A nurse is caring for a 19-year-old client in the emergency department who reports passing out while at school.

The vital signs are as follows: BP 84/48 mm Hg, Pulse rate 48/min, Respiratory rate 16/min, Temperature 36.4° C (97.5 F). A nurse is assessing the client for manifestations of anorexia nervosa.

Which of the following findings should the nurse expect?

Choice A rationale: A 13-year-old girl worrying about a pimple on her face is a common concern at this age. Adolescence is a time of significant physical changes, including the onset of acne. While this can cause distress and affect self-esteem, it is not as immediate a concern as some of the other options.

Choice B rationale: Menarche, or the onset of menstruation, typically occurs around the age of 12-14, but it can vary widely. Some girls may start their periods as early as 9 or as late as 16. This girl’s concern about not having started her period yet, while valid, is not unusual or immediately concerning given her age.

Choice C rationale: Feeling like one’s parents are treating them like a baby is a common sentiment among adolescents who are striving for more independence. It’s a normal part of the developmental process and, while it can cause conflict and frustration, it is not an immediate concern.

Choice D rationale: This statement indicates that the girl is feeling socially isolated, which can be a sign of social problems or mental health issues such as depression or anxiety. Social relationships and a sense of belonging are crucial for mental health, particularly during adolescence. This should be the nurse’s priority to address.

Please note that these rationales are based on general knowledge and understanding of adolescent development and mental health. For a more accurate and detailed explanation, it would be best to consult with a healthcare professional or refer to trusted health resources.

Choice A rationale:

The client’s reported behavior of using laxatives and inducing vomiting after eating can lead to a condition known as hypomagnesemia. Hypomagnesemia is a condition characterized by low levels of magnesium in the blood. This condition can be caused by poor intake, excessive loss, or movement of magnesium from the blood into less accessible locations. The use of laxatives can lead to excessive loss of magnesium through increased bowel movements. Similarly, self-induced vomiting can also result in a loss of magnesium. Therefore, the client’s behavior puts them at risk for developing hypomagnesemia.

Choice B rationale:

Renal failure, also known as kidney failure, occurs when the kidneys lose their ability to filter waste products from the blood. While the use of laxatives and self-induced vomiting can lead to dehydration, which can strain the kidneys, these behaviors are not directly associated with renal failure. Therefore, while it’s possible for the client to develop kidney problems, it’s less likely compared to hypomagnesemia.

Choice C rationale:

Heart failure occurs when the heart muscle doesn’t pump blood as well as it should. This condition can cause symptoms like shortness of breath, swelling, fatigue, and other symptoms. While severe electrolyte imbalances, such as those that might result from the use of laxatives and self-induced vomiting, can affect heart function, they would typically result in arrhythmias (irregular heartbeats) rather than heart failure. Therefore, it’s less likely for the client to develop heart failure based on the behaviors described.

Choice D rationale:

Hyperthyroidism is a condition where the thyroid gland produces and releases too much thyroid hormone. This condition can cause symptoms like rapid heartbeat, weight loss, and anxiety. The client’s behaviors of using laxatives and inducing vomiting after eating do not directly influence the production of thyroid hormones. Therefore, it’s less likely for the client to develop hyperthyroidism based on the behaviors described.