A nurse is caring for a female client who has bulimia nervosa and reports frequent self-induced vomiting. Which of the following findings should the nurse expect?

Choice A rationale Amenorrhea, the absence of menstruation, can occur in individuals with bulimia nervosa, but it is more commonly associated with anorexia nervosa due to severe caloric restriction and low body fat leading to hypothalamic dysfunction and disruption of the pulsatile release of GnRH, impacting ovarian function. While possible, dental decay is a more direct and frequent consequence of recurrent self-induced vomiting. Choice B rationale Frequent self-induced vomiting exposes dental enamel to highly acidic gastric contents. This repeated exposure leads to the erosion of tooth enamel, increasing susceptibility to cavities, discoloration, and potential loss of teeth. The acid decalcifies the enamel, a process known as perimylolysis, which is a hallmark sign. Choice C rationale Clients with bulimia nervosa often maintain a body weight that is within or even above the normal expected reference range. Unlike anorexia nervosa, bulimia involves cycles of binging and compensatory behaviors, which may not always result in significant weight loss. Therefore, lower than normal expected body weight is not a defining characteristic. Choice D rationale Self-induced vomiting causes a significant loss of gastric acid, which primarily contains hydrogen chloride. To compensate for this loss, the kidneys excrete potassium to conserve hydrogen ions, leading to hypokalemia. The normal reference range for potassium is 3.5-5.0 mEq/L. Therefore, hyperkalemia, an elevated potassium level, is not an expected finding.