A teenage female has been admitted for complications resulting ...

[formula1]

A teenage female has been admitted for complications resulting from bulimia nervosa. She has abused laxatives for many years and has been self-inducing vomiting since the age of 9.
 
  The nurse's admission assessment should pay close attention to which of the following complications that can arise from this disorder? Select all that apply. Assess for
  A)
  dry, cracked lips and poor skin turgor.
  B)
  missing tooth enamel and increased number of dental cavities.
  C)
  painful swallowing and stomach cramping related to reflux and esophagitis.
  D)
  fruity breath and labored, deep, gasping respirations.
  E)
  jaundice of the skin and eyes.

Question 2

A patient is admitted to the hospital in adrenal crisis 1 month after a diagnosis of Addison disease. The nurse knows which of the following clinical manifestations would support this diagnosis?
 
  A)
  Hyperactive deep tendon reflexes and slow, shallow breathing
  B)
  Cerebral spinal fluid leakage and impaired swallowing
  C)
  Irregular heart rate and decreased temperature
  D)
  Change in the level of consciousness and profound hypotension

[Christopher]

Answer to Question 1

Ans:
A, B, C

Feedback:

Distracters A, B, and C are associated with complications of bulimia nervosa. Answer choice A relates to dehydration/fluid volume deficit; answer choice B relates to dental abnormalities associated with high acid content of the vomitus; answer choice C relates to esophagitis. Answer choice D is indicative of DKA primarily caused by undiagnosed or undertreated diabetes. Jaundice of the skin and eyes is usually associated with liver disease.

Answer to Question 2

Ans:
D

Feedback:

Acute adrenal crisis is a life-threatening situation. Exposure to even a minor illness or stress can cause a client with Addison disease to develop nausea, vomiting, muscular weakness, hypotension, dehydration, and vascular collapse (which causes a change in LOC). Hemorrhage (low BP) can be caused by septicemia, adrenal trauma, anticoagulant therapy, adrenal vein thrombosis, or adrenal metastases. A hyperactive reflex may indicate disease of the pyramidal tract above the level of the reflex arc being tested. Generalized hyperactivity of DTRs may be caused by hyperthyroidism. Any tear or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the fluid that surrounds those organs to leak. This fluid is called the cerebrospinal fluid (CSF). When it leaks out, the pressure around the brain and spinal cord drops. Causes of leakage through the dura include certain head, brain, or spinal surgeries; head injury; placement of tubes for epidural anesthesia or pain medications; or lumbar puncture. Irregular heart rates (arrhythmias) may be caused by many different factors, including coronary artery disease; electrolyte imbalances in your blood (such as sodium or potassium); changes in your heart muscle; or injury from a heart attack.