A nurse is caring for a client who has bulimia nervosa. Which of the following findings should the nurse expect?

Choice A rationale Lanugo, a fine, downy hair growth on the body, is more commonly associated with anorexia nervosa, particularly in severe cases, as a physiological response to malnutrition and hypothermia, where the body attempts to conserve heat. It is not typically a characteristic finding in bulimia nervosa, where significant weight loss and malnourishment are not always present to the same extent due to compensatory behaviors that may prevent extreme weight deficits. Choice B rationale Hyperkalemia, an elevated potassium level, is not a typical finding in bulimia nervosa. Instead, hypokalemia, a low potassium level, is a common and serious electrolyte imbalance in bulimia, resulting from frequent vomiting, diuretic abuse, or laxative misuse, which lead to significant loss of electrolytes from the body. Normal serum potassium levels typically range from 3.5 to 5.0 mEq/L. Choice C rationale Sunken parotid glands are not a characteristic finding in bulimia nervosa. On the contrary, chronic and recurrent vomiting, a hallmark of bulimia, often leads to hypertrophy (enlargement) of the parotid glands, giving the cheeks a swollen appearance. This enlargement is due to inflammation and compensatory growth in response to repeated stimulation and irritation from gastric acid exposure. Choice D rationale Russell's sign refers to calluses or abrasions on the dorsal aspect of the hand, particularly over the knuckles, caused by repeated trauma from inducing vomiting using fingers or other objects. This physical manifestation is a strong indicator of self-induced vomiting and is a classic clinical finding in individuals with bulimia nervosa, providing objective evidence of the compensatory behaviors central to the disorder.