Which of the following nursing evaluations of a client diagnosed with anorexia nervosa would lead the treatment team to consider discharge? (Select all that apply).

Choice A rationale Consuming adequate calories as determined by a dietitian is a primary goal for discharging a client with anorexia nervosa. This indicates that the client is compliant with the nutritional rehabilitation plan and is capable of maintaining a caloric intake sufficient for metabolic needs. Stabilization of eating patterns and the ability to self-regulate intake without purging or restriction are essential benchmarks. It reflects an improvement in the behavioral aspects of the eating disorder and physiological stability. Choice B rationale A body mass index (BMI) of 15 is significantly below the healthy range (18.5 to 24.9 kg/m) and indicates that the client remains severely underweight and malnourished. Discharging a client with such a low BMI would be unsafe as they remain at high risk for cardiac arrhythmias, electrolyte imbalances, and organ failure. Clinical guidelines usually require a higher BMI, typically at least 17 or more, along with weight stability, before considering a transition to outpatient care. Choice C rationale Dependency on a parent for basic needs indicates a lack of developmental autonomy and poor coping mechanisms, which are often underlying psychological issues in anorexia nervosa. Discharge readiness requires the client to demonstrate age-appropriate independence and the ability to manage self-care. Continued dependency suggests that the psychological triggers and family dynamics contributing to the disorder have not been adequately addressed. The client needs to show functional improvement and emotional resilience before leaving an intensive treatment environment. Choice D rationale The statement regarding not being perfect indicates a positive shift in the cognitive distortions and perfectionism frequently associated with anorexia nervosa. Acknowledging that perfection is unattainable suggests that the client is developing healthier thought patterns and reducing the internal pressure that drives restrictive eating. Cognitive behavioral progress is a critical metric for discharge, as it reduces the likelihood of relapse. This shift in mindset shows the client is engaging effectively with psychotherapy and emotional processing. Choice E rationale A blood pressure of 108/74 mm Hg is within the normal range (systolic 90 to 120 and diastolic 60 to 80), indicating cardiovascular stability. Clients with active anorexia nervosa often suffer from bradycardia and hypotension due to starvation and reduced metabolic rate. Achieving a stable, normal blood pressure suggests that the client’s autonomic nervous system and fluid volume are recovering. This physiological normalization is a necessary prerequisite for discharge to ensure the client can safely transition to a lower level of care.