A nurse is assessing a client to identify contraindications of hormonal contraceptive use.
Which of the following Questions should the nurse ask the client? (Select All that Apply.)

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.

Choice A rationale

Providing a calm, structured environment with consistent routines helps children with ADHD regulate their behavior and attention. Predictable schedules and clear expectations reduce sensory overload and provide a framework for self-management, thereby promoting focus and minimizing disruptive behaviors by optimizing neurological processing.

Choice B rationale

Removing the child from the classroom as a primary intervention is counterproductive. While a brief cool-down period might sometimes be useful, consistent removal can isolate the child, disrupt their learning, and prevent them from developing coping mechanisms within the regular classroom setting, hindering social and academic integration.

Choice C rationale

Punishing a child with ADHD each time rules are broken is generally ineffective and can be detrimental. ADHD is a neurodevelopmental disorder affecting impulse control and attention; punishment alone does not address the underlying neurological differences. It can lead to increased anxiety, defiance, and a negative self-concept.

Choice D rationale

Recommending home schooling for a child with ADHD should not be the most appropriate first intervention. While home schooling can be an option for some families, it removes the child from valuable social learning experiences and peer interaction crucial for development. Classroom interventions and support should be exhausted first.