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

A. Lanugo is fine, soft hair that develops as a compensatory mechanism to conserve heat in clients with anorexia nervosa, not bulimia nervosa. It reflects chronic malnutrition and low body fat. B. Bulimia nervosa is associated with swollen, not sunken, parotid glands, due to repeated vomiting and stimulation of the salivary glands. Sunken parotids are not a typical finding. C. Clients with bulimia nervosa who purge frequently often develop hypokalemia, not hyperkalemia, due to loss of potassium through vomiting or laxative use. Hyperkalemia is uncommon in this population. D. Russell’s sign refers to calluses or scars on the dorsal surface of the hands or knuckles, caused by repeated contact with teeth during self-induced vomiting. This is a classic physical manifestation of bulimia nervosa and is often observed during physical assessment.