Which signs would be expected by the nurse during assessment of the client with anorexia nervosa?

Choice A rationale Anorexia nervosa causes significant physiological adaptations to starvation, leading to a hypometabolic state. Bradycardia, characterized by a pulse rate less than 60 beats per minute, and hypotension occur as the body attempts to conserve energy and maintain cardiac output with reduced myocardial mass. Normal adult pulse ranges from 60 to 100 beats per minute, and normal blood pressure is typically around 120/80 mmHg. Significant drops in these parameters are common clinical findings in malnutrition. Choice B rationale Regular menstrual periods are not expected in clients with significant anorexia nervosa. Amenorrhea, or the absence of at least three consecutive menstrual cycles, is a hallmark diagnostic feature due to the suppression of the hypothalamic pituitary ovarian axis. Low body fat levels lead to decreased estrogen production, which halts the normal reproductive cycle. Therefore, regular periods with spotting would be an inconsistent finding in a client suffering from the severe weight loss associated with this eating disorder. Choice C rationale A body mass index greater than 20 is generally considered within the healthy range for most adults, whereas anorexia nervosa is characterized by a significantly low body weight. Specifically, a body mass index of 17.5 or less is often used as a clinical indicator for the diagnosis. Finding a BMI over 20 would suggest that the client is not currently in a state of severe emaciation or that their weight has been restored to a normal level. Choice D rationale Lanugo is the growth of fine, downy hair on the face, back, and arms, which is a physical manifestation of severe malnutrition. The body develops this hair as a compensatory mechanism to provide insulation and retain heat in the absence of adequate subcutaneous fat layers. Because individuals with anorexia nervosa often have very low body temperatures and little body fat, the presence of lanugo is a classic clinical sign of the body's attempt to regulate thermoregulation. Choice E rationale Protein calorie malnutrition in anorexia nervosa leads to deficiencies in essential vitamins and minerals necessary for the maintenance of integumentary structures. Hair becomes thin, dry, and brittle, often falling out in patches, a condition known as alopecia. Similarly, the nails become fragile and break easily due to the lack of keratin and other nutrients. These findings reflect the systemic impact of chronic starvation on the body's ability to renew and repair its tissues.