A nurse is assisting in the care of an adolescent in a pediatric clinic. Click to highlight the findings the nurse should report to the provider. To deselect a finding, click on the finding again. Body System Findings Cardiovascular Heart rhythm irregular. No murmurs noted. Blood pressure 80/50 mm Hg Gastrointestinal Abdomen soft and nontender to palpation. Hypoactive bowel sounds. Height/Weight Height 157.5 cm (62 in) Weight 39.9 kg (88 lb) BMI 16.1 (4th percentile) Behavioral Guardian states. "They have always been a good kid. They have never been in trouble or anything." Also reports exercising a lot and will run up and down the stairs when guardians are not home.

Rationale for correct choices: • Heart rhythm irregular: Bradycardia and arrhythmias are common in adolescents with severe caloric restriction and low body weight. Reporting this finding is essential because cardiac complications are a leading cause of morbidity in anorexia nervosa. • Blood pressure 80/50 mm Hg: Hypotension indicates cardiovascular compromise from malnutrition and fluid/electrolyte imbalance. Immediate provider awareness is needed to prevent syncope, shock, or other complications. • Hypoactive bowel sounds: Reduced gastrointestinal motility is associated with prolonged starvation and electrolyte imbalances. Reporting this finding helps guide interventions for nutrition and gastrointestinal support. • Weight 39.9 kg (88 lb): Significant weight loss over a short period and extremely low body weight indicates severe malnutrition. This is critical information for the provider for determining hospitalization or intensive intervention. • BMI 16.1 (4th percentile): A BMI this low confirms severe underweight status and risk for multisystem complications. Reporting ensures the provider can prioritize medical and nutritional stabilization. • Adolescent exercising excessively: Excessive exercise and caloric restriction are behaviors consistent with anorexia nervosa and increase risk for cardiac events, electrolyte imbalance, and musculoskeletal injury. Provider intervention is required for safety and treatment planning. Rationale for incorrect choices: • No murmurs noted: Absence of heart murmurs does not require reporting, as it is a normal finding and does not indicate acute risk. • Abdomen soft and nontender to palpation: Normal abdominal assessment does not indicate acute concern. The priority is on hypoactive bowel sounds and associated gastrointestinal compromise.