A nurse is caring for a client who has bulimia nervosa and has a new prescription for a selective serotonin reuptake inhibitor (SSRI). Which of the following medications should the nurse anticipate administering?

Choice A rationale

Learning and memory deficits involve difficulties acquiring new information or recalling past events. While often present in Alzheimer's disease, the specific difficulty with multitasking, which requires planning and coordinating multiple cognitive processes, points to a higher-order cognitive impairment than solely learning and memory.

Choice B rationale

Executive function encompasses a set of higher-level cognitive processes necessary for goal-directed behavior, including planning, organizing, sequencing, problem-solving, and multitasking. Difficulty with multitasking specifically indicates an impairment in the ability to manage and coordinate multiple cognitive operations simultaneously.

Choice C rationale

Perceptual-motor deficits involve difficulties in integrating sensory information with motor responses, such as issues with hand-eye coordination or spatial awareness. While these can occur in Alzheimer's, multitasking primarily involves cognitive processing and planning rather than motor execution or perception.

Choice D rationale

Complex attention refers to the ability to sustain attention on multiple stimuli simultaneously or to switch attention efficiently between tasks. While related to multitasking, executive function more broadly describes the strategic planning and organization required to successfully execute multiple tasks.

Rationale for correct condition The client has a BMI of 13–14.1, indicating severe malnutrition. Clinical signs include bradycardia, hypotension, hypothermia, electrolyte imbalances (hyponatremia, hypokalemia), and cachexia. These findings are consistent with anorexia nervosa, not bulimia or endocrine disorders. Improvement in weight and labs by December 15 supports ongoing nutritional rehabilitation. The persistent bradycardia and low BP reflect the chronic effects of starvation.

Rationale for correct actions IV fluids with electrolyte replacement correct dehydration and restore sodium and potassium levels, preventing cardiac arrhythmias and renal impairment. Electrolyte normalization is critical in refeeding. Cognitive-behavioral therapy (CBT) addresses distorted body image, fear of weight gain, and restrictive behaviors, forming the cornerstone of long-term recovery in anorexia nervosa.

Rationale for correct parameters Daily weight tracking provides objective data on nutritional rehabilitation and guides caloric adjustments. It also helps detect fluid shifts or refeeding syndrome. Heart rate and rhythm monitoring is essential due to the risk of bradyarrhythmias and sudden cardiac death in malnourished clients, especially during refeeding.

Rationale for incorrect conditions Bulimia nervosa involves binge-purge cycles, not severe weight loss or bradycardia. Hypothyroidism causes fatigue and weight gain, not cachexia or electrolyte loss. Addison’s disease presents with hyperpigmentation, hypotension, and hyperkalemia—not starvation or fear of weight gain.

Rationale for incorrect actions Thyroid hormone therapy is not indicated without hypothyroidism. High-calorie snacks are helpful but must be cautiously introduced to avoid refeeding syndrome. Corticosteroids treat adrenal insufficiency, not anorexia nervosa.

Rationale for incorrect parameters TSH and cortisol levels are not primary concerns unless endocrine dysfunction is suspected. Binge-purge frequency is relevant to bulimia, not restrictive anorexia.

Take home points

• Anorexia nervosa with severe malnutrition presents with bradycardia, hypotension, and electrolyte imbalances.
• Treatment includes cautious rehydration, electrolyte correction, and psychotherapy.
• Weight and cardiac monitoring are essential during nutritional rehabilitation.
• Differentiate from bulimia, hypothyroidism, and adrenal insufficiency based on clinical and lab findings.