A nurse in the emergency department is caring for a 14-year-old who has anorexia nervosa.

• The client was brought to the emergency department by a parent due to fainting at home earlier this evening.
• The parent reports that the client has been worried about their weight and has been refusing to eat.
• The parent also reports the client has been spending several hours at the local gym.
• Vital signs were obtained and labs were drawn as requested by the provider.

Which of the following 5 assessment findings require immediate follow-up?

The correct answer/s is C

Choice A rationale: Hyperkalemia, or high potassium levels in the blood, is not typically associated with anorexia nervosa. In fact, individuals with anorexia nervosa are more likely to experience hypokalemia, or low potassium levels, due to inadequate dietary intake and excessive loss of potassium through vomiting or use of diuretics1.

Choice B rationale: Metrorrhagia, or irregular menstrual bleeding between periods, can occur in females with anorexia nervosa due to hormonal imbalances caused by extreme weight loss and malnutrition. However, amenorrhea, or the absence of menstruation, is more commonly observed1.

Choice C rationale: Lanugo, which is fine, soft hair that grows on the face and body, is a common finding in individuals with anorexia nervosa. It is the body’s response to severe weight loss and starvation as an attempt to provide insulation and maintain body temperature1.

Choice D rationale: Tachycardia, or a rapid heart rate, is not typically associated with anorexia nervosa. Instead, individuals with anorexia nervosa often experience bradycardia, or a slower than normal heart rate, as the body’s response to starvation1.

Choice A rationale:

Judgmental and challenging: Asking "Why did you feel you needed to do that at this time?" implies that the parents' decision may not have been the best one. It puts them on the defensive and could make them feel like they need to justify their actions.

Not empathetic: This response does not acknowledge the parents' feelings of sadness, disappointment, or loss. It focuses on the decision itself rather than on the emotional impact it has had on the family.

Not supportive: The nurse's role is to provide support and understanding, not to the parents' decisions. This response does not offer any emotional support or validation.

Choice B rationale:

Empathetic and validating: This response acknowledges the parents' feelings and shows that the nurse understands how difficult it must have been to cancel their son's baseball registration. It also validates their decision, which can be helpful in coping with difficult situations.

Opens up communication: By expressing empathy, the nurse encourages the parents to share their feelings and experiences. This can help them to process their emotions and feel more supported.

Facilitates understanding: By recognizing the parents' frustration, the nurse can better understand their perspective and provide more tailored support. This can help to strengthen the nurse-client relationship and promote trust.

Choice C rationale:

False hope: While it is possible that the child's condition could improve, it is not realistic to offer false hope to the parents. This response could make it more difficult for them to accept the reality of their child's illness and could lead to disappointment and frustration in the future.

Dismissive of feelings: This response does not acknowledge the parents' current feelings of sadness and loss. It focuses on the future, which can be overwhelming and anxiety-provoking for parents who are facing a terminal illness.

Choice D rationale:

Irrelevant and insensitive: The dangers of baseball are not relevant to the parents' decision to cancel their son's registration. This response is dismissive of their feelings and does not offer any support or understanding.

Potentially offensive: This response could be interpreted as suggesting that the parents are being overprotective or that they are making a decision based on fear rather than on their child's best interests.