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

Choice A rationale Excessive dental caries and enlarged tonsils are more commonly associated with bulimia nervosa due to the repeated exposure of teeth to gastric acid from purging and chronic inflammation of the tonsils. Anorexia nervosa primarily involves severe caloric restriction, leading to different physiological adaptations. Choice B rationale Skeletal appearance with lanugo on arms is a classic physical finding supporting anorexia nervosa. The emaciated or skeletal appearance is due to severe caloric restriction and muscle wasting. Lanugo, fine downy hair, develops as the body attempts to conserve heat due to insufficient adipose tissue. Choice C rationale Irregular heart rate, specifically bradycardia, is common in anorexia nervosa due to metabolic slowdown. However, heavy menstruation (menorrhagia) is not typical; instead, amenorrhea (absence of menstruation) is a hallmark sign, resulting from hormonal imbalances due to malnutrition and low body fat. Choice D rationale Overweight with a puffy face is not indicative of anorexia nervosa. Anorexia nervosa is characterized by an extreme fear of gaining weight and a disturbed body image, leading to self-starvation and significant underweight. A puffy face can be associated with refeeding syndrome or specific medical conditions, not primary anorexia.