hypokalemia (low potassium levels), which can result from frequent vomiting and laxative abuse. Hypokalemia can lead to serious complications, including cardiac arrhythmias. In this case, the client’s potassium level improved from 3.2 mEq/L (below the normal range of 3.5 to 5 mEq/L) on June 1 to 3.7 mEq/L (within the normal range) on June 15. This improvement indicates a positive response to treatment, as it suggests that the client is experiencing fewer episodes of vomiting or laxative abuse, leading to better electrolyte balance.
Choice B: ECG Report
Reason: While the ECG report is important for assessing cardiac health, it is not a direct indicator of therapeutic response to bulimia nervosa treatment. The presence of premature ventricular contractions (PVCs) on the ECG can be related to electrolyte imbalances, particularly hypokalemia. However, the ECG itself does not provide information about the client’s behaviors or coping mechanisms, which are more directly related to the treatment of bulimia
nervosa. Therefore, while the ECG report is useful for monitoring cardiac health, it is not one of the primary indicators of therapeutic response in this context.
Choice C: BUN Level
Reason: Blood Urea Nitrogen (BUN) levels can indicate kidney function and hydration status. Elevated BUN levels, as seen in this client (28 mg/dL on June 1 and 26 mg/dL on June 15, with a normal range of 10 to 20 mg/dL), may suggest dehydration or impaired kidney function. However, BUN levels are not specific indicators of therapeutic
response to bulimia nervosa treatment. They do not directly reflect changes in the client’s eating behaviors, purging habits, or coping skills. Therefore, while monitoring BUN levels is important for overall health, it is not a primary indicator of therapeutic response in this case.
Choice D: Laxative Usage
Reason: Reducing or eliminating laxative usage is a significant indicator of therapeutic response in clients with bulimia nervosa. Laxative abuse is a common purging behavior in bulimia nervosa, and its reduction indicates progress in treatment. The client’s report of laxative usage provides direct insight into their purging behaviors. A
decrease in laxative use suggests that the client is gaining better control over their eating disorder and is adhering to the treatment plan. This behavioral change is a critical component of recovery and indicates a positive therapeutic response.
Choice E: Overeating Cycle/Purging
Reason: Assessing changes in the client’s overeating and purging cycle is essential for evaluating therapeutic response. Bulimia nervosa is characterized by cycles of binge eating followed by purging behaviors such as vomiting or laxative abuse. A reduction in the frequency or severity of these cycles indicates that the client is responding well to treatment. The client’s self-reported behaviors regarding overeating and purging provide valuable information about their progress. A decrease in these behaviors suggests that the client is developing healthier eating patterns and coping mechanisms, which are key goals of treatment.
Choice F: Coping Skills
Reason: Developing effective coping skills is a crucial aspect of treatment for bulimia nervosa. Clients often use disordered eating behaviors as a way to cope with emotional distress. By learning and implementing healthier coping strategies, clients can reduce their reliance on harmful behaviors such as binge eating and purging. Assessing the client’s coping skills involves evaluating their ability to manage stress, emotions, and triggers in a healthy manner. Improvement in coping skills indicates that the client is making progress in their recovery and is better equipped to handle challenges without resorting to disordered eating behaviors.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason:
The arterial blood gas (ABG) values of pH 7.26, HCO₃ 14, and PaCO₂ 30 indicate metabolic acidosis with partial respiratory compensation. Acute kidney injury (AKI) often leads to metabolic acidosis due to the kidneys’ inability to excrete acid and reabsorb bicarbonate. The low pH indicates acidosis, the low bicarbonate (HCO₃) reflects metabolic acidosis, and the low PaCO₂ shows that the respiratory system is trying to compensate by blowing off CO₂.
Choice B reason:
The ABG values of pH 7.49, HCO₃ 30, and PaCO₂ 40 indicate metabolic alkalosis. This condition is characterized by an elevated pH and bicarbonate level. Metabolic alkalosis is not typically associated with acute kidney injury. Instead, it can result from excessive bicarbonate intake, loss of gastric acid (e.g., vomiting), or diuretic use.
Choice C reason:
The ABG values of pH 7.26, HCO₃ 24, and PaCO₂ 46 suggest respiratory acidosis. The low pH indicates acidosis, but the normal bicarbonate level and elevated PaCO₂ point to a respiratory cause rather than a metabolic one. Respiratory acidosis occurs when the lungs cannot remove enough CO₂, leading to its accumulation. This is not a typical presentation of AKI.
Choice D reason:
The ABG values of pH 7.49, HCO₃ 24, and PaCO₂ 30 indicate respiratory alkalosis. The high pH and low PaCO₂ suggest that the patient is hyperventilating, leading to excessive CO₂ loss. This condition is not commonly associated with acute kidney injury, which more frequently causes metabolic acidosis.
Correct Answer is D
Explanation
Choice A reason: Consume a high-protein diet
A high-protein diet is not typically recommended for clients with hepatitis B. While protein is essential for overall health, excessive protein intake can put additional strain on the liver, which is already compromised in hepatitis B patients. A balanced diet with adequate protein, carbohydrates, and fats is more appropriate.
Choice B reason: You may donate blood 6 months after completing the medication regimen
Clients with hepatitis B should not donate blood. The hepatitis B virus can be transmitted through blood, and even after completing a medication regimen, the virus can still be present in the blood. Therefore, this statement is incorrect and potentially harmful.
Choice C reason: Take acetaminophen every 4 hours, as needed, for discomfort
Acetaminophen should be used with caution in clients with hepatitis B. The liver metabolizes acetaminophen, and excessive use can lead to liver damage. It is crucial to consult with a healthcare provider before taking any medication, including acetaminophen, to avoid exacerbating liver issues.
Choice D reason: Rest frequently throughout the day
Resting frequently throughout the day is an important part of managing hepatitis B. The liver plays a crucial role in energy metabolism, and when it is compromised, clients may experience fatigue. Adequate rest helps the body recover and manage symptoms more effectively.
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