A pediatric nurse is assessing a 10-year-old girl with signs of anorexia nervosa. Which physical assessment would support the diagnosis?

Choice A rationale Excessive dental caries and enlarged tonsils are more commonly associated with bulimia nervosa due to the erosive effects of recurrent vomiting on tooth enamel and compensatory hypertrophy of lymphoid tissue in the pharynx. While indicative of disordered eating, they are not primary physical markers for anorexia nervosa. Choice B rationale A skeletal appearance with lanugo on arms is highly indicative of anorexia nervosa. The emaciation results from severe caloric restriction, leading to significant adipose tissue and muscle loss. Lanugo, fine downy hair, develops as a compensatory mechanism to conserve body heat due to the lack of insulating fat. Choice C rationale An irregular heart rate, such as bradycardia, is a common finding in anorexia nervosa due to metabolic slowdown and electrolyte imbalances. However, heavy menstruation (menorrhagia) is not typically associated with anorexia; amenorrhea (absence of menstruation) is a classic sign due to hormonal suppression from malnutrition. Choice D rationale Being overweight with a puffy face is inconsistent with the diagnostic criteria for anorexia nervosa, which is characterized by significantly low body weight. A puffy face might suggest fluid retention or salivary gland enlargement, which can occur in bulimia, but not typical for anorexia.