A nurse is caring for a 24-year-old female client with anorexia nervosa on an inpatient eating disorder unit. A nurse on an inpatient eating disorder unit is assessing a 24-year-old female client with anorexia nervosa. Which of the following assessment findings indicate a therapeutic response to the treatment plan? Select all that apply.

Choice A rationale: The client’s creatinine level improved from 1.2 mg/dL to 0.9 mg/dL, returning to the normal range of 0.5 to 1.0 mg/dL. Elevated creatinine in anorexia nervosa often reflects dehydration and muscle catabolism. The normalization of creatinine suggests improved hydration status and reduced catabolic stress, indicating a positive physiologic response to nutritional and fluid therapy. Choice B rationale: The sodium level increased slightly from 128 mEq/L to 130 mEq/L but remains below the normal range of 136 to 145 mEq/L. Although this is a mild improvement, it does not yet reflect a fully therapeutic response. Persistent hyponatremia may indicate ongoing fluid imbalance or inappropriate antidiuretic hormone secretion, which can occur in malnourished states. Therefore, this finding still requires monitoring. Choice C rationale: The respiratory rate improved from 24/min to 20/min, and the client’s breathing changed from slightly labored to even and unlabored. This reflects improved metabolic and cardiovascular function. In anorexia nervosa, respiratory abnormalities can result from muscle wasting and acid-base imbalances. The normalization of respiratory effort and rate indicates better physiologic stability and response to refeeding. Choice D rationale: The client’s weight increased from 34.5 kg to 37.2 kg, and BMI rose from 13 to 14.1. Although still underweight, this gain reflects a positive trend in nutritional rehabilitation. Weight restoration is a primary goal in anorexia nervosa treatment, as it correlates with improved organ function, cognitive clarity, and emotional regulation. This weight gain is a clear indicator of therapeutic progress. Choice E rationale: The ECG continued to show sinus bradycardia on both assessments. While bradycardia is common in anorexia due to metabolic adaptation and malnutrition, persistence of this finding suggests incomplete physiologic recovery. A therapeutic response would include normalization of heart rate as nutritional status improves. Therefore, this finding does not yet indicate full therapeutic response. Choice F rationale: The client’s temperature improved from 35.6°C (96°F) to 36°C (97°F), indicating better thermoregulation. Hypothermia in anorexia results from decreased metabolic rate and subcutaneous fat loss. An increase in body temperature suggests improved metabolic function and energy availability, which are signs of physiologic recovery during refeeding and weight restoration.