A nurse in an outpatient mental health clinic is caring for a client who has an eating disorder. Which of the following findings in the client's medical record indicates the client has bulimia nervosa? Click to highlight the findings in the client's medical record that indicate the client has bulimia nervosa. To deselect a finding, click on the finding again. 1400: BMI 20.1 Erosion of teeth, numerous dental caries. Client reports overeating with subsequent episodes of induced vomiting every weekday evening following work; takes over-the-counter laxative and diuretic medications every morning. Reports good relationship with family and friends. Denies substance use. Reports doing little exercise except on weekends. 1500: 12-lead ECG Sinus rhythm with frequent premature ventricular contractions (PVCs), heart rate 72/min. 1500: Potassium 3.2 mEq/L 1600: Potassium 3.2 mEq/L

Choice A reason: A normal body mass index does not exclude bulimia nervosa. Individuals with bulimia nervosa often maintain a weight within or near the normal range because their binge-purge cycles offset caloric intake. Therefore, BMI alone is not diagnostic. Bulimia nervosa differs from anorexia nervosa precisely because weight can remain normal. This finding does not indicate bulimia nervosa. Choice B reason: Dental erosion and caries are classic physical complications of bulimia nervosa. Repeated self-induced vomiting exposes teeth to gastric acid, leading to enamel erosion and increased risk of cavities. Numerous case studies in psychiatric journals highlight dental erosion as a hallmark sign of chronic purging. This finding strongly supports the diagnosis. Choice C reason: Recurrent binge eating followed by compensatory behaviors such as vomiting is the central diagnostic criterion for bulimia nervosa in DSM-5. The client’s report of overeating followed by induced vomiting every weekday evening is a textbook description of bulimia nervosa. Secrecy and shame around these behaviors are common. This finding is the most direct evidence of the disorder. Choice D reason: Having good relationships with family and friends does not indicate bulimia nervosa. Maslow’s Hierarchy of Needs suggests that social belonging can be intact even when physiological and psychological needs are unmet. Many individuals with bulimia nervosa maintain outwardly functional social lives while concealing their disorder. Thus, this finding is not diagnostic. Choice E reason: Denial of substance use is not relevant to bulimia nervosa diagnosis. While comorbid substance use disorders can occur, their absence does not exclude bulimia nervosa. DSM-5 criteria focus on binge eating and compensatory behaviors, not substance use. Therefore, this finding does not indicate bulimia nervosa. Choice F reason: Limited exercise is not diagnostic of bulimia nervosa. Some individuals may engage in excessive exercise as a compensatory behavior, but lack of exercise does not confirm or deny the disorder. This finding is not specific to bulimia nervosa. Choice G reason: Cardiac arrhythmias such as PVCs are medical complications of bulimia nervosa. Electrolyte disturbances from vomiting, laxative, and diuretic abuse predispose patients to arrhythmias. Misuse of diuretics and laxatives can cause dangerous cardiac effects. This finding indicates a complication of bulimia nervosa. Choice H reason: Hypokalemia (low potassium) is a hallmark laboratory abnormality in bulimia nervosa. Vomiting and diuretic use lead to potassium loss, which can cause muscle weakness, arrhythmias, and even sudden death. Electrolyte imbalances are a direct consequence of purging behaviors. This finding strongly supports the diagnosis.