A client referred to the eating disorders clinic is diagnosed with Bulimia Nervosa. For which physical manifestations should a nurse assess? (Select all that apply.)

Choice A rationale Muscle weakening in bulimia nervosa stems from electrolyte imbalances and chronic dehydration caused by recurrent purging behaviors. Specifically, the loss of potassium through emesis or laxative abuse leads to hypokalemia, where serum potassium levels fall below the normal range of 3.5 to 5.0 mEq/L. Since potassium is essential for proper skeletal muscle contraction and electrochemical signaling, its depletion results in physical weakness and fatigue, which are common clinical manifestations in these patients. Choice B rationale Dental caries are a classic hallmark of bulimia nervosa due to the frequent exposure of tooth enamel to gastric acid during self-induced vomiting. The stomach acid has an extremely low pH, which chemically erodes the protective enamel and creates a high-acid environment that promotes tooth decay and cavities. This process, often referred to as perimylolysis, typically affects the lingual surfaces of the teeth and is an important physical indicator for nurses during a systemic assessment. Choice C rationale Lanugo is a fine, downy hair growth that is typically a diagnostic feature of anorexia nervosa rather than bulimia nervosa. It is a physiological adaptation to extreme malnutrition and the loss of subcutaneous fat as the body attempts to maintain core temperature and provide insulation. Since individuals with bulimia nervosa often maintain a weight within or near the normal range, they do not usually experience the severe thermoregulatory deficits that trigger the growth of lanugo. Choice D rationale Calluses on the hands, specifically over the knuckles or dorsal surface, are known as Russells sign. This physical manifestation occurs when a patient uses their fingers to induce the gag reflex for purging. Repeated friction and contact with the upper incisors during this process lead to skin thickening and scarring in that specific area. It is a highly specific physical finding that suggests the presence of self-induced vomiting behavior even when the patient denies purging. Choice E rationale Normal weight is a significant diagnostic differentiator for bulimia nervosa compared to other eating disorders. While patients with anorexia nervosa are significantly underweight, those with bulimia often stay within a normal body mass index range or may even be slightly overweight. This occurs because the binge-purge cycle does not always result in a net caloric deficit. Therefore, maintaining a normal weight does not rule out the disorder and is a common assessment finding in this population.