A nurse is collecting data from a female client who has bulimia nervosa.
Which of the following manifestations should the nurse expect?

Choice A rationale

Depression is a mood disorder characterized by persistent sadness, loss of interest, and feelings of hopelessness. While it can co-occur with alcohol use disorder, it is not typically the initial manifestation of acute alcohol withdrawal. Acute withdrawal primarily involves physiological and neurological symptoms resulting from the abrupt cessation of alcohol consumption.

Choice B rationale

Delusions are fixed false beliefs that are not based in reality. These are more characteristic of severe alcohol withdrawal, such as delirium tremens, or other psychotic disorders, rather than the initial stage of acute withdrawal. The initial stage is typically marked by milder symptoms related to central nervous system hyperactivity.

Choice C rationale

Tremors, particularly hand tremors, are a common and characteristic early sign of acute alcohol withdrawal. Alcohol has a depressant effect on the central nervous system. When alcohol consumption is stopped, the central nervous system rebounds, leading to increased neuronal excitability. This hyperactivity manifests as tremors, along with other symptoms like anxiety and increased heart rate.

Choice D rationale

Bradycardia, a heart rate below 60 beats per minute, is not a typical finding in the initial stage of acute alcohol withdrawal. Instead, the sympathetic nervous system activation that occurs during withdrawal usually leads to tachycardia (an elevated heart rate) and hypertension as the body attempts to compensate for the absence of alcohol's depressant effects.

Choice A rationale

Reflecting the client's feeling back to them, such as "You are feeling like a failure," acknowledges their emotional state without judgment or dismissal. This therapeutic communication technique validates the client's feelings and encourages further exploration of their thoughts and emotions.

Choice B rationale

While intended to be positive, stating "I see many positive things about you" can minimize the client's current feelings and may not address the underlying reasons for their negative self-perception. It can also sound dismissive of their distress.

Choice C rationale

Saying "You're not the only client who feels this way" can minimize the client's individual experience and may make them feel that their feelings are not unique or important. It does not directly address their specific statement of wanting to be dead.

Choice D rationale

Asking "How can you feel that way when you have so much to live for?" invalidates the client's current feelings and can make them feel misunderstood or defensive. It does not address the depth of their despair and suicidal ideation.